KHANH HOA PROVINCE, Vietnam » When patients at the government-run health clinic in Ninh Tho used to complain about waiting too long to see a doctor or nurse, the staff would just ignore them, manager Pham Thi Thanh Can said.
"Before the (customer service) training, we didn’t care about that. They (patients) go home," she said. "Before, we didn’t have to keep the client."
These days, Pham said, she apologizes to patients and tries to find out what happened.
The change in attitude is due to a pilot project in "social franchising" in commune health stations in Khanh Hoa and Da Nang provinces. The project combines free-market principles with the communist government health care system.
University of Hawaii business professor Dana Alden was a consultant on the project with Marie Stopes International and the Atlantic Philanthropies, a charity started by Duty Free Shoppers co-founder Charles Feeney.
"The commune health services were perceived to be cheap and low-quality," said Dr. Le Nhan Phuong, the Vietnam country representative for the Atlantic Philanthropies.
Phuong, a Vietnamese-American doctor working in Vietnam, said people were bypassing the commune health stations — the primary source of health care in Vietnam, especially for the rural poor — and going directly to hospitals or private clinics.
"If no one’s coming to the clinics because of perceived poor quality, the resources going to the clinics are also decreased, therefore the services become worse year after year. You have to break the cycle at some point," he said.
So as part of a multimillion-dollar renovation and upgrade of commune health stations in two provinces, the Atlantic Philanthropies funded the experiment in social franchising.
Marie Stopes International created a women’s health care franchise in some of the government clinics using the same principles of branding, training, quality control and marketing that business franchises like McDonald’s and KFC use.
Alden and MSI hired marketing consultants, and using focus groups came up with a brand: "Tinh Chi Em," which means "sisterhood." The brand promises high-quality service, privacy and a caring attitude. The clinics also began advertising and charging higher fees.
"There’s just tons of research that shows if you’re giving something away, it’s not valued," Alden said.
"We didn’t know if it would work or not," said Nguyen Thi Bich Hang, the MSI country representative. "It’s not something you can change overnight."
But five years later, the program appears to be a success and has expanded to three more provinces in Vietnam.
At the Nich Binh clinic, about an hour’s drive from the coastal resort of Nha Trang, staff said patient visits are up about 50 percent since they adopted the Tinh Chi Em franchise.
"We even attract clients from other communes," said clinic manager Le Thi A Ly.
"We are like sisters," said Nguyen Thi Huong, a 51-year-old homemaker who lives in a nearby village. "I can talk and if I have some woman problems, they can tell me about prevention and treatment."
Posters with the Tinh Chi Em logo, a pink heart surrounded by silhouettes of three women holding hands in a circle, let patients know about the services available and provide health information. Brightly colored brochures about AIDS prevention, childbirth, birth control and other women’s health issues are also given out to those who need information.
MSI is an international organization similar to Planned Parenthood in the United States, but the government clinics offer a full range of services, including childbirth and cancer testing.
Patient Nguyen Thi Kim Hoan, a 33-year-old beautician, said she doesn’t mind paying more because the clinic is cleaner and the health workers pay attention to her needs.
"The price is a little bit higher, but it doesn’t matter because the service is better and it’s much cheaper than the hospital," she said.
The extra income is used to buy better equipment and services to help maintain quality, and to provide incentives to staff.
A short distance away at the Ninh Tho clinic, where water buffalo graze in nearby rice paddies, Pham said the number of patient visits has more than doubled since they started the Tinh Chi Em service, from about 170 to 300 visits a month to 600 to 700 a month, and the staff now makes more money.
Before getting training on customer service, marketing and clinical skills, the staff thought they were better than the patients, Pham said.
"After training, most of the staff changed their mind and focused on the client. They understand they need the client," she said. "If more clients come to the clinic, staff income will increase."
The Tinh Chi Em franchises were in 10 clinics in Da Nang province and 23 clinics in Khanh Hoa.
Two clinics in Khanh Hoa, which did not meet standards, were stripped of the franchise — an indication, Alden said, that the clinics and managers are serious about maintaining the quality and the reputation of the Tinh Chi Em brand.
It’s the first time social franchising was used in public health care in Vietnam, Alden said, and there were some problems. Some government officials were reluctant to charge fees in the clinics and it was difficult to establish a consistent fee schedule.
But for the most part, patients seem happier with the service and the staff feels like they are doing a better job.
"People get the brand. They get the promise. They have by and large been happy with the quality," Alden said.
The program, Alden said, is a model not just for Vietnam, but other countries.
"I think there’s a lesson to be learned for may of us," Phuong said. "Even government clinics in the United States."