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Family franchise: reproductive healthcare and the private sector

Can family planning be successfully contracted out to the private sector? Would such franchises be sustainable in developing countries? Marie Stopes International (MSI) looked at the experiences of two such initiatives funded by USAID in Mexico and the Philippines. MSI found that social franchising, which is still in its early stages, has the potential to increase access to good quality affordable family planning services. However, the franchises did have problems which would need to be addressed if they were to be implemented effectively.

Franchising has long been used in the commercial sector for the rapid expansion of a business or service. In principal, it allows the quality of the product to be controlled and uses existing resources in the private sector. Entrepreneurs can expand their businesses without requiring large amounts of capital or new staff. For a fee they pass on their business ideas and format to others who operate on a semi-independent basis. Social franchising adapts commercial techniques to achieve social rather than commercial goals. The study found that franchising provided a number of advantages to governments and donors wishing to expand family planning services:

The utilisation of spare capacity in the private health sector in developing countries.
Control of the quality of care and the provision of affordable family planning services.
Products and procedures, such as injections, implants, sterilisation and abortion, which must be provided by trained professionals, become more widely available.
Franchising can be used to target specific groups, such as long-distance truck drivers and their sexual partners who are at high risk of contracting sexual diseases.

However, there are financial problems with franchising. Start-up costs are high and its success depends on whether people are willing and able to pay for the services. Whilst there is increasing evidence that people are prepared to pay for good quality services, the poorest members of society will always need to be subsidised. The social franchise design in the study required large start-up funds from donors, long-term technical support from US agencies and subsidised contraceptive supplies. Yet ideally the franchises should be self-sustaining in the long term.

The report recommends that for social franchising to be successful:

costs must be taken into account at an early stage of designing the franchise
a tried and tested model needs to be in place for both franchiser and franchisee
the medical practitioners used for the franchise should be carefully chosen
a model for the legal details of the relationship between the franchiser and franchisee needs to be established
existing family planning franchises should be carefully evaluated in order to develop a better understanding of this approach.

While social franchising is not the only way of mobilising the private health sector it is a means of encouraging private practices to provide high quality family planning for the first time. However, careful thought must be given as to whether subsidising social franchising is the best use of scarce donor funds.

Source(s):
‘Social franchising reproductive health services: can it work? A review of the experience’ Marie Stopes International Working Paper 5, by E. Smith, 2002 Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 25 September 2003

Further Information:

Marie Stopes International
153-157 Cleveland Street
London
W1T 6QW
UK

Tel: 44 (0)20 7574 7400
Fax: 44 (0)20 7574 7417
Contact the contributor: msi@stopes.org.uk

Marie Stopes International

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