Close
Explore more Centres, Projects and Groups
Welcome
Welcome Banner
West Bengal, India. © Neil Spicer

Service Delivery and Quality of Care

Strengthening health service delivery and quality of care through high-impact, interdisciplinary research.

Bottom Content
About

Our research seeks to understand the challenges in delivering health services and suggest evidence-informed solutions.

About
About QoC 2 columns
About QoC 2 columns left paragraph
Paragraph

What factors foster quality, coverage and effectiveness of health service delivery in low- and middle-income settings? Our research seeks to understand the challenges in delivering health services and suggest evidence-informed solutions. In order to strengthen quality of care, we:

  • conduct policy- and practice-oriented research
  • generate scientific knowledge, concepts and evidence on health service delivery 
  • work closely with policy decision makers, practitioners, funders, nongovernmental organisations and other researchers 

Our work is closely linked with LSHTM’s Health Systems group.

Themes
Themes QoC 2 columns
Themes QoC 2 columns left paragraph
Paragraph

Our interdisciplinary research covers a wide range of subjects, including:

  • human resources for health 
  • scale-up and sustainability of interventions to strengthen health services 
  • understanding and improving quality of care 
  • pluralistic healthcare delivery 
  • access to and utilisation of healthcare services 
Team
Team Block
Team

Dina
Balabanova

Associate Professor

Tracey
Chantler

Assistant Professor

Lucy
Gilson

Professor

Johanna
Hanefeld

Associate Professor

Jessica
King

Research Fellow

Marco
Liverani

Assistant Professor

Rosalind
Miller

Assistant Professor

Sandra
Mounier-Jack

Associate Professor

Timothy
Powell-Jackson

Associate Professor

Neha
Singh

Assistant Professor

Neil
Spicer

Associate Professor
Projects
Projects Quality of Care 2 columns
Projects Quality of Care 2 columns left
Paragraph
    Closing the gap in antenatal syphilis and HIV detection and treatment in Indonesia

    The dual elimination of mother-to-child transmission (EMTCT) of HIV and syphilis through screening and treatment of pregnant women has been identified as a global public health priority. Indonesia, the 4th most populous country in the world, has a national HIV prevalence rate among pregnant women of around 0.3% (15,900 women) with some provinces (e.g. Jakarta) close to the 1% threshold for a generalised epidemic. Comparable estimates for syphilis in pregnancy are unavailable but thought to be similar to those for HIV. The country also has the lowest rate of antenatal screening and treatment for HIV/syphilis in South-East Asia. Despite 98% of pregnant women attending antenatal care at least once during pregnancy, only 10% are tested for HIV and 1% for syphilis (using a mixture of rapid tests and laboratory-based testing). Only 48% of those testing positive for HIV and 30% for syphilis receive treatment.

    This poses a formidable challenge and is recognised as one of the most significant gaps in antenatal care in Indonesia. Persistent barriers to antenatal screening for HIV/syphilis include (but are not restricted to): limited awareness among health workers of the need for universal screening; some women are fearful of the test; lack of local standard operating procedures at the clinic level; supply chain gaps in tests and treatments; problems with the referral processes; and difficulties tracking women as they move across the health system. Context-specific interventions to better support the integration of HIV and syphilis testing and treatment into the ANC platform are urgently needed in Indonesia.

    Continuous Quality Improvement (CQI), which involves local ANC teams systematically collecting and reflecting on local data to inform the design and implementation of service delivery, has been effectively used to strengthen ANC services in a number of Sub-Saharan African countries. This approach holds considerable promise for Indonesia, a highly populous and diverse country where a ‘one size fits all’ approach to the delivery of quality ANC rarely applies. Using a cluster-randomised design, we will evaluate the effectiveness, cost-effectiveness, acceptability, fidelity and reach of a multi-faceted CQI intervention to improve antenatal testing and treatment of HIV/syphilis in ANC clinics in 6 districts across 3 Provinces (West Java, South Sumatra and South Kalimantan).

