Process evaluation of a social franchising model to improve maternal health: evidence from a multi-methods study in Uttar Pradesh, India.

摘要: A prominent strategy to engage private sector health providers in low- and middle-income countries is clinical social franchising, an organisational model that applies the principles of commercial franchising for socially beneficial goals. The Matrika programme, a multi-faceted franchise improve maternal health, was implemented three districts Uttar Pradesh, India, between 2013 2016. Previous research indicates intervention not effective improving quality coverage services at population level. This paper reports findings from independent external process evaluation, conducted alongside impact with aim explaining findings. It focuses on main component “Sky” franchise. We first developed theory change, mapping key mechanisms through which programme hypothesised have impact. then undertook multi-methods study, drawing both quantitative qualitative primary data wide range sources assess extent implementation understand role contextual factors. analysed descriptively generate indicators implementation. thematic analysis before holding reflective meetings triangulate across sources, synthesise evidence, identify Finally, we used framework provided by change organise interpret our report six First, despite franchisor achieving its recruitment targets, competitive nature market antenatal care meant achieved very low share. Second, all Sky were branded but community awareness remained low. Third, using lower-level volunteers encourage women attend franchised ineffective. Fourth, referral linkages sufficiently strong network delivery providers. Fifth, had better knowledge self-reported practice than comparable providers, overall, evidence pointed poor board. telemedicine perceived clients as attractive feature, problems technology effect likely limited. These point towards importance designing programmes based understanding conditions what patients value, rigorously testing new technologies. design future should take account challenges documented this other evaluations.