In the mid-1990s, facing reductions in donor funds and pressure to achieve sustainability, APROFAM re-examined its strategies and practices. Within this context, USAID asked MSH to assist APROFAM in strengthening management and organizational performance to meet the goal of becoming a self-financed health care provider.

Summary of Work

APROFAM and MSH have pursued a holistic approach to management development since 1995. With technical assistance from the Management and Leadership Program (M&L), APROFAM is currently converting its Rural Development Program into a social marketing program, with an emphasis on computerized information, management and leadership training for clinic managers, and better supervisory systems. APROFAM is establishing a business model that applies marketing methods to achieve positive social outcomes such as improved health care coverage in remote villages. Training APROFAM staff in sales and marketing; and implementing a compensation system that rewards productivity, efficiency, and quality; are expected to contribute to the overall objective of generating revenue and making the RDP more self-financing.

The focus on social marketing fits into APROFAM's long-term effort to link management practices with the goals of better service quality, efficiency, coverage, and responsiveness to client needs. Management interventions have included:

• enabling APROFAM to evolve from a family planning service provider to a highly diversified family health organization;
   
• organization-wide strategic planning and departmental re-engineering;
   
• supporting diversification of services and financial sustainability of clinics by
   
  • applying MSH's Cost-Revenue Analysis Tool (CORE);
     
  • acquiring and remodeling clinics;
     
  • positioning the organization to succeed in a competitive niche;
     
  • redesigning client flow and improving utilization of clinic space;
     
  • creating training plans; and
     
  • developing business plans for the clinics.

With M&L support, APROFAM reworked or developed new policies, procedures, manuals, and instruments. The re-engineering process focused on decentralization, diversification, and integration of clinic services to improve efficiency, productivity, and quality of management and services.

Results

A top-to-bottom overhaul of management systems turned APROFAM into an increasingly self-financed health care organization between 1996 and 2002. In 2003, the organization began reformulating its Rural Development Program, which expands coverage and access to FP and other reproductive health services.

APROFAM has demonstrated the value of the social marketing model in a new seamless automated system of contraceptive distribution. The system, which greatly reduces costs and increases efficiency, features hand-held devices that download information to local computers to trigger JUST-IN-TIME ordering, re-supply, and inventory activities.

A new culture has emerged at APROFAM. The new culture is typified by "systems thinking" in which department leaders and staff think about the implications of changes in their own sphere and how it can better service the "internal client" - the direct deliverers of the organization's goods and services. This is key to APROFAM's current success and bodes well for the future. Changes in operations are internalized and sustainable.

The marketing department drove an internal and external service focus on quality and client satisfaction. This focus on quality and client responsiveness are prominent features of the "new" APROFAM culture. The marketing department provides information for planning and monitoring, continually studies client satisfaction, and is a unifying force for institutional identity and culture.

At the Annual Western Hemisphere Regional Meeting of IPPF in the Dominican Republic in September 2003, APROFAM was recognized for demonstrating the highest level of clinic self-financing in the Western hemisphere. While APROFAM operates internally as a commercial enterprise, it remains committed to its NGO identity; it is still governed by social goals, mission, and vision.

APROFAM's growth in revenue has been exceptional. This is especially true in light of recent competition from the Ministry of Health, which provides free contraceptive methods. The decline in APROFAM's family planning users has been more than compensated for by the increase in users of other health services. The diversification and expansion of clinical services, and the depth and breadth of marketing efforts have made APROFAM a successful enterprise.