Franchising of health services in low-income countries


Where do the poor go for health care? The answer may surprise you. It is not the government-sponsored public sector; it is usually the private sector. In doing so, the poor pay more for health products and services than many richer people. But, in resource-poor settings, it is often their only option.

Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health-related social franchises in developing countries.

Published in Health Policy and Planning, 6 2002, 17(2):121-30

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Dominic Montagu
Publication date: 
March 8, 2002
Publication type: 
Review Article