Sub-Saharan Africa accounts for 24 percent of the global burden of disease, yet it only has 11 percent of the world's population.  The healthcare systems in Sub-Saharan Africa face numerous challenges, including lack of training and organization, insufficient standards and quality monitoring, and high out-of-pocket expenditures. While many efforts to address problems in the healthcare sector have focused on government clinics and hospitals, private providers are in fact the first source of care for many Africans. Though millions of people rely on private clinics, regulation and enforcement of the quality of care in private facilities is generally weak.  As a result, governments and NGOs have recently turned their attention to improving care in private facilities. This study will test whether a multi-faceted approach can improve the quality of care and ultimately health outcomes in the region.
The African Health Market for Equity (AHME) initiative is a multi-faceted program that aims to improve both the supply and demand for private healthcare among the poor. Supply-side interventions aim to ensure high quality of care, while demand-side interventions aim to reduce barriers to accessing high-quality care. The initiative was designed and is being implemented by Marie Stopes International, Population Services International, PharmAccess Foundation, Grameen Foundation, the International Finance Corporation, and Society for Family Health.
- Social franchising: Evidence suggests that grouping private providers under a franchised brand with a social goal could improve both access to and the quality of some clinical medical services. Such “social franchising” entails creating a valued brand for goods or services with a social goal, and extending the reach of that brand by leasing the right to use it. Private providers will be trained and certified to deliver standardized care under the franchised brand. The brand will aim to signal to the client that the clinic offers high-quality services, and local and national marketing for the brand will aim to build demand for the franchised services.
- SafeCare: The program will provide participating clinics with a standardized assessment of facility quality, support in developing quality improvement plans, and incentives for clinics to improve quality of care.
- Medical Credit Fund: The fund will provide strategic planning support tied to performance-based financing to eligible SafeCare-participating clinics.
- Demand-side financing: AHME will facilitate registration with Kenya’s National Health Insurance Fund for SafeCare-participating clinics that meet a minimum standard of quality.
- Information and communications technology (ICT): Mobile phones and other technology will be utilized to enable clinic personnel to, among other things, collect data and directly reach clients to improve operational efficiency.
Results and Policy Implications