Social Franchising and the Efficiency of Sexual and Reproductive Health Care in India
Building business franchises to deliver basic services traditionally provided by the government social franchising is being explored by private and non-governmental actors to improve the dire state of child and maternal health in India. In 2000, a non-profit organization called Janani began bringing the private providers of sexual and reproductive health (SRH) services throughout India into a franchise network. Janani believed that social franchising of existing private SRH providers could increase the quality and efficiency of the services provided while keeping cost within reach of the poor. This paper uses a 2004 survey of 1,686 health facilities in India including both members and non-members of the Janani franchise to statistically assess the relationship between efficiency of health care provision and franchise membership. The results suggest that franchise facilities are more efficient at providing SRH services under certain circumstances. Specifically, additional doctors and/or clinical support staff are correlated with higher client throughput at franchise facilities than at non-franchised facilities. This increase in client throughput appears to occur without a hint of corresponding declines in the client perception of the quality of care. These results suggest that policies encouraging franchise membership are warranted in specific circumstances.
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