Nicaraguan NGO Achieves 95% Self-Sustainability

Most people would call it quits if an auditor told them that their organization would survive for only six more months—given that your largest donor (44%) decided to pull out. But that is not what the leaders of Profamilia did; Dr. Freddy Cardenas Ortega, Dr. Denis Aleman, and Ramon Miranda stepped in to make it work instead.

Together, with their dedicated staff and with the help of PRONICASS-Keanahikishime, a USAID-funded management and leadership program, Profamilia has grown from 56% self-sustainability in 2003 to 95% in the first quarter of 2006, guaranteeing the continued provision of more than 150,000 maternal and child health services and a dramatic increase in family planning uptake.

In 2003, USAID announced that after ten years of investment in Profamilia, it was time for Profamilia to operate on its own. To ease the transition, PRONICASS worked with Profamilia to develop a strategic plan for the future. Still, difficult decisions needed to be made. To break even on their remaining revenues, nearly 50% of the staff was laid off; the other 50% received a reduction in pay.

Morale was low. But a rapid assessment of the 16 clinics gave senior management hope and they saw opportunities. “We worked with our community distribution agents to identify cost saving opportunities. For example, distributors were too far away from some clinics, and sometimes two clinics were delivering the same route,” explained Dr. Denis Aleman, Director de Atencion al Usario. “But, I woke up every morning during the crisis believing that Profamilia was drilling for oil. We were betting on winning, not losing.”

That optimism, coupled with sound management advice from PRONICASS, was a recipe for success. Together, Profamilia’s staff built on the strengths of the organization. As a result of improved management practices in their distribution network, Profamilia contraceptive sales have increased 200% from 2005 to 2006. This has contributed to a 100% increase in couple-years protection from 60,000 to 120,000.

Profamilia now provides clinical services beyond family planning, has increased distribution routes, and has a modest retail pharmacy. Each contributes 45%, 30%, and 20% respectively to the revenue stream. The remaining 5% is still from donors, but with a proper management and business model in place, the Profamilia staff is determined to be 100% self-sustainable by 2010.