Health Plus Social Franchising Analysis

+ Savings and capital build-up among the organized poor.

- Economically disadvantaged majority

+ NPF’s present social franchising technology is the result of the DOH and years of learning lessons from "foreign experts" in evolving a delivery system of medicines to the poor. The franchise package includes revolving stock, monitoring, computerized accounting systems and training programs.

+ Government people are experienced in tri-partite program implementation, so are relatively easier to work with, reasonable, transparent and accountable in joint programs.

+ PEF committed to support the project’s institutional and client development, and willing to provide leverage for AFON to advance. 

- Local DOH-BFAD and RHUs are not so aware / convinced of the NPF being a serious national government health program. 

+ Elongated seacoast (marine resources) to the west, and the Madya-as Mountain range (forest resources) to the east.

+ Not along the typhoon path, not vulnerable to natural disasters

- More than half of land area not suitable for agriculture because of the steep slope and serious erosion problem

- Denuded forests

- Dwindling marine resources due to illegal fishing and over-fishing

+ People organizations and processes. Network of primary coops, people organizations, self-help groups, coalitions and alliances in the province with well-established by-laws, policies and systems. Many potential owning organizations that can manage and operate a Health Plus Outlet retail franchise.

+ Area coverage, dispersal and years in existence. AFON is present in all the eighteen municipalities so there is no need to establish a new group to reach out to far-flung places. Most of these organizations have existed for over a decade. AFON has almost twenty years of experience working as a network with heterogeneous interests but finding ways to work as one.

+ Economic structures and processes. Multi-purpose coops are a significant economic force in some municipalities operating a credit union, consumers’ store, cable TV and other services.

+ Enabling laws and enforcement of laws. The Law on Generic Drugs and the Botika ng Barangay (BnB) law promote generics and the establishment of community pharmacy outlets that will make medicines affordable and accessible to the poor. DOH-BFAD monitors distribution of drugs, maintains standards.

+ Governance. Existence of Provincial Development Council, Municipal Development Council where AFON is represented; existence of Barangay Development Councils, but not in all barangays + 

- Devolved health department has cut down resources for public health services including hospital care, free medicines, and other health services.

- Problematic financial sustainability of AFON secretariat operations; some NGO and PO organizations are oriented more towards advocacy rather than economics

+ Resourceful and influential AFON executive director. He works late hours, constantly looks for solutions to problems along the way, and thinks about future possibilities. + General competence and professionalism of AFON affiliates in managing service-oriented businesses particularly in running successful cooperatives

+ Presence of personnel in barangay RHUs: doctors, barangay health workers (BHW) and barangay nutrition scholars (BNS)

- Half the population of Antique live below the poverty line;

- Provincial health status indicators below national average; prevalence of preventable diseases;

- Some of AFON people organizations are not business-oriented/enterprising, more inclined to advocacy work;

- BHWs and BNS who will be tapped as HPO operators have limited backgrounds in selling, recording or preparing financial statements.

- Some medical personnel are also into the pharmaceuticals business and views HPOs as competitors.

+ AFON and their member organizations on the ground have harmonious relationships with the LGU’s established through the years either as professional partners or as personal friends.

+ Tradition of "cooperativism" – a profitable business owned, operated and serving its members. Major businesses are operated by cooperatives – consumers’ store, credit coops, cable TV, etc.

+ "Captured market" – AFON has many individual members who can patronize Health Plus outlets

- "Branded is better than generics" mentality among the general populace and some RHU personnel.

- Negative attitude of people to Botika ng Barangay (BnB); failure of original government program so that many regard HPOs as no different from the BnBs of some years back.

+ Paved highways, roads and bridges connecting all Antique municipalities to Iloilo in the south and Aklan in the north; affordable fares – bus, jeeps, tricycles and V-Hires; available public transportation

+ Electricity available in all the municipalities

+ Buildings (RHU) and coop offices that can offer space for the Health Plus Outlet

- Rough farm to market roads, barangay roads

• Network of community-based organizations affiliated with AFON willing to invest, own and operate an HPO;
• Law on Generic Drugs and Administrative Order on Botika ng Barangay;

• Harmonious relationships between LGUs and community-based organizations stemming from years of working together;

• PEF grant;
• NPF social franchising technology;
• LGU / DOH;

• Enterprising capable and dedicated leader / executive director;
• Presence of BHWs and BNS who could operate HPOs;

• Resistance from some MHO to prescribe generic drugs

• "Branded is better than generics" mentality

• Together with NPF Director (stakeholder capital) convinced the AFON Board to invest in the Health Plus franchise (stakeholder capital);
• With the support of AFON Board (stakeholder capital) convinced AFON affiliate members to become owning organizations (structural capital);
• Convinced LGU officials and MHOs (stakeholder and social capital);
• Accessed funds from PEF (stakeholder and financial capital);Hired qualified and dedicated staff (human capital)

Processing of licenses (structural capital)

• BFAD licensing of HPOs as Botika ng Barangay;

System installation and capacity building facilitated by NPF (stakeholder capital)

• Training of operators (human capital);
• Installation of financial accounting software (structural capital) and training of staff (human capital);

Monitoring and evaluation system (structural capital)

• Facilitated by NPF (stakeholder capital);
• Facilitated by PEF (stakeholder capital);

Promotions/advocacy of generics (cultural and human capital)
 

• Accessibility of safe low-priced medicines with one’s neighborhood, no more need to ride or walk far distances;
• Social franchising technology;
• Collaboration between civil society and GO strengthened;
• AFON provincial franchise gained a good reputation and goodwill among social franchisees;
• Accreditation of AFON in the provincial and in almost all municipalities in the LGU’s procurement / bidding process for medicines;

• Reduced medicine costs;
• Savings at the household level estimated at the 50%  level, at least;
• Provided increased income (employment) to forty-three HPO operators;
• Improved financial sustainability of AFON secretariat;
• Owning organizations earned a little additional income: 30% of net income from HPOs; 

• Owning organizations strengthened / had a consolidating effect on their organizations because of the health service to its members.

• Poor within catchment area can buy cheap over-the-counter medicines
• New knowledge and skills on generics, HPO operations;
• Presumably better health as a result of accessible essential medicines;

• Forty-three HPOs each serving a catchment area of 5000 people or covering 215,000 or almost half the population in Antique;
• One self-sustaining provincial franchise;