    This 3-year multi-disciplinary trial will involve clinicians, epidemiologists, economists, social scientists, health services reserachers and policy-makers from the London School of Hygiene & Tropical Medicine, the University of Gadjah Mada, the Indonesian Ministry of Health, World Health Organization and the Kirby Institute. Stakeholders from each study site will also be engaged in the research process including development of a scale-up strategy. This research has the potential to contribute significantly to improved maternal and child health in Indonesia while also strengthening the underlying health system.

    Principal investigators:

    Professor Virginia Wiseman
    Professor Ari Probandari (Universitas Sebelas Maret, Indonesia)
    Professor Shunmay Yeung (London School of Hygiene & Tropical Medicine, UK)

     

    Project funder: MRC UK

    Project collaborators:

    Professor John Kaldor (Kirby Institute, University of New South Wales, Australia)
    Professor Yanri Subronto (University of Gadjah Mada, Indonesia)
    Dr Marco Liverani (London School of Hygiene & Tropical Medicine, UK)
    Professor Matthew Law (Kirby Institute, University of New South Wales, Australia)
    Professor Rebecca Guy (Kirby Institute, University of New South Wales, Australia)
    Professor Rosanna Peeling (London School of Hygiene & Tropical Medicine, UK)
    Dr Ignatius Praptoraharjo (Gadjah Mada University)
    Dr Shita Dewi (Gadjah Mada University)

     

    Addressing quality in the private healthcare sector: A randomised controlled trial of the SafeCare Quality Improvement Programme in Tanzania

    SafeCare is a quality improvement model developed by the NGO PharmAccess, aimed at lower-level public and private health facilities in sub-Saharan Africa. The private sector is a major and growing source of care, but there are concerns about quality and safety, and these are insufficiently addressed by government regulation or international hospital accreditation standards. SafeCare was designed to address this gap, offering realistic setting-appropriate standards and stepwise certification, as well as access to credit for implementing improvements.

    We undertook a large-scale randomised controlled trial to evaluate the impact on quality of care of the roll out of SafeCare to private for-profit and faith-based facilities in Tanzania. The trial assessed the effects on the quality of care received by patients through comparison of 237 intervention and control facilities after 1.5–2 years of implementation. To do this, we:

    • measured clinical quality through standardised patient surveys
    • observed infection prevention and control (IPC) behaviours
    • conducted in-depth interviews with facility in-charges and implementing staff to assess the perceived benefits and costs of participating, and the factors affecting quality improvement and business performance
    • interviewed national level key informants to explore how the SafeCare model had shaped the market for healthcare and the policy environment

    The results are expected to make an important contribution to the evidence base on improving private sector care, and to the literature on measuring process quality of patient care.

    Papers

    Outputs

    People

    Dates

    Until end of June 2020

    HERA – Healthcare Responding to Violence and Abuse

    The HERA research study – Healthcare Responding to Violence and Abuse – aims to help health care systems in low-and-middle-income countries (LMIC) to respond effectively to women who experience violence. By strengthening research capacity and conducting research on training and support programmes as well as working with existing services (to strengthen and/or develop their responses to violence against women, VAW), the project will ensure women and their children receive appropriate care by doctors and nurses in primary care (including sexual and reproductive health settings), leading to better health outcomes.

    A multi-country study conducted in Brazil, the Occupied Palestinian Territories (West Bank), Nepal and Sri Lanka, HERA is funded by two research grants:

    • the Medical Research Council (MRC) Global Challenges Research Fund (GCRF) Foundation Award (2017 to 2019)
    • the NIHR Global Health Research Group Award (2018 to 2021)

    Through multi-disciplinary research we aim to:

    • evaluate the readiness of the Brazilian, Occupied Palestinian Territory/West Bank (oPT/WB),
    • Nepalese and Sri Lankan sexual and reproductive health services to identify VAW, respond to the needs of women experiencing violence, and offer referral to VAW services
    • conduct research studies with patients and providers to inform the development of the intervention
    • develop a tailored training and support intervention for health care professionals with stakeholder involvement
    • pilot the intervention in reproductive and sexual health and primary care settings

    Capacity strengthening in research is integral to our global partnership and we have used a co-production approach to developing the capacity strengthening programme within HERA which has been independently evaluated.

