Transcript The CATALYST Consortium

The CATALYST Consortium
PROFAMILIA/COLOMBIA AND
THE HEALTH SECTOR REFORM
IN COLOMBIA
María Isabel Plata
PROFAMILIA - COLOMBIA
JULY 16, 2003
PROFAMILIA
The Case Study
The case study was made possible
with funding from USAID as a part
of the CATALYST Consortium
South-to-South Program.
PROFAMILIA
Purpose of the Case Study
1. Document the success of PROFAMILIA in
providing SRH services to low income
populations during the health sector
reform
2. Share lessons learned and best practices
with other NGOs and donors working in
the context of health sector reform in
other regions
PROFAMILIA
Methodology
Semi structured interviews with key
external actors
Semi structured interviews with staff
Client Profile Surveys (CPS)
Assessment and participatory strategic
design workshop with technical and
management staff
Review of documents
PROFAMILIA
In the Preparatory Stages of the
Health Sector Reform
PROFAMILIA:
Conducted a study tour in Chile to evaluate
what impact the health reform could have on
its mission
Knew when and how to opportunely influence
the health reform to institutionalize SRH as a
human right:
supported an article in the 1991
Constitution
advised the MOH on the regulation of Law
100
PROFAMILIA
In the Preparatory Stages of the Health
Sector Reform
PROFAMILIA:
Created a group to study Law 100
Conducted trainings to educate its staff
about implications of Law 100
With funding from USAID Transition
project (1992-1996), strengthened the
MIS, invested in hardware and software,
and upgraded clinic infrastructures
PROFAMILIA
During the Health Sector Reform
PROFAMILIA:
Improved skills in marketing, sales,
contracting, invoicing and billing
Budgeted for working capital to cover
operational expenses in case of
temporary deficit
Learned how to market services to the
insurance companies and municipal and
departmental governments
PROFAMILIA
During the Health Sector Reform
PROFAMILIA restructured its managerial
and administrative functions:
Decentralization of functions
Creation of new managerial substructures
to plan, manage, monitor and evaluate
programs
Administration and Finance Departments
split and decentralized
Creation of the Service Marketing Direction
Creation of the Public Relation Direction
PROFAMILIA
During the Health Sector Reform
Creation and decentralization of the SRH
Services Direction
Health managers with hospital
administration degrees were hired to lead
the clinics
Staff size reduced by 20%
PROFAMILIA
During the Health Sector Reform
Developed a quality assurance
control system to sell services to
better informed and more
demanding clients
PROFAMILIA
During the Health Sector Reform
PROFAMILIA conducted a market study to:
understand PROFAMILIA’s position in the
new market environment with public and
private Service Provider Institutions (IPS)
and Insurance Administrators(EPS)
understand how it was recognized as a
service provider institution
PROFAMILIA
Lessons Learned for Replication
by other NGOs Working in the
Context of Health Sector Reform
Lessons Learned in Programmatic
Matters
Specialization in FP positioned
PROFAMILIA in the communities
where these services were needed
Gradual introduction of SRH services
provided PROFAMILIA with the
opportunity to adapt to the changes
in the health care market
PROFAMILIA
Lessons Learned in Financial Matters
PROFAMILIA developed alternative
sources of income
Social security reform made it possible
for PROFAMILIA to sell FP products and
services at a profitable price
SRH services and products generate the
highest source of income and have
compensated for the decrease in
international donations
PROFAMILIA
Lessons Learned in Financial Matters
Health sector reform forced PROFAMILIA
to use its infrastructures and
technological and human resources more
efficiently and to generate income from
local donations and non-operational
funds
PROFAMILIA had to strengthen its
institutional capacity by investing in its
infrastructure and medical equipment
PROFAMILIA
What has been the Impact on
PROFAMILIA’s Clients?
PROFAMILIA Service Users
Socioeconomic Characteristics
CPS 95
CPS 02
2.3
3.4
% DIF. CPS
02-95
+ 47.8
65.4
73.8
+ 2.8
CRITICAL LEVEL OF
OVERCROWDING
2.4
4.0
+66.7
HOUSEHOLDS WITH
PRECARIOUS FLOOR
MATERIALS
3.8
5.2
+36.8
27.2
28.7
+5.5
USER SPOUSE
UNEMPLOYED
HOUSEHOLDS
WITH < 4
MINIMUM WAGE
SALARIES
HOUSEHOLDS
WITH UNMET
BASIC NEEDS
Source: PROFAMILIA Client Profile Surveys, 1995 and 2002
PROFAMILIA
Impact on Client Profile
Working to achieve sustainability
does not conflict with PROFAMILIA’s
mission. PROFAMILIA has
demonstrated that it is possible to
continue to serve the low income
populations.
PROFAMILIA
Best Practices
PROFAMILIA always considered itself
a business:
Developed strategies to become selfsufficient
General policy: No free services or
products. Use of partial subsidies for
services and products
PROFAMILIA
Best Practices
The educational and community
work PROFAMILIA conducted prior
to the health sector reform was one
of its best marketing strategies
PROFAMILIA
Best Practices
Building partnerships has helped
PROFAMILIA achieve programmatic
and financial sustainability:
Public sector with health institutions funded
by MOH
Private commercial sector through corporate
social responsibility activities
Local NGOs (clinical and non-clinical),
community leaders, schools
International donors (USAID, IPPF)
PROFAMILIA
Best Practices
PROFAMILIA’s political neutrality has
been an important factor to position
itself successfully in the changing
environment
PROFAMILIA
Conclusion
Specialization in FP and
diversification of SRH services have
enabled PROFAMILIA to compete and
adapt to changing market conditions
PROFAMILIA