Case Study Biruh Tesfa

The Biruh Tesfa social franchise in Ethiopia is a network of private providers initiated by Pathfinder International in 2000 with support from the Packard Foundation, with the goal of increasing access to RH/FP services in the private sector. The network is comprised of private clinic facilities, work-based sites and community based health workers and market agents. The network currently includes 130 private clinics, 27 workplace sites, 90 market place agents and 350 CBHAs operating in five zones (regions) of the country.

All clinic franchises offer RH/FP and STI services. Depending on their qualifications, some providers also offer ANC, delivery, immunization and/or VCT services. Among the key benefits that franchised providers receive are support to improve the quality of care they provide – through clinical training like Norplant/IUCD implant/insertion, syndromic management of STI, program management for RH/FP, and the provision of equipment and contraceptive supplies.

During its first phase, the focus was on recruiting providers to grow the network. As it entered the second phase of operations in 2002, the network shifted its focus to developing a strategy for sustainability. It sought to institutionalize the key functions of the franchisor by partnering with an existing professional association that would gradually take on the role of franchisor.

A partnership with the Medical Association of Physicians in the Private Practice in Ethiopia (MAPPP-E) was initiated in 2005 with the goal to transition certain core functions, such as monitoring and quality assurance, from the franchisor to the association. While the partnership is still in the early stages, MAPPP-E is playing an increasing role in ensuring quality of services provided at franchised clinics, advocacy, and improving public trust and perception of private health providers. MAPPP-E operates with a paid staff of three and seven physician volunteers, and is supported by a grant from SIDA.

Recognizing their current limited capacity, the association plans to develop a strategic plan to identify opportunities to generate revenues and work towards financial sustainability. MAPPP-E must also position itself so that it may legally function as the franchisor for the Biruh Tesfa network, which is the long-term goal.

Sun Quality and Myanmar Medical Association Case Study