SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
October, 2016 - SUPPORT Summary of a systematic review | print this article | download PDF
Social franchising adapts ideas and approaches developed and used in commercial franchising to the provision of public health services. While commercial franchising is driven by profit generation,social franchising strives to achieve social benefits. Social franchising has been identified as a way of increasing access to health services rapidly, particularly amongst the poorest populations, while maintaining quality standards in low and middle income countries.In such settings, access to health services is currently inadequate and private health service providers play an important role.
Key messages
Koehlmoos TP, Gazi R, Hossain SS, Zaman K. The effect of social franchising on access to and quality of health services in low and middle income countries. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007136.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
Social franchising takes place when a franchisee (e.g. an NGO) adopts a defined concept for health service delivery from a franchiser and then implements this under an established brand name.Quality standards and reporting requirements are required to match those set by the franchiser. Examples of social franchising networks include the provision of standardised training, supplies, and case management according to unified protocols.While commercial franchising is driven by profit generation, social franchising strives to achieve social benefits. Social franchising has been identified as a way of increasing accessto health services rapidly in low and middle income countries while maintaining standards of quality. Access to health services in such settings is currently inadequate and private health service providers play an important role.
| Review objectives: To assess the effects of the social franchising of health service delivery on access to and the quality of services and health outcomes in low and middle income countries | ||
| Type of | What the review authors searched for | What the review authors found |
|---|---|---|
| Study designs & interventions | Randomised trials, non randomised trials, interrupted time series studies,and controlled before after studies reporting on social franchises delivering health services, driven by seeking social benefits. |
No studies meeting the inclusion criteria were identified. |
| Participants | All levels of healthcare delivery, all types of patients and healthcare providers. |
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| Settings | Low and middle income countries. |
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| Outcomes | Healthcare access, quality of care, health outcomes,adverse effects, equitable access or utilization, cost/service, patient satisfaction |
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| Date of most recent search: October 2007 – March 2008 | ||
| Limitations: This is a well conducted systematic review with only minor limitations, but the last search for studies was done in 2008. | ||
Koehlmoos TP, Gazi R, Hossain SS, Zaman K. The effect of social franchising on access to and quality of health services in low and middle income countries. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007136.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
This is a well conducted systematic review with only minor limitations. It failed to identify any studies meeting the inclusion criteria.
| Findings | Interpretation* |
|---|---|
| APPLICABILITY | |
| The review did not find any studies conducted in low and middle income countries that met its inclusion criteria. |
Although social franchising is currently used and advocated in low and middle income countries, no rigorous evaluations of its impacts (both positive and negative) are available. |
| EQUITY | |
| Equity (access to, and utilisation of, health services) was a considered outcome. |
Social franchising promotes social rather than financial benefits, and therefore its effects on equity could be assumed to be positive. Social franchising, for instance,could help particularly with expanding access to health services amongst the poorest populations. However, there are no rigorousevaluations of its impacts on equity.
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| ECONOMIC CONSIDERATIONS | |
| Cost/service (from a societal perspective or the perspective of the franchiser, fran-chisee or patients) was a considered outcome. |
The cost and cost effectiveness of social franchising are unknown.
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| MONITORING & EVALUATION | |
| The review found an absence of robust evidence from rigorously designed studies. |
There is a need for well designed experimental studies informed by theoretical and empirical literature.
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*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low income countries. For additional details about how these judgements were made see:www.supportsummaries.org/methods.
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Beyeler N, York De La Cruz A, Montagu D. The impact of clinical social franchising on health services in low and middle income countries: a systematic review. PLoS One 2013; 8(4):e60669.
Viswanathan R, Behl R, Seefeld CA. Clinical Social Franchising Compendium: An Annual Survey of Programs: findings from 2015. San Francisco: The Global Health Group,Global Health Sciences, University of California, San Francisco, 2016. http://sf4health.org/sites/sf4health.org/files/sf4h-social-franchising-compendium-2016.pdf.
Lonnroth K, Aung T, Maung W, et al. Social franchising of TB through GBs in Myanmar: an assessment of treatment results, access, equity and financial protection. Health Policy and Planning 2007; 22:156–66.
Montagu D. Franchising of health services in developing countries. Health Policy and Planning 2002; 17(2):121–30.
WHO, USAID. Public policy and franchising reproductive health: current evidence and future directions. Guidance from a technical consultation meeting. Geneva: WHO, 2007.
http://apps.who.int/iris/bitstream/10665/43735/1/9789241596021_eng.pdf
Peter Steinmann, Swiss Tropical and Public Health Institute, Switzerland.
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Tracey Koehlmoos, Catherine Goodman, Vivian Welch, Simon Goudie, and Hanna Bergman.
Koehlmoos TP, Gazi R, Hossain SS, Zaman K. The effect of social franchising on access to and quality of health services in low and middle income countries. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007136.
Steinmann P. Does social franchising have an effect on access to and quality of health services in low and middle income countries? A SUPPORT Summary of a systematic review. October 2016. www.supportsummaries.org.
evidence informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care, social franchising
