Protocol for the evaluation of a social franchising model to improve maternal health in Uttar Pradesh, India

Abstract

BackgroundSocial franchising is the fastest growing market-based approach to organising and improving the quality of care in the private sector of low- and middle-income countries, but there is limited evidence on its impact and cost-effectiveness. The “Sky” social franchise model was introduced in the Indian state of Uttar Pradesh in late 2013.Methods/designDifference-in-difference methods will be used to estimate the impact of the social franchise programme on the quality and coverage of health services along the continuum of care for reproductive, maternal and newborn health. Comparison clusters will be selected to be as similar as possible to intervention clusters using nearest neighbour matching methods. Two rounds of data will be collected from a household survey of 3600 women with a birth in the last 2 years and a survey of 450 health providers in the same localities. To capture the full range of effects, 59 study outcomes have been specified and then grouped into conceptually similar domains. Methods to account for multiple inferences will be used based on the pre-specified grouping of outcomes. A process evaluation will seek to understand the scale of the social franchise network, the extent to which various components of the programme are implemented and how impacts are achieved. An economic evaluation will measure the costs of setting up, maintaining and running the social franchise as well as the cost-effectiveness and financial sustainability of the programme.DiscussionThere is a dearth of evidence demonstrating whether market-based approaches such as social franchising can improve care in the private sector. This evaluation will provide rigorous evidence on whether an innovative model of social franchising can contribute to better population health in a low-income setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0269-2) contains supplementary material, which is available to authorized users.

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

“…We prespecified all outcomes and there were no major deviations from the published protocol. 21 We removed two outcomes and modified one other. An outcome for multiple births detected at pregnancy was excluded because very few women in the sample had multiple births.…”

“…We selected study clusters 1 year after the first social franchisee was contracted with the following procedures. 21 First, every Sky health provider was linked to its census area. 393 private providers were in the network at the time of selection, with membership reflecting decisions by the providers on whether to join and by the franchiser on which providers to target.…”

“…27,28 We used census data on village characteristics for the matching. 21 To limit problems of contamination, we did not select comparison clusters adjacent to intervention areas. Finally, we did the same matching procedure to select 60 external comparison clusters from neighbouring districts.…”

Quality of routine essential care during childbirth: clinical observations of uncomplicated births in Uttar Pradesh, India

“…This study was conducted in three districts of Uttar Pradesh: Kannauj, Kanpur Dehat and Kanpur Nagar 30 . In 2012–2013, Uttar Pradesh was the Indian state with the largest population and the second and third highest levels of maternal and neonatal mortality, respectively 31 .…”

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

“…Many franchisors use new information technologies to improve the efficiency and coordination of their network of franchisees. However, despite the rapid growth of social franchising in developing countries, there is little evidence that it affects the quality of care provided on a large scale, 14 – 16 except for a recent programme in Myanmar where the introduction of social franchising was accompanied by a substantial increase in the number of health-care workers 17 , 18 …”