    Papers

    People

    Outputs

    Dates

    Until March 2021

    The rise of chain pharmacies in India and implications for public health

    For her PhD, Rosalind Miller studied private retail pharmacies in India. In many communities in low- and middle-income countries (LMICs), pharmacies are widely utilised for obtaining medicines and seeking health advice, but their practice is often poor. Insufficient history taking, a lack of adherence to treatment guidelines, and inappropriate dispensing of medicines are commonplace. In recent years, pharmacy chains have been emerging in South America, Africa and Asia. Chains may have the potential to improve quality, but this has been little studied in LMICs. Miller used mixed methods, including a standardised patient survey and key informant interviews, to understand the effect of chain pharmacies in Bangalore, India on the quality of case management for two tracer conditions.

    The management of childhood diarrhoea and suspected tuberculosis was similarly substandard in chains and independents for most areas of assessment. However, chains were found to sell significantly fewer harmful and prescription-only medicines for the diarrhoea patient. In-depth interviews explored a set of hypotheses regarding how being organised in a chain may affected key behaviours relating to quality failures. In practice, few differences were identified in:

    • employment of qualified staff
    • regulation of firms are regulated
    • financial incentives faced by staff

    Rosalind is now undertaking an ESRC-funded post-doctoral fellowship which seeks to address shortcomings in pharmacy practice in LMICs. She is working with the International Federation of Pharmacists (FIP) to survey national pharmacy associations to learn more about what guidelines, specifically written for pharmacies, are currently in existence. The ultimate aim of this project is to work towards the creation of a set of global level, pharmacy-specific guidelines for the management of key conditions.

    Chains were found to exert strong influence over their staff but the potential to exploit this has not been realised.

    Papers

    People

    • Rosalind Miller
    • Catherine Goodman, primary supervisor
    • Eleanor Hutchinson, secondary supervisor
    The PINTAR study

    Improving the dispensing of antibiotics by private drug sellers in Indonesia is the missing tactic in the fight against antimicrobial resistance (AMR). Despite the prominence of private drug sellers (PDS) in Indonesia’s health system, little is known about their practices or how to improve governance of this sector.

    The goal of this mixed-methods study is to develop and test strategies to improve antibiotic dispensing by PDS in Indonesia. Specific aims are to:

    • Understand the economic and social factors that influence the antibiotic dispensing practices of PDS
    • Determine the proportion of consumer visits to PDSs for common clinical conditions in which antibiotics are dispensed without a prescription;
    • Design and evaluate the effect and cost-effectiveness of a multi-faceted intervention to reduce inappropriate dispensing of antibiotics without prescription by PDS;
    • Design a strategy for intervention expansion and monitoring across Indonesia;
    • Build capacity in health systems research and evidence-based strategies for improving PDS governance and public-private collaboration (see criteria 2 for details).

    Publications

    • Wiseman V, Lagarde M, Kovacs R, et al. Using unannounced standardised patients to obtain data on quality of care in lowincome and middle-income countries: key challenges and opportunities. BMJ Global Health 2019;4:e001908. doi:10.1136/ bmjgh-2019-001908

    People involved

    • Virginia Wiseman
    • Mishal Khan
    • Shunmay Yeung
    • Marco Liverani
    • Johanna Hannefeld
    • Probadari A
    • Wibawa T
    • Jan S
    • Kaldor J
    • Law M
    • Guy R
    • Batura N
    • Schierhout G
    • Parathon H
    • Heaney A

