PROFAMILIA The CATALYST Consortium PROFAMILIA/COLOMBIA AND THE HEALTH SECTOR REFORM IN COLOMBIA María Isabel Plata PROFAMILIA - COLOMBIA JULY 16, 2003

PROFAMILIPROFAMILIAA

The CATALYST Consortium

PROFAMILIA/COLOMBIA AND THE HEALTH SECTOR REFORM IN COLOMBIA

María Isabel PlataPROFAMILIA - COLOMBIA

JULY 16, 2003


The Case Study

The case study was made possible with funding from USAID as a part of the CATALYST Consortium South-to-South Program.


Purpose of the Case StudyPurpose 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


Semi structured interviews with key external actorsSemi structured interviews with staffClient Profile Surveys (CPS)Assessment and participatory strategic design workshop with technical and management staffReview of documents

Methodology


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 Constitutionadvised the MOH on the regulation of Law 100


In the Preparatory Stages of the Health Sector Reform

PROFAMILIA: Created a group to study Law 100Conducted trainings to educate its staff about implications of Law 100With funding from USAID Transition project (1992-1996), strengthened the MIS, invested in hardware and software, and upgraded clinic infrastructures


During the Health Sector Reform

PROFAMILIA:Improved skills in marketing, sales, contracting, invoicing and billingBudgeted 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 restructured its managerial and administrative functions:

Decentralization of functionsCreation of new managerial substructures to plan, manage, monitor and evaluate programsAdministration and Finance Departments split and decentralizedCreation of the Service Marketing Direction Creation of the Public Relation Direction



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%



Developed a quality assurance control system to sell services to better informed and more demanding clients



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

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 neededGradual introduction of SRH services provided PROFAMILIA with the opportunity to adapt to the changes in the health care market


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 priceSRH services and products generate the highest source of income and have compensated for the decrease in international donations


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

What has been the Impact on PROFAMILIA’s Clients?


PROFAMILIA Service Users Socioeconomic Characteristics

USER SPOUSE UNEMPLOYED

HOUSEHOLDS WITH < 4 MINIMUM WAGE SALARIES

CRITICAL LEVEL OF OVERCROWDING

HOUSEHOLDS WITH PRECARIOUS FLOOR MATERIALS

HOUSEHOLDS WITH UNMET BASIC NEEDS

CPS 95 CPS 02

2.3 3.4 + 47.8

65.4 73.8 + 2.8

% DIF. CPS02-95

2.4 4.0 +66.7

3.8 5.2 +36.8

27.2 28.7 +5.5

Source: PROFAMILIA Client Profile Surveys, 1995 and 2002


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.


Best Practices

PROFAMILIA always considered itself a business:

Developed strategies to become self-sufficientGeneral policy: No free services or products. Use of partial subsidies for services and products


Best Practices

The educational and community work PROFAMILIA conducted prior to the health sector reform was one of its best marketing strategies


Best Practices

Building partnerships has helped PROFAMILIA achieve programmatic and financial sustainability:

Public sector with health institutions funded by MOHPrivate commercial sector through corporate social responsibility activitiesLocal NGOs (clinical and non-clinical), community leaders, schoolsInternational donors (USAID, IPPF)


Best Practices

PROFAMILIA’s political neutrality has been an important factor to position itself successfully in the changing environment


Conclusion

Specialization in FP and diversification of SRH services have enabled PROFAMILIA to compete and adapt to changing market conditions

Documents

PROFAMILIA The CATALYST Consortium PROFAMILIA/COLOMBIA AND THE HEALTH SECTOR REFORM IN COLOMBIA María Isabel Plata PROFAMILIA - COLOMBIA JULY 16, 2003