Increasing family planning in Myanmar: the role of the private sector and social franchise programs

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Abstract

Background

This study examines the influence of clinical social franchise program on modern contraceptive use.

Methods

This was a cross-sectional survey of contraceptive use among 2390 currently married women across 25 townships in Myanmar in 2014. Social franchise program measures were from programmatic records.

Results

Multivariable models show that women who lived in communities with at least 1-5 years of a clinical social franchise intrauterine device (IUD) program had 4.770 higher odds of using a modern contraceptive method compared to women living in communities with no IUD program [CI: 3.739-6.084]. Townships where the reproductive health program had existed for at least 10 years had 1.428 higher odds of reporting modern method use compared to women living in townships where the programs had existed for less than 10 years [CI: 1.016-2.008].

Conclusions

This study found consistent and robust evidence for an increase in family planning methods over program duration as well as intensity of social franchise programs.

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Most cited references 9

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Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection.

Hans Kluge, Tin Aung, Knut Lonnroth … (2007)

This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21%) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84%, close to the World Health Organization target of 85% and similar to the treatment success of 81% in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68% of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68% of annual per capita household income, with a median of 28%. However, 83% of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3% for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further.

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The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam

Anh D. Ngo, Dana Alden, Hoang Van Pham … (2010)

Background Service franchising is a business model that involves building a network of outlets (franchisees) that are locally owned, but act in coordinated manner with the guidance of a central headquarters (franchisor). The franchisor maintains quality standards, provides managerial training, conducts centralized purchasing and promotes a common brand. Research indicates that franchising private reproductive health and family planning (RHFP) services in developing countries improves quality and utilization. However, there is very little evidence that franchising improves RHFP services delivered through community-based public health clinics. This study evaluates behavioral outcomes associated with a new approach - the Government Social Franchise (GSF) model - developed to improve RHFP service quality and capacity in Vietnam's commune health stations (CHSs). Methods The project involved networking and branding 36 commune health station (CHS) clinics in two central provinces of Da Nang and Khanh Hoa, Vietnam. A quasi-experimental design with 36 control CHSs assessed GSF model effects on client use as measured by: 1) clinic-reported client volume; 2) the proportion of self-reported RHFP service users at participating CHS clinics over the total sample of respondents; and 3) self-reported RHFP service use frequency. Monthly clinic records were analyzed. In addition, household surveys of 1,181 CHS users and potential users were conducted prior to launch and then 6 and 12 months after implementing the GSF network. Regression analyses controlled for baseline differences between intervention and control groups. Results CHS franchise membership was significantly associated with a 40% plus increase in clinic-reported client volumes for both reproductive and general health services. A 45% increase in clinic-reported family planning service clients related to GSF membership was marginally significant (p = 0.05). Self-reported frequency of RHFP service use increased by 20% from the baseline survey to the 12 month post-launch survey (p < 0.05). However, changes in self-reported usage rate were not significantly associated with franchise membership (p = 0.15). Conclusions This study provides preliminary evidence regarding the ability of the Government Social Franchise model to increase use of reproductive health and family planning service in smaller public sector clinics. Further investigations, including assessment of health outcomes associated with increased use of GSF services and cost-effectiveness of the model, are required to better delineate the effectiveness and limitations of franchising RHFP services in the public health system in Vietnam and other developing countries.

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Improving malaria knowledge and practices in rural Myanmar through a village health worker intervention: a cross-sectional study

Moh Moh Lwin, May Sudhinaraset, Aung Kyaw San … (2014)

Background Since 2008 the Sun Primary Health (SPH) franchise programme has networked and branded community health workers in rural Myanmar to provide high quality malaria information and treatment. The purpose of this paper is to compare the malaria knowledge level and health practices of individuals in SPH intervention areas to individuals without SPH intervention Methods This study uses data from a cross-sectional household survey of 1,040 individuals living in eight rural townships to compare the knowledge level of individuals in SPH intervention areas to individuals without SPH intervention. Results This study found that the presence of a SPH provider in the community is associated with increased malaria knowledge and higher likelihood of going to trained providers for fevers. Furthermore, the study found a dose–response, where the longer the duration of the programme in a community, the greater the community knowledge level. Conclusion The study suggests that community health workers might have significant impact on malaria-related mortality and morbidity in rural Myanmar.

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Author and article information

Contributors

Tin Aung: taung@psimyanmar.org

Nang Mo Hom: nhom@psimyanmar.org

May Sudhinaraset:

ORCID: http://orcid.org/0000-0003-1942-6186

msudhinaraset@ucla.edu

Journal

Journal ID (nlm-ta): BMC Womens Health

Journal ID (iso-abbrev): BMC Womens Health

Title: BMC Women's Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6874

Publication date (Electronic): 1 July 2017

Publication date PMC-release: 1 July 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 46

Affiliations

[1 ]Population Services International, Myanmar, No. 16, Shwe Gon Taing Street 4, Yangon, Myanmar

[2 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Global Health Sciences, Department of Epidemiology and Biostatistics, , University of California, San Francisco, ; 550 16th Street, San Francisco, CA 94158 USA

[3 ]ISNI 0000 0000 9632 6718, GRID grid.19006.3e, Community Health Sciences, , University of California, Los Angeles, ; 650 Charles E Young Dr. S, 21-245C, Los Angeles, CA 90095 USA

Author information

May Sudhinaraset http://orcid.org/0000-0003-1942-6186

Article

Publisher ID: 400

DOI: 10.1186/s12905-017-0400-4

PMC ID: 5493840

PubMed ID: 28668083

SO-VID: 71850d7d-a530-4db7-8242-f76a89f77e8b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 March 2016

Date accepted : 8 June 2017

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: myanmar,family planning,social franchise program,private sector

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: myanmar, family planning, social franchise program, private sector

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Increasing family planning in Myanmar: the role of the private sector and social franchise programs

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Pan African Medical Journal

Most cited references 9

Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection.

The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam

Improving malaria knowledge and practices in rural Myanmar through a village health worker intervention: a cross-sectional study

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