    Dates

    2019 – 22

    The PINTAR project – Protecting Indonesia from the threat of antibiotic resistance (2018-2021)

    Research to date from the PINTAR study has revealed widespread inappropriate use of antibiotics amongst private drug sellers (PDS) in Indonesia. There is a real and present danger that the COVID-19 pandemic may further exacerbate problems of unnecessary self-medication and spark irrational use and hoarding of antimicrobial drugs such as antivirals, antimalarials and antibiotics. Our team are undertaking a national survey of all registered community pharmacies and drug stores across Indonesia to explore their understanding of the COVID-19 pandemic and the different medicines and advice given to clients in relation to COVID-19. We are also asking about actions that could be taken to improve COVID-19 management practices by private drug sellers, who are the first source of care for the vast majority of patients in Indonesia.

    We already have strong engagement with PDS and the Indonesian Pharmacy Associations through Phase 1 of the PINTAR study. Drawing on these existing collaborations, we will investigate the impact of COVID-19 on the practices of PDS in Indonesia.

    Our team are undertaking a mixed-methods study among PDS in Indonesia to explore:

    • PDS knowledge and understanding of COVID-19 including information sources;
    • Current advice and medicines given to clients in relation to COVID-19;
    • PDS interactions with patients and client expectations of PDS;
    • Measures taken by PDS to protect pharmacy and outlet staff from COVID-19
    • Any immediate actions that could be taken to improve COVID-19 management practices by PDS

     

    We will explore these issues through a nationwide online survey of all registered PDS and telephone interviews with a sub-sample of survey participants. To best of our knowledge, this would be the first study in Indonesia exploring such issues.

    This study will provide vital evidence on the types of advice given and medicines dispensed by community pharmacies and drug stores to suspected COVID-19 patients. This evidence will inform the design of interventions and policies to improve the quality of care offered by private drug sellers during the current COVID-19 outbreak and any future pandemics.

    Principal investigator: Professor Virginia Wiseman 

    Project funder: This research is being funded by a grant from the Indo-Pacific Institute for Health Security (DFAT) under the ‘Stronger Health Systems for Health Security’ Scheme 

    Project collaborators: 

    • Professor Tri Wibawa (Universitas Gadjah Mada, Indonesia)
    • Associate Professor Ari Probandari (Universitas Sebelas Maret, Indonesia)
    • Associate Professor Virginia Wiseman (Kirby Institute, University of New South Wales, Australia)
    • Dr Mishal Khan (London School of Hygiene & Tropical Medicine, UK)
    • Doctor Liverani, Marco (London School of Hygiene & Tropical Medicine, UK)
    • Professor Stephen Jan (George Institute for Global Health, Australia)
    • Associate Professor Shunmay Yeung (London School of Hygiene & Tropical Medicine, UK)
    • Professor John Kaldor (Kirby Institute, University of New South Wales, Australia)
    • Professor Matthew Law (Kirby Institute, University of New South Wales, Australia)
    • Professor Ric Day (Medical Faculty, University of New South Wales, Australia)
    • Doctor Neha Batura (University College London, UK)
    • Professor Rebecca Guy (Kirby Institute, University of New South Wales, Australia)
    • Associate Professor Johanna Hanefeld (London School of Hygiene & Tropical Medicine, UK)
    • Ms Aine Heaney (NPS MedicineWise, Australia)
    • Doctor Harry Parathon, Harry (Chair Antimicrobial Resistance Control Committee, Indonesian Ministry of Health, Indonesia)
    • Doctor Gill Schierhout (Kirby Institute, University of New South Wales, Australia)
    • Dr Luh Putu Lila Wulandari, MPH (Kirby Institute, University of New South Wales, Australia)
    • Dr Astri Ferdiana (Pusat Kedokteran Tropis, Universitas Gadjah Mada, Indonesia)
    • Dr Yusuf Ari Mashuri (Universitas Sebelas Maret, Indonesia)

     

    Understanding the role of community pharmacies and drug stores during the COVID-19 outbreak in Indonesia (a sub-study of the PINTAR project) (2020-2021)

    This is a sub-study of the 'Protecting Indonesia from the Threat of Antimicrobial Resistance' (PINTAR Study). 

