Provider Motivation in Social Franchises for Reproductive Health

Dominic Montagu, University of California, Berkeley
Kristin Bradbury, University of California, Berkeley
Bella P. Uttekar, Center for Operations Research and Training (CORT)

Four reproductive health franchises in three countries were surveyed. Providers, family planning clients, and women from the local community were interviewed. Clinical vignettes were used to measure provider skill. Results were analyzed using theories of financial motivation and organizational behavior from transaction economics. Comparisons of providers in all four franchises were analyzed to test the accuracy of motivational aspects of membership and the results on behavior, particularly compliance with quality guidelines. We found family planning services to be highly profitable for members of the franchises, and quality within active franchises to be higher than the quality of services provided in passive ‘network’ franchises, where regular follow-up does not exist. We find that franchise membership is correlated with higher quality services, and that there is evidence to indicate that quality improvements are a result of membership. We conclude with hypotheses regarding quality management techniques applicable to this model of service delivery.