MSC/INTERNATIONAL DEVELOPMENT 20014/15

STUDENT NUMBER: 18323

UNIT NUMBER: POLIM 2048

UNIT TITLE:  International Development

Organizations

UNIT TUTOR: Gastón Fornés       

ESSAY QUESTION NUMBER: N.A.

ESSAY TITLE:  Profamilia and the Balanced

Scorecard: Planning for Survival.

WORD COUNT: 1497

1

PROFAMILIA AND THE BSC: PLANNING

FOR SURVIVAL

SITUATION:

The “Asociación Probienestar de la Familia Colombiana”, called also “Profamilia”, is a

non-profit organization specialized in providing sexual and reproductive health

services (SRHS) to the poorest segment of Colombia’s population. Administered as an

enterprise with a social orientation, Profamilia is the biggest national organisation

providing these services. With a proven successful track record, it was capable of

attracting generous international donations and to close distribution agreements with

global pharmaceutical companies. The key factor for its expansion lie in the distinctive

characteristic of its social objective: provide services at a lower cost than market value

without compromising quality.

At the beginning of the 1990s, two events threatened Profamilia’s survival: USAID, its

principal international donor, began to withdraw its support, while the “Law 100”

modified the way in which health services were offered, provided and financed (see

Exhibit 1). To respond to an increasingly competitive environment, Profamilia had to

alter its financial sustainability from donation-based to sales-based. However, in June

of 2004 senior management perceived that the efforts to secure sustainability without

compromising the social mission were insufficient. Therefore, a strategic plan is

required.

PROBLEMS:

The problems that Profamilia have to face were described as “natural consequences of

the change of the sector1”. The health care system liberalisation, together with the

vertical integration of health insurance and care provision, reduced significantly its

market share of SRHS and family planning services, which were previously contracted

out in a condition of quasi-monopoly. This affected also the sales of contraceptive

products: the quantity of contraceptive pills sold plummeted in the mid-1990s, while

the condoms declined less dramatically. Moreover, the rapid fall of USAID donations

deepened the organisation’s financial problems.

As a value based organisation, Profamilia do not want to risk damaging its social

1 Lobo Ivan D, Gutierrez, Roberto, and Sanabria, Raul. 2006. “Profamilia: Planning For Survive”. Social Enterprise Knowledge Network, November 30, p.11.

2

commitment. However, for its own survival, it has to decide which direction to take

and where to specialize.

TOOLS AND TECHNIQUES

Developing a balanced scorecard (BSc) can be a useful operation to help Profamilia

defining its objectives while moving towards its uncertain future position. The BSc is a

methodological tool based upon the cause-and-effect relationship of financial and

operational measures derived from the organisation’s decisions. It offers a full and

straightforward picture of the business while maintaining focus on its bottom-line

goal2. Identifying and measuring the specific value drivers that underpin performance,

the BSc converts vision and strategy into goals, indicators and targets. The aim is to

have each area equally aligned with the overall strategic objective and organisation’s

mission3.

Adopting the balanced scorecard paradigm presents a number of advantages for

Profamilia. Firstly, it enables senior management to understand that decisions to

improve one area may have negative impacts in another. Secondly, it facilitates

communication and understanding of goals and strategies at all levels of the

organisation, structuring personal objectives with the organisational ones4.

ANALYSIS

As stated above, the main Profamilia challenge derives from the increasingly

competitive environment. In a five years period, the NGO saw its income reduce by

26% (see Exhibit 2). Furthermore, the health sector reform and the contraction of aid

marked a drastic change in its financial structure. The organisation’s income shifted to

70% dependence on sales of products and SRHS, with a cross subsidy between these

services and other financially unviable but socially necessary programs. However,

even if the distribution of contraceptive products (in particular contraceptive pills) has

been one of its major sources of income, nowadays competitors control a good part of

the market share. Moreover, the RSHS suffered a slight decrease, underlining that the

organisation have to look for new customers and focus on different services to return

to the levels reached in mid 1990s (see Exhibit 3). Undoubtedly, the large number of 2 Kaplan, S. Robert and Norton, P. David. 1992. “The Balanced Scorecard – Measures that Drive Performance”, Harvard Business Review, January – February, Harvard Business School Publishing, Boston, MA, US.3 Contrada, Michael. 1999. “Using the Balanced Scorecard to Manage Value in Your Business”. Harvard Business Review, January, Harvard Business School Publishing, Boston, MA, US.4 Kaplan, S. Robert. 2002. “Lead and Manage Your Organization with the Balanced Scorecard”. Harvard Business Review, July, Harvard Business School Publishing, Boston, MA, US.

3

Colombians uncovered by either contributory or subsidized regime creates a concrete

expansion opportunity (see Exhibit 4). Since this is a strong non-profit organisation,

Profamilia possess the knowledge, local infrastructures, and relationships necessary

for reaching low- income customers, qualities often neglected by private corporations5.

Internally, improvements in management effectiveness and accountability, as well as

the professionalization and specialisation of its administrative structure, are key

factors for the accomplishment of its mission. Managing donations requires a relatively

simple structure, while generating income and competing in a free market requires

complex organisational skills and a well-crafted architecture, which deficiency is

potentially resource consuming. Indeed, achieving efficiency will contribute

substantially to maintaining affordable prices for disadvantaged people. Avoid loss of

quality is another imperative, since not only is it stated in Profamilia mission, but also

surveys on the perception of clients show that superior service quality and timely

attention are relevant driving forces for its success (see Exhibit 5).

For the creation of an effective business plan, Profamilia needs to individuate its own

competitive advantages and align them with its values. The prestigious image that

Profamilia created during 36 years of service, its specialisation, the ties with

international suppliers, and the relationship with the local population are inestimable

resources to play in the Colombian RSHS arena.

RECOMMENDATIONS

The organisation needs to embark on a new process of strategic planning in order to

“refine the business”6 and strengthen itself as an enterprise. It should define its

objectives under the four perspectives embodied in the BSc, deciding which factors

will drive future financial performance without compromising Profamilia’s vision (see

Exhibit 6).

Financial Perspective

Concerning the financial perspective, Profamilia needs to increase revenues as

well as improve efficiency within the organisation. In expanding revenues,

Profamilia should launch new services and products, in order to cross subsidise

socially necessary programmes and therefore sustain its bottom-line objective.

Crucial to its survival, increase the market share by targeting the unmet

demand must assume a pivotal role. Decentralisation, community-based

5 Brugmann, Jeb and Proahalad, Coimbatore K. 2007. “Cocreating Business’s New Social Compact”. Harvard Business Review, February, Harvard Business School Publishing, Boston, MA, US.6 Lobo Ivan D, Gutierrez, Roberto, and Sanabria, Raul. 2006. “Profamilia: Planning For Survive”. Social Enterprise Knowledge Network, November 30, p.11.

4

programmes, and strengthening the mobile brigades are viable options, but an

evaluation of community needs should be the first step of the operation.

Undoubtedly, a positive cash flow as well as low ratio of asset to liabilities

represents essential indicators for measuring Profamilia’s success in the RSHS

sector.

Customer Perspective

Regarding the customer perspective, the intent is to improve the general image

of the NGO by developing regular communication between customer,

stakeholders and employees. Systematise communication between

departments, foster transparency and involve stakeholders in the amelioration

of the business are key elements for increasing the eminent and trustworthy

reputation that Profamilia already enjoy. Moreover, the publication of an annual

memory, together with a constant presence on the web, will facilitate the

process with tangible and immediate results.

Internal Business Perspective

In support of achieving its customer and financial objectives, Profamilia should

elaborate initiatives to sustain its image and grow its revenue base. To maintain

affordable prices for low-income population, the organisation must strengthen

the relationship with suppliers and evaluate and provide operational excellence

in the cross subside system. Furthermore, Profamilia needs to deepen the

relationship with local population by making consumers aware of available

services, both to increase its customer base and to spread family planning

culture. Diversification of RSHS and schools programmes are useful initiatives

that will create long-term benefits necessary to achieve its goals.

Learning & Growth Perspective

In order to satisfy the strategic objective, Profamilia must create an

environment that maximize the contribution of his employees. Spreading an

objective-oriented culture among personnel is a challenging task for every

enterprise that is willing to compete at its best. Generally, training and

outcome-based agreements are the most common solution for fostering such an

environment. However, the elaboration of a BSc in every department of

Profamilia’s structure will definitely help this process, as it defines clear targets

and increases the commitment of lower level management. The amelioration of

existent structures and equipment is another pivotal point, as surveys show that

quality of installation figures are at the bottom side among the reasons for

choosing Profamilia services (see Exhibit 5).

5

CONLCUSIONS

Refine the business, meet the unmet demand, and launch new products and services

are undoubtedly the organisation priorities. The workload for the employees is

considerable, and the lack of focus on the human resources dimension is perhaps the

greatest BSc weakness. However, thanks to Profamilia solid reputation and

experience, the organisation has substantial room of improvement in the RSHS sector.

Exhibit 1. The Health Sector Reform in Colombia

6

Exhibit 2. Profamilia – Composition of Income (in US Dollars)

7

Exhibit 3. Volume of Services in Profamilia

Exhibit 4. Population and Participation to the Contributory Regime (by type of insurer)

8

Population and Participation to the Subsidized Regime (by type of insurer)

Exhibit 5. Percentage of Clients by Preferences (by type of client)

9

10

11

12

Perception of Quality of Attention (by type of client)

13

14

15

16

17

PR

OFA

MIL

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ent

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du

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ices

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itie

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tral.

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thly

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thly

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s

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ics

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ise A

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em

ory

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pro

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# O

f C

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ly Info

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all

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isit

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ease

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m t

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ala

nced

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card

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ob

ert

S.

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lan

an

d D

ave P

. N

ort

on

. H

arv

ard

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sin

ess S

ch

ool

Pre

ss.

19

96

.

Exhibit 6. Profamilia BSc

Actu

al

De

c

‘0

4

Jun

‘05

Dec

‘04

Target

% of Customer Judging Quality of Attention as

“Very Good”

45.5

%

2% 1.5

%

1% 50%

% Returning Customer 77.5

%

5% 4% 3.5

%

90%

% of Clinics Showing Advertising Material X 75

%

25% 0% 100%

% of Customer Considering Profamilia “Extrimely

Trustworthy”

X 80

%

10% 5% 95%

# of Clincs Producing High-Quality Monthly

Reports

X 80

%

20% 0% 100%

# of Clinics Publicising Annual Memory X 80

%

10% 10% 100%

# of Clinincs Producing Monthly Informs X 80

%

10% 10% 100%

18

Objectives

A) LEADERSHIP IN FAMILY PLANNIG SECTOR

B) GIVE A TRUSTWORTHY IMMAGE

C) TRANSPARENT COMMUNICATION WITH CUSTOMER

AND STAKEHOLDERS SYSTEMATISED

D)ADVOCACY IMPROVED

Actua

l

Dec

‘04

Jun

‘05

Dec

‘04

Target

Ratio of Total Asset to Current Liabilities X X X X X

Ratio of Current Assets to Total Liabilities X X X X X

Net Income $1378706

0

+1

%

+1

%

+2

%

$14345464

19

- R e v ie w A n d A m e l io r a t e Q u a l i t y C o n t r o l S y s t e m- M o n t h ly S e r v ic e - L e v e l R e v ie w M e e ti n g T o R e v ie w S e r v ic e - L e v e l C o m p l ia n c e A n d Im p le m e n t Im p r o v e m e n t s- P r o a c ti v e M a n a g e m e n t O f R is k T o R e p u t a ti o n- E la b o r a t e A S y s t e m A n d A P r a c ti c a l G u id e T o H a n d l in g C u s t o m e r C o m p la in t sB e n c h m a r k C o m p e ti t o r s F o r Q u a l i t y , P r ic in g A n d C o v e r a g e

- R e n e w A d v e r ti s in g- Im p r o v e M a t e r ia l D is t r ib u ti o n- R e f r e s h C o n s t a n t ly W e b P a g e s- Im p r o v e D o c t o r - P a ti e n t C o m m u n ic a ti o n- C l in ic B a la n c e A v a i la b le O n R e q u e s t- Id e n ti f y K e y S t a k e h o ld e r s W h o C a n H e lp P r o v id e A n O u t s id e - In V ie w

- P r e s e n t A n n u a l H ig h - Q u a l i t y R e p o r t ( F in a n c ia l a n d P r o g r a m m a ti c ) T o S t a k e h o ld e r s- P u b l i s h A n A n n u a l M e m o r y- F o s t e r A C u lt u r e O f S y s t e m a ti s a ti o n A n d P u b l ic a ti o n O f P u b l ic R e p o r t s A b o u t T h e C o m p a n y 's A c ti v iti e s

- S t r e n g t h E ff o r t s T o G e n e r a t e S t r o n g P u b l ic , P o l iti c a l , A n d F in a n c ia l C o m m it m e n t T o A n d S u p p o r t F o r S e x u a l A n d R e p r o d u c ti v e H e a l t h A n d R ig h t s A t T h e N a ti o n a l A n d In t e r n a ti o n a l L e v e l

Initiatives

Objectives

A) LEADERSHIP IN FAMILY PLANNIG SECTOR

B) GIVE A TRUSTWORTHY IMMAGE

C) TRANSPARENT COMMUNICATION WITH CUSTOMER

AND STAKEHOLDERS SYSTEMATISED

D)ADVOCACY IMPROVED

A

B

C

D

Gross Revenues X X X X X

Total Market Share Quota X X X X X

# of New Affiliates to Profamilia X 170

0

170

0

170

0

5600

Mean-Time Response to a Service Call X -5% -5% -5% -15%

Cost of Physician Visit / Number of Physician X X X X X

Cost Per Couple Year Protection X X X X X

*The case study does not provide sufficient data to carry out an accurate financial analysis.

20

Objectives

A) FINANCIAL STABILITY MANTAINED

B) GROWTH NEW REVENUE

C) INCREASE THE MARKET SHARE

Actu

al

Dec

‘04

Jun

‘05

Dec

‘04

Target

Start of Period Prices / End of Period Prices 0 +0

%

+0

%

+0

%

+0%

% of Local School Launching Familiy Planning

Programme

0 10% 10% 10% 30%

Market Share Quota For Alternative

Contraceptove Methods*

X X X X X

21

- O r g a n is a ti o n R e s t r u c t u r in g- C o n d u c t A F e a s ib i l i t y A n a ly s is , P r e p a r e F in a n c ia l P r o je c ti o n s A n d A B u s in e s s P la n- P r o v id e H ig h - Q u a l i t y F in a n c ia l In f o r m s- E v a lu a t e T h e O p p o r t u n it y O f F in a n c ia l I n v e s t m e n t s- I n c r e a s e P r iv a t e D o n a ti o n s- R e d u c e / R e o r g a n is e P e r s o n n e l C o s t s

- D iv e r s ifi c a ti o n O f S e x u a l A n d R e p r o d u c ti v e H e a l t h S e r v ic e s- S a le s O f N o n - C o n t r a c e p ti v e ( P a p S m e a r K i t , P r e g n a n c y T e s t )- A d v e r ti s in g C a m p a ig n T h r o u g h E d u c a ti o n a l C o m m u n it y P r o g r a m m e

- E v a lu a t e N e e d s O f L o c a l C o m m u n iti e s- C r e a t e A C o m m u n it y - B a s e d D is t r ib u ti o n P r o g r a m F o r R u r a l A r e a s- E m p o w e r A n d S u s t a in M o b i le B r ig a d e s- D e c e n t r a l i z in g B u d g e ti n g A n d M a n a g e m e n t O f S e r v ic e D e l iv e r y , W it h L o c a l M a n a g e r s R a t h e r T h a n H e a d q u a r t e r s O ffi c ia ls M a k in g S t a ffi n g A n d S p e n d in g D e c is io n s

- B e n c h m a r k O t h e r O r g a n is a ti o n- M e a s u r e E m p lo y e e s P r o d u c ti v i t y- A p p ly C o d e O f C o n d u c t

Initiatives

Objectives

A) FINANCIAL STABILITY MANTAINED

B) GROWTH NEW REVENUE

C) INCREASE THE MARKET SHARE

A

B

C

D

# of New Opportunities Identified 0 1 1 1 3

*The case study does not provide sufficient data about the market share quota.

22

Objectives

A) PROVIDE AFFORDABLE SERVICE FOR LOWER CLASS

B) EDUCATE YOUNG COUPLE TO FAMILY PLANNING

C) PROVIDE A VAST RANGE OF PRODUCTS AND

PROCEDURES FOR FAMILY PLANNING

D)SEXUAL AND REPRODUCTIVE HEALTH SERVICES

DIVERSIFICATED

Actu

al

De

c

‘0

4

Jun

‘05

De

c

‘0

4

Target

# of Clinics Providing Monthly Reports X 35 X X 35

(100%)

# of Chief Physicians Successfully Completing

Leadership Training

X 17 17 17 51

23

- M a i n t a i n F a v o r a b l e R e l a ti o n s h i p W i t h S u p p l i e r s M a k i n g E a r l y C a s h P a y m e n t - S t r e n g t h e n T i e s W i t h L o c a l R e t a i l e r s W i t h A n O n - T i m e S u p p l y , O n g o i n g C o m m u n i c a ti o n A n d D i s c o u n t F o r I m m e d i a t e C a s h P a y m e n t - V a l u e E ffi c i e n c y O f C r o s s S u b s i d y

- D e s i g n F a m i l y P l a n n i n g P r o g r a m m e F o r Y o u n g C o u p l e s - M o n t h l y H o u r s T o S p e n d W i t h i n S c h o o l P r o g r a m m e s

- E s t a b l i s h A C o m m i s s i o n F o r I n c r e a s e A w a r e n e s s O f A l t e r n a ti v e C o n t r a c e p ti v e M e t h o d s A m o n g P o p u l a ti o n

- M o n t h l y S e r v i c e - O p p o r t u n i t y R e v i e w M e e ti n g T o R e v i e w C o m m u n i t y N e e d s- I m p r o v e M o b i l e B r i g a d e s A n d C l i n i c s C o m m u n i c a ti o n

A

B

CrD

Objectives

A) PROVIDE AFFORDABLE SERVICE FOR LOWER CLASS

B) EDUCATE YOUNG COUPLE TO FAMILY PLANNING

C) PROVIDE A VAST RANGE OF PRODUCTS AND

PROCEDURES FOR FAMILY PLANNING

D)SEXUAL AND REPRODUCTIVE HEALTH SERVICES

DIVERSIFICATED

Initiatives

# of Employees Successfully Completing Risk

Management Training

X 80 80 80 240

# of Clinics Developing a BSc X 35 X X 35

(100%)

# of Value Bases Training Hours X 40 40 40 120

# of Clinics Elaborating Diagnosis for Technical

Equipment

X 35 X X 35(100

%)

# of New Products Launched X X 1 1 2

24

- N e g o ti a t e O u t c o m e - B a s e d A g r e e m e n t A n d G o a l s W i t h P e r s o n n e l- C o n d u c t A S W O T A n a l y s i s- F o r m u l a t e A n d E v a l u a t e O p e r a ti o n a l P l a n s P e r i o d i c a l l y - E s t a b l i s h I n d i c a t o r s A n d A g r e e i n g O n O u t c o m e s T o M o n i t o r A n d E v a l u a t e- I m p l e m e n t P e r f o r m a n c e - R e l a t e d P o l i c y O f B e n e fi t s A n d S a n c ti o n s- D e v e l o p A R i s k M a n a g e m e n t T r a i n i n g P r o g r a m m e F o r E m p l o y e e s- P r o v i d e G u i d e l i n e s F o r M a n a g e m e n t T o A s s e s s R i s k P r o b a b i l i ti e s O r I m p a c t s- E s t a b l i s h L o n g - T e r m S t r a t e g i c G o a l s - C r e a t e A L e a d e r s h i p T r a i n i n gA n d P r o v i d e C h i e f P h y s i c i a n s W i t h L e a d e r s h i p M a n u a l s- B e n c h m a r k s F o r A c ti v i ti e s A n d I m m e d i a t e O u t p u t s

- R e n e w A d v e r ti s i n g- I m p r o v e M a t e r i a l D i s t r i b u ti o n- R e f r e s h C o n s t a n t l y W e b P a g e s- I m p r o v e D o c t o r - P a ti e n t C o m m u n i c a ti o n- C l i n i c B a l a n c e A v a i l a b l e O n R e q u e s t- I d e n ti f y K e y S t a k e h o l d e r s W h o C a n H e l p P r o v i d e A n O u t s i d e - I n V i e w

- E l a b o r a t e A D i a g n o s i s F o r T e c h n i c a l E q u i p m e n t- C o n t a c t S u p p l i e r s N e w E q u i p m e n t P r o p o s a l

- D e v e l o p N o n - C o n t r a c e p ti v e P r o d u c t s ( P a p S m e a r K i t , P r e g n a n c y T e s t )

Objectives

A) OBJECTIVE-ORIENTED MANAGEMENT CULTURE

DEVELOPED

B) CULTURAL ALIGNEMENT AMONG EMPLOYEES

C) DIAGNOSIS AND STOCK LISTING OF TECHNICAL

EQUIPMENT DRAFTED

D)NEW PRODUCTS INTRODUCED

A

B

C

D

Initiatives

Bibliography

Brugmann, Jeb and Proahalad, Coimbatore K. 2007. “Cocreating Business’s New Social Compact”. Harvard Business Review, February, Harvard Business School Publishing, Boston, MA, US.

Contrada, Michael. 1999. “Using the Balanced Scorecard to Manage Value in Your Business”. Harvard Business Review, January, Harvard Business School Publishing, Boston, MA, US.

Kaplan, S. Robert. 2002. “Lead and Manage Your Organization with the Balanced Scorecard”. Harvard Business Review, July, Harvard Business School Publishing, Boston, MA, US.

Kaplan, S. Robert and Norton, P. David. 1992. “The Balanced Scorecard – Measures that Drive Performance”, Harvard Business Review, January – February, Harvard Business School Publishing, Boston, MA, US.

Case Study:

Lobo Ivan D, Gutierrez, Roberto, and Sanabria, Raul. 2006. “Profamilia: Planning For Survive”. Social Enterprise Knowledge Network, November 30.

25

Objectives

A) OBJECTIVE-ORIENTED MANAGEMENT CULTURE

DEVELOPED

B) CULTURAL ALIGNEMENT AMONG EMPLOYEES

C) DIAGNOSIS AND STOCK LISTING OF TECHNICAL

EQUIPMENT DRAFTED

D)NEW PRODUCTS INTRODUCED