Development of an Integrated Social Franchising/ Health Co-op Model to Address TB and HIV among Poor in Sub-Saharan Africa

Investigator: Dominic Montagu, DrPH
Sponsor: Rockefeller Foundation

Location(s): Ethiopia; Malawi; Mozambique; Rwanda; Uganda; Tanzania; Cameroon; Burkina Faso; Nigeria


This study was undertaken by the Institute for Health Sector Development (IHSD) on behalf of WHO and the Rockefeller Foundation to identify the potential for franchising TB and HIV/AIDS diagnosis and care to mid-level private health care providers in the following nine Sub-Saharan African Countries: Burkina Faso, Cameroon, Ethiopia, Malawi, Mozambique, Nigeria, Rwanda, Tanzania and Uganda. 
The aim of the study (as outlined in the terms of reference) was to gather information from the nine countries on the following: 
a) The existence, number, and geographic distribution of those with a Bachelor of Medicine and Bachelor of Surgery (MBBS) qualification (basic medical doctor) and mid-level providers (Nurses, Clinical Officers, Assistant Nurse Midwives (ANMs) or equivalent) operating privately and independently (distinguishing full-time private from after-hours government workers). 
b) The legal status and ability to prescribe drugs by private mid-level providers, include restricted prescription lists, if any, for particular provider types (eg: ANMs). 
c) Government attitude toward current private providers, and likely willingness to consider organized franchise as a model for expanding access, particularly to TB and HIV programmes. 
d) Estimate of incomes for mid-level providers: to answer the question of whether proposed franchise income estimates would be sufficient to attract them? (True income to be estimated using multiple methods where data is available, so as to assure best-possible result).