"Grouping existing providers under a franchised brand, supported by training, advertising, and supplies, is a potentially important way of improving access and assuring quality to some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper first describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health related social franchises in developing countries. Subsequent chapters evaluate the accuracy of the model and describe the motivation and behavior of franchise clients, potential clients, and franchise member providers. The data used comes from surveys of four franchises conducted in Kenya, Pakistan and India between May 2000 and August 2001. The surveys sampled providers, family planning clients, and within one kilometer of the selected franchise clinics. Findings have implications for social franchise operations. Assuring technical quality is the most important franchise activity, with the greatest potential to provide value to clients. While this is of greatest importance to clients receiving invasive clinical services, our data shows that all clients and indeed all women in the communities where franchises are active, value provider skill above all other attributes. However, they are unable to judge the technical quality of services they receive. Insofar as franchise organizations are able to both increase provider technical quality, and communicate that assurance of skill level to all potential clients, they will have a significant positive impact on the transaction costs of clients seeking care. The chief motivational benefit offered to providers, by the franchise organizations, are training in all cases, and increased client load in well established franchises. Implications for future franchise development, expansion, and improvement are discussed."