Healthspot Franchise International (Healthspot) presents the design and budget for an international program to deliver close-to-client Tuberculosis (TB) and HIV/AID services to poor at-risk populations in sub-Saharan Africa . The plan uses an innovative application of social franchising that involves private providers, who are the main source of healthcare for the poor in most of Africa , including care for TB and HIV/AIDS.

Government programs in many countries of sub-Saharan Africa are diagnosing and curing decreasing percentages of active TB and HIV cases as the diseases expand in populations with poor access to or ability to make use of government services. Using a business model well established in the for-profit sector, Healthspot’s model provides a framework for incentives and control structures to group mid-level providers – the providers most active in populations that are underserved by government healthcare systems. This structure leverages their pre-invested infrastructure and existing clientele to rapidly expand standardized diagnostic and treatment systems, while assuring quality through a range of levers of control.

Immediate benefits will be threefold:

Pre-payment and well-documented information regarding available public-sector services will ensure that clients, who choose treatment in the private sector, do so with an awareness of their options, and with minimized financial incentives to discontinue treatment. Systems for follow up of patients will also be in place. Both care and testing will benefit significantly from the localized provision of care close to the clients’ homes.

Healthspot’s model will deliver diagnosis and treatment for TB and opportunistic infections related to HIV/AIDS at operating subsidy costs below those of any national TB program in sub-Saharan Africa, while serving populations that national programs are least able to reach. The use of existing human resource capacity in health service delivery is particularly relevant as HIV/AIDS services expand to deliver ARV treatment.

As WHO begins mobilization for three million people in the third world to be receiving ARV therapy by 2005, the need to develop an effective and large-scale system for involving private providers in TB/HIV is increasingly urgent. This plan calls for a two-stage introduction of private sector TB/HIV care over five years. The first stage will prove the effectiveness of the methodology and test the systems for procurement, training, support, and quality control. This will take place in Kenya and Tanzania, with projects serving cachement populations of one million people each. In each country, the initiative will enroll 50 clinics as franchisees, and by the end of the second year serve on average 11,000 HIV+ clients for opportunistic infections and prophylaxis and 1,900 TB patients. For TB, and the continuation phase, higher numbers are expected to receive testing from the franchised clinics and subsequently enter treatment in the national health services. Anti-retroviral delivery will be initiated in high-performing clinical-officer and nurse operated franchise clinics six months after the first clinics begin operation.

The second stage of this plan will involve the expansion of services within the phase-one countries, and start of operation in 5 additional high-burden countries in sub-Saharan Africa, namely Cameroon, Malawi, Nigeria, Uganda and Zambia. In all seven countries services will be scaled up over three to four years to cover cachement areas serving one third of the national population.

74 New Montgomery, Suite 508, San Francisco, California 94105-3411, USA