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Health Policy and Planning Advance Access published online on July 20, 2007
Health Policy and Planning, doi:10.1093/heapol/czm025
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2007; all rights reserved.

The impact of a reproductive health franchise on client satisfaction in rural Nepal

Sohail Agha1,*, Ali Mehryar Karim2, Asma Balal3 and Steve Sosler4

1Research Associate Professor, Department of International Health and Development, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA, USA.
2John Snow International, Boston, MA, USA.
3Monitoring & Evaluation Specialist, Options, London, UK.
4Centers for Disease Control, Atlanta, GA, USA.

*Corresponding author. Department of International Health and Development, School of Public Health & Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA. Tel: +1 504 988 3543. Fax: +1 504 988 3653. Email: sagha{at}tulane.edu

This study evaluates the impact of a nurse and paramedic reproductive health franchise in rural Nepal on client satisfaction and utilization of services. A quasi-experimental study design, with baseline and follow-up measurements on nonequivalent control groups, was used to assess the effects of the intervention. The study collected data from exit interviews with male and female clients at clinics and from household interviews with married women. Our assessment covers the project's performance for about a year of actual implementation. Client satisfaction with the quality of services increased across a range of indicators at intervention clinics but not at control clinics. Overall satisfaction with services also increased only at intervention clinics but not at control clinics. Consistent with these changes, loyalty increased among clients of franchised clinics. The analysis showed a positive relationship between client satisfaction and loyalty. Although the project's implementation was examined over a relatively short period of time, there appears to have been a net positive effect of the intervention on obtaining family planning products from medical stores/pharmacies. The study shows that franchising reproductive health services increases a provider's interest in delivering better quality services in rural areas of a developing country.

Key Words: Reproductive health, franchising, quality of care, client perception, rural

Accepted for publication 1 May 2007.


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