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Social franchising is the application of commercial franchising concepts to achieve socially beneficial ends, rather than profit .


Social franchising, similar to commercial franchising, is a contractual relationship wherein an independent coordinating organization (usually a non-governmental organization, but occasionally a governmental body or private company) 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. 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 . Members also gain beneficial spin-off effects such as increased consumer volume and improved reputation due to brand affiliation . 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 . 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.

Social franchising for health services

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 , sexual transmitted infection management , primary care, and HIV / AIDS treatment .

Strengths and weaknesses of social franchising


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 . 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 . 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 . 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 . There also exists the possibility of “tragedy of the commons” wherein franchisees provide low quality, low cost due to incomplete monitoring . 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.

History of Social Franchise Programs

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 . 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 .

Existing Clinical Social Franchises

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 Kenyamarker Marie Stopes International 2004 144
ARV Care South Africa BroadReach 2002 4500
Biruh Tesfa Ethiopiamarker Pathfinder International 2000 130
Blue Star (Bangladesh) Bangladeshmarker Social Marketing Company 1998 3600
BlueStar (Ethiopia) Ethiopiamarker Marie Stopes International 2007 107
BlueStar (Ghana) Ghanamarker Marie Stopes International 2008 102
BlueStar (Malawi) Malawimarker Marie Stopes International 2008 59
BlueStar (Philippines) Philippinesmarker Marie Stopes International 2007 66
BlueStar (Sierra Leone) Sierra Leonemarker Marie Stopes International 2008 70
BlueStar (Vietnam) Vietnammarker Marie Stopes International 2007 32
Confiance Democratic Republic of the Congomarker Population Services International 2004 78
CFWshops Kenya Kenyamarker Child and Family Wellness Shops CFW 2000 67
CFWshops Rwanda Rwandamarker Child and Family Wellness Shops CFW 2008 2
DiMPA Network Indiamarker PSP-One 1998 1150
FriendlyCare (Philippines) Philippinesmarker FriendlyCare 1999 6
Greenstar Pakistanmarker Population Services International 1995 8000
Gold Star Kenyamarker Family Health International 2006 279
Merrygold Health Indiamarker Hindustan Latex FP Trust 2007
Key Clinics Indiamarker Population Services International 2004 701
K-Met (Kenya) Kenyamarker K-MET 1995 200
Mexico (Community Doctors Program Mexicomarker Mexfam 1986 300
New Start (South Africa) South Africa Population Services International 2007 11
New Start (Lesotho) Lesothomarker Population Services International 2004 6
New Start (Swaziland) Swazilandmarker Population Services International 2003 16
New Start (Zambia) Zambiamarker Population Services International 2002 8
New Start (Zimbabwe) Zimbabwemarker Population Services International 1999 41
Operation Light House Indiamarker Population Services International 2002 12
ProFam (Benin) Beninmarker Population Services International 2004 30
ProFam (Cameroon) Cameroonmarker Population Services International 2004 25
ProFam (Mali) Malimarker Population Services International 2005 33
PSI Togo Togomarker Population Services International 2002 13
PSI Uganda Uganda Population Services International 2007 2
RedPlan Salud Perumarker INPPARES 2002 1668
Sangini Nepalmarker Nepal CRS Company 1994 2928
SkyHealth / SkyCare Centres Indiamarker World Health Partners 2008
Smiling Sun Bangladeshmarker Chemonics International 2008 40
Society for Family Health Nigeriamarker Population Services International 2006
Sun Quality Health (Myanmar) Myanmarmarker Population Services International 2001 846
Sun Quality Health (Cambodia) Cambodiamarker Population Services International 2002 164
Surya Clinic Indiamarker Janani/DKT International 1998 564
Top Reseau Madagascarmarker Population Services International 2001 155
Well-Family Midwife Clinics Philippinesmarker Well-Family Midwife Clinic 1997 100

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