Social franchising of contraceptives and family planning services employs available resources, particularly retail shops and rural medical practitioners, to respond to India’s huge unmet family planning needs. Though the demand is high, public facilities are either not functioning or unpopular thus dissuading potential users of family planning products and services. Private practitioners, on the other hand, charge prohibitive fees.
The social marketing programme in Andhra Pradesh had so far focused only on over-the-counter products like condoms and oral contraceptive pills. It did not provide clinical family planning services like insertion of inter-uterine devices (IUDs) and female sterilisation, for which there is a great demand. To fill this gap, a pilot project aimed at providing quality family planning services at affordable rates was initiated in Andhra Pradesh by establishing a chain of franchisee clinics brand-named Vanita Clinics.
The project was implemented by Andhra Pradesh unit of Hindustan Latex Family Planning Promotion Trust (HLFPPT) with financial assistance from the European Commission. The project was initiated April 8, 2001 and concluded after three years in December 2003. Criteria of selecting the clinics were two-fold, one was location specific and other was based on popularity of the doctor. The scheme franchises with maternity hospitals that operate 24 hours a day and are owned by Obstetrician-Gynaecologist.
Memorandum of association is initially signed for one year between HLFPPT and the doctor of the clinic and it is renewable depending on the performance of the clinic. Each franchisee pays INR 500 for registration for the first year only. The franchisee gets payment for the services and products sold to the customers and they in turn pay royalty to HLFPPT. Initially, a model Vanita clinic was set up in the Government Maternity Hospital, Hyderabad. A training centre was also set up at this hospital to equip doctors to start such clinics in rural towns.
To give these clinics a customised look so that clients identified it with low-cost quality service, a uniform signboard was put up before each one of them with the price board prominently displayed. Publicity was done extensively to popularise the clinics by placing humorous advertisements in local newspaper and on Andhra Pradesh State government buses. The Vanita Franchisee Clinics (VFC) established a network with chemist shops, bangle stores, sari shops and beauty parlours to spread the word about their services.
The identified doctors underwent training on IUD insertion at Central Resource Centre, Hyderabad. A senior medical consultant from Federation of Obstetrics and Gynaecological Societies of India (FOGSI) was appointed by HLFPPT for the purpose. The paramedical staff at each clinic was trained in-house by a master trainer from HLFPPT.
The user charges for family planning services are uniform across all franchisee clinics. The emergency contraceptive pills and urine pregnancy card (Dipstick urine test) was introduced to meet the needs of the clients and help the clinics sustain themselves through their sale. The franchisee clinics also provide comprehensive services such as medical termination of pregnancies (MTP), tubectomy and antenatal check-ups.
Various social marketing strategies were adopted to popularise the clinics. One example was the ‘Double Benefits, Double Happiness’ scheme for women who sought the clinic’s services and referred others to the clinic. She was given an incentive of either 4 gm silver coin or free health check-up at home for herself and her children below 3 years. Besides, each clinic, for every 1000 IUD insertions, drew at a Lucky Draw contest and silver and gold coins were given to the winners.
Monitoring was done by going through the records maintained by the franchisee clinic (client record, client card for IUD insertion, Clinic bill book and service utilisation report). Every month, information was sent to HLFPPT about the users. Getting feedback from franchisees and customers was also used as a monitoring tool.
Under the social marketing programme, 57 Vanita Clinics were set up in Andhra Pradesh, of which 26 were in Hyderabad. By the end of the project period there were only 38 Vanita clinics operational in 5 districts of the state; 50 % of the revenue came from the model Vanita Clinic in Hyderabad. The minimum patient load at the clinics ranged from 3 to 15 a month.
The project was evaluated by Administrative Staff College of India (ASCI), Hyderabad and the World Bank (WB). For excerpts see Reference. According to the WB report, doctors reported franchising has led to increase in the number of people seeking family planning services in their clinics. The ASCI report mentions that initial enthusiasm was considerably high, but gradually it waned due to lower client inflow than expected.
The criteria of selecting the location of Vanita clinic differed in rural and urban areas. In urban areas, the suitable location was adjacent to slums with a population of 1000. While, small towns adjacent to rural areas were identified as locations for establishing rural franchisee clinics.