Table 1 Components of the social franchising programme
Organising delivery | Programmes that reduce fragmentation and informality of health care delivery and that may enable financing, regulation, training and new business models | |
|---|---|---|
Franchise | A group of providers that operates under the same brand but where outlets are operator-owned and services are standardised by a central franchisor | SkyCare/SkyHealth (stand-alone franchises); franchise clinic/franchise diagnostic (fractional franchises) |
Chain | A group of providers that operates under the same brand but where operators are paid employees of a sponsoring organisation | Three franchisor-owned clinics (also called mini-clinics) |
Network | A group of providers that are loosely joined to deliver services to specific population groups. Each provider is a separate entity and retains its own branding. Membership in the network may entitle the provider to payments, patient volume, central services or training | Franchisees are linked to a network of shops selling drugs which receive socially marketed products |
Regulating performance | Programmes that set standards and enforce or incentivize higher quality care or increased access for target populations | |
Quality enforcement/monitoring | Programmes that mandate specific clinical practice guidelines, and/or monitor providers over time to ensure quality | Monitoring and supervision of quality standards in franchisees, exit surveys and encourage feedback from competitors |
Price regulation | Programmes or regulations that specify prices that must be charged to users for services | Fixed prices for below the poverty line clients at Sky Centres; fixed prices for franchised services at franchised clinics |
Financing care | Programmes that mobilise funds for health care and align provider incentives to increase access for targeted groups of patients or to support select health interventions | |
Links to government health financing mechanisms | Initiatives that link private providers to existing government health financing mechanisms that can contract and reimburse private providers for care provided to specified patient groups | Plan to facilitate linking franchisees and beneficiaries to government cash incentive and insurance schemes. Training of community health workers to link with government schemes |
Cross subsidisation | Programmes that charge full-fees for services to patients that are able to afford them and use the profits to subsidise services for the poor | Subsidies for telemedicine for clients below the poverty line off-set to some degree by franchise fee paid per client above the poverty line |
Changing behaviours | Programmes designed to change the behaviour of individuals involved in health care transactions | |
Social marketing | Programmes that aim to change consumer care-seeking behaviours through marketing/advertisement techniques, with or without a branded and/or subsidised product | Branding, advertising, SMS messages, provision of SkyMeds |
Community health workers | Programmes that use community health workers to generate demand for products or services | Government community health workers refer women to public and franchised facilities |
Provider training | Programmes that seek to improve the quality and/or efficiency of services by training health care workers and/or building the internal capacity of organisations | Training of SkyCentre staff, franchise clinic staff, community health workers and public sector staff. Sky centre staff also trained on telemedicine technology |
Other health awareness/education | Programmes that create social awareness and educate the public about specific health topics such as disease prevention and treatment, healthy behaviours, correct use of pharmaceuticals, etc. | Community system to give health messages |
Organising delivery | Programmes that reduce fragmentation and informality of health care delivery and that may enable financing, regulation, training and new business models | |
Enhancing processes | Processes, technologies, or products that facilitate increased efficiency, lower costs, higher quality, and/or improved access | |
Information and communications technology | Programmes that utilise technology to enable remotely delivered care, communication and exchange of medical information (e.g. telemedicine, call centre, cell phone technology, biometric system, etc.). | Cell phone/smartphone/tablet/telemedicine services through franchisees, including remote diagnostics |
Innovative operational processes | Programmes that improve quality, reduce costs or enhance efficiency of services through new business or care processes (e.g. high-volume/low-cost operational models, process standardization). | Telemedicine; getting auxiliary nurse midwives to insert intrauterine devices in rural areas |
Mobile health | Programmes that utilise various models of transportation to deliver services to rural and remote populations. (e.g. ambulance services, health worker transport, travelling clinics/products, etc.) | May have Sky ambulance and link to “108” ambulance |
Supply chain enhancements | Programmes that reduce costs and improve efficiency of supply chains that move medical products from manufacturer to retailer | Last mile outriders (SkyMeds and diagnostics) |
Innovative medical products and equipment | Programmes that design, manufacture and sell new products such as rapid testing kits, nutritional supplements or other medical supplies that reduce costs, improve quality or enable remote care | Non-pneumatic anti-shock garment; stabilisation procedures at lower levels; remote diagnostics; safe delivery kits |