During the opening session of the 2011 Social Franchising Conference for Health in Mombasa, Karl Hofmann, the president of Population Services International, argued that the integration of more services should be one of the key steps forward for health franchises in the in the near future. However, this can be difficult due to equipment and human resource constraints, as well as government restrictions on the scope of services that clinics or health workers of a certain level are allowed to offer. In response to this challenge, many franchises have developed referral networks to connect health workers, clinics and hospitals. However, while referral networks are an innovative way to overcome gaps in service, a number of challenges still remain in their implementation.
First, there is the question of why clinics and franchisees would buy in to the referral system? What’s in it for them to refer patients away from their clinics? [BlueStar, Vietnam](http://healthmarketinnovations.org/program/bluestar-vietnam) addressed this issue by implementing referral fees. In this case, the clinic that made the referral is entitled to 10% of what the patient pays at the other clinic. The clinics settle these payments to each other at a meeting for all franchised clinics that takes place every 3 months.
But if clinics are paying each other based on the number of referrals, the issue of tracking referrals then becomes very important . While a number of clinics use paper-based forms for tracking, a more reliable method seems to be the use of mobile phones. In this way, clinicians are not only able to record referrals but also warn clinics that a patient has been referred to them, as well as pass along patient data to avoid redundancies during the visit. Programs such as [M-Afya Kiosks](http://healthmarketinnovations.org/program/m-afya-kiosks) and [Jacaranda Health](http://healthmarketinnovations.org/program/jacaranda-health) both aim to do this.
Finally, there is the issue of accessibility. Even when someone is referred to another clinic or hospital for a certain service, who can say if they can actually make it to the clinic, especially if it is located many miles away? To solve this, one program in Kenya has begun providing vouchers to patients who can use them with a certain taxi company. At the end of the month, the taxi company presents the program with the vouchers to get reimbursed. Another program, called [Comprehensive Community Based Rehabilitation Tanzania](http://healthmarketinnovations.org/program/comprehensive-community-based...), uses mPesa to transfer money to remote locations to pay for travel to the clinic.
Referral networks are useful tools but provide a number of challenges. However, as shown above, with proper planning and implementation, solutions can be found. Still, there are other problems that will be even more difficult to solve. For example, many patients want a one-stop shop where they can access any service and buy any drug that they should need, but this idea directly contradicts referral networks. Therefore, referral networks, while promising, still require much thought and debate.
*This blog was originally posted on the [Social Franchising for Health](http://sf4healthconference2011.com).*