BMJ Open 2:e000589 doi:10.1136/bmjopen-2011-000589
  • Global health
    • Research

The impact of a novel franchise clinic network on access to medicines and vaccinations in Kenya: a cross-sectional study

  1. Achyuta Adhvaryu2
  1. 1School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
  2. 2Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Justin Berk; justin.berk{at}
  • Received 8 February 2012
  • Accepted 6 June 2012
  • Published 10 July 2012


Objectives To study the impact of a new franchise health clinic model (The HealthStore Foundation's CFWShops) on access to vaccinations and treatment for acute illnesses in a nationally representative sample of children in Kenya.

Design The authors used multivariate linear and count regressions to examine associations between receipt of vaccinations or treatment and proximity to a franchise health clinic, adjusting for individual, household and clinic attributes as well as region fixed effects.

Setting Demographic and Health Survey data from Kenya, 2008–2009.

Participants 6079 Kenyan children younger than 5 years, of whom 2310 reported recent acute illness.

Main outcome measures Outcomes for all children were number of polio doses received, number of DPT doses received, receipt of BCG vaccine, receipt of measles vaccine and number of total vaccinations received. Outcomes for acutely ill children were receipt of any medical treatment, treatment for fever, treatment for malaria and treatments specifically stocked by CFWShops.

Results Children living within 30 km of a CFWShop received 0.129 (p=0.017) and 0.113 (p=0.025) more DPT and polio doses, respectively; and 0.285 more total vaccinations (p=0.023). Among acutely ill children, CFWShop proximity was associated with significant increases in the probabilities of receiving any medical treatment (0.142; p<0.001), treatment for fever (0.117; p=0.007) and treatments specifically stocked by CFWShops (0.064; p=0.015). Use of CFWShop services was not significantly different for lower-income vis-a-vis higher-income households.

Conclusions The franchise health clinic model could substantially increase access to essential vaccinations and treatments in low-income countries. Moreover, the model's benefits may accrue to lesser- and higher-income households alike.


  • To cite: Berk J, Adhvaryu A. The impact of a novel franchise clinic network on access to medicines and vaccinations in Kenya: a cross-sectional study. BMJ Open 2012;2:e000589. doi:10.1136/bmjopen-2011-000589

  • Contributors Both authors (JB and AA) made substantial contributions to the conception, design, data acquisition and analysis of the study. Both authors contributed equally to the writing, revising and approval of the final version of the paper.

  • Funding AA gratefully acknowledges funding from the MacMillan Center at Yale and from his NIH/NICHD Career Development Award (1K01HD071949-01).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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