Franchising Reproductive Health Services

Authors

  • Rob Stephenson,

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    • Address correspondence to Rob Stephenson, Ph.D., Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., W4503, Baltimore, MD 21205-2179. Amy Ong Tsui, Ph.D., is also with the Bill and Melinda Gates Institute for Population and Reproductive Health. Sara Sulzbach, M.P.H., is with Abt Associates, Bethesda, MD. Phil Bardsley, Ph.D., is with the Carolina Population Center, University of North Carolina at Chapel Hill. Getachew Bekele, B.A., is with Marie Stopes International-Ethiopia, Addis Ababa, Ethiopia. Tilahun Giday, M.P.S., is with Pathfinder International-Ethiopia, Addis Ababa, Ethiopia. Rehana Ahmed, M.D., is an Independent Health Consultant, Population Services International, Nairobi, Kenya. Gopi Gopalkrishnan, M.A. (Hons), is with Janani, Rashmi Complex, P&T Colony, Kidwaipuri, Patna, Bihar, India. Bamikale Feyesitan, Ph.D., is with Family Health International, Arlington, VA.

  • Amy Ong Tsui,

  • Sara Sulzbach,

  • Phil Bardsley,

  • Getachew Bekele,

  • Tilahun Giday,

  • Rehana Ahmed,

  • Gopi Gopalkrishnan,

  • Bamikale Feyesitan


  • The authors gratefully acknowledge support from grant number 2000–3003 from the David and Lucile Packard Foundation to conduct this research.

Abstract

Objectives. Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client.

Methods. Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings.

Results. Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings.

Conclusions. Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.

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