Social Franchising for Reproductive Health Services: The Experience of Family Guidance Association of Ethiopia (FGAE)

In Ethiopia, an estimated 24% of women had an unmet need for modern contraception in 2017, with rural communities forming a significant portion of those who lack access to family planning services.

While there has indeed been a rise in the number of private health facilities in Ethiopia, only a small proportion (8%) provide reproductive health services. Consequently, social franchising, whereby private sector health providers deliver quality-assured health services under a common franchise brand, has been shown to positively engage private providers with public health goals – including increasing access to much-needed family planning services.

IPPF's Member Association in the country - The Family Guidance Association of Ethiopia (FGAE) initiated the social franchising program to mainly contribute to national efforts to address the population’s unmet need of family planning. FGAE’s Strategic Plan (2016-2020), Strategic Objective 3.2 aims to deliver 10 million integrated Sexual Reproductive Health (SRH) services through other outlets -mainly private and public facilities.

Towards this, FGAE thus established a network of socially franchised clinics in 2013 called Family Health Network (FHN). It started with 10 private clinics for the pilot. Since 2013, the network has grown substantially, with over 300 private clinics in 2018; mainly medium clinics in small towns which have been able to effectively reach underserved populations.

To make the best use of limited resources, FGAE, like other service delivery organizations, needs to consider how cost-effective social franchising is as a service delivery model.

FGAE Franchised Model:

FGAE’s “Fractional social franchising model” involves a contractual relationship between franchisee and franchiser in which the franchisee agrees to produce or market some important SRH products or services in accordance with an overall “Blue Print” devised by the franchiser.

Expansion of SRH Services through Family Health Network Clinics (FHNCs)

FGAE franchised four services:

Family planning
Comprehensive Abortion Care (CAC)
HIV
STI services

FGAE Support Provided to FHNCs

- Family planning commodities, HIV test kits and STI drugs,
- Other supplies and equipment, especially for Infection prevention mechanism
- Minor renovation
- Training of service providers
- Technical support to ensure Quality of Care (QoC) in the service provision
- Standardized data capturing and reporting tools

Future Strategies and Direction:

FGAE has made great progress in establishing and growing a thriving social franchising program that continues to expand access to voluntary family planning services for underserved, low-income populations. The FGAE experience can serve to provide lessons to other service delivery organizations that are either establishing or managing a franchise program.

The costings analysis done on the social franchising program of FGAE demonstrated that, for service delivery organizations, social franchising can offer a cost-effective model for expanding reach to underserved populations. This evaluation showed that it is more cost-effective for FGAE to deliver SRH services via the social franchise model compared to the FGAE-owned (static) clinics. FGAE has been sharing its experience to Member Associations in Africa and beyond the Africa region.

FGAE's social franchising model was identified as one of the Member Association’s Good Practices during the 3rd Cycle of Accreditation. A Good Practice is an activity or practice that has been proven to work and yields positive results. The sharing of Good Practices by IPPF Member Associations offers learning experiences for their counterparts.