Social franchising evaluations: A scoping review

BACKGROUND:

Social franchising developed as a possible means of improving the provision of non-state sector health services in low- and middle-income countries. The objective of this systematic review was to examine the scope and nature of existing research literature on social franchising interventions, including reach, implementation, sustainability and goals, in health service delivery.

METHODS:

A rigorous search strategy was run in nine major databases, including Medline, Embase and CINAHL. Grey literature was also searched. All types of evaluative study designs were eligible for inclusion. Existing data abstraction and analysis tools were used. The AMSTAR measurement tool was applied to assess the quality of included systematic reviews. Framework analysis was chosen for synthesising qualitative and quantitative research.

RESULTS:

Twelve studies were included in this review: three systematic reviews and nine primary studies. Social franchising has been evaluated in Asia and Africa, particularly from lowincome countries. Most studies focused on reproductive health and family planning. We found a paucity of rigorous study designs, so the evidence supporting social franchising is weak. Across settings, the government continues to have the highest volume of clients for family planning and other services; however, franchises do better than non-franchised private providers in terms of client volume. The clients of social franchises are satisfied with the quality of care and consistently report an intent to return.

CONCLUSIONS:

Given that social franchising remains an area of great interest and investment, we recommend evaluations of implementation processes and sustainability, and more rigorous evaluations of the effects of different models.