1. RESULTS
HEALTH IMPACT : The SPH network increased optimal treatment of
childhood diarrhoea with ORS and Zinc in rural Myanmar.
QUALITY : SPH providers’ ability to correctly diagnose and treat
pediatric malaria improved.
EQUITY : SQH providers successfully reach low-income TB patients
in urban areas.
COST-EFFECTIVENESS : SPH is a cost-effective intervention for
improving diarrhoea treatment in rural Myanmar.
The Role of Social Marketing in
Delivering Health Services at Scale in A
Developing Context:
Social Franchising in Myanmar
Authors: Han Win Htat, Daniel Crapper, Tin Aung
Population Services International
PROJECT OVERVIEW
Population Services International (PSI) Myanmar received five years
of core funding from the Bill and Melinda Gates Foundation to
demonstrate that social franchising, the application of commercial
franchising techniques in a social setting, can deliver health impact by
improving access to products and services, quality of care, equity,
and cost-effectiveness.
BACKGROUND
Myanmar has among the lowest government investment in health
expenditure globally. In 2008, out-of-pocket expenditure on health
was estimated at 95.7% and clients regularly received essential
health through both formal and informal private services. In 2010
over 42% of children under five with suspected pneumonia were
treated by private providers.
PARTNERSHIP
Partners included the Ministry of Health at national and local level, the
Myanmar Medical Association, private health care providers, local
research and marketing agencies and NGO partners. The University
of California, San Francisco conducted a range of evaluations to
measure the project goals, with results widely disseminated in peer-
reviewed journals.
PROJECT DESCRIPTION
Since funding was flexible, PSI was able to analyze the burden of
disease and consumer preferences to determine how and where
services should be delivered.
The project chose to scale up the existing Sun Quality Health
private service delivery franchise, (doubling the number of general
practitioners in this primarily urban network to 1,554 providers), and
to establish over 2,000 new village based Sun Primary Health
providers to reach rural areas.
The project expanded existing services in HIV prevention, TB,
malaria and reproductive health, and integrated new branded
products and services in HIV testing, pneumonia and diarrhea. To
ensure quality, PSI provided international standard training,
monthly supportive supervision, and WHO-certified commodities.
A strong sense of social responsibility among franchisees enabled
subsidies to be targeted towards the poor. PSI was able to set
lower prices in rural areas and used performance based incentives
to reduce the cost of care at point of use for the poor.
All activities were supported through evidence based
communications campaigns.
LESSONS LEARNED
Social franchising has moved from an experimental mode of
delivering care to a proven and effective model. This project provides
a foundation to improve programs and practices that can affect the
lives of millions of people for whom the private sector is the preferred
or only source of healthcare.
25%
of SQH TB patients
were in the lowest
wealth quintile
vs
16.6%
of TB patients
in the national
sample
$431 PER DALY
Preliminary results show that
having SPH providers distribute
ORASEL cost $431 per DALY
(Disability-Adjusted Life Year)
averted.
$431 PER DALY
This is less than half of the
Myanmar GDP per capita, which
mans that distributing ORASEL
through SPH providers is good
value for money.
PSI Address: 1120 19th Street, NW, Suite 600
Washington, DC 20036
Contact: hwhtat@psimyanmar.org
For a copy of this poster go to www.psi.org