    Research to date from the PINTAR study has revealed widespread inappropriate use of antibiotics amongst private drug sellers (PDS) in Indonesia. There is a real and present danger that the COVID-19 pandemic may further exacerbate problems of unnecessary self-medication and spark irrational use and hoarding of antimicrobial drugs such as antivirals, antimalarials and antibiotics. Our team are undertaking a national survey of all registered 
    community pharmacies and drug stores across Indonesia to explore their  understanding of the COVID-19 pandemic and the different advice and medicines given to clients in relation to COVID-19. We are also seeking to identify immediate actions that could be taken to improve COVID-19 management practices by private drug sellers, who are the first source of care for the vast majority of patients in Indonesia.

    We already have strong engagement with PDS and the Indonesian Pharmacy Association through Phase 1 of the PINTAR study. It is our intention to capitalise on this existing collaboration to undertake research
    on the impact of COVID-19 on the practices of PDS in Indonesia.

    We are proposing to undertake a mixed-methods study among PDS in Indonesia to explore the following issues:

    • PDS knowledge and understanding of COVID-19 including information sources;
    • Current advice and medicines given to clients in relation to COVID-19;
    • PDS interactions with patients and client expectations of PDS;
    • Measures taken by PDS to protect pharmacy and outlet staff from COVID-19
    • Any immediate actions that could be taken to improve COVID-19 management practices by PDS

    We will explore these issues through a nationwide online survey of all registered PDS and telephone interviews with a sub sample of survey participants. To best of our knowledge, this would be the first study in Indonesia exploring such issues. 

    This study will provide vital evidence on the types of advice given and medicines dispensed by community pharmacies and drug stores to suspected COVID-19 patients. This evidence will inform the design of interventions and policies to improve the quality of care offered by private drug sellers during the pandemic. 

    Principal investigator: Professor Virginia Wiseman 

    Project funder: This research is being funded by a grant from the Indo-Pacific Institute for Health Security (DFAT) under the ‘Stronger Health Systems for Health Security’ Scheme 

    Project collaborators:

    • Professor Tri Wibawa (Universitas Gadjah Mada, Indonesia)
    • Associate Professor Ari Probandari (Universitas Sebelas Maret, Indonesia)
    • Associate Professor Virginia Wiseman (Kirby Institute, University of New South Wales, Australia)
    • Dr Mishal Khan (London School of Hygiene & Tropical Medicine, UK)
    • Doctor Liverani, Marco (London School of Hygiene & Tropical Medicine, UK)
    • Professor Stephen Jan (George Institute for Global Health, Australia)
    • Associate Professor Shunmay Yeung (London School of Hygiene & Tropical Medicine, UK)
    • Professor John Kaldor (Kirby Institute, University of New South Wales, Australia)
    • Professor Matthew Law (Kirby Institute, University of New South Wales, Australia)
    • Professor Ric Day (Medical Faculty, University of New South Wales, Australia)
    • Doctor Neha Batura (University College London, UK)
    • Professor Rebecca Guy (Kirby Institute, University of New South Wales, Australia)
    • Associate Professor Johanna Hanefeld (London School of Hygiene & Tropical Medicine, UK)
    • Ms Aine Heaney (NPS MedicineWise, Australia)
    • Doctor Harry Parathon, Harry (Chair Antimicrobial Resistance Control Committee, Indonesian Ministry of Health, Indonesia)
    • Doctor Gill Schierhout (Kirby Institute, University of New South Wales, Australia)
    • Dr Luh Putu Lila Wulandari, MPH (Kirby Institute, University of New South Wales, Australia)
    • Dr Astri Ferdiana (Pusat Kedokteran Tropis, Universitas Gadjah Mada, Indonesia)
    • Dr Yusuf Ari Mashuri (Universitas Sebelas Maret, Indonesia)
    An implementation trial of continuous quality improvement for antenatal syphilis and HIV detection and treatment in Indonesia: The MENJAGA (protection) Study (2021-2022)

