EQUITY PROFILES OF THREE SOCIAL
FRANCHISE NETWORKS IN WEST AFRICA
Nirali Chakraborty, Ph.D
Research Advisor for Reproductive Health
9th World Congress on Health Economics,
Sydney, Australia
10 July 2013
Outline
 Background
– Franchising
– Study sites
 Equity calculation methodology
 Results
– Benin
– Democratic Republic of Congo (DRC)
– Mali
 Implications
PAGE 2
24 FRANCHISES
IN 23 COUNTRIES
+10,000 FRANCHISEES
10 MILLION CLIENTS
PER YEAR
SOCIAL FRANCHISING AT PSI
Goals of Social Franchising
+
Health Impact
✓
Quality
$
Cost-Effectiveness
Improving population health
Ensuring adherence to clinical standards for client care
Providing services at equal or lower cost to alternatives
Equity
Enabling the poorest to access services
Market Expansion
Delivering services that would not otherwise be provided
Study objectives
 Pilot equity measurement at franchises
 Justify use of national or sub-national reference
population, for program decision making
page 5
Study context
 Client exit interviews
 Equity benchmarked
to reference
population
 Franchises primarily
urban and periurban
page 6
Benin
Indicator
Total
Urban
Rural
CPR among married
women
6.1
9.0
4.5
Unmet need among
married women
27.3
26.3
27.9
Under 5 mortality
136
116
145
Has electricity
27.9
56.6
8.5
Urban residence
41.4
Private Health
Expenditure/THE
46.7
Out of Pocket/PHE
91.2
Source: DHS 2006 and WHO Global Health Observatory 2011 data
page 7
Benin – ProFam franchise
 Offers Family Planning,
SRH/HIV and MNCH
services
 185 clinic outlets
 ~33% of providers are
MDs
 ~100,000 clinic visits
recorded in 2012
Source: 2013 Social Franchising Compendium, www.sf4health.org
page 8
Democratic Republic of Congo
Indicator
Total
Urban
Rural
CPR among married
women
5.8
9.5
3.3
Unmet need among
married women
26.9
28.1
26.1
Under 5 mortality
155
122
177
Has electricity
15.2
36.6
1.1
Urban residence
45.4
Private Health
Expenditure/THE
66.3
Out of Pocket/PHE
65.7
Source: DHS 2007 and WHO Global Health Observatory 2011 data
page 9
DRC – Réseau Confiance
 Offers Family Planning,
MNCH and Water
Purification services
 138 clinic outlets
 ~15% of providers are
MDs
 ~192,000 clinic visits
recorded in 2012
Source: 2013 Social Franchising Compendium, www.sf4health.org
page 10
Mali
Indicator
Total
Urban
Rural
CPR among married
women
6.9
13
4.2
Unmet need among
married women
27.6
28.4
27.2
Under 5 mortality
215
158
234
Has electricity
16.6
47.4
3.2
Urban residence
33.7
Private Health
Expenditure/THE
54.9
Out of Pocket/PHE
99.6
Source: DHS 2006 and WHO Global Health Observatory 2011 data
page 11
Mali – ProFam franchise
 Offers Family Planning,
SRH/HIV and MNCH
services
 71 clinic outlets
 ~42% of providers are
MDs
 ~43,000 clinic visits
recorded in 2012
Source: 2013 Social Franchising Compendium, www.sf4health.org
page 12
Equity measurement methodology
PAGE 13
Data collection
Placing clients within reference population
1.
2.
3.
4.
5.
6.
Principal Components Analysis on weighted DHS asset
ownership data
Capture eigenvector from first principal component for each
asset, and quintile cut-points from asset index
Standardize Client data to DHS data
Multiply each asset by eigenvector
Sum (Std value*eigenvector) for each client
Place clients within DHS quintiles
Calculation done twice:
National population
Urban only

Mathematically speaking…
 Let Ai1=Asset score for each household i in DHS
 Let vˆ =standardized value of each asset for
i
household i in DHS
 Let v = Value of eigenvector from first component for
variable v
 Let Ai2=Asset score for each client i sampled
DHS data
page 16
Client data
Results: Client wealth profile
 Wealth quintiles of franchising clients, within national
reference population
Quintile
page 17
Benin
DRC
Mali
n=535
n=242
n=293
1 (Poorest)
3.4
0
0
2
2.4
0
0
3
4.3
0
0.3
4
13.1
9.1
13.9
5 (Richest)
76.8
90.9
85.7
Results: Client wealth profiles in context
Benin – ProFam Franchise
Quintile
National
Urban
Poorest
3.4
6.7
Quintile 2
2.4
8.8
Quintile 3
4.3
11.4
Quintile 4
13.1
33.3
Richest
76.8
39.8
page 18
90
80
70
60
50
40
30
20
10
0
National
Urban
Results: Client wealth profiles in context
DRC – Réseau Confiance
0
Quintile 2
0
4.6
Quintile 3
0
12.8
Quintile 4
9.1
40.9
Richest
90.9
41.7
National
Urban
page 19
Richest
0
Q4
Poorest
100
90
80
70
60
50
40
30
20
10
0
Q3
Urban
Q2
National
Poorest
Quintile
Results: Client wealth profiles in context
Mali – ProFam Franchise
Quintile
National
Urban
Poorest
0
0.3
Quintile 2
0
2.1
Quintile 3
0.3
4.1
Quintile 4
14.0
15.0
Richest
85.7
78.5
page 20
90
80
70
60
50
40
30
20
10
0
National
Urban
Implications
 Social Franchise community of practice is
recommending client equity to be benchmarked
against national reference population
 For program decision making, sub-national reference
population may be more informative
 In these 3 countries, franchises appear to serve a
wealthy population segment
 Do social franchises serve the poor? Should social
franchises aim to serve the poor(est)?
page 21
Acknowledgements: I gratefully acknowledge the PSI research managers
from the three countries where this data was collected: Cyprien Zinsou
(Benin), Willy Onema (DRC), and Mamadou Bah (Mali).
page 22
Questions?
nchakraborty@psi.org
PSI
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