In Ecuador, the Centro Médico de Orientación y Planificación Familiar
(CEMOPLAF) has been searching for ways to generate income and recover costs, while
increasing clients' access to family planning services and improving quality of care.
One of CEMOPLAF's strategies is charging client fees to recover some of the costs of
providing family planning services. Another is subsidizing family planning through income
gained from selling ultrasound diagnostic services.
CEMOPLAF's main mission is to provide family planning services," says Teresa de
Vargas, administrative director. "However, CEMOPLAF also offers other health services
to increase self-sufficiency and better service to clients. A focus on sustainability does
not imply abandoning our social mission."
In 1992, CEMOPLAF began an ultrasound service at a clinic in Quito. The service was
established after staff conducted an extensive assessment of potential costs to the clinic
for providing this specialized service, possible demand from clients, and expected income
during the first five years. Ultrasound was chosen over other services because of the
clinic's high number of gynecology and prenatal clients.
The service was so successful at the Quito clinic that managers decided to expand
ultrasound to some of CEMOPLAF's 20 other clinics and 12 satellite clinics. However,
ultrasound equipment is expensive, as are the costs of training, personnel, materials and
supplies. To ensure that services were needed and would be profitable, CEMOPLAF conducted
an analysis.
Twelve sites were easily eliminated because estimated client use would be too low and
the sites lacked necessary staff. In the remaining clinics, detailed estimates examined
demand for services, costs, and projected income. In the end, CEMOPLAF purchased three
additional ultrasound machines, and services have proven to be profitable. Prior to the
evaluation, staff suggested buying 10 machines, which cost U.S. $25,000 each. The analysis
helped CEMOPLAF make better decisions, based on estimated demand and income, rather than
speculation.
In another effort to improve sustainability, CEMOPLAF recently examined its fee
structure. Although one of CEMOPLAF's main goals is to serve the poor, a questionnaire
given to clients revealed that many were middle- to upper-income. Forty percent of clients
owned homes, while 35 percent had completed secondary school or attended a university, and
33 percent sent their children to private schools. In reviewing its charges, CEMOPLAF
learned that prices for family planning services varied as much as 65 percent among its 21
clinics. Also, the organization learned that one of the clinics with the highest fees
served the largest group of low-income clients.
CEMOPLAF concluded that prices were too low in most clinics, deciding to raise prices
periodically (twice a year). Also, the difference in charges among clinics is being
reduced.
CEMOPLAF is developing plans for greater financial independence because support from
donors is expected to decline. FHI, the Population Council's Investigación Operativa y
Asistencia Técnica en Planificación Familiar y Salud Materno-infantil en América Latina
y el Caribe (INOPAL) III Project, and The Futures Group International have worked with
CEMOPLAF to conduct studies on financial sustainability.
"Some family planning managers may think that just offering a service ensures that
it will be profitable, but this point of view is not very realistic," says John
Bratt, a senior research associate at FHI, who helped conduct the studies. "There has
to be a market for any service, and clients must be willing and able to pay for it."
The financial gains from ultrasound services and standardized pricing are relatively
small, but contribute to a cumulative, long-term commitment toward financial
sustainability. In 1997, CEMOPLAF will generate 75 percent of its operating budget from
client fees, a significant increase from previous years. "Progress toward
sustainability is often measured in small steps," says Bratt.
-- Barbara Barnett
For more information, visit Family Health International's Website at www.fhi.org
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