Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey

Montagu, Dominic; Sudhinaraset, May; Lwin, Thandar; Onozaki, Ikushi; Zaw, Win; Aung, Tin

doi:10.1186/1475-9276-12-5

Cited by 13 publications

(16 citation statements)

References 19 publications

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“…The social gradient in diagnosed disease was less clear than for prevalent disease. The effects were subtle, but this might suggest some social patterning in access to treatment, as noted elsewhere [1][2][3]. Note the ZAMSTAR communities had their diagnostic capacity strengthened through participation in this trial.…”

Section: Results In Contextmentioning

confidence: 77%

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Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Yates

Ayles

Leacy

et al. 2018

Tropical Med Int Health

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ObjectiveTo describe the associations between socio‐economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era.MethodsThe main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio‐economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients.ResultsThe quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33–0.92) times and 0.70 (95% CI 0.54–0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university‐educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12–0.54) and 0.42 (95% CI 0.25–0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status.ConclusionThese data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics.

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Section: Results In Contextmentioning

confidence: 77%

“…Few prevalence surveys [1][2][3][4][5][6][7][8][9] have quantified the association between SEP and prevalent TB. Four [4,6,8,9] occurred in areas with generalised HIV epidemics.…”

Section: Introductionmentioning

confidence: 99%

Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Yates

Ayles

Leacy

et al. 2018

Tropical Med Int Health

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“…Community level health workers have always been instrumental in terms of reaching out to the disadvantaged groups [31,32]. The high level of satisfaction of the women who received contraceptive services from the social franchise providers can also be considered as one of the outcomes of medical and business training and continuous monitoring of the field staff; and this has been endorsed by many other studies as well [12,13,33,34]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Social Franchising on Contraceptive Use When Complemented by Vouchers: A Quasi-Experimental Study in Rural Pakistan

et al. 2013

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BackgroundPakistan has had a low contraceptive prevalence rate for the last two decades; with preference for natural birth spacing methods and condoms. Family planning services offered by the public sector have never fulfilled the demand for contraception, particularly in rural areas. In the private sector, cost is a major constraint. In 2008, Marie Stopes Society – a local NGO started a social franchise programme along with a free voucher scheme to promote uptake of IUCDs amongst the poor. This paper evaluates the effectiveness of this approach, which is designed to increase modern long term contraceptive awareness and use in rural areas of Pakistan.MethodologyWe used a quasi-experimental study design with controls, selecting one intervention district and one control district from the Sindh and Punjab provinces. In each district, we chose a total of four service providers. A baseline survey was carried out among 4,992 married women of reproductive age (MWRA) in February 2009. Eighteen months after the start of intervention, an independent endline survey was conducted among 4,003 women. We used multilevel logistic regression for analysis using Stata 11.ResultsSocial franchising used alongside free vouchers for long term contraceptive choices significantly increased the awareness of modern contraception. Awareness increased by 5% in the intervention district. Similarly, the ever use of modern contraceptive increased by 28.5%, and the overall contraceptive prevalence rate increased by 19.6%. A significant change (11.1%) was recorded in the uptake of IUCDs, which were being promoted with vouchers.ConclusionFamily planning franchise model promotes awareness and uptake of contraceptives. Moreover, supplemented with vouchers, it may enhance the use of IUCDs, which have a significant cost attached. Our research also supports a multi-pronged approach- generating demand through counselling, overcoming financial constraints by offering vouchers, training, accreditation and branding of the service providers, and ensuring uninterrupted contraceptive supplies.

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“…Furthermore in the absence of PSI’s social franchise, the quality of unsupervised consultations would probably have been lower. Studies are emerging that measure the degree of quality improvement and the degree to which the subsidies help the poor in PSI Myanmar [10,11]. …”

Section: Resultsmentioning

confidence: 99%

“…There is also evidence that Myanmar’s PSI network is able to target the poor. In urban areas, TB patients at SQH clinics were more likely to be in the poorest quintile compared to the general TB positive urban population [11]. These promising results motivate the present investigation into the cost of PSI/Myanmar’s service improvement and delivery model.…”

Section: Introductionmentioning

confidence: 89%

The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

Bishai

LeFevre

Theuss³

et al. 2013

Cost Eff Resour Alloc

Self Cite

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IntroductionThis paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009.MethodsThe social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies.ResultsIn 2009 PSI Myanmar’s social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities.ConclusionIn Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO’s, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers’ cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

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Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey

Cited by 13 publications

References 19 publications

Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Socio‐economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa

Impact of Social Franchising on Contraceptive Use When Complemented by Vouchers: A Quasi-Experimental Study in Rural Pakistan

The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

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