Improving Innovative Health Care Delivery Systems that Serve the Poor

Ndola Prata, University of California, Berkeley
Dominic Montagu, University of California, San Francisco

Using data from the World Bank’s HNP Poverty Thematic Reports of 22 countries in Africa, we assess the use of services by asset quintile groups, for treatment of childhood diseases, proxies for publicly subsidized services. Results show that public sector services disproportionately serves the wealthy, and further clarifies the role of the private sector in serving the poor. We assess the evidence on using franchise networks to supplement government programs. Examples from health franchises in Africa and Asia are provided to illustrate the potential for franchise systems to leverage private providers and so increase delivery-point availability for public-benefit services. Having explored the range of systems that have been tested for working with private providers, from contracting to vouchers to behavioral change and provider education, we conclude that franchising has the greatest potential for integration into large-scale programs in Africa that will address critical illnesses of public health importance.