What do we want to know?
Given the increased urgency to meet the Millennium Development Goals, there is growing agreement that the non-state sector must be engaged. Social franchising is one approach for contracting out health services to the non-state sector used in low- and middle-income countries. A social franchise is a system of contractual relationships modelled after a commercial franchise but designed to serve a social purpose, generally funded by development partners and implemented by a Non-Governmental Organization.
Despite the enthusiasm within the donor community and attention within the literature, previous reviews of social franchising found a lack of evidence. Thus, there is a need to identify models of franchising for which there are sound theoretical bases for causal assumptions, detailed descriptions of the franchising model, good evidence of reach, implementation, sustainability, and agreement on measurable and testable social franchising activities and goals.
The objective of the review was to illustrate the range of social franchising models that have been evaluated and therefore perhaps provide lessons about their applicability in different contexts.
Who wants to know?
In recent years policy makers, health sector leaders and donors have focused increasing attention on social franchising as a solution for increasing access to and improving the quality of primary care, reproductive and sexual health, TB and HIV/AIDS diagnosis and care in low- and middle-income countries.
What did we find?
We found that there are some reviews and primary studies that attempt to evaluate social franchising. Most of the evaluated franchises are from Asia and Africa, particularly from low-income countries. Most social franchises focused on reproductive health and family planning. We found a paucity of rigorous study designs, so the evidence supporting social franchising is weak. Across settings, the public sector continues to have the highest volume of clients for family planning and other services; however, franchises do better than non-franchised private providers in terms of client volume. The clients of social franchises are satisfied with the quality of care and consistently report an intent to return.
What are the implications?
The findings of this review tell us that given that social franchising remains an area of great interest as a model for engaging the non-state sector in the provision of health services in developing country settings, more rigorous evaluations of both the implementation aspects and the effects of different models of social franchising are needed.
How did we get these results?
The review questions that enabled us to collect the evidence were:
- What is the scope of the literature addressing the reach (adoption by franchisees and service users), implementation (adherence and integrity), maintenance (or sustainability) and effects of social franchising?
- Does this literature describe in detail testable models of social franchising, their theoretical bases and measures of social franchising activities and goals.
The review considered literature describing a range of social franchising evaluations.
The EPPI Centre reference number for this report is 1908. This review should be cited as:
Koehlmoos T, Gazi R, Hossain S, Rashid M (2011) Social franchising evaluations: a scoping review. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.