Open Access Research article

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

Karen Schlein1, Anna York De La Cruz1*, Tisha Gopalakrishnan2 and Dominic Montagu1

Author Affiliations

1 The Global Health Group, University of California, San Francisco, San Francisco, CA, USA

2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

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BMC Health Services Research 2013, 13:4  doi:10.1186/1472-6963-13-4

Published: 3 January 2013

Abstract

Background

Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs.

Methods

The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits.

Results

Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback.

Conclusions

These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of a quality assurance system that are most correlated with improved quality of clinical care for patients.

Keywords:
Social franchising; Private sector; Private health care; Private providers; Quality assurance; Quality; Developing countries