Over the past six years with the assistance of Management Sciences for Health (MSH), APROFAM has made great strides in its goal to become self-financing. APROFAM is the Guatemalan affiliate of the International Planned Parenthood Federation. Its network of 32 urban clinics reached a level of 125% self-financing by the end of 2003. However, a greater challenge still remained-taking its rural community-based distribution (CBD) program, which included 3,500 volunteer promoters spread throughout the country, and ensuring that it would be sustainable and largely self-financing. APROFAM provides over 40% of the contraceptive products used in Guatemala, and the rural program is a primary source of services for populations most in need. The challenge of sustainability was further complicated by the newly established services of the government offering free contraceptives in many rural areas on a sporadic basis.

APROFAM's CBD program had operated for more than 15 years with large subsidies from USAID/Guatemala. In addition to distributing contraceptives, it performed a vital information and education function that was responsible for considerable demand creation during that period. With the growth of the government program, subsidies from USAID were being reduced and USAID/Guatemala requested that MSH assist APROFAM to ensure that its rural presence continue within the context of a sustainable and self-financing structure. In addition to its 3,500 volunteer distributors, APROFAM had 90 staff Educators who supervised, supplied, and supported the volunteers.

At the outset, it was clear that for APROFAM to maintain a sustainable rural presence without subsidies from USAID, the CBD program would need to be converted to a non-traditional Social Marketing Program. To structure and guide this process, MSH looked to the private sector for successful models of rural product sales in Guatemala. The most successful model identified was Pepsi Cola, which included several key elements:

• Efficient, well-defined sales routes that offer immediate sales volume and the possibility of sales growth in the future;
• A variable compensation structure for the sales force that rewards both sales volume and the development of new clients;
• The use of modern information technology;
• Supervision that is supportive, "hands-on," and continuous.

Historically, the Rural Development Program operated at a level of 48% self-financing. As a first step in the process of conversion, MSH did an in-depth analysis of existing sales routes in terms of volume, types of products sold, and income generated. This led to the development of an interactive computer model that graphically represented each sales route in the country and the sales and income volume for each of its volunteer promoters. Applying baseline income and sales volume criteria, routes were redesigned to achieve maximum productivity.

As part of the redesign process, careful consideration was given to the actual volume/income of sales for each available product. Products were reviewed and classified as "A, B, and C" depending on their viability/volume in each route. This classification led to important decisions as to which products would be included, encouraged, and/or removed from the portfolio in each route to promote maximum sales and efficiency.

Once the routes and the listing of products were established, MSH helped APROFAM develop a variable compensation program that rewards sales and encourages the development of new clients. The program, a combination of fixed base salary and variable compensation, was based on the costing of expenses for each route.

To ensure the quality of sales and the information necessary to adequately supervise the sales force and calculate its variable compensation, state-of-the-art information technology was developed. Each educator responsible for a sales route was given a Palm PilotT equipped with a special program designed to record sales information in terms of both individual product sales and income.

Educators were able to immediately download this information at the nearest APROFAM clinic to the organization's network. The data is used to calculate variable compensation and to generate a re-supply order for each volunteer promoter. The re-supply time improved to four days from two weeks using this system.

As a final piece of the conversion, MSH developed a specialized training program for Educators that emphasized supportive supervision and sales motivation. Educators, in turn, worked with volunteers to develop their sales skills.

A pilot program was conducted from September to December, 2003, in three representational Departments of the country. During this period, sales volume increased, average overall salaries based in part on variable compensation increased, and the overall level of self-financing of the Rural Development Program increased to 70%. During the first quarter of 2004, the rest of the program was converted to the new delivery model. With the eventual addition of new products (such as pregnancy test kits) and the development of new markets (such as to other NGOs, small government pharmacies, and company and large farm clinic dispensaries) there is every reason to believe that the CBD program will be sustainable over the long term.