In 2012 the the British Medical Journal published a study examining the impact of Healthstore’s CFW Clinics network on access to vaccinations and treatment for acute illnesses among children in Kenya. They started with two key questions: Can franchised health clinics improve access to essential medicines and vaccinations among children? Do the benefits of this social enterprise only accrue to individuals who are relatively less poor?
Using demographic health survey data from Kenya, investigators processed the data of more than 6,000 children. They found that children living within 30 kilometers of a CFW Clinic received more vaccinations than other children, and that, among children with acute conditions, CFW Clinic proximity was associated with significant increases in the probability of receiving any medical treatment. Importantly, they found no significant difference in use of CFW services between low- and high-income households, and concluded that the franchise health clinic model could substantially increase access to essential vaccinations and treatments in low-income countries. “The franchise clinic model has the potential to fill an important gap in health service delivery in low-income countries by exploiting returns to standardisation and economies of scale,” wrote researchers Justin Berk and Achyuta Adhvaryu.
They noted that many low-income countries lack access to essential medicines and preventive health care—where treatments exist, their cost often puts them out of reach for average families. Additionally, health systems often suffer from an inadequate supply of medicine; unreliable distribution systems, if any exist at all; a dearth of public health infrastructure and staff, particularly in rural areas; large price markups from providers; and the pervasiveness of counterfeit drugs. “New healthcare delivery models designed to overcome these barriers have the potential to generate large public health gains,” the authors wrote:
“Given that households in low-income countries use the informal healthcare sector for the majority of acute illness episodes, private sector delivery models have received considerable recent interest. In this paper, we focus on one novel idea in this class of delivery models: the application of the franchise business model to healthcare delivery, leveraging the benefits of standardisation across a network of identical outlets. Standardisation, in theory, allows each outlet to offer consistently high-quality (noncounterfeit) drugs and lowers costs by exploiting economies of scale within the franchise. …
“The HSF creates a blueprint for local nurses to own and operate CFWShops, by providing business training, preparing a physical location, conducting regular inspections to ensure compliance to business plans and providing assistance in ordering inventory and running marketing programmes. The majority of CFWShop franchisees are nurses with at least 4 years of training and 10 years of field experience (the equivalent of a nurse practitioner in the USA). These nurses own the CFWShop outlet and also operate the clinic and interact with patients.“
Every CFW Clinic provides diagnostic services and treatments, HIV testing, vaccinations, antenatal care, and hygiene products, in addition to drugs offered for common ailments like malaria, diarrhea, and respiratory infections. A short list of diseases, including these, are responsible for 70 percent of childhood deaths in developing countries.
“Overall, our results suggest that models similar to the one employed by the HSF could reap substantial returns in terms of increased access to prevention and care and improved public health outcomes, particularly for young children,” Berk and Adhvaryu conclude. “Global health policymakers should continue to look towards innovative delivery models like the franchise health clinic model to improve cost-effectiveness and efficiency in treating the diseases that pose the greatest burden on children.”
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