Franchise Evaluation Study priorities Global Health Group University of California, San Francisco November 20, 2008
Health Franchise Programs Current None Unknown status
Determining what we want to know • Operations, finance, and economics • Cost-effectiveness? • Difference in incentive/financing models? • What structures work best? • Quality, equity, and access • Increasing access to underserved populations? • Improved quality and service delivery?
Study methods • Case studies • Cross-sectional surveys • Case-control • Randomized, non-randomized • By clinic, district • Before/after studies • Data collected prior to launching of new franchise or service • Prospective/retrospective longitudinal analysis
Qualitative methods • Focus groups • In-depth interviews • Observation • Ethnographic research
Existing tools • StarScan (MSI): Adherence to franchisee agreement • Monthly franchisee reports (PSI) • Rapid Assessment Audit Tool (PSI) • Clinic records (financial, services, clientele)
Tools: Monitoring quality • Mystery client • Exit interviews • Quality Technical Assistance review (MSI) • Surprise inspections (PSI) • Facility assessment (Clincscan/MSI) • Observation
Program outcomes • CYP • 1.4M CYP (GreenStar Pakistan) • Cost per CYP • $8 (GreenStar) • DALYs • 72,009 DALYs (New Start South Africa) • Sustainability
Defining key terms • What do we mean by… • a clinical franchise? • Increased access? • Improved quality?
Indicators • Clients served and demographics • Products and services sold • Quality of care (client satisfaction, compliance with standards) • CYP • DALY • Cost recovery, cost effectiveness
Small group discussion • What are the priority issues for further research? What do we want to learn? • What are possible study designs? • What are the key indicators?