Diarrhea, Infantile Clinical Trial
Official title:
Bihar Evaluation of Social Franchising and Telemedicine in India
This study will conduct an evaluation of the World Health Partners (WHP) private provider project to see if the social franchising and telemedicine project has an impact on health outcomes in treatment vs. control areas. The evaluation will also estimate specific parameters of the WHP program that can be used to maximize financial sustainability and replicability/scalability of the program.
In 2011, World Health Partners (WHP) will launch a large social franchising program of
healthcare delivery in Bihar, India, with funding from the Bill and Melinda Gates Foundation
(BMGF). The WHP project is particularly innovative in integrating a social franchising
delivery model with a telemedicine platform. Although social franchising models of delivery
are becoming increasingly common, to our knowledge, none of these efforts has been
rigorously evaluated.
COHESIVE-India plans to undertake an evaluation of the BMGF-financed WHP project. The
overarching focus of the evaluation project (called Bihar Evaluation of Social Franchising
and Telemedicine (BEST)) is to provide evidence on the performance and effectiveness of the
WHP program. In addition to studying the overall impact and effectiveness of the social
franchising and telemedicine program, the evaluation will estimate how the WHP model
influences outcomes related to two target diseases of interest to BMGF: childhood diarrhea
and childhood pneumonia.
The Evaluation Design The core objective of the evaluation is to estimate the causal impact
of the WHP program on BMGF target disease outcomes as well as other indicators of its
primary health care success. The key design feature of the evaluation is that it relies on
the franchisee network model of the WHP program. The evaluation design involves identifying
villages in Bihar that have asymmetric digital subscriber line (ADSL) connectivity where WHP
is likely to find providers who would participate in the program. The areas surrounding
these villages that form catchment areas for providers will be identified; 360 such areas
will be randomly sampled from the list and divided into 180 treatment and 180 control areas
for implementation of the WHP program.
The study also includes a detailed costing component to estimate the costs associated with
the target diseases and the benefits from the program intervention. In doing so, the
evaluation strategy addresses specific policy-relevant questions about sustainability,
affordability, replicability, and future Government support for privately provided
healthcare options in Bihar as well as in other parts of India.
In addition, COHESIVE-India, with funding from external sources also plans to conduct
studies that will provide insights on how to improve the effectiveness of the WHP model, as
well as its financial sustainability. These studies include the distribution of vouchers for
WHP services to estimate household's willingness to pay for them, as well experiments on
financial incentives to learn how to improve the performance of network providers.
This evaluation is closely aligned with the objectives of the Government of Bihar to reduce
the burden of disease. Through a rigorous evaluation of the WHP program, this study will
provide evidence on whether this model of rural health service delivery is efficient and
whether it can be scaled up. The stated goals of the WHP program indicate the many potential
health and economic benefits to the people of Bihar. The evaluation will provide an
empirical and objective assessment of the impact of WHP's effort on quality of care
available in rural areas (the program anticipates a significant improvement), increases in
access to healthcare providers and improved drug supply, reductions in time lapse between
onset of disease and optimal care, as well as reductions in unnecessary healthcare
expenditures.
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Observational Model: Case Control, Time Perspective: Prospective
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