A couple of weeks ago PBS aired an interesting show about CFW, an organization that is using a franchising model to open health centers in Kenya. The whole PBS show, and some other information, is available on the PBS website. CFW has also recently been covered in Business Daily Africa, a Nairobi based newspaper.
The founders of CFW noted that over half a trillion dollars in the last 40 years have been given in foreign aid to Sub-Sahara Africa, but that all of this money has had little impact. They concluded that instead of more money, a new approach was needed. They decided to borrow from the franchise concept, which has had so much success in fast food and other industries, and to use it to address health care in Kenya.
Kenyans own and operate the individual CFW franchises, which are for profit enterprises. In exchange for their $300 franchise fee, they get business and medical training, marketing assistance, and a loan for medical supplies. They focus on easily preventable diseases. Over 70% of the childhood deaths in Africa are caused by easily prevented diseases, for which cheap medicines exist. The government run health care system in Kenya provides these medicines for free. Problems ranging from counterfeit drugs, logistical failings, inability to regulate pharmacies (an estimated 2/3 of which are operating illegally), and overcrowding, make their efforts largely ineffective however.
Despite treating many patients that are unable to pay, the franchises typically make a profit and provide a living for both the owner/operator and in most cases a hired nurse as well. The standardization, oversight, and timely delivery of drugs from CFW ensures that their medicines are good and that they are effectively administered. The franchisor obligations of CFW are supported by donations, which makes it an interesting combination of charity and for-profit business. The hope though is that as more franchises open, that CFW will be able to become completely self-supporting from franchise fees and selling medicines to the individual franchises.
This concept shows promise that it can succeed in bettering people’s lives in places where foreign aid has been far less successful than hoped.
Interesting. I would guess that this franchise idea is along the same likes as many micro-finance projects that seem to be the current rage in international development circles. They make sense in that when people own things they are more responsible with them.
I did read the links and conclude that this idea is a good one for as far as it goes. It is perhaps analogous to my complaint here in my country that one doesn’t always need a full hospital and a fully-trained doctor to meet a particular health need. Sometimes cheaper and less-time-consuming alternatives are adequate. So, if these franchises can provide health care for common but less complicated needs, that is wonderful.
Of course, we still have a continent full of serious health issues, including the ugly specter of AIDS, hanging over so much of Africa that isn’t going to be helped much by these small drugstore/clinics.
It would be interesting to see if these clinics stay around for the long haul, or if they will be thwarted by cultural, educational, economic, or political factors.
It’s true that this won’t help people with HIV, but it will address malaria which is about as big as a problem in Africa.
And I agree, it’ll be interesting to now how these clinics do long-term.
If they really want to stop malaria, they need to re-introduce the spraying of DDT into Africa. If not for environmentalist nutcases, malaria would be nearly non-existent in Africa.
Darius, I have had malaria and have watched my children suffer with it too. But that doesn’t make me a fan of DDT. When I watched a litter of kittens die from DDT poisoning I got very nervous how it was going to affect my newborn, living in the same house. Then there’s the problem that the mosquitoes have become resistant to it. And what about surge in the rat population because the cats all died from licking DDT off their fur. It would take a nutcase to reintroduce DDT spraying.
(My observations come from the Pacific, not Africa, but you get my point.)
“They concluded that instead of more money, a new approach was needed. They decided to borrow from the franchise concept, which has had so much success in fast food and other industries, and to use it to address health care in Kenya.”
Any effort to help those in need should involve training the target group to be able to serve themselves, and reward them for helping others. Small business ownership is an excellent way to do this, and the franchise model provides the support needed to more rapidly train and support such businesses.
“Kenyans own and operate the individual CFW franchises, which are for profit enterprises. In exchange for their $300 franchise fee, they get business and medical training, marketing assistance, and a loan for medical supplies. They focus on easily preventable diseases.”
No offense to the doctors on this site, but much of what doctors do can be replicated by a student with far less training. By providing a low entry cost and high income potential, there is huge motivation for people to enter into this kind of opportunity. If the franchise structure also allows for or encourages referring patients needing greater expertise, all the better.
“Problems ranging from counterfeit drugs, logistical failings, inability to regulate pharmacies (an estimated 2/3 of which are operating illegally), and overcrowding, make their efforts largely ineffective however.”
Interesting that even with “free drugs” they still have problems with counterfeits, but logistical failings are a norm for government run programs. This is the failing of socialism, in that without a profit motive it is hard to get enough resources to their needed destination at the time needed. There are only so many altruistic individuals willing to sacrifice themselves for others with no clear personal benefit.
“The hope though is that as more franchises open, that CFW will be able to become completely self-supporting from franchise fees and selling medicines to the individual franchises.”
I am far more willing to contribute to an organization with plans to be self-funding in the future, since any successful program should produce wealth rather than consume it. If the program produces wealth, it should be able to fund itself once it is properly scaled.
thainamu, our discussion of DDT was apropos and timely. Here is today’s Wall Street Journal commentary by Sam Zaramba (Minister of Health in Uganda) about its desperately needed use in Africa.
http://online.wsj.com/article_email/SB118160970924631993-lMyQjAxMDE3ODExMjYxMDI5Wj.html
Well written editorial, but it doesn’t convince me. I’ve seen with my own eyes how the sprayers mishandle the chemical (like rinsing out their equipment in the river) and I’ve seen how the chemical upsets the balance of nature with the cat-rat thing. Watching those kittens die with a nervous system malfunction gave me enough common sense to realize the stuff is dangerous. On a less personal level, it doesn’t take much google research into the scientific literature to find plenty of evidence that DDT is dangerous and how easily it has been misused.
Don’t get me wrong, I have great sympathy for people who live with mosquitoes and malaria so I hope that some safer alternative to DDT can be found. Even common sense things can help, like not leaving standing water around for mosquitoes to breed in and sleeping under mosquito nets.
DDT is obviously dangerous if used in harmful-to-human amounts, however, if properly applied, it’s very useful. Of course it would be great if they found an alternative to DDT, but until they do, I don’t see how the millions of people dying each year from malaria can wait. So what if a few animals or even a handful of people die from DDT, considering that it will save millions? I don’t have any personal experience with DDT, but your anecdotal evidence hasn’t served to change my mind, since everything you’ve mentioned is about harm to animals (which is insignificant compared to the harm that malaria poses to humans) and the perceived future issues with food/water contamination that have no basis in the most recent and scientifically serious studies.