The effect of social franchising on access to and quality of health services in low- and middle-income countries

 

Abstract

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 methods

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.

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.

 

Plain language summary

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.

 

摘要

背景

社會特許經營以獲得保健服務與品質在中低收入國家所造成的影響

社會特許經營已經發展成為一個在中低收入國家中經由參與非政府部門來提供改善保健服務的可能方法。

目標

檢視獲得社會特許經營以得到保健服務及品質在中低收入國家的證據。

搜尋策略

我們檢索了Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (截至2007年10月, Cochrane Central Register of Controlled Trials (Cochrane 圖書館 2007 年第 3 輯), MEDLINE, Ovid (1950年至2007年9月第三週), EMBASE, Ovid (1980年至2007年第38週), CINAHL, Ovid (1982年至2007年9月第3週), EconLit, WebSPIRS (1969年至2007年9月), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 年至2008年3月), Sociological Abstracts, CSA Illumnia(1952年至2007年9月)，WHOLIS(1948年至2007年11月)。

選擇標準

以隨機對照試驗、非隨機對照試驗、控制之前和之後的研究、與中斷時間序列的研究方式對社會特許經營模式與其他模式的保健服務機構、其他社會特許經營模式、或缺乏保健服務來做比較。

資料收集與分析

兩位獨立審查作者使用適當的選入與排除標準分別地檢視標題和摘要。同樣的兩個獨立審查作者再個別地審視所選引證的全文報告。在每個階段，比較結果與以經由討論方式來解決意見分歧。

主要結論

本篇評論文章未發現並納入合適的研究。

作者結論

有必要制定更精確的研究，以評估社會特許經營以獲得保健服務與品質在中低收入國家所造成的影響。這些研究應該以更廣泛的文獻來探討，以確定具有良好理論依據的社會特許經營模式以及解決其範圍、可接受性、可行性、維持、和計量的經驗研究。

翻譯人

本摘要由高雄榮民總醫院張運德翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

中低收入國家的社會特許經營 ： 社會特許經營是一具有契約關係的設計，使用一已測試與具再現性的保健服務模式來產生社會公益。社會特許經營是一個非政府部門的介入措施，因為在中低收入國家可提供高可利用性的私人服務而具重要性。我們在中斷時間序列或控制前與後的研究中，並沒有發現有任何試驗探討社會特許經營的影響。廣泛的說，對於社會特許經營的高度樂觀與興趣，強化我們對於過程與結果評估的緊迫性。然而目前，沒有精確的證據可以證明社會特許經營獲得保健服務與品質在中低收入國家所造成的影響。