The Impact of Franchising Reproductive Health Services on Client Service Use in Ethiopia, India and Pakistan

Andreea A. Creanga, Johns Hopkins Bloomberg School of Public Health
Ye-Mon Myint, Johns Hopkins University

Clinic franchising is being implemented in several developing countries to improve access to and quality of reproductive health (RH) services. This study examines the impact of three franchise networks by focusing on the association between franchise membership and four client outcomes: franchise logo recognition, reproductive health as a clinic visit reason, current family planning use status, and willingness to return to the same establishment for RH services. The analysis uses client data collected independently during probability sample surveys of health facilities in Ethiopia, India (Bihar state) and Pakistan, with standardized questionnaires. Franchise services perform significantly better than non-franchised services on client logo recognition (4.2-4.3 times better in India and Ethiopia), attracting RH clients (23-31% better in Pakistan and India), and willingness to return in all three settings (39-107% more likely). In all sites, franchising RH services increases the likelihood of serving current contraceptive users by 3-15%, but not significantly.