Social franchising to increase access to and quality of health services in low- and middle-income countries

Governments are looking for ways to increase the access to and quality of health care services in low- and middle-income countries.  One system not connected to the public sector, has been to provide health services through a franchise, called social franchising. The concept of franchising for health services is similar to franchises in business.  A franchiser develops a successful way to provide the health services, and then other franchisees copy the model in other franchises.  Each franchisee, though, has to follow the original model.  There is also usually specific training, protocols and standards to follow, monitoring, and a brand name or logo which identifies that the provider is part of a franchise.   

There is hope and early work reports that social franchising may quickly spread health services in low- and middle income countries to improve health.  But this Cochrane review did not find any rigorous evidence to demonstrate the effect of social franchising on access to and quality of care in low- and middle-income countries.  Well designed studies are needed.

Authors' conclusions: 

There is a need to develop rigorous studies to evaluate the effects of social franchising on access to and quality of health services in low- and middle-income countries. Such studies should be informed by the wider literature to identify models of social franchising that have a sound theoretical basis and empirical research addressing their reach, acceptability, feasibility, maintenance and measurability.

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Background: 

Social franchising has developed as a possible means of improving provision of health services through engaging the non-state sector in low- and middle-income countries.

Objectives: 

To examine the evidence that social franchising has on access to and quality of health services in low- and middle-income countries.

Search strategy: 

We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (up to October 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, Ovid (1950 to September Week 3 2007), EMBASE, Ovid (1980 to 2007 Week 38), CINAHL, Ovid  (1982 to September Week 3 2007), EconLit, WebSPIRS (1969 to Sept 2007), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 to March 2008), Sociological Abstracts, CSA Illumnia (1952 September 2007), WHOLIS (1948 November 2007).

Selection criteria: 

Randomized controlled trials, non-randomized controlled trials, controlled before and after studies and interrupted time series comparing social franchising models with other models of health service delivery, other social franchising models or absence of health services.

Data collection and analysis: 

Two review authors independently applied the criteria for inclusion and exclusion of studies to scan titles and abstracts.  The same two review authors independently screened full reports of selected citations . At each stage, results were compared and discrepancies settled through discussion.

Main results: 

No studies were found which were eligible for inclusion in this review.

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