Public sector social franchising: the key to contraceptive choice for women?
Boubacar Cissé – Social Franchise Director MSI MaliAnne Coolen – Country Director Marie Stopes International MaliBrendan Hayes – Head of Social Franchise MSI
Contraceptive Choice in Mali
Challenges for family planning West Africa
There is a high unmet need for FP in the region
Ghana
Liberia
Togo
Mauritania
Senegal
Sierra Leone
Mali
Benin
Cote d'Ivoire
Burkina Faso
Nigeria
Niger
0% 5% 10% 15% 20% 25% 30% 35% 40%
SpacingLimiting
Source: most recent DHS
Set up Social Franchise for FP and HIV VCT in Mali
Why Social Franchises in the Public Sector in Mali?
Increase long-term impact of Mobile Outreach
Potential to offer a whole range of FP services daily
Community Health Centre is the entry point for the health system
2010 – 2011 political situation favorable with political engagement to Franchise Public Sector
Social Franchising in Mali
Contractual arrangements ASACO
Capacity building through:
– Training of providers on FP counselling and service provision
– Supportive supervision
Quality assurance - Facility audits
Contraceptives supply chain support
Branding
Standardized pricing
Demand generation
RESULTS
Results of the different channelsNumber of CYPs per channel, 2008-2013
2008 2009 2010 2011 2012 2013 (est)0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
Centres
Equipes Mobiles
Mkts Social
Franchise Social
Results Feb 2011- Jun 2014
Number
Number of Franchisees 140
Number of total FP clients 111 482
Clients that use a FP method for the first time 29 849
Number of Implants 41 589
Number of IUDs 3 196
Clients that have benefited from HIV counselling
60 228
Number of clients tested for HIV 11 812
Number of clients tested positive 230
Total CYPs 186 131
Results External Evaluation
Utilization of Family Planning: quadrupled the contraceptive prevalence rate in BlueStar zones
Geographic Accessibility
Financial accessibility by 77% of the women interviewed
Quality of service and the level of client satisfaction of 80%
Behavior change activities: 51% of the people interviewed had been involved in the activities
BlueStar vs non-BlueStar
Satis-
Santé
Ouesle
sseb
ougo
u
Asaco
dia
Farad
aKok
o
Koulou
ba
Mor
ibabo
ugou
Liber
té
N'gaba
coro
CSRef D
ioila
Espoir
Kerela
Bougo
ukou
rala
Sonike
gny
Baman
anto
u
Doum
ba
Kambil
a0
500
1000
1500
2000
2500
3000
Couple of Years Protection
Programme implications
Increased acceptors of family planning and long-acting family planning methods in particular.
Public sector franchising may be a cost-effective alternative to family planning outreach
Pre-conditions for an intervention like public-sector franchising:
– Government appropriation
– Management arrangement of facility staff
– Strong support: supervision and on the job training
– Demand creation
Potential for Sustainability Appropriation of Social Franchise by the Government
Increasing contribution from ASACO (investments in material, equipment etc)
Capacity building:
– Trained staff - all FP methods, Management of Emergencies, Clinical Quality
– Most importantly, change provider behavior
Increased acceptability - Reaching a threshold of awareness on importance of FP and continuous demand in the area
CONCLUSION
Social Franchise has proved an interesting approach for Mali
Great successes with the BlueStar network
Potential is great with over a 1000 community health centres
However, BlueStar has not (yet) reached sustainability
Efforts needed to continue to reduce subsidies and improve contribution of the franchisees
QUESTIONS?