    The MENJAGA (protection) Study (2021-2022)

    The dual elimination of mother-to-child transmission (EMTCT) of HIV and syphilis through screening and treatment of pregnant women has been identified as a global public health priority. Indonesia, the 4th most populous country in the world, has a national HIV prevalence rate among pregnant women of around 0.3% (15,900 women) with some provinces (e.g. Jakarta) close to the 1% threshold for a generalised epidemic. Comparable estimates for syphilis in pregnancy are unavailable but thought to be similar to those for HIV. The country also has the lowest rate of antenatal screening and treatment for HIV/syphilis in South-East Asia. Despite 98% of pregnant women attending antenatal care at least once during pregnancy, only 10% are tested for HIV and 1% for syphilis (using a mixture of rapid tests and laboratory-based testing). Only 48% of those testing positive for HIV and 30% for syphilis receive treatment.

    This poses a formidable challenge and is recognised as one of the most significant gaps in antenatal care in Indonesia. Persistent barriers to antenatal screening for HIV/syphilis include (but are not restricted to): limited awareness among health workers of the need for universal screening; some women are fearful of the test; lack of local standard operating procedures at the clinic level; supply chain gaps in tests and treatments; problems with the referral processes; and difficulties tracking women as they move across the health system. Context-specific interventions to better support the integration of HIV and syphilis testing and treatment into the ANC platform are urgently needed in Indonesia.

    Continuous Quality Improvement (CQI), which involves local ANC teams systematically collecting and reflecting on local data to inform the design and implementation of service delivery, has been effectively used to strengthen ANC services in a number of Sub-Saharan African countries. This approach holds considerable promise for Indonesia, a highly populous and diverse country where a ‘one size fits all’ approach to the delivery of quality ANC rarely applies. Using a cluster-randomised design, we will evaluate the effectiveness, cost-effectiveness, acceptability, fidelity and reach of a multi-faceted CQI intervention to improve antenatal testing and treatment of HIV/syphilis in ANC clinics in 6 districts across 3 Provinces (West Java, South Sumatra and South Kalimantan).

    This 3-year multi-disciplinary trial will involve clinicians, epidemiologists, economists, social scientists, health services reserachers and policy-makers from the London School of Hygiene & Tropical Medicine, the University of Gadjah Mada, the Indonesian Ministry of Health, World Health Organization and the Kirby Institute. Stakeholders from each study site will also be engaged in the research process including development of a scale-up strategy. This research has the potential to contribute significantly to improved maternal and child health in Indonesia while also strengthening the underlying health system.

    Principal investigators:

    Professor Virginia Wiseman

    Professor Ari Probandari (Universitas Sebelas Maret, Indonesia)

    Professor Shunmay Yeung (London School of Hygiene & Tropical Medicine, UK)

    Project funder: MRC UK

    Project collaborators:

    • Professor John Kaldor (Kirby Institute, University of New South Wales, Australia)
    • Professor Yanri Subronto (University of Gadjah Mada, Indonesia)
    • Doctor Liverani, Marco (London School of Hygiene & Tropical Medicine, UK)
    • Professor Matthew Law (Kirby Institute, University of New South Wales, Australia)
    • Professor Rebecca Guy (Kirby Institute, University of New South Wales, Australia)
    • Professor Rosanna Peeling (London School of Hygiene & Tropical Medicine, UK)
    • Dr Ignatius Praptoraharjo (Gadjah Mada University)
    • Dr Shita Dewi (Gadjah Mada University)
    The DOMINO Study: Measuring and mitigating the indirect effects of COVID-19 on TB and HIV care in Indonesia (2020-2022)

