SANGINI FRANCHISING NETWORK
In 1994, CRS was the first organization in the world to provide the three monthly ‘Sangini’ DMPA through the private medical network. Sangini is a fractional social franchising network that introduced FP/RH/MCH services through private pharmacies. Prior to Sangini, DMPA was available in Nepal only through public sector clinics and hospitals. Since 2010, with the support of the USAID supported GGMS project, the network has been expanding and increasing the accessibility and availability of DMPA, and other FP/MCH commodities and services in all 75 districts of Nepal.
The goal of the program is to increase awareness of DMPA as an effective and safe method and increase access to and use of DMPA through the private health sector by training the private pharmacists that include Health Assistants (HA), Staff Nurse, Auxiliary Nurse Midwives (ANM) and Community Medical Assistants (CMA) and enrolling them into a network of clinics that provide FP contraceptive methods. These are paramedics certified by GoN eligible for receiving training on DMPA.
The major objectives of Sangini network are:
• To increase the demand, access and availability of Sangini through social franchising.
• Empower women to make informed choice on the family planning methods through qualified and certified network of service providers.
• To leverage the GoN’s efforts in increasing the accessibility and availability of injectable by making it available through the private sector.
• Contribute to the health equity by shifting users who can afford services at social franchises, thereby freeing up public sector resources for use by those who need it most.
• To provide quality family planning services with a focus on Sangini.
KEY COMPONENTS OF SANGINI NETWORK
The Sangini network is a partial franchising model that operates through pre-existing medical outlets. The medical outlets are certified to administer Sangini, once they have attended the three days basic training on Sangini. CRS periodically monitors the quality of these outlets through Quality Assurance Officers (QAOs).
A. Capacity Building of Providers
Given that the 3-monthly injectable contraceptive, DMPA, was relatively new and had low use in Nepal, prior to mid-90s, due to lack of awareness and confidence among the providers, a key need was to inform the providers a about this method. The Sangini providers are paramedics who undergo the basic and refresher trainings on Sangini. These trainings are conducted by National Fertility Care Center (NFCC), a not for profit, nongovernmental organization that provide standardize reproductive health services across Nepal as well as support GoN by training government and non-governmental health personnel with skills necessary for efficient and effective health service delivery.
Sangini Basic and Refresher trainings emphasize on following correct technique and timing of administering the injectable contraceptive while following infection prevention, management of common side effects, and effective counseling of clients on FP was some of the points that are stressed upon during these training sessions.
B. Monitoring of Quality Assurance
CRS brands the Sangini outlets to ensure a certain quality standard. To be part of the Sangini network, providers are required to adhere to strict guidelines for screening and counseling clients, safe injection practices and safe waste disposal, stocking of injectable contraceptives and should be willing to be monitored by the program. CRS appointed QAOs are responsible for monitoring the quality of care at Sangini outlets. QAOs conduct regular technical support visits to collect relevant service delivery information and provide on the spot technical support visit. QAOs during the visits mark the status of the outlets using a preset checklist and verify conformity to standards. On the basis of the result, outlets are further classified into different classes: excellent, good, and needs improvement. Apart from this, CRS with technical assistance also conducts Mystery Client Survey to identify the percentage of Sangini outlets that meet minimum quality standards.
C. Demand Generation Activities
To increase demand for family planning services including DMPA, CRS conducts multiple activities: Women’s Group Meetings targeting women of reproductive age. CRS reaches approximately 3500 women every year through these meetings; targeted mass media campaigns including airing radio jingles in various radio stations, TV adverts, and print adverts in leading newspapers/ magazines. CRS also sponsors a Dial a Doc (Dial a Doctor) program in various radio stations, in which a medical doctor is invited to answers the queries put by the callers.
D. Increasing Availability (Supply Side Mechanism)
CRS uses commercial trade channels to supply Sangini at subsidized prices to the outlets. CRS sales staff also conducts routine follow-up visits to ensure product availability at all Sangini outlets. CRS has a fleet of 31 medical distributors located at the major hubs of the country, which are the primary component of CRS distribution channel. Around 80% of the sales are routed through commercial supply chain i.e. from distributors to wholesalers to Sangini outlets whereas 20% of the sales are directly done by CRS field staffs.