Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India.


Journal Article

OBJECTIVE:To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program. METHODS:We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers' performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. FINDINGS:The programme did not significantly improve health-care providers' knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. CONCLUSION:Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

Full Text

Duke Authors

Cited Authors

  • Mohanan, M; Giardili, S; Das, V; Rabin, TL; Raj, SS; Schwartz, JI; Seth, A; Goldhaber-Fiebert, JD; Miller, G; Vera-Hernández, M

Published Date

  • May 2017

Published In

Volume / Issue

  • 95 / 5

Start / End Page

  • 343 - 352E

PubMed ID

  • 28479635

Pubmed Central ID

  • 28479635

Electronic International Standard Serial Number (EISSN)

  • 1564-0604

International Standard Serial Number (ISSN)

  • 0042-9686

Digital Object Identifier (DOI)

  • 10.2471/BLT.16.179556


  • eng