title: User experiences with clinical social franchising: qualitative insights from providers and clients in Ghana and Kenya.
abstract: BACKGROUND
  Clinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries. Despite this growth, little is known about providers' perceptions of the benefits and challenges of social franchising or clients' reasons for choosing franchised facilities over other healthcare options. We examine these questions in the context of three social franchise networks in Ghana and Kenya.
  
  
  METHODS
  We conducted in-depth interviews with a purposive sample of providers from the BlueStar Ghana, and Amua and Tunza networks in Kenya. We also conducted qualitative exit interviews with female clients who were leaving franchised facilities after a visit for a reproductive or child health reason. The total sample consists of 47 providers and 47 clients across the three networks.
  
  
  RESULTS
  Providers perceived the main benefits of participation in a social franchise network to be training opportunities and access to a consistent supply of low-cost family planning commodities; few providers mentioned branding as a benefit of participation. Although most providers said that client flows for franchised services increased after joining the network, they did not associate this with improved finances for their facility. Clients overwhelmingly cited the quality of the client-provider relationship as their main motivation for attending the franchise facility. Recognition of the franchise brand was low among clients who were exiting a franchised facility.
  
  
  CONCLUSIONS
  The most important benefit of social franchise programs to both providers and their clients may have more to do with training on business practices, patient counseling and customer service, than with subsidies, technical input, branding or clinical support. This finding may lead to a reconsideration of how franchise programs interact with both their member clinics and the larger health-seeking communities they serve.
authors: Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA. SieverdingM@globalhealth.ucsf.edu.
authors: Maia
authors: M
authors: Sieverding
authors: Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA. BrieglebC@globlhealth.ucsf.edu.
authors: Christina
authors: C
authors: Briegleb
authors: Global Health Group, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA. MontaguD@globalhealth.ucsf.edu.
authors: Dominic
authors: D
authors: Montagu
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D005869:Ghana; D006282:Health Personnel / Q000523:psychology*; D006302:Health Services Research; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D011203:Poverty / Q000706:statistics & numerical data; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D034121:Reproductive Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires
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