Access Restriction

Author Sundari, Ravindran T. K. ♦ Fonn, Sharon
Source Sree Chitra Tirunal Institute for Medical Sciences & Technology
Content type Text
Publisher Reproductive Health Matters
File Format PDF
Language English
Subject Domain (in DDC) Technology ♦ Medicine & health ♦ Incidence & prevention of disease ♦ Gynecology, obstetrics, pediatrics & geriatrics
Subject Domain (in MeSH) Female Urogenital Diseases and Pregnancy Complications ♦ Diseases ♦ Health Care Facilities, Manpower, and Services ♦ Health Care
Subject Keyword Public Health
Abstract A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming.
Education Level UG and PG
Learning Resource Type Article
Educational Framework Medical Council of India (MCI)
Journal Reproductive health matters
Volume Number 19
Issue Number 38
Page Count 17
Starting Page 85
Ending Page 101