Top Reseau provides youth friendly health services: education and outreach through a mix of television and radio advertisements, mobile video units, and peer educators to promote safe sexual behavior, including prompt STI treatment, abstinence, partner reduction, and condom use. The clinics deliver an integrated intervention of interpersonal activities, mass media communication, and youth-friendly clinical service to motivate youth to adopt safer behavior and thus improve their sexual and reproductive health. Each clinic is a fractional franchise and offers a varied menu of services in addition to RH/FP services; however, services are uniformly priced within each region. By joining the network and agreeing to the standards of care and youth-friendly services (rigorously enforced through supervision and inspections),these private clinics benefit from free training and peer education. Some ten percent of all private physicians are now affiliated with Top Réseau. By working through the existing private sector rather than creating a new government system, Madagascar has been able to quickly and effectively implement a national infrastructure of clinics providing consistent, high-quality and nonjudgmental education, treatment and care.
At present, the franchise consists of 140 youth-friendly clinics, with 215 trained physicians (1-2 providers per clinic), 26 nurses, 25 midwives, and 76 trained peer educators. To help finance the cost of care, patients receive vouchers which can be used to cover half of the doctors’ fees.
The franchise implements a voucher scheme that targets youth and high risk groups and subsidizes FP/RH counseling and STI treatment. The scheme was launched in 2005, and to date, 282,552 vouchers have been disbursed. The voucher is free to the client.