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Table 1 Components of the social franchising programme

From: Protocol for the evaluation of a social franchising model to improve maternal health in Uttar Pradesh, India

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