Across the world, PSI fosters healthcare networks – both in the public and private sectors – that deliver vital health services for women and their families. One of the ways in which we deliver services is through social franchising. PSI operates 26 health franchise networks in 25 countries in Asia, Africa and Latin America, making our social franchise networks for health the world’s largest. Our technical expertise, marketing acumen and strong relationships with franchisees has kept us on the cutting edge of healthcare innovation since the launch of our first franchise in Pakistan in 1995.
PSI empowers women and girls to make healthcare choices that best suit their needs by offering a range of health services and cadres of health providers at community and local levels. With the goal towards contributing to the Sustainable Development goals of Universal Health Coverage, PSI strives to better shape healthcare markets.
How Does Social Franchising Work?
Social franchising focuses on harnessing the private health sector to deliver affordable, reliable and high quality services to millions. We work with fragmented, independent, (predominately) private healthcare facilities and pharmacies to strengthen and maximize their health impact. The result is a consolidated, burgeoning private health system, where women and their families can access quality-assured services. By working with the private sector, we are leveraging the enormous resources embedded in their existing role, to expand access to high quality health services and achieve greater scale.
PSI approaches the development of health service networks by starting with a deep understanding of market development and social and behavior change. This in-depth analysis of our target consumer and how markets can be strengthened helps us shape the way in which we support the private sector to contribute to health systems strengthening. What sets us apart is our dedication to understanding our target consumers’ behaviors and to developing solutions to meet their needs. What remains constant is our unwavering commitment to achieving and maintaining quality services, at prices that are affordable for women and their families.
Leveraging more than two decades of leadership in social franchising, PSI is pushing the boundaries of this approach in response to rapidly evolving developing country health markets, digital and medical technology. In many markets, consumers’ preferences and behaviors are changing, technology and its ubiquity is evolving, the private health sector wants to better serve its customers, and governments are working towards the development of strategic purchasing mechanisms and universal health coverage. In this dynamic environment, PSI is evolving the way it works with private providers, to foster greater private sector contribution within a mixed health system, with the vision of universal health coverage.
How Does Social Franchising Strengthen Health Systems?
- Address market failures to improve the quality of health services
- Consolidate and regulate quality in private sector clinics and pharmacies
- Support networks to become part of the broader health system, thereby improving referral mechanisms and contributing to UHC
- Clinics receive support to expand and develop through access to loans and improving their business acumen
- Enable clinics to provide quality assured services through in-service trainings and supportive supervision.
- Reach underserved populations through demand side subsidies who may not otherwise have convenient access to affordable health services
- Support demand generation and marketing activities to reach more clients, thereby improving national health indicators
- Provide reliable access to lower cost, high quality drugs and reducing stock outs.
How Do People and Communities Benefit?
- Help communities access preventive and life-saving primary care services
- Access to high-quality care
- Access to quality-assured drugs
- Convenient one-stop shop to meet a family’s wide range of health needs
- Affordable prices
- Receive counseling and support to make more informed decisions about their health
How Can I Learn More?
Read more about social franchising and other service delivery channels through PSI’s programmatic briefs:
- A Review of Social Franchising Innovations in Franchising at PSI
- Myanmar Package of Services
- Myanmar Strategic Purchasing
- Public sector service delivery
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Our network of social franchises brings preventative and life-saving primary care services to people in the developing world, including: a variety of family planning options; reproductive health and maternal child health services; tuberculosis and pneumonia testing and treatment; HIV counseling and testing; malaria prevention, diagnosis and treatment; and diarrheal disease treatment.
Our franchises work to help strengthen national health systems and improve health standards in local communities. In 2016 we had almost 7 million client visits in our 26 franchise networks across 25 countries.
How Are We Evolving and Innovating?
Franchising and primary healthcare:
Economies and health markets in Latin American and Caribbean countries are changing and developing. Viewed through the market development lens, PSI saw the need for a new model that offered a better value proposition to Red Segura franchisees, as well as better serve the future healthcare consumer. PSI is now developing a full primary care clinic model consisting of family planning and reproductive health services, pharmacy services, and gender-based violence screenings and referrals. Scale up can be achieved through offering the clinic model to existing franchisees in four countries (Guatemala, Honduras, El Salvador, Nicaragua), as well as to new health entrepreneurs, thereby supporting the crowding in of new expertise to this sector.
