Let’s Stay HIP: Social Franchising as a High Impact Practice

by Sarah Anderson, Communications Intern, PSI

What does the restaurant industry have in common with global health organizations like PSI?   

The answer is that both are using franchises. In the commercial sector, franchising refers to purchasing the rights to use a trademark in order to produce a good or service with certain specifications. In short, you can’t open a curb-side shop and call it a Subway. You must first buy into the Subway franchise and become a franchisee.    

In global health, franchising is applied in a similar way: an organization or the government (the franchisor) recruits private clinics to participate in their network. The clinic (the franchisee) agrees to provide specific services and deliver healthcare at prescribed high-quality standards. The franchisor then works to support franchisees in a variety of ways, such as providing training, linking to commodities, and raising awareness in the community for the services offered.    

Social franchising addresses a critical issue in family planning (FP): while private providers are a main source of FP services, governments are often unable to regulate the quality of care in the private sector. Clinics also struggle to cover the cost of providing a broad range of contraceptive options.    

Social franchising is considered a high impact practice (HIP) in family planning because evidence shows that it increases quality of care, number of clients, and usage of long-acting reversible contraceptives.   

What are key ways to ensure high impact? After our experience with social franchising in countries like Myanmar and Uganda, PSI is learning every day how to make it even more effective.    

Recently, PSI’s Senior Technical Advisor Sarah Thurston and Deputy Country Representative of PSI Myanmar Daniel Crapper took part in the webinar hosted by HIPs for FP2020 and the IBP Secretariat to share their experiences and findings about social franchising. Here’s what they’ve learned:    

  1. Choose Wisely: One of the most important elements of social franchising is choosing the right clinics in the right locations. Franchisees should be/ in places that serve high-need populations and be ready and eager to expand their services.    
  2. Finance Carefully: Sufficient financing is necessary to ensuring sustainability in franchising. If donor financing is reduced, the franchise shouldn’t fall apart. This involves encouraging private-public partnerships and linking private clinics with domestic health financing.     
  3. Quality Matters: Patients come to franchised clinics knowing they can expect high-quality care due to strict standards. Just as restaurants must ensure that the food they serves meet quality standards at all locations, social franchisors must ensure that franchisee clinics are held to the same high standards of care wherever they are. For example, PSI Myanmar’s rigorous quality monitoring system revealed that one franchisee was treating patients poorly, and the provider was immediately dismissed from the network. This illustrates the effectiveness of performance-based incentives in some social franchises.    
  4. Be Flexible: Social franchising can be adapted and implemented in a variety of ways to work effectively in different countries. In Ethiopia, a tiered structure allows franchisees to progress and eventually “graduate” out of the system; while in Myanmar, social franchising is coupled with interventions to increase demand, including providing patients with health cards entitling them to significantly reduced costs for services at clinics.    
  5. Think Broadly: Consider a broad range of primary care services for social franchising, including but not limited to family planning services. A broader range of services will facilitate the linking of franchisees with domestic financing, which is crucial for sustainability.   


With contribution from Hilary Kinka, East Africa Technical Adviser, Franchised Health Service Delivery, PSI
Banner image © Chris White / Population Services International 




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