Health Networks & Franchises

The Abt Associates-led PSP-One project defines networks as “an affiliation of health service providers (members) who are grouped together under an umbrella structure or organization (parent)”. Networks are based on a relationship of mutual benefit and obligation between the parent and members, defined according to particular market conditions and health and financial objectives. As such, their structure and operations can vary substantially. Broadly speaking, networks can be categorized as social franchises, not-for-profit or commercial networks. Pharmacy networks typically entail a loose affiliation of retail outlets, and can be particularly useful in meeting the demand for nonclinical FP methods as well as meet the RH needs of youth.

Networks of private health providers are a promising mechanism to expand the supply of quality RH/FP services: they achieve economies of scale in training, procurement and marketing, allow for rapid expansion to increase coverage, improve financial access by standardizing prices, and ensure quality and brand recognition.

Private health providers benefit from participating in a network as they develop their clinical and business skills, increase their clientele through marketing of branded services and products, control costs through pooled procurement, access credit or technical assistance, and receive ongoing supervision, mentoring and peer support. In return, providers adhere to quality standards, offer a fixed package of services at set prices, pay fees or royalties to the parent, meet reporting requirements (e.g. service statistics and sales revenue), and sometimes target a particular clientele.

The PSP-One team offers technical assistance in developing a new network or improving the viability, service quality or scale of an existing one. Assistance can be tailored for the parent (such as an NGO or commercial entity) or for private providers (such as midwives or pharmacists).

Examples of assistance for the parent or franchisor:

• Conduct feasibility studies to determine the need for a network, including its structure and design
• Engage potential partners (e.g. NGO, commercial company, Ministry of Health, or local professional or training association)
• Provide assistance in business and financial planning to ensure viability
• Assist with market analysis to identify an optimal service mix and target market
• Structure or modify benefits and obligations between the parent and the provider
• Develop and institute quality assurance and monitoring systems
• Evaluate the impact of a private provider network

Examples of assistance offered to individual private health providers:

• Offer clinical training to improve the quality of RH/FP health services
• Offer business and management training
• Provide assistance to improve marketing and client relations
• Facilitate access to financial services through PSP-One’s sister project Banking on Health.

Current Activities
PSP-One is supporting the scale up of Total Health Trust (THT), a commercial HMO network in Nigeria. THT’s coverage in Nigeria is expanding rapidly through their contract with the National Health Insurance Scheme (NHIS). A partnership with Total Health Trust offers PSP-One the opportunity to test mechanisms to improve the delivery and utilization of RH/FP services that have the potential for replication to other HMO networks, and has the broader goal of influencing the policy and practice of NHIS. Specifically, PSP-One’s technical assistance package to Total Health Trust comprises two activities:

• Provider training in business management and client relations with a focus on RH/FP promotion;
• Support to THT to develop a cost-effective quality accreditation and monitoring system, focused on RH/FP services and aligned with the reporting requirements of NHIS.

Accomplishments