Franchising reproductive health in Kenya

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. While Emily’s clinic provides a broad spectrum of primary care, she was approached by PSI to offer franchised FP/RH services under the Tunza brand.

Why did she join the network? Tunza gives qualified doctors, clinical officers, and nurses access to training, technical assistance and the advantage of being associated with a brand recognized for its quality. Franchisees also receive discounted equipment, some at as much as 1/8 of the original cost, as well as continuous medical education. This is highly valued as these trainings are generally only available to public providers in Kenya.

Another advantage of joining Tunza is reliable access to affordable methods of contraception. Many Tunza clinics are able to get most of their contraceptives for free from the government, but when the government has a stock out, the clinicians can turn to PSI to fill in the gap. In addition, PSI is the only provider of intra-uterine devices (IUDs) to the Tunza franchisees - the devices are delivered in easy to use kits that include the IUD itself, gloves and a sterile pad. With all of these advantages, the Tunza franchise has been able to grow by more than 100 outlets since it launched with 150 clinics in 2009. PSI hopes to incorporate another 30 private clinics per year.

Tunza also employs community mobilization both to educate the local population about contraception and family planning and to encourage traffic in Tunza clinics. Mobilizers, who come from the communities in which they work, run 1 to 2 sessions per week, with 15 to 20 people in attendance. To increase interest in the sessions, mobilizers visit areas where men and women already gather, work with local leaders, and go door-to-door. After an open discussion to answer the wide range of questions from attendees, mobilizers encourage them to visit one of the franchised clinics. They may also hand out vouchers to those who would otherwise be unable to pay for Tunza’s services.

These days, the Tunza branding is visibly displayed alongside the St. Hillarias sign on the front of the clinic. The clinic itself is a modest sized two-story facility that’s marked by the bright orange and purple colors characteristic of the Tunza brand. Six staff – including four full-time nurses – run the clinic around the clock. While St. Hillarias offers 24-hour a day curative services, the Tunza-branded family planning and reproductive health services are available between 8am and 6pm daily. The vast majority of patients visiting the clinic are women. Male resistance to contraception is still prevalent in the area and women often favor injections as a form of contraception because it isn't visible to their partners.

Since becoming part of the Tunza network, Emily has seen patient volumes increase significantly. As the nearby government facility does not offer IUD insertions, her success has been bolstered by becoming a referral clinic for patients seeking this form of contraception. The brand has become so visible that the Duka la Dawa, or chemist shop, across the street has painted its façade in Tunza colors to make customers believe that they are associated with the franchise. It’s a lucky coincidence that St. Hillarias clinic is looking to create formal partnerships with several drug shops in the area to which they can reliably guide patients to purchase certain medications unavailable at the clinic. While no formal agreement has been reached with the neighboring shop, the clinic’s staff admit that there is a certain benefit to reaching out to them – “they already have our colors!”

The Tunza site visit was organized by the First Global Conference on Social Franchising, taking place in Mombasa, Kenya, November 9-11. This post, co-authored by Trevor Lewis, also appears on the Social Franchising Conference Blog.