Social franchising is the application of commercial franchising concepts to achieve socially beneficial ends, rather than profit [1].
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Social franchising is the application of the principles of commercial franchising to promote social benefit rather than private profit.
In the first sense, it refers to a contractual relationship wherein an independent coordinating organization (usually a non-governmental organization, but occasionally a governmental body or private company[2]) offers individual independent operators the ability join into a franchise network for the provision of selected services over a specified area in accordance with an overall blueprint devised by the franchisor[3]. Once joining the network, operators are given the right to employ previously tested incentives including: professional training, use of brands or brand advertisements, subsidized or proprietary supplies and equipment, support services, and access to professional advice [4]. Members also gain beneficial spin-off effects such as increased consumer volume and improved reputation due to brand affiliation [1]. Franchisees must adhere to a range of requirements including: providing socially beneficial services, meeting quality and pricing standards, undergoing mandatory education on provision of services, subjecting outlets to quality assurance mechanisms, reporting service and sales statistics, and occasionally, paying fixed or profit-share fees [1][5]. Social franchises have been used for primary health services, pharmaceutical sales of essential drugs, HIV testing and counseling, and reproductive health services in the developing world.
A second application of social franchising is as a means of enabling social enterprises and the social economy to create more employment for disadvantaged people and achieve social aims. This is done principally by enabling joint working and knowledge sharing and transfer. The European Social Franchising Network has identified over 60 social franchises of this type in Europe, which employ over 13,000 people. The largest of these is De Kringwinkel in Flanders employing 5,000 people. Others, like the Le Mat hotel and tourism social franchise or the School for Social Entrepreneurs operate in more than one country. Social franchising provides an opportunity to rapidly grow the sector to the benefit of disadvantaged people and society more generally.
Social franchising for essential health services is an emerging technique used by governments and aid-donors in developing countries where a substantial percentage of health services are provided by private sector (including non-profit NGOs and private for-profit) to improve access, equity, effectiveness, and quality. Clinical franchising often takes the form of a fractional model where franchised services are added to an existing medical practice, but also can exist as a stand alone practice wherein the site exclusively provides franchise supported services or commodities. Social franchising has been used to deliver a wide range of services including DOTS tuberculosis treatment [6], sexual transmitted infection management [7][8], primary care, and HIV / AIDS treatment [9][10].
By organizing small independent providers into larger units, social franchises can yield returns to scale in investment in physical capital, supply chains, advertising, and worker training and supervision [2]. Additionally, social franchises can offer the ability to: faster scale up programs, decrease transaction costs, provide uniform services to a broad market, collectively negotiate financial reimbursement mechanisms, and replicate best practice services among a large group [8]. Franchisees can also cross-subsidize less profitable services with the more profitable ones supported by the franchisor. The use of brand advertising makes social franchising compatible with social marketing [1][11]. In addition, social franchising for health services allows an expansion of services because of cross-subsidization, addition of less-profitable services if fractionally franchised, and access to costly medicines if subsidized by the coordinating organization.
Several inherent logistical and economic weaknesses are present within the social franchising model. These include the difficulty in standardizing medical care among participants, the need for networks to be sufficiently large to attain an economy of scale, the cost and challenge of regulatory oversight of outlets, and the need to base organizational decisions on the population demand which may not maximize quality or minimize cost [11]. There also exists the possibility of “tragedy of the commons” wherein franchisees provide low quality, low cost due to incomplete monitoring [1]. Social franchising for health services runs the risk of overly procedural, “cookie cutter” medical provision, overtreatment of disease conditions, and the possibility of fraud if oversight is not present.
The first significant implementation of social franchising was conducted in 1995 by the Greenstar franchise in Pakistan. Since its inception, Greenstar has trained over 24,000 providers, and provides family planning, sexual and reproductive health services, maternal and child health services, and tuberculosis diagnosis and treatment through over 80,000 retail outlets [12]. Since then, over 35 additional social franchise programs have arisen, with much of the increase in the number and size of social franchises occurring in the last four years. Franchises have additionally expanded their services from mostly family planning to testing and treatment of malaria, tuberculosis, and HIV / AIDS [13].
