Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study.

摘要: Summary Background How to harness the private sector improve population health in low-income and middle-income countries is heavily debated one prominent strategy social franchising. We aimed evaluate whether Matrika franchising model—a multifaceted intervention that established a network of providers strengthened skills both public clinicians—could quality coverage services along continuum care for maternal, newborn, reproductive health. Methods did quasi-experimental study, which combined matching with difference-in-differences methods. matched 60 clusters (wards or villages) franchisee 120 comparison six districts Uttar Pradesh, India. The was implemented by two not-for-profit organisations from September, 2013, May, 2016. rounds (January, 2015, 2016) household survey women who had given birth up 2 years previously. primary outcome proportion gave health-care facility. An additional 56 prespecified outcomes measured maternal use, content care, patient experience, other dimensions care. organised conceptually similar into 14 families create summary indices. used multivariate methods analyses accounted multiple inference. Findings introduction not significantly associated change facility births (4 percentage points, 95% CI −1 9; p=0·100). Effects any individual indices were significant. Evidence weak an increase 0·13 SD (95% 0·00 0·27; p=0·053) recommended delivery practices. Interpretation franchise model effective improving at level. Several key reasons identified absence effect potentially provide generalisable lessons programmes elsewhere. Funding Merck Sharp Dohme Limited.