Incorporating elements of social franchising in government health services improves the quality of infant and young child feeding counselling services at commune health centres in Vietnam.
BACKGROUND
Although social franchising has been shown to enhance the quality of reproductive health services in developing countries, its effect on nutrition services remains unexamined. This study assessed the effects of incorporating elements of social franchising on shaping the quality of infant and young child feeding (IYCF) counselling facilities and services in Vietnam.


METHODS
Process-related data collected 12 months after the launch of the first franchises were used to compare randomly assigned Alive & Thrive-supported health facilities (AT-F, n = 20) with standard facilities (SF, n = 12) across three dimensions of service quality: 'structure', 'process' and 'outcome' that capture the quality of facilities, service delivery, and client perceptions and use, respectively. Data collection included facility assessments (n = 32), staff surveys (n = 96), counselling observations (n = 137), client exit interviews (n = 137) and in-depth interviews with mothers (n = 48).


RESULTS
Structure: AT-F were more likely to have an unshared, well-equipped room for nutrition counselling than SF (65.0% vs 10.0%).


METHODS
Compared with SF providers, AT-F staff had better IYCF knowledge (mean score 9.9 vs 8.8, range 0-11 for breastfeeding; mean score 3.6 vs 3.2, range 0-4 for complementary feeding). AT-F providers also demonstrated significantly better interpersonal communication skills (score 9.6 vs 5.1, range 0-13) and offered more comprehensive counselling sessions.


RESULTS
Overall utilization of franchises was low (10%). A higher proportion of pregnant women utilized franchise services (48.9%), compared with mothers with children 6-23.9 months (1.4%). There was no quantitative difference in client satisfaction with counselling services between AT-F and SF, but franchise users praised the AT-F for problem solving related to child feeding.


CONCLUSIONS
Incorporating elements of social franchising significantly enhances the quality of IYCF counselling services within government primary healthcare facilities, particularly their structural and process attributes. Provided that service utilization is improved through demand generation, this model has the potential to impact IYCF practices and child nutrition.
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India P.H.Nguyen@cgiar.org.
Phuong H
PH
Nguyen
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Sunny S
SS
Kim
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Sarah C
SC
Keithly
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Nemat
N
Hajeebhoy
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Lan M
LM
Tran
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Marie T
MT
Ruel
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Rahul
R
Rawat
International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India.
Purnima
P
Menon
D001942:Breast Feeding; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement; D014744:Vietnam
Social franchise; Vietnam; infant and young child feeding; nutrition counselling; quality of care