Franchising Reproductive Health Services

Sara Sulzbach, University of North Carolina at Chapel Hill
Phil Bardsley, University of North Carolina at Chapel Hill
Rob Stephenson, University of North Carolina
Getachew Bekele, Marie Stopes International (MSI), Ethiopia
Tewodros Melesse, Pathfinder International
Rehana Ahmed, Population Services International (PSI)
Shejo Bose, DKT International

Although family planning (FP) and reproductive health (RH) services have historically been the domain of the public sector, shortcomings in quality and accessibility have heightened interest in "franchising" these services. To date there is little evidence of the added value of RH franchises. Using 2001 data from probability sample surveys of 2,694 health facilities and 13,904 clients in three countries - Pakistan, India, and Ethiopia - this study comparatively evaluates the role of reproductive health franchises in improving delivery and increasing use of FP and other RH services. Preliminary analysis indicates that franchises are located in underserved areas and serve low to middle income clients. Providers benefit from franchise participation, both in technical support and clinic business. Franchises compete well with government in the provision of FP/RH services, although given the low proportion of clients seeking FP/RH services (<20%), revenues from such services alone are not likely to be substantial.