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

2. 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.

3. 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

4. PROFAMILIA 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 Methodology

5. 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

6. 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

7. 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

8. 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

9. 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%

10. PROFAMILIA During the Health Sector Reform Developed a quality assurance control system to sell services to better informed and more demanding clients

11. 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

12. Lessons Learned for Replication by other NGOs Working in the Context of Health Sector Reform

13. PROFAMILIA 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

14. 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

15. 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

16. What has been the Impact on PROFAMILIA’s Clients?

17. PROFAMILIA 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 95CPS 02 2.33.4 + 47.8 65.473.8 + 2.8 % DIF. CPS 02-95 2.44.0+66.7 3.85.2+36.8 27.228.7+5.5 Source: PROFAMILIA Client Profile Surveys, 1995 and 2002

18. 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.

19. PROFAMILIA Best Practices PROFAMILIA always considered itself a business: Developed strategies to become self- sufficient General policy: No free services or products. Use of partial subsidies for services and products

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

21. 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)

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

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