Impact of voluntary counseling and testing (VCT) franchising in Zambia, Namibia and Zimbabwe

Background

PSI manages its own voluntary HIV counseling and testing (VCT) sites and develops operational/institutional capacity of public and private sector managed VCT centers through social franchising throughout Sub-Saharan Africa. PSI's franchising programs have been successful in improving quality and encouraging widespread access to VCT services, through training, standardized operating procedure guidelines, licensing agreements, supervision, and standard logos to ensure adherence to quality of care.

The first franchise was launched in 1999 in Zimbabwe where over 715,000 clients have accessed VCT to date (15/20 managed by local franchisees) and 48% of clients accessed services at franchise sites in 2006. In Zambia, 6 out of 8 sites are managed by public/private franchisees where 47% of 52,000 clients tested in 2006. In Namibia, 16 out of 17 sites are operated by NGO/CBO/FBO franchisees. These sites tested over 44,000 clients (80% of the total) in 2006.

Design and Methods

VCT site and client intake data was analyzed to assess the effectiveness of franchising in terms of increases in client flow, numbers of sites, and referrals.

Results

All three countries had significant increases in client flow in the franchise-sites. In 2006, Namibia's franchisees had a 30% increase in client flow compared to a 2% increase in the direct-managed site. Referrals to post-test care and support were higher in integrated franchise sites in Zambia where over 45% of clients in franchise sites were referred in 2006, compared to only 30% of directly managed sites. In Zimbabwe, client flow increased by 30% in franchise-sites compared to only 13% in directly managed sites and client referrals increased in 2006 from 27% to 45% of clients referred.

Recommendations

The advantages of partnership over direct implementation include increased access to VCT by hard-to-reach and rural populations, sustained VCT service delivery and better linkages and referral systems between VCT and post-test support service providers. Challenges include standardization of services across diverse providers and time constraints in building capacity. The franchise model is good model for VCT providers who want to expand service delivery through local partners. The use of standardized operating procedures and supervision guidelines ensures that quality services are provided across diverse partners.