Evaluating the impact of social franchising on family planning use in Kenya|
Chakraborty, Nirali M.; Mbondo, Mwende & Wanderi, Joyce
Background: In Kenya, as in many low-income countries, the private sector is an important component of health
service delivery and of providing access to preventive and curative health services. The Tunza Social Franchise
Network, operated by Population Services Kenya, is Kenya’s largest network of private providers, comprising 329
clinics. Franchised clinics are only one source of family planning (FP), and this study seeks to understand whether
access to a franchise increases the overall use or provides another alternative for women who would have found
FP services in the public sector.
Methods: A quasi-experimental study compared 50 catchment areas where there is a Tunza franchise and no other
franchised provider with 50 purposively matched control areas within 20 km of each selected Tunza area, with a
health facility, but no franchised facility. Data from 5609 women of reproductive age were collected on demographic
and socioeconomic status, FP use, and care-seeking behavior. Multivariate logistic regression, with intervention and
control respondents matched using coarsened exact matching, was conducted.
Results: Overall modern contraceptive use in this population was 53 %, with 24.8 % of women using a long-acting or
permanent method (LAPM). There was no significant difference in odds of current or new FP use by group, adjusted
for age. However, respondents in Tunza catchment areas are significantly more likely to be LAPM users (adj. OR = 1.49,
p = 0.015). Further, women aged 18–24 and 41–49 in Tunza catchment areas have a significantly higher marginal
probability of LAPM use than those in control areas.
Conclusions: This study indicates that access to a franchise is correlated with access to and increased use of LAPMs,
which are more effective, and cost-effective, methods of FP. While franchised facilities may provide additional points of
access for FP and other services, the presence of the franchise does not, in and of itself, increase the use of FP in Kenya.