May, 2011 - SUPPORT Summary of a systematic review | print this article |
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. Effective overviews and quality standard enforcements of social franchising are often lacking.
|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.|
|/||What the review authors searched for||What the review authors found|
Social franchises delivering health ser-vices, driven by seeking social benefits
Considered were: Randomized Controlled Trials (RCT), Non-Randomized Controlled Trials (CCT), Interrupted Time Series (ITS), Controlled Before-After Studies (CBA)
|No studies meeting the inclusion criteria were identified.
All levels of health care delivery
All types of patients and health care providers
|Settings||Low-and middle-income countries
1. Health care access
2. Quality of care
3. Health outcomes
4. Adverse effects
5. Equitable access or utilization
7. Patient satisfaction
|Date of most recent search: October 2007 – March 2008|
|Limitations: : This is a good quality systematic review with only minor limitations|
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. DOI:10.1002/14651858.CD007136.pub2.
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. DOI:10.1002/14651858.CD007136.pub2. See in Cochrane Library
This is a good quality systematic review with only minor limitations. It failed to identify any study meeting the inclusion criteria.
As new ways of expanding health services in LMICs are explored, social franchising is attracting increasing interest. However, initial optimistic assumptions and expectations have not been supported by rigorous evidence, and potentially adverse effects have not been assessed in detail. The methodology for establishing the evidence required is available but, to date, no conclusions regarding the ef-fectiveness of social franchising on access to, and the quality of, health services in LMICs can be drawn.
| Equity (access to, and utilisation of, health services) was a considered outcome.
|MONITORING & EVALUATION|
| The review noted the absence of robust evidence from rigorously designed studies.
*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- and middle-income countries. For additional details about how these judgements were made see:
Clinical Social Franchising Compendium – An Annual Survey of Programs, 2010. The Global Health Group; University of California. http://globalhealthsciences.ucsf.edu/GHG/docs/Social-Franchising-Compendium-2010.pdf
Lonnroth K, Aung T, Maung W, Kluge H, Uplekar M. Social franchising of TB through GBs in Myanmar: an assessment of treatment results, access, equity and financial protection. Heatlh 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 evi-dence and future directions. Guidance from a technical consultation meeting (unpublished) 2007.
This summary was prepared by
Peter Steinmann, Swiss Tropical and Public Health Institute, Switzerland.
Conflict of interest
None. For details, see: Conflicts of interest
This summary has been peer reviewed by: Tracey Koehlmoos, Bangladesh; Catherine
Goodman, Kenya; Vivian Welch, Canada.
This summary should be cited as
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. May 2011. www.support-collaboration.org/summaries.htm
All Summaries: evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low- and middle-income countries, developing countries, primary health care,