Franchise Name | Country | Coordinating Organization | Date Founded | Number of Clinics | Family Planning | HIV | Sexual and Reproductive Health | Maternal and Child Health | Tuberculosis | Malaria | Other | |
AMUA | Kenya | Marie Stopes International | 2004 | 144 | Yes | |||||||
Andalan | Indonesia | DKT International | 2001 | 5,000 | Yes | Yes | Yes | |||||
ARV Care | South Africa | BroadReach | 2002 | 4500 | Yes | Yes | ||||||
Biruh Tesfa | Ethiopia | Pathfinder International | 2000 | 130 | Yes | Yes | Yes | |||||
Blue Star (Bangladesh) | Bangladesh | Social Marketing Company | 1998 | 3600 | Yes | |||||||
BlueStar (Ethiopia) | Ethiopia | Marie Stopes International | 2007 | 107 | Yes | Yes | ||||||
BlueStar (Ghana) | Ghana | Marie Stopes International | 2008 | 102 | Yes | Yes | ||||||
BlueStar (Malawi) | Malawi | Marie Stopes International | 2008 | 59 | Yes | Yes | Yes | |||||
BlueStar (Philippines) | Philippines | Marie Stopes International | 2007 | 66 | Yes | Yes | ||||||
BlueStar (Sierra Leone) | Sierra Leone | Marie Stopes International | 2008 | 70 | Yes | |||||||
BlueStar (Vietnam) | Vietnam | Marie Stopes International | 2007 | 32 | Yes | Yes | ||||||
Confiance | Democratic Republic of the Congo | Population Services International | 2004 | 78 | Yes | Yes | ||||||
CFWshops Kenya | Kenya | Child and Family Wellness Shops CFW | 2000 | 67 | Yes | Yes | Yes | |||||
CFWshops Rwanda | Rwanda | Child and Family Wellness Shops CFW | 2008 | 2 | Yes | Yes | ||||||
DiMPA Network | India | PSP-One | 1998 | 1150 | Yes | |||||||
FriendlyCare (Philippines) | Philippines | FriendlyCare | 1999 | 6 | Yes | Yes | ||||||
Greenstar | Pakistan | Population Services International | 1995 | 8000 | Yes | Yes | Yes | Yes | ||||
Gold Star | Kenya | Family Health International | 2006 | 279 | Yes | Yes | Yes | Yes | Yes | |||
Merrygold Health | India | Hindustan Latex FP Trust | 2007 | Yes | Yes | Yes | Yes | |||||
Intimo | Mozambique | DKT International | 2011 | 9 | Yes | Yes | Yes | |||||
Key Clinics | India | Population Services International | 2004 | 701 | Yes | Yes | ||||||
K-Met (Kenya) | Kenya | K-MET | 1995 | 200 | Yes | Yes | ||||||
Mexico (Community Doctors Program | Mexico | Mexfam | 1986 | 300 | Yes | |||||||
New Start (South Africa) | South Africa | Population Services International | 2007 | 11 | Yes | |||||||
New Start (Lesotho) | Lesotho | Population Services International | 2004 | 6 | Yes | |||||||
New Start (Swaziland) | Swaziland | Population Services International | 2003 | 16 | Yes | Yes | ||||||
New Start (Zambia) | Zambia | Population Services International | 2002 | 8 | Yes | |||||||
New Start (Zimbabwe) | Zimbabwe | Population Services International | 1999 | 41 | Yes | Yes | Yes | |||||
POPSHOPS | Philippines | DKT International | 2005 | 300 | Yes | Yes | ||||||
Operation Light House | India | Population Services International | 2002 | 12 | Yes | |||||||
ProFam (Benin) | Benin | Population Services International | 2004 | 30 | Yes | Yes | Yes | Yes | ||||
ProFam (Cameroon) | Cameroon | Population Services International | 2004 | 25 | Yes | Yes | ||||||
ProFam (Mali) | Mali | Population Services International | 2005 | 33 | Yes | |||||||
PSI Togo | Togo | Population Services International | 2002 | 13 | Yes | |||||||
PSI Uganda | Uganda | Population Services International | 2007 | 2 | Yes | |||||||
RedPlan Salud | Peru | INPPARES | 2002 | 1668 | Yes | Yes | Yes | Yes | Yes | |||
Sahath Al-om (MotherHealth) | Sudan | DKT International | 2011 | 12 | Yes | Yes | ||||||
Sangini | Nepal | Nepal CRS Company | 1994 | 2928 | Yes | Yes | Yes | Yes | ||||
SkyHealth / SkyCare Centres | India | World Health Partners | 2008 | Yes | Yes | Yes | ||||||
Smiling Sun | Bangladesh | Chemonics International | 2008 | 40 | Yes | Yes | Yes | |||||
Society for Family Health | Nigeria | Population Services International | 2006 | Yes | Yes | Yes | Yes | |||||
Sun Quality Health (Myanmar) | Myanmar | Population Services International | 2001 | 846 | Yes | Yes | Yes | Yes | ||||
Sun Quality Health (Cambodia) | Cambodia | Population Services International | 2002 | 164 | Yes | Yes | Yes | Yes | ||||
Surya Clinics | India | Janani/DKT International | 2000 | 63 | Yes | Yes | Yes | |||||
Top Reseau | Madagascar | Population Services International | 2001 | 155 | Yes | Yes | Yes | |||||
Well-Family Midwife Clinics | Philippines | Well-Family Midwife Clinic | 1997 | 100 | Yes | Yes |