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?