    The global health community has made urgent calls for countries to find solutions to minimising the impact of COVID-19 on programs targeting long-standing health problems such as TB and HIV (1). Indonesia, with a population of around a quarter of a billion people, currently has the highest number of COVID-19 infection cases in Southeast Asia, averaging 1000-1300 new infections each day since the 15th June and a case fatality rate of around 6.6% (2). It is also ranked third in TB burden globally (3) and one of a few countries where the number of new HIV infections is rising (4). In recent years Indonesia has strengthened its commitment to controlling these two important diseases. However, the diversion of health resources to the pandemic along with social distancing policies is creating new vulnerabilities and exacerbating existing ones for TB and HIV programs and affected populations.

    Our team is partnering with the Indonesian government and community organisations to conduct an observational cohort study across all TB and HIV facilities in the major cities of Bandung (N=62) and Yogyakarta (N=30) to assess clinical outcomes before and during the pandemic. We will analyse routinely collected data to measure linkage to care, retention in care and treatment outcomes along TB and HIV cascades of care. Qualitative methods will be used to explore the experiences of TB and HIV patients and their health care providers during the pandemic, including changes to treatment seeking and actions to minimise disruptions. Out-of-pocket health spending by TB and HIV patients and their families during the pandemic will be measured using structured diaries. Wider health system impacts of COVID-19 on stocks of medicines/tests and health facility funding levels will be assessed using facility records and interviews with health authorities and facility staff. Our findings will generate recommendations on how to minimise disruptions to HIV and TB services in the face of the pandemic.

    Principal investigators:

    Professor Virginia Wiseman

    Professor Ari Probandari (Universitas Sebelas Maret, Indonesia)

    Project funder: UKRI

    Project collaborators:

    • Professor John Kaldor (Kirby Institute, University of New South Wales, Australia)
    • Doctor Liverani, Marco (London School of Hygiene & Tropical Medicine, UK)
    • Professor Matthew Law (Kirby Institute, University of New South Wales, Australia)
    • Professor Yanri Subronto (University of Gadjah Mada, Indonesia)
    • Professor Hasbullah Thabrany (USAID Indonesia)
    • Professor Riris Ahmad (University of Gadjah Mada, Indonesia)

    Completed projects

    Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn and reproductive health-care services in Uttar Pradesh, India

    How can we harness the private sector to improve population health in low-income and middle-income countries? One strategy, heavily supported by the donor community in recent years, is social franchising. In this quasi-experimental study, we evaluated whether the Matrika social franchising model – a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians – could improve the quality and coverage of health services along the continuum of care for maternal, newborn and reproductive health.

    We found that the programme did not have a measurable effect on the proportion of women giving birth in a health-care facility, nor did it improve any other individual outcome. We measured a wide range of pre-specified outcomes along the continuum of care for maternal, newborn and reproductive health, and found consistent results of no measurable effect. The findings should place a higher burden of proof on policy makers and funders looking to invest in social franchising for maternal health.

    Find out more on the Maternal Healthcare Markets Evaluation Team website.

    Publications

    Sarah Tougher, Varun Dutt, Shreya Pereira, Kaveri Haldar, Vasudha Shukla, Kultar Singh, Paresh Kumar, Catherine Goodman, Timothy Powell-Jackson, (2018) Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study, Lancet Global Health

    Penn-Kekana, L., Powell-Jackson, T., Haemmerli, M. et al. (2018) Process evaluation of a social franchising model to improve maternal health: evidence from a multi-methods study in Uttar Pradesh, IndiaImplementation Science

    Pereira, S.K., Kumar, P., Dutt, V. et al. (2015) Protocol for the evaluation of a social franchising model to improve maternal health in Uttar Pradesh, IndiaImplementation Science

    People

    • Timothy Powell-Jackson
    • Sarah Tougher
    • Catherine Goodman