A Quasi-Experimental Study to Assess the Performance of a Reproductive Health Franchise in Nepal

Sohail Agha, Tulane University
Ali M. Karim, John Snow, Inc.
Asma Balal, Commercial Market Strategies
Steve Sosler, Tulane University

Objective: To assess the performance of a nurse and paramedic franchise that was established to increase client satisfaction and utilization of reproductive health services. Methods: A quasi-experimental study design, with baseline and follow-up measurements on nonequivalent control groups, was used. Client exit interviews, provider interviews and household interviews were administered. Multi-level random effect models were used to estimate clinic/cluster level variances. Results: Client satisfaction and loyalty increased at intervention but not at control clinics. The increase in client loyalty was, in part, explained by the increase in client satisfaction. At the population level, we did not find consistent increases in utilization of various reproductive health services, possibly because a) providers were not proactive in informing clients about the reproductive health services being offered b) mass media activities had limited impact c) the intervention was implemented for too short a period of time to have had a measurable impact.