Highlight from M&L's Semiannual Report, June 30, 2004

COMBASE is a nonprofit Christian evangelical organization founded in 1964 to provide health services to the people of Cochabamba, Bolivia, and surrounding areas (a population of approximately 1.5 million). Through its small general hospital and five clinics, COMBASE serves low income groups, primarily women and children. Though the bulk of the services are in pediatric and obstetric/gynecologic care, COMBASE's hospital also offers neurology, cardiology, urology, and plastic surgery services.

Three years ago USAID/Bolivia identified COMBASE as one of two NGOs to receive technical assistance from M&L to support a continuous process of leadership and management development to build organizational capacity.

After three years:

• COMBASE is no longer in debt;
• Overall cost recovery rate is 105%;
• Four clinics' recovery rate is greater than 100%, the fifth clinic has a recovery rate of 90%.

M&L initiated its technical assistance program with the application of two participatory assessment approaches: Management and Organizational Sustainability Tool (MOST) and Cost Revenue Analysis Tool (CORE). The assessments showed that poor leadership, deficiencies in management systems, cash shortages, and debts were affecting the performance, financial stability, and sustainability of the organization. These challenges took on even greater importance as the national health insurance scheme began to provide free services to mothers and children under five and USAID plans to cease financial support in 2004.

An action plan was developed to:

• Modernize the program and financial information systems;
• Design new human resource, administrative, and financial management systems;
• Improve overall organizational performance, including annual planning.

Modernization of the information systems

The accounting system had typical shortcomings: timely financial information was difficult to produce and not connected to service delivery information; pharmacies were unable to manage their inventories or expiration dates; and records were scattered, duplicative, and generally maintained manually.

The new information system—now functioning in all five clinics—has integrated service delivery and financial outputs. It is a database with client information, clinical information, and financial information. It provides the management team with up-to-date and reliable information so that it can make informed decisions. Financial statements are ready by the 20th of the following month.

New human resource, administrative, and financial management systems

Manuals are now being used in Human Resource Management, Administrative and Financial Management, and Procurement. The procedures detailed in the manuals will formalize many processes introduced by the new information system. For example, the Procurement Manual will formalize all the processes related to the procurement of drugs and other supplies and allow for better monitoring of inventory and the transparent management of the procurement of medical supplies.

Improving overall organizational performance

COMBASE has started to plan on a yearly basis. Today it is monitoring actual and projected expenses. Performance has improved—four clinics have a recovery rate (ratio of income over expenses) greater than 100%, while the fifth clinic is recovering costs at a rate of approximately 90%. Another example was the decision to change the remuneration of doctors from a salary system to a fee-driven system, tying payments to performance.