title: Protocol for the evaluation of a social franchising model to improve maternal health in Uttar Pradesh, India.
abstract: BACKGROUND
  Social franchising is the fastest growing market-based approach to organising and improving the quality of care in the private sector of low- and middle-income countries, but there is limited evidence on its impact and cost-effectiveness. The "Sky" social franchise model was introduced in the Indian state of Uttar Pradesh in late 2013.
  
  
  METHODS
  Difference-in-difference methods will be used to estimate the impact of the social franchise programme on the quality and coverage of health services along the continuum of care for reproductive, maternal and newborn health. Comparison clusters will be selected to be as similar as possible to intervention clusters using nearest neighbour matching methods. Two rounds of data will be collected from a household survey of 3600 women with a birth in the last 2 years and a survey of 450 health providers in the same localities. To capture the full range of effects, 59 study outcomes have been specified and then grouped into conceptually similar domains. Methods to account for multiple inferences will be used based on the pre-specified grouping of outcomes. A process evaluation will seek to understand the scale of the social franchise network, the extent to which various components of the programme are implemented and how impacts are achieved. An economic evaluation will measure the costs of setting up, maintaining and running the social franchise as well as the cost-effectiveness and financial sustainability of the programme.
  
  
  CONCLUSIONS
  There is a dearth of evidence demonstrating whether market-based approaches such as social franchising can improve care in the private sector. This evaluation will provide rigorous evidence on whether an innovative model of social franchising can contribute to better population health in a low-income setting.
authors.affiliation: Department of Global Health and Development, London School Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. Shreya.Pereira@lshtm.ac.uk.
authors.forename: Shreya K
authors.initials: SK
authors.lastname: Pereira
authors.affiliation: Sambodhi Research and Communications Limited, C-126, Sector-2, Noida, Uttar Pradesh, India. paresh@sambodhi.co.in.
authors.forename: Paresh
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Sambodhi Research and Communications Limited, C-126, Sector-2, Noida, Uttar Pradesh, India. varun.dutt@sambodhi.co.in.
authors.forename: Varun
authors.initials: V
authors.lastname: Dutt
authors.affiliation: Sambodhi Research and Communications Limited, C-126, Sector-2, Noida, Uttar Pradesh, India. kaveri@sambodhi.co.in.
authors.forename: Kaveri
authors.initials: K
authors.lastname: Haldar
authors.affiliation: Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Loveday.Penn-Kekana@lshtm.ac.uk.
authors.forename: Loveday
authors.initials: L
authors.lastname: Penn-Kekana
authors.affiliation: Department of Global Health and Development, London School Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. Andreia.Santos@lshtm.ac.uk.
authors.forename: Andreia
authors.initials: A
authors.lastname: Santos
authors.affiliation: Department of Global Health and Development, London School Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. Timothy.Powell-Jackson@lshtm.ac.uk.
authors.forename: Timothy
authors.initials: T
authors.lastname: Powell-Jackson
mesh_terms: D000067576:Child Health; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D000068097:Maternal Health; D000068101:Maternal-Child Health Services / Q000191:economics / Q000458:organization & administration*; D009042:Motivation; D017149:Private Sector / Q000191:economics / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*