Expanding choice and access to contraceptives, especially long-acting reversible (LARC) and permanent methods (PM), is one of the best ways to prevent infant, early childhood, and maternal deaths. The right tools let women and their families plan ahead and have children at times in their lives when they are prepared for the entire experience, from pregnancy through early childhood.
But expanding choice and access to contraceptive methods is fraught with challenges—from language and culture to logistics and quality. Social franchising has shown promise as a tactic that can help overcome many of those challenges. In 2013 alone, social franchisees affiliated with Population Services International (PSI) or Marie Stopes International (MSI) delivered more than 1.2 million long-acting reversible or permanent contraceptives.
By gathering networks of private providers who deliver services under a common brand, in accordance with franchise standards, social franchising supports safe, affordable services, while also establishing trusted brands that cut across different communities and even different generations of providers and patients.
Earlier this year, implementers from USAID’s LARC and PM Community of Practice gathered to discuss their experiences in using social franchising to expand choice and access to long-acting reversible and permanent contraceptives.
The group explored several outstanding questions such as who social franchising is best placed to reach, and how it can be leveraged to reach new family planning users. There was also discussion of the effectiveness of links with health financing mechanisms such as vouchers as a viable channel to reach the poorest.
Reaching the poorest, reaching new patients
In Uganda, there is a high unmet need for family planning, and a high rate of users dropping out of short-term contraceptive methods. MSI-affiliated and PSI network member organizations in the country have scaled up social franchising, supporting 592 clinics, to address this gap.
In 2013, an estimated one-third of all long-acting reversible and permanent contraceptive users in Uganda received their method from an MSI/PSI-affiliated franchisee – adding up to more than 170,000 services delivered
Adapting to overcome barriers
Logistical barriers that might seem mundane can still have noticeable affects. The experience of the PSI-affiliated Tunza Franchise Network in Tanzania illustrates such barriers. Tunza’s network combines more than 300 individual providers – 80 percent of them nurses – with around 300 Tunza Mobilizers, hired from the local population to conduct group and one-on-one education sessions about family planning as well as other health issues like cervical cancer screening and HIV.
Tunza’s Mobilizers made two adjustments in 2013. First, they emphasized one-on-one rather than group education sessions, noting that in the group sessions quieter members of the community often left without asking the questions they might have wanted to ask if not for others dominating the discussion. Second, the mobilizers reversed the order of their family planning presentations, to go over long-acting reversible contraceptives before short-term. Why? They realized most women already knew about short-term methods and thus lost interest by the time they brought up long-term methods. First-quarter 2014 data suggests demand for long-acting reversible contraceptives has increased.
In closing, Elaine Menotti from USAID’s Bureau for Global Health reminded participants that choice of provider as well as choice of method is important. She encouraged everyone in the global health community to share results and continue a dialogue. She noted that next steps are to work on the harmonization of metrics across organizations, improve integration of services and focus on not only insertions but removals as well.
For more on expanding choice and access to long-acting reversible and permanent contraceptives through social franchising, download a full briefing on the community of practice’s May 2014 meeting.