Since 1996, Janani, an affiliate of DKT International, has operated a social marketing and social franchising program in Bihar (now divided into the states of Bihar and Jharkhand). It combines the strengths of classic social marketing with a clinic-based service delivery program and a franchisee program through which doctors in rural areas provide low-cost services. It also includes a network of over 22,000 rural medical practitioners who have been recruited and trained to provide condoms, pills, pregnancy tests, and referrals to the clinic network for family planning.
A network of rural health practitioners, each working in partnership with a woman who is a family member, serves as the conduit between the clinics and rural communities. After training by Janani, the rural practitioners are franchised as Butterfly (Titli) centers to sell non-clinical products and over-the-counter pregnancy tests. Clients needing clinical services are counseled and referred to nearby Surya clinics, which earns the Titli centers a commission. The more than 40,000 trained networked rural providers are monitored by project field teams set up by entrepreneurs, and 620 franchisee medical clinics are supervised by Janani. The franchise clinics are complemented by a widespread social marketing infrastructure that includes over 31,000 shops and stockists that sell products such as contraceptives in urban and semiurban areas and replenish supplies to rural health franchisee centers and franchisee medical clinics.
Janani is in the process of adding HIV/AIDS prevention services in its clinics, including franchisee clinics, and through training and information at the Titli centers and in the commercial network as well.
For condoms and pills, the government of India provides a substantial subsidy, enabling the program to make contraceptives available at very low, affordable prices of 3¢ per condom and 11¢ per cycle of oral contraceptives. This subsidy also contributes to the goal of eventual financial self-sufficiency for the project.
In 2009, DKT’s program sold over 27 million condoms and over 2 million oral contraceptives in Bihar, Jharkhand, and Madhya Pradesh. DKT also sold over 100,000 medical abortion pills and over 30,000 IUDs. Together with clinic-based family planning services, this translates into 1,321,746 CYPs, a 10 percent increase from last year.