Social enterprise for health:
PSI is an established market player in East Africa with decades of experience helping women and families access high quality contraceptives and other priority health products and services. In 2008, PSI launched the Tunza Family Health Care Network in Kenya. Based on changing market dynamics across East Africa, PSI turned a critical eye to how Tunza (‘to nurture’ or ‘to care for’ in Kiswahili) could best respond to market failures and opportunities. PSI is transforming its Tunza social franchise network into a financially sustainable social enterprise. This will test the concept that, by helping its franchisees grow their businesses and sharing the incremental revenue that results, a previously donor-reliant franchise network can transition to self-sufficiency. Launching in Uganda in early 2017, and scaling thereafter to Malawi and Tanzania, the new Tunza model aims to reach self-sufficient in five to six years. To do this, Tunza must help its franchisees grow their health businesses while at the same time strategically reducing its own operating costs.
Universal health coverage:
In Myanmar, PSI operates one of the world’s largest social franchises, with over 1,000 franchisees across the country. Many people in Myanmar access most of their healthcare through the formal and informal private sector, primarily paid for out-of-pocket by clients. This ultimately places an undue financial burden on poor and vulnerable populations. In response to the Government of Myanmar’s long-term universal health coverage strategy, PSI has developed a government-supported pilot project to demonstrate the capacity of private general practitioners in its Sun Quality Health Network to offer a basic package of primary care services. Over the course of 2017, this project is testing a strategic purchasing mechanism involving capitation payments. The project aims to demonstrate that it can increase the range of services private providers can offer, decrease out-of-pocket payment incurred by the 2,500 registered low-income households, and decrease the time to seek treatment from the start of signs and symptoms.
Mixed health systems:
In Malawi, where 85% of the population lives in rural areas, PSI has collaborated with the Ministry of Health since 1994 to extend the reach of the health system and to improve reproductive health. As of 2010, more than a quarter (27%) of rural married women expressed an unmet need for family planning, including 12% who wished to limit births but were using no modern method. In 2014, PSI used teams of its own clinical providers and nurse midwives in Malawi to offer outreach services to underserved, hard-to-reach rural populations in collaboration with the Ministry of Health. While on site, the clinical officer also offered on-the-job training and mentorship focused on family planning for the public health staff who worked at the facility. Over time, this support reduced to PSI providers returning every one to two months to provide supportive supervision and to offer help delivering services when needed. This mixed health system approach reduced the burden for public sector providers in the short term and built their capacity to offer an expanded method mix in the long term.
- National Demand Analysis – Qualitative Assessment
Qualitative analysis of family planning needs in Cote d’Ivoire to inform quantitative research leading to behavioral/attitudinal segmentation.
- Myanmar Strategic Purchasing Brief Series #3: Targeting Poor Households
- Myanmar Strategic Purchasing Brief Series #2: Calculating a Capitation Payment
This is the second in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar.
- Myanmar Strategic Purchasing Brief Series #1: Package of Services
This is the first in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar.
- Social Marketing Evidence Base: Tuberculosis
The Social Marketing Evidence Base was compiled from a systematic review of published literature evaluating social marketing interventions in global health. This document provides an overview of the results from the studies on tuberculosis.
- Social Marketing Evidence Base: Reproductive Health
The Social Marketing Evidence Base was compiled from a systematic review of published literature evaluating social marketing interventions in global health. This document provides an overview of the results from the studies on reproductive health.
- Infographic: The Social Marketing Evidence Base
In response to questions about the effectiveness of social marketing in global health, we systematically reviewed all literature published over two decades on social marketing for several health areas; reproductive health, malaria, child survival, and tuberculosis in developing countries. The methods and findings are summarized here in the form of an infographic.
- A 2017 Review of Social Franchising Innovations at PSI
There is no one-size-fits-all solution to any health system challenge, so diverse models of social franchising are needed to respond to diverse challenges across countries. This programmatic brief highlights four models across all health areas—three of which are being tested to improve the sustainability and equity of franchising, and one of which is a cross-cutting approach to support quality improvement.
- Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International
Family planning social franchising has succeeded in countries with an active private sector serving low- and middle-income clients, with services provided mostly by mid-level providers, such as nurses and midwives. Key support for social franchising includes: clinical training and supportive supervision, help building sustainable businesses, marketing and demand creation, and mechanisms to make services affordable for clients. The forward agenda includes selectively introducing other priority health services, improving cost-effectiveness of the model, and promoting sustainability and health systems integration.
- Developing Family Planning Markets in Francophone West Africa
In Francophone West Africa, PSI partners with Ministries of Health to achieve the goals set out by the Ouagadougou Partnership to reach at least 2.2 million additional family planning users by 2020. The pillars of our response are access, choice, quality, and equity.