title: Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?
abstract: Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.
authors: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe Street E8014, Baltimore, MD 21205, USA. nmshah@jhsph.edu
authors: Nirali M
authors: NM
authors: Shah
authors: Wenjuan
authors: W
authors: Wang
authors: David M
authors: DM
authors: Bishai
mesh_terms: D005002:Ethiopia; D005193:Family Planning Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006077:Government Agencies / Q000191:economics / Q000592:standards*; D017048:Health Care Costs / Q000592:standards; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006801:Humans; D009938:Organizations / Q000191:economics / Q000592:standards*; D010154:Pakistan; D011203:Poverty; D017149:Private Sector / Q000191:economics / Q000592:standards*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000191:economics / Q000592:standards