title: Effect Of A Large-Scale Social Franchising And Telemedicine Program On Childhood Diarrhea And Pneumonia Outcomes In India.
abstract: Despite the rapid growth of social franchising, there is little evidence on its population impact in the health sector. Similar in many ways to private-sector commercial franchising, social franchising can be found in sectors with a social objective, such as health care. This article evaluates the World Health Partners (WHP) Sky program, a large-scale social franchising and telemedicine program in Bihar, India. We studied appropriate treatment for childhood diarrhea and pneumonia and associated health care outcomes. We used multivariate difference-in-differences models to analyze data on 67,950 children ages five and under in 2011 and 2014. We found that the WHP-Sky program did not improve rates of appropriate treatment or disease prevalence. Both provider participation and service use among target populations were low. Our results do not imply that social franchising cannot succeed; instead, they underscore the importance of understanding factors that explain variation in the performance of social franchises. Our findings also highlight, for donors and governments in particular, the importance of conducting rigorous impact evaluations of new and potentially innovative health care delivery programs before investing in scaling them up.
authors.affiliation: Manoj Mohanan (manoj.mohanan@duke.edu) is an assistant professor of public policy and economics in the Sanford School of Public Policy at Duke University, an assistant research professor at the Duke Global Health Institute, and faculty research scholar at the Duke Population Research Institute, all in Durham, North Carolina.
authors.forename: Manoj
authors.initials: M
authors.lastname: Mohanan
authors.affiliation: Kimberly S. Babiarz is a research associate in the Center for Primary Care and Outcomes Research (CHP/PCOR), School of Medicine, at Stanford University, in California.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Babiarz
authors.affiliation: Jeremy D. Goldhaber-Fiebert is an associate professor of medicine at the CHP/PCOR, Stanford University.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
authors.affiliation: Grant Miller is an associate professor at the School of Medicine, Stanford University; director of the Stanford Center for International Development; senior fellow, Freeman Spogli Institute for International Studies; senior fellow, Stanford Institute for Economic Policy Research; and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts.
authors.forename: Grant
authors.initials: G
authors.lastname: Miller
authors.affiliation: Marcos Vera-Hernández is a reader in economics at University College London and a research fellow at the Institute for Fiscal Studies, both in the United Kingdom.
authors.forename: Marcos
authors.initials: M
authors.lastname: Vera-Hernández
mesh_terms: D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003906:Developing Countries; D003967:Diarrhea / Q000628:therapy*; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D063868:Patient Outcome Assessment; D011014:Pneumonia / Q000628:therapy*; D017149:Private Sector / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*
keywords: International/global health studies; Organization and Delivery of Care; Quality Of Care; Social Franchising; Telemedicine