Is franchising in health care valuable? A systematic review

Nijmeijer, Karlijn J.; Fabbricotti, Isabelle; Huijsman, Robbert

doi:10.1093/heapol/czt001

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…13 In 2014, franchises reached almost 30 million people in lowincome and middleincome countries (LMICs), with most funding coming from international donors. 14 Although considerable resources are being channelled to social franchising in LMICs, evidence from rigorous studies on the effectiveness of clinical social franchising is scarce, [15][16][17] and this gap in knowledge urgently needs to be addressed.…”

Section: Introductionmentioning

confidence: 99%

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study

Tougher

Dutt

Pereira

et al. 2018

The Lancet Global Health

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Section: Introductionmentioning

confidence: 99%

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study

Tougher

Dutt

Pereira

et al. 2018

The Lancet Global Health

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“…Relevant to treatment of childhood illness, this has been a common strategy for increasing use of ORS for treatment of childhood diarrhea. Beyond distribution of specific commodities, programs have engaged medicine shops seeking to improve quality of specific health services, using a "social franchising" strategy that entails private outlets joining a network, being allowed to use the network branding, and often benefiting from training, marketing, and quality assurance provided by the franchisor [27,28]. Nepal has a long history with both social marketing and social franchising.…”

Section: Policy and Program Implicationsmentioning

confidence: 99%

A National Survey of Private-Sector Outpatient Care of Sick Infants and Young Children in Nepal

Ban

Hodgins²,

Thapa³

et al. 2020

Preprint

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Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged <2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings.Methods: A nationally representative sample of medicine shops was drawn, in rural settings and small urban centers in Nepal, from 25 of the 75 districts in Nepal, using multi-stage cluster methodology, with a final sample of 501 shops and 82 physician-run clinics. Face-to-face interviews were conducted.Results: Most medicine shops outside urban areas were not registered with the Department of Drug Administration (DDA). Most functioned as de facto clinics, with credentialed paramedical workers (having 2-3 years of training) diagnosing patients and making treatment decisions. Such a role falls outside their formally sanctioned scope of practice. Quality of care problems were identified among medicine shop-based providers and physicians, including over-use of antibiotics for treating diarrhea, inaccurate weighing technique to determine antibiotic dose, and inappropriate use of injectable steroids for treating potentially severe infections in young infants.Conclusions: Medicine shop-based practitioners in Nepal represent a particular type of informal provider; although most have recognized paramedical credentials, they offer services falling outside their formal scope of practice. Nevertheless, given the large proportion of the population served by these practitioners, engagement to strengthen quality of care by these providers and referral to the formal health sector is warranted.

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“…So, Nepal has a well-established and long-running family planning social franchising program, under Ministry oversight, that can serve as a model for other technical areas. Those leading such efforts in Nepal can also draw lessons from Bangladesh experience engaging with village doctors to improve care of sick children [28][29][30][31].…”

Section: Policy and Program Implicationsmentioning

confidence: 99%

A National Survey of Private-Sector Outpatient Care of Sick Infants and Young Children in Nepal

Ban

Hodgins²,

Thapa³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged <2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings. Methods: A nationally representative sample of medicine shops was drawn, in rural settings and small urban centers in Nepal, from 25 of the 75 districts in Nepal, using multi-stage cluster methodology, with a final sample of 501 shops and 82 physician-run clinics. Face-to-face interviews were conducted. Results: Most medicine shops outside urban areas were not registered with the Department of Drug Administration (DDA). Most functioned as de facto clinics, with credentialed paramedical workers (having 2-3 years of training) diagnosing patients and making treatment decisions. Such a role falls outside their formally sanctioned scope of practice. Quality of care problems were identified among medicine shop-based providers and physicians, including over-use of antibiotics for treating diarrhea, inaccurate weighing technique to determine antibiotic dose, and inappropriate use of injectable steroids for treating potentially severe infections in young infants. Conclusions : Medicine shop-based practitioners in Nepal represent a particular type of informal provider; although most have recognized paramedical credentials, they offer services falling outside their formal scope of practice. Nevertheless, given the large proportion of the population served by these practitioners, engagement to strengthen quality of care by these providers and referral to the formal health sector is warranted.

show abstract

Is franchising in health care valuable? A systematic review

Cited by 26 publications

References 29 publications

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study

A National Survey of Private-Sector Outpatient Care of Sick Infants and Young Children in Nepal

A National Survey of Private-Sector Outpatient Care of Sick Infants and Young Children in Nepal

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