Manoj Mohanan (Duke), Grant Miller (Stanford), Marcos Vera-Hernández (UCL), Jeremy Goldhaber-Fiebert (Stanford)
[Funding: Bill and Melinda Gates Foundation OPP1025880]


In 2011, World Health Partners (WHP) launched a large social franchising program of healthcare delivery in Bihar, India, with funding from the Bill and Melinda Gates Foundation (BMGF). The WHP project was considered particularly innovative in integrating a social franchising delivery model with a telemedicine platform. Although social franchising models of delivery are becoming increasingly common, to our knowledge, none of these efforts has been rigorously evaluated.

COHESIVE-India has been conducting an evaluation of the BMGF-financed WHP project. The overarching focus of the evaluation project (called Bihar Evaluation of Social Franchising and Telemedicine (BEST)) is to provide evidence on the performance and effectiveness of the WHP program. In addition to studying the overall impact and effectiveness of the social franchising and telemedicine program, the evaluation will estimate how the WHP model influences outcomes related to two target diseases of interest to BMGF: childhood diarrhea and childhood pneumonia.

SkyHealth Center. Photo by Margaret Pendzich

The core objective of the evaluation is to estimate the causal impact of the WHP program on BMGF target disease outcomes (diarrhea and pneumonia among children less than five years of age), quality of care (provider knowledge and effort) as well as other indicators of its primary health care success. The key design feature of the evaluation is that it relies on the franchisee network model of the WHP program. 

This evaluation is closely aligned with the objectives of the Government of Bihar to reduce the burden of disease. Through a rigorous evaluation of the WHP program, this study will provide evidence on whether this model of rural health service delivery is efficient and whether it can be scaled up. The stated goals of the WHP program indicate the many potential health and economic benefits to the people of Bihar. The evaluation will provide an empirical and objective assessment of the impact of WHP's effort on quality of care available in rural areas (the program anticipates a significant improvement), increases in access to healthcare providers and improved drug supply, reductions in time lapse between onset of disease and optimal care, as well as reductions in unnecessary healthcare expenditures.


Effect Of A Large-Scale Social Franchising and Telemedicine Program on Childhood Diarrhea and Pneumonia Outcomes in India. Health Affairs (2016); 35, no. 10: 1800-1809

  • Manoj Mohanan, Kimberly Singer Babiarz, Grant Miller, Jeremy Goldhaber-Fiebert, and Marcos Vera-Hernández

​Effect of Social Franchising and Telemedicine Based Model of Delivery of Healthcare on Provider Knowledge and Quality of Care in Bihar, India. Under Review

  • Manoj Mohanan, Soledad Giardili, Veena Das, Tracy Rabin, Sunil Raj, Jeremy Schwartz, Aparna Seth, Grant Miller, Jeremy Goldhaber-Fiebert, and Marcos Vera-Hernández


Tuberculosis treatment discontinuation and symptom persistence: an observational study of Bihar, India's public care system covering >100,000,000 inhabitants. BMC Public Health (2014); 14:418

  • Kimberkly Babiarz, Sze-chuan Suen, and Jeremy Goldhaber-Fiebert


The Know-Do Gap in Quality of Health Care for Childhood Diarrhea and Pneumonia in Rural India. JAMA Pediatrics (2015)​; 169(4): 349-357

  • Manoj Mohanan, Marcos Vera-Hernández, Veena Das, Soledad Giardili, Jeremy Goldhaber-Fiebert, Tracy Rabin, Sunil Raj, Jeremy Schwartz, and Aparna Seth

Supplemental Content @ JAMA Pediatrics​  

Dataset, Do-files, Data Collection Instruments, & Drug List