SLIDE 1 Efficiency of the BlueStar Social Franchise network and prospect of investment in reproductive health private clinics in Viet Nam Marie Stopes International in Viet Nam Cebu, Oct 22-24, 2014, Cebu, Philippines

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 2 Content 4 Viet Nam – Health Context MSIVN overview BlueStar Social Franchise Model – Highlights and Lowlights Challenges The way forward

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 3 Viet Nam – Health context  90 million people, 24.3 million women of RH age (27%); 40.9% under 25  Health Insurance coverage: 65% (2013). FP is not covered.  CPR modern method 76.2% amongst married women. High unmet need for modern contraceptives amongst youth under 24  High abortion rate (average per woman/lifetime). Around 30% amongst young women under 20.  Rapid growth of private health sector: >35,000 private clinics/hospitals serving about 48 million client visits per year (JAHR-2012) accounting for 32% of the health service market.  Private sector contributes only 14% of FP services (USAID 2010) Sources: Population Changes and Family Planning Survey 2012; Joint Annual Health Review 2013; *Goodkind D, Abortion rate in Vietnam: Measurements, puzzles and concerns

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 4 BlueStar Social Franchise Model Organization: Marie Stopes International in Vietnam Year of beginning: 2008 Network of 300 SFs. First tier: 150 Ob/Gyn, 70 GPs; Second tier: 80 Midwives Franchised services: FP and safe abortion, Essential RH services as add-on Locations: Urban/peri-urban areas Target clients: low income women Key support: standardization, training/certifying & accreditation; quality control; brand promotion/demand generation; SRH commodities supply; linkage with public health sector for support.

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 5 BlueStar Social Franchise Model mobile trips targeting at low income women 2.Offered free essential RH/FP services to about 160,000 factory workers 3.Introduced 5 Voucher schemes, serving 63,000 MA and IUD clients 1.Served more than 4.1 million client visits between 2008 – Provided FP services to more than 1.3 million clients 3.Offered CAC to 660,000 clients 1.Develop financial sustainable social franchise model Cost sharing Cost reduction Government contributions 2.Central purchase of high quality products at discounted price 1.More than 2500 service providers trained and certified on various RH/FP services; 1,500 participants attended advanced clinical seminar via BlueStar club 2.External QTA scores increased from 76% in 2011 to 85% in Infection prevention increased from 45% to 88% 3.Client satisfaction: 75% to 93% Objectives & key achieveme nts 1. Increase access 2. Improve service quality 3. Increase equitable access 4. Increase cost effectiveness

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 6 Strengths: Low cost per CYP: less than USD2/CYP compared to MSI average of USD7/CYP Good productivity: over 120 CYPs/franchisee/month compared to MSI global average of 110 Quality improvement:  From under QTA 50 baseline to over QTA 90  CS score: from 86% to 95% Reaching under 25 year old youth (30% of client visits in 2013) Strong professional network – BlueStar club BlueStar Vietnam

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 7 BlueStar Vietnam Why is the BlueStar Vietnam model efficient? Strong focus on sustainability at the core of our strategy Government contributions Quality control: joint monitoring and evaluation with the government Social marketing sales Increasing cost-sharing approach with franchisees

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 8 Challenges Sustaining private sector social franchising model beyond donor funding is a big challenge. Provider behavior change: from willingness to participate in BlueStar – willingness to invest in BlueStar. Takes time. Post abortion family planning: Providers’ behaviour change (it may influence incomes?) Government policies Baseline

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 9 Lesson learnt and the way forward Our response will no longer be general; but targeted Sustain the quality control intervention Diversify the services/products provided at BlueStar network Financial sustainability of BlueStar model through: Cost reduction and cost sharing Diversify/generate income sources: membership fees, SMPs Advocate for policy change to extend the scope of services for 2 nd tier providers - midwives

EFFICIENCY OF THE BLUESTAR SOCIAL FRANCHISE NETWORK AND PROSPECT OF INVESTMENT IN REPRODUCTIVE HEALTH PRIVATE CLINICS IN VIETNAM SLIDE 10 Thank You Marie Stopes International in Viet Nam BlueStar Viet Nam