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or her first few years to become of life, Jyoti Devi lived one of the world’s largest Fwith four siblings in private providers of family Musahar Community in planning to low-income Bihar, one of the poorest people in the developing states in . When she world, DKT increasingly uses was just five years old, Jyoti’s social franchising, a highly parents abandoned her at effective and growing a school for poor children. channel for delivery of Though she had every family planning products and reason to despair, Jyoti services. DKT implements seized on her plight as an social franchising through opportunity to study and public and private clinics, learn, showing wisdom and midwives and rural medical Jyoti and her grandson. resilience beyond her years. practitioners — whatever These traits served her well later in life works best in each of the five focus countries as she worked as a teacher, seamstress, of and — and it is accounting for school founder, community organizer and a growing share of DKT’s health impact. anganwadi (health care) worker. Social franchising aims to increase the It was her interest in women, children and number of providers and health services their health that led Jyoti to Janani, DKT offered (access), to provide services at International’s affiliate in Bihar, and itsSurya an equal or lower cost to other delivery social franchising program in family planning options (cost-effectiveness), to provide in 2009. As a Surya health promoter, she services that adhere to quality standards rode a motorcycle to remote villages all over (quality) and serve all population groups, Bihar, encouraging both women and men especially those most in need (equity). to try family planning at Surya and franchise clinics. In 2010, Jyoti was elected by her Simply put, a social franchise is a network of community to the Bihar legislative assembly private (and sometimes government) health with the recommendation of the chief providers (the franchisees) whose products minister of Bihar. and services are standardized and promoted by a single entity (the franchisor) that is, in Jyoti is just one example of DKT Interna- this case, DKT. Franchises are demonstrating tional changing lives with its growing social franchising work. Just as it has capitalized on (continued) that quality health products and services can approach to the realities of each country, be delivered cost-effectively at increasing so no two programs are the same. However, scale. A 2011 study showed that social they all share a few common characteristics: franchises of private family planning n All the social franchise networks providers “were found to greatly improve are branded. the quality of care in family planning…”1 n All deliver both products and clinical services. DKT’s goal is to improve people’s health n by turning non-users of contraceptives into All create demand to bring people users. Moreover, once those people are to these products and services. users, it hopes they will shift — over time — from free to partially subsidized (social But each program is unique in its own way. marketing) to non-subsidized (commercial) Here are snapshots of DKT’s five social products. The idea is that the product will franchises: gradually be less and less subsidized by donors, ensuring eventual sustainability. India: Social franchising since 2000. DKT started its work in social franchising in Social franchising brand: Surya. India in 2000 and, since then, has launched Number of sterilizations: programs in , the , 50,000 through 136 clinics and . DKT tailors its Janani, DKT’s affiliate What is Social Franchising? in East India, operates DKT’s flagship social A social franchisee is defined as a franchising program Surya network of private health providers in Bihar, Jharkhand and Uttar Pradesh, three with the following characteristics: of India’s poorest states. Surya, considered a 1. Outlets are operator-owned. “classic” social franchising model, provides 2. Payments to outlets are based on products and services through franchised services provided, although the and DKT clinics as well as rural medical mechanisms of payment may vary. practitioners. It sells Surya brand , oral contraceptives (OCs), intrauterine 3. Franchised services are standardized, although additional, non-franchised devices (IUDs) and other contraception, and products and services may also be conducts female and male sterilizations as offered. well as abortions. DKT also partners with the government to strengthen service delivery 4. Clinical services are offered, with or without franchise-branded at public health facilities. A unique feature commodities. of the Surya franchises is that they do not charge for sterilization, which is subsidized —University of California, San Francisco Global Health Sciences by the government. Janani website: www.janani.org/ 1 “Comparing private sector family planning services to government and NGO services in and : how do social franchises compare across quality, equity and cost?” Health Policy and Planning, March 1, 2011: http://bit.ly/sQ5fOB Indonesia: in government clinics that are seeking a sustainable way of offering products. Social franchising since 2001. DKT helps them avoid stock-outs, with Social franchising brand: Andalan. contraceptive security as the overriding Midwives trained: More than 40,000 goal. DKT provides training to government DKT Indonesia, the providers and promotes increased largest contraceptive contraceptive use through education social marketing program and branding. In addition, POPSHOPs in the world, achieved continue to offer profitable services such more than 6.6 million Couple Years of as safe delivery and newborn screening as Protection (CYPs) in 2011 as its contribution they were before they became POPSHOP to one of the great family planning franchises. success stories. The social franchising POPSHOP website: www.popshop.com.ph/ program Andalan (meaning trustworthy in Indonesian) is positioned as a reliable, Mozambique: one-stop shop for midwives with high- quality, affordable contraceptives and Social franchising since 2011. reproductive health products. DKT Social franchising brand name: Intimo. Indonesia’s training of more than 40,000 Current number of franchised clinics: 11 midwives in IUD and implant insertion and The Intimo´ program removal supports the social franchising provides condoms, program and has helped Andalan brand OCs, IUDs, implants, some 10,000 midwife clinics. DKT regularly EC and misoprostol reaches or visits at least 10,000 midwives (to prevent post- each month, and more than 4,400 have partum hemorrhaging) signed contracts with DKT. in eleven clinics which had previously not Andalan website: www.tundakehamilan.com/ offered family planning products. DKT teams move house to house to educate Philippines: people on family planning options and promote the clinics. Intimo´ has used Social franchising since 2005. innovations like social media to increase Social franchising brand: POPSHOP. access to its clinics; its Facebook page Current number of franchised clinics: reaches over 8,000 Mozambicans (85% 300+ between the ages of 18 and 34) with More than 300 POPSHOP information on family planning and clinics ensure access to reproductive health. DKT is exploring high-quality and affordable plans to expand these successful clinics reproductive health from the capital of Maputo to other parts products, services and of Mozambique. information to nearly Intimo´ on Facebook: http://on.fb.me/w1Gk8Z 50,000 couples in 2011. POPSHOP franchises set up family planning “corners” (continued) Sudan: lowest such rate among major Social franchising since May 2011. family planning Social franchising brand: providers. Social Sahath Al-Om (MotherHealth). franchising Current number of franchised clinics: 10 provides a An unusual feature small but of the Sahath Al-Om growing share Access to family planning network is that it of this health remains a challenge for impact, and actively collaborates many Sudanese women. with government helps DKT hospitals, exemplifying reaches more people with high quality a harmonious public-private partnership as and affordable reproductive products and recommended by Millennium Development services. DKT expects social franchising’s Goal 8. These franchised clinics also collabo- share to increase in the years ahead, as the rate with stakeholders including religious five countries profiled here deliver more leaders, community elders and, especially, of their products and services through husbands. Though the doctors and nurses franchises and new DKT countries adopt are on the payroll of the hospitals, they the practice. are provided incentives for sales volume. DKT Sudan believes that Sahath Al-Om Jyoti says her association with Janani will become not only fully self-sustaining changed her life not only by providing a but able to cross-subsidize extended decent salary but the opportunity to educate mother care programs. women and men about their family planning options. “The incentives given for referring n 2011, DKT served 24.5 million couples, clients helped me to educate my son,” using standard conversion factors for she says. “I am very thankful to Janani for Icouple years of protection, at a cost giving me the opportunity to become a per couple of around $2 annually, the Surya health promoter.”

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