Article Text

The impact of a novel franchise clinic network on access to medicines and vaccinations in Kenya: a cross-sectional study
  1. Justin Berk1,
  2. 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}


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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.