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A Quasi-Experimental Study to Assess the Performance of a Reproductive Health Franchise in Nepal

In 2001, the Commercial Market Strategies project established a nurse and paramedic franchise in Nepal to increase utilization of reproductive health services and client satisfaction with service quality. To assess the impact of the intervention, CMS used a quasi-experimental study design, with baseline and follow-up measurements on non-equivalent control groups. CMS found that at the clinic level, client satisfaction increased at intervention but not at control clinics. Client loyalty, measured by return visits, also increased at intervention but not at control clinics. The increase in client loyalty was, in part, explained by the increase in satisfaction with service quality. At the population level, CMS did not find consistent increases in utilization of various reproductive health services. While utilization of other reproductive health services did not change, an increase in contraceptive use may have been associated with use of the nurse and paramedic network. CMS concluded that a franchiser that provides training to franchised clinics in reproductive health service delivery and in client-provider interaction, and that monitors the quality of care provided at these clinics, can help increase client satisfaction at network clinics.