By Andrea Mooney, Communications and Knowledge Management Advisor, PSI
In many developing countries, the private sector represents a major and growing source of voluntary family planning services for women and couples. This often presents a challenge for national health systems who are ill-equipped to ensure private providers sufficiently advance public health goals and adhere to national standards of care. At the International Conference on Family Planning (ICFP) this week, key presentations by Association de Santé Familiale (ASF) – PSI network member in the Democratic Republic of Congo (DRC) – outlined how social franchising can play an essential role in leveraging existing private sector infrastructure to improve both access and quality of care.
The DRC’s public health system is plagued by a shortage of qualified staff, poor quality of care and infrastructure, lack of family planning commodities and poor reproductive health knowledge. This has had consequences as the contraceptive prevalence rate (CPR) decreased from 15% in 1989 to 8% in 2012.
As a result, 57% of those seeking family planning products and services in the DRC prefer the private sector. But private sector clinics are still largely unregulated and have historically lacked trained providers, as well as an adequate supply of relevant commodities and equipment.
Through its social franchising program, ASF promotes and improves clinical services among existing private providers through technical assistance, a strengthening of the commodities supply chain and application of social marketing techniques. This allows franchise providers to serve clients, many of them on the bottom of the pyramid, while maintaining consistent, high-quality and affordable care.
To increase the uptake of voluntary family planning among women and couples in the DRC, ASF helps build capacity in both its own its own private sector Confiance social franchise clinics and public health facilities. Key activities include working with the Ministry of Health (MoH) to design communication, training and supervision tools for private health providers and pharmacists. These tools include clinic supervision checklists, information leaflets (addressing misconceptions about family planning methods), family planning flipcharts for Interpersonal Communication (IPC) agents, quality assurance protocols, complication prevention posters for clinics, IUD and implant insertion guidelines. A total of 276 franchise clinic providers and 145 community health workers were trained on these tools to operate on standardized quality assurance protocols aligned with national family planning policies.
By involving the MoH in its training and monitoring activities, ASF has immediate support to train other providers in both the public and private sectors, as well as conduct regular supervision in compliance with quality assurance standards. This reinforced the public institutions and contributed to the creation of a sustainable monitoring and supervisory system.
ASF also engaged in demand generation activities, including the use of IPC agents and mass media, to raise awareness and to attract a loyal client base. Each franchise clinic had at least one community health worker trained to spread contraceptive knowledge in the community and refer interested clients to Confiance clinic services. The organization also developed and broadcasted TV and radio spots directed at women of reproductive age with supporting messages.
The program’s “open days” attracted hundreds of women at the community level (40-80 per event) and provided further opportunity to inform on Confiance franchise clinics’ integrated health services.
The program targeted men with family planning and reproductive health information through a uniquely marketed free hotline with trained operators. Of the more than 57,000 calls received over the duration of the project, approximately 71% of the callers were men.
Where private sector health care delivery is concerned, the project aims to expand the Confiance social franchise network, extending coverage to more provinces and health zones, as well as integrating more services to increase the value and sustainability of the network. Service delivery integration through social franchises continues to be an important vehicle in ensuring that all people have access to quality healthcare without causing undue financial hardship, as well as achieving the Sustainable Development Goals.
