Impact of Social Franchising on Healthcare Expenditure within Private Facilities in Embu County Kenya
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The Kenyan private health sector is one of the most developed in Sub-Saharan Africa and is highly critical in healthcare delivery. It is often the first point of contact of 47 percent of the first quintile of income earners when they fall sick and 33 percent of women seek family planning services in this sector. Despite private sector ability to provide greater choices for customers, in several parts of Kenya, the cost of health services is a great impediment to service utilization. The concept of social franchising attempts to increase access to services in the private sector through various strategies such as capacity building of healthcare service providers, lowering cost of treatments by provision use of vouchers or supply of subsidized medical supplies and demand creation. However, there is scant literature on the impact of social franchising on healthcare expenditure within private healthcare facilities in Embu County, Kenya. This study investigated how social franchising has affected the consumer expenditure on private healthcare services namely family planning and children treatment services. The family planning methods included three-month short term family planning method Depo-Provera and long term family planning methods IUCD and Norplant’s implants which are supported by social franchisors. The study used a cross-section descriptive study design and conducted a cluster sampling in communities near franchised and non-franchised private health clinics in Embu County. The study used a total of 215 responses analyzed with STATA 14. Descriptive statistics used in this study include mean, median, and frequencies and inferential statistics include binary logistic regression with marginal effects and propensity score matching to determine the impact of social franchising on healthcare expenditure. The results reveal that expenditure on children's illnesses treatments and that of short-term family planning services were not statistically different between franchised and non-franchised health facilities. The study however found that there is a huge variance on the expenditure of long-term family planning services between the two classes of clinics with women in franchised health facilities paying on average $4.5 less due to provision of vouchers by the franchisors. The study recommends expansion of social franchisors network to reach bottom of economic pyramid and scaling up the capacity building of medical workers through training to improve quality of services provided.