Public sector social
franchising: the key to
contraceptive choice for
women?
Boubacar Cissé – Social Franchise Director MSI Mali
Anne Coolen – Country Director Marie Stopes International Mali
Brendan 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
Niger
Nigeria
Burkina Faso
Cote d'Ivoire
Benin
Mali
Sierra Leone
Senegal
Mauritania
Togo
Liberia
Ghana
Spacing
Limiting
0%
5%
10%
15%
20%
25%
30%
35%
40%
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 channels
Number of CYPs per channel, 2008-2013
200000
180000
160000
140000
120000
Centres
Equipes Mobiles
100000
Mkts Social
Franchise Social
80000
60000
40000
20000
0
2008
2009
2010
2011
2012
2013 (est)
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
Couple of Years Protection
3000
2500
2000
1500
1000
500
0
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?