Center for Health Market Innovations (CHMI)

Health programs around the world deal with the question: how do you get patients to visit a clinic when, due to travel distance and wait times, it frequently requires them to give up a full day’s pay that they desperately need? The obvious solution would be to build more clinics closer to patients’ homes; however, this is hardly feasible in rural areas where there isn’t enough money or manpower to create clinics in everyone town.

Emily Mbotela opened the St. Hillarias Clinic in 2000 in the Migadini community of Mombasa, Kenya to provide basic primary care and maternity services. Then, in 2009, Tunza came calling. Tunza, a fractional franchise implemented by Population Services International (PSI), offers standardized and quality-assured family planning and reproductive health services (FP/RH) through 258 outlets across Kenya.

The majority of well-documented social franchises are operated by large coordinating organizations like PSI and MSI that give small, fragmented providers access to great benefits: professional training, branded marketing materials, subsidized equipment, and access to professional advice.

Smaller franchise networks, on the other hand are unable to reap the benefits of these networks to quickly scale up, lower margins, and implement best management practices.

Your clinic is filling up with women who look increasingly frustrated as wait times inch up. Mobile phones trill and children fuss. You hear murmurs that the clinic down the road – run by a popular quack, or untrained medical provider – is treating patients more quickly despite a continually heavy client load that rivals your own. Do you:

a) Rush patients through with little counseling or attention to their concerns. You need to make sure you can pay your bills this month and there’s no way you’re turning people away.
b) Assume re-using needles once won’t do much harm.