Evaluation of a Social Franchising and Telemedicine Programme and the Care Provided for Childhood Diarrhoea and Pneumonia, Bihar, India/Evaluacion De Un Programa De Telemedicina Y Franquicia Social Y la Atencion Proporcionada Para la Diarrea Y la Neumonia Infantiles, Bihar, India/Evaluation D'un Programme De Franchises Sociales et Telemedecine et De la Prise En Charge De la Diarrhee et De la Pneumonie Infantiles Dans

By Mohanan, Manoj; Giardili, Soledad et al. | Bulletin of the World Health Organization, May 2017 | Go to article overview

Evaluation of a Social Franchising and Telemedicine Programme and the Care Provided for Childhood Diarrhoea and Pneumonia, Bihar, India/Evaluacion De Un Programa De Telemedicina Y Franquicia Social Y la Atencion Proporcionada Para la Diarrea Y la Neumonia Infantiles, Bihar, India/Evaluation D'un Programme De Franchises Sociales et Telemedecine et De la Prise En Charge De la Diarrhee et De la Pneumonie Infantiles Dans


Mohanan, Manoj, Giardili, Soledad, Das, Veena, Rabin, Tracy L., Raj, Sunil S., Schwartz, Jeremy I., Seth, Aparna, Goldhaber-Fiebert, Jeremy D., Miller, Grant, Vera-Hernandez, Marcos, Bulletin of the World Health Organization


Introduction

Diarrhoea and pneumonia are leading causes of childhood morbidity and mortality despite being targeted by global investment in health for decades. In the last 5 years, these diseases were responsible for almost 25% of deaths among children aged 1 to 4 years worldwide. (1) In India, nearly 500 000 children younger than 5 years died from diarrhoea or respiratory infections in 2013. (2) These poor health outcomes were partially due to the low quality of care in both public and private health sectors, including absenteeism, poor knowledge and the know-do gap, i.e. the gap between knowledge of appropriate care and the care actually delivered. (3-12)

Efforts to improve the quality of primary care in developing countries have focused on a variety of strategies, ranging from training and performance incentives to organizational innovations in the private sector and the use of new technologies, such as telemedicine. (1-3) One prominent approach is social franchising, which is similar to commercial franchising. The aim is to improve a socially desirable outcome, such as health, while generating sufficient revenue to be self-sustaining. In social franchising, a franchisor offers a standardized, branded set of products or services through franchisees who pay a subscription fee to join the franchisor's network. Franchisees, who are typically existing local providers, in turn, receive training and follow service delivery protocols established by the franchisor. They also benefit from marketing, branding, supply chain management and diagnostic services organized by the franchisor. Many franchisors use new information technologies to improve the efficiency and coordination of their network of franchisees. However, despite the rapid growth of social franchising in developing countries, there is little evidence that it affects the quality of care provided on a large scale, (14-16) except for a recent programme in Myanmar where the introduction of social franchising was accompanied by a substantial increase in the number of health-care workers. (17,18)

In this study, we investigated the effectiveness of the World Health Partners' Sky Program in improving the knowledge and performance of health-care providers in Bihar, India. In addition to its effect on participating health-care providers, it was hoped that the programme would also improve the performance of other local providers through spillover effects and by encouraging competition. Understanding of the programme's effect on the quality of care could help to explain why a programme in rural Bihar costing over 23 million United States dollars (US$) failed to increase the appropriate treatment of childhood diarrhoea or pneumonia. (19)

The programme was originally developed as a hub-and-spoke model: SkyHealth providers with telemedicine facilities at the hub would link to peripheral rural health providers with smaller, more basic facilities (called SkyCare providers). SkyCare providers typically offered basic primary care and symptom-based treatment and could refer patients to SkyHealth providers. (20) SkyHealth providers had access to telemedicine technology that was able to connect physicians at the World Health Partners' central medical facility in Delhi to patients in rural areas via an audiovisual interface. Using this technology, physicians were able to examine patients by auscultation, assess their blood pressure and pulse and obtain electrocardiogram results if needed. In addition, SkyCare providers could offer mobile phone consultations with these physicians or refer patients to SkyHealth providers.

Although planned as a hub-andspoke model in which SkyHealth providers would be responsible for the empanelment of SkyCare providers, the programme was instead implemented as a two-tier model without referral networks in which the two types of provider were recruited directly by World Health Partners. Existing informal health-care providers or pharmacists in rural areas were approached by World Health Partners' field representatives, given information about the programme and offered the opportunity to join the network by paying a franchisee fee. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Evaluation of a Social Franchising and Telemedicine Programme and the Care Provided for Childhood Diarrhoea and Pneumonia, Bihar, India/Evaluacion De Un Programa De Telemedicina Y Franquicia Social Y la Atencion Proporcionada Para la Diarrea Y la Neumonia Infantiles, Bihar, India/Evaluation D'un Programme De Franchises Sociales et Telemedecine et De la Prise En Charge De la Diarrhee et De la Pneumonie Infantiles Dans
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.