|
 |
Colombia's experience with its Health Sector Reform (HSR) of the 1990's is widely believed to be one of the success stories of health services reform, particularly in terms of ensuring access to family planning and reproductive health services. The objective of this USAID-funded study is to document, disseminate and share lessons learned from the experience of PROFAMILIA, a Colombian NGO provider of sexual and reproductive health (SRH) services in the context of that reform.
The NGO sector is vastly important for the provision of sustainable high quality reproductive health services. Equally vast are the adaptations required of NGOs in order to operate in a modern health services reform environment. Because of this, USAID has requested that CATALYST document 1) the steps and activities taken by PROFAMILIA to ensure that FP/RH was included in the HSR agenda in Colombia, 2) the impact of the HSR on Colombia, and 3) the internal changes that were necessary for PROFAMILIA's survival in the new competitive environment that emerged after the implementation of the HSR. The full report will be available in Spanish on the web. In addition, an executive summary is available in both Spanish and English.
The prestige and image that PROFAMILIA has built during its 37 years of existence has without a doubt helped the organization to survive in the HSR context. PROFAMILIA advised the Ministry of Health to incorporate family planning and reproductive health into the health package offered to Colombians. The educational and community work that PROFAMILIA carried out prior to the HSR proved to be an excellent marketing strategy for the institution and its products. Furthermore, PROFAMILIA has always been managed as a business-services and products were from the beginning only partially subsidized, clients were always asked to contribute and nothing was handed out free of charge.
In 1993, Law 100 was promulgated in Columbia, guaranteeing the universal coverage of health services for all Columbians. In order to prepare for the new competitive environment of the HSR context and to strengthen its position in the market, PROFAMILIA created a group to study Law 100, trained its staff in the new legislation and initiated an administrative restructuring. A market study was conducted to better understand how PROFAMILIA was perceived by its clientele. In addition, PROFAMILIA invested in the infrastructure of its clinics as well as in its management information system.
PROFAMILIA thrived in the HSR context by replacing international donations with local income through services contracts with various governmental and non-governmental institutions. However, PROFAMILIA had to learn how to manage a new financial risk since payments from contractors were not always expedient. Accounting structures had to be changed accordingly, and a billing department created to process invoices to contractors and collect payments. In addition, PROFAMILIA had to learn how to market its services to insurance companies, municipal and departmental governments. A division for Sales of Services was established within the social marketing department to serve that function.
PROFAMILIA was able to compete both on price and quality and thus retained its clientele. Prices were kept low by reducing costs through a 20% reduction of personnel. In addition, PROFAMILIA constantly monitors the costs of its products and services in order to adjust prices and/or subsidies. If PROFAMILIA had not developed alternative sources of income, operations would have had to be reduced by approximately 38% once USAID phased out. The diversification of services represents not only financial stability but also the most important method of replacing discontinued external donations. In addition, diversified services generate a surplus that cross-subsidizes family planning services.
|
 |
