Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model. Controlling the quality of services provided by independent practitioners is difficult, since positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction. Understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. Maintaining provider satisfaction and motivation may also be a challenge, especially because providers, usually located in low-income urban and peri-urban areas and serving a relatively limited number of clients, may not always understand the driving needs of the organization. These needs may be driven by policies, donors, the market, including the competition, or national level indicators such as contraceptive prevalence and unmet need.
Greenstar Social Marketing, one of the leading organizations in Pakistan for social marketing of contraceptives, plays a significant role in providing access to family planning services for the poor, especially in urban and semi-urban areas.
This study aimed to determine the major motivating as well as de-motivating factors that affect provider performance both positively and negatively, in order to identify concrete ways of improving provider motivation and hence their outreach to married women of reproductive age for family planning services. It was conducted with forty providers in three provinces across Pakistan: Sindh, Punjab and Khyber Pakhtunkhwa. In-depth interviews were conducted with these forty providers and the results were analyzed to assess the extent and reasons for motivation and de-motivation among providers.
De-motivation and dissatisfaction among a few providers appears to be a local issue, linked to the quality of the Greenstar offices in particular areas, whose staff has infrequent contact with providers and does not provide mentoring or supervision to the satisfaction of the providers. Another factor for provider motivation, linked to client load, and stated by many providers, was the removal of Greenstar’s Interpersonal Communication (IPC) workers in several areas, who used to be assigned to each provider to bring clients from the community. This has now come to an end in many areas and several providers said that reinstating the IPC workers would significantly help increase their client load.
The majority of providers indicated a fairly high level of motivation, and appreciated the frequent trainings they are invited to attend, which enhance their skills and knowledge, the close contact with Greenstar, which includes mentoring, monitoring, supervision and ensuring regular supplies, and the affiliation with a large, national level, well-known organization. Most providers appeared to take pride in their affiliation with Greenstar, and had the Greenstar products on prominent display. Many also expressed satisfaction because they felt that they were providing a much-needed service to their clients.