Social franchising in the public health sector in Vietnam: a tale of two change pathways

Purpose
That social franchising programs induce favorable outcomes is readily taken for granted, albeit lacking robust empirical support. Addressing this situation, our paper takes a closer look at a fractional social franchising program in the public healthcare sector in Vietnam to better understand how such programs work. We expand the nascent body of empirical research that has examined the inner workings of social franchising programs from the perspective of clients by focusing on the health professionals who work there.
Methodology
Using an exploratory qualitative research design, we conducted 25 semi-structured interviews with health professionals of a fractional franchising program called Sisterhood, which introduced reproductive health and family planning services into existing health facilities in Vietnam. Interviews were triangulated with Sisterhood’s internal documents as well as with publicly available reports.
Findings
The analysis highlights two pathways through which the social franchising program brought about positive change. On the one hand, the analysis suggests that many of the positive outcomes reported by public health professionals were consistent with the stated goals and measures used by the Sisterhood program, providing evidence that improving the quality of health care for disadvantaged communities can be achieved through careful design and execution. On the other hand, the analysis revealed beneficial outcomes that were outside the scope of the Sisterhood program and in this sense “unexpected”. Specifically, our paper sheds light on unintended knowledge spillover effects in which non-franchised health professionals began to adopt new practices and principles introduced by the social franchising program.
Originality
The paper taps into a largely under-researched phenomenon – fractional social franchising – from the perspective of health professionals. Unpacking how the social franchising program created favorable outcomes, some by design and others by accident, the paper opens new empirical and policy insights into how social franchising can improve public health in hard-to-reach communities in the global South. Based on our findings, we argue for the intentional promotion and institutionalization of knowledge transfers from franchised to non-franchised health facilities to reinforce and scale up the positive impact of social franchising. We conclude by emphasizing the need for future research to adopt a complexity-sensitive approach that accounts for the dynamic, non-linear adoption pathways social franchising can take. Such an approach is essential to uncover the beneficial outcomes that can result from social franchising programs but cannot be readily predicted by program design.