Feasibility study of a primary health care system for Union of the Agrarian Reform Cooperatives (UCRAPROBEX) El Salvador

To help determine the feasibility of establishing a self-sustaining health care system in the Union of the Agrarian Reform Cooperatives (UCRAPROBEX), a private union of coffee cooperatives, PROFIT conducted two studies -- a market study and a clinic study -- to assess the demand for and supply of health services within the UCRAPROBEX population. Survey results indicated an unmet need for primary health care (PHC) services, notably FP and maternal and child health services. The population is low-income, but there is strong evidence it is willing and able to pay for medical services and that it values access -- minimal travel time to a source of care. The individual cooperatives have been spending significant and unpredictable amounts on medical care, primarily for secondary and tertiary care services. PROFIT proposes the establishment of a PHC system for the UCRAPROBEX cooperatives that will offer improved access to quality PHC and become financially self-sustaining. Under the system, trained health promoters supervised by circulating physicians would provide curative care, preventive care, health education services, medications, and referrals for specialized care. The system would be owned by UCRAPROBEX and managed by a central management team. Cooperatives would pay a fixed monthly fee of US$7 per family and patients would pay for medicines. The financial analysis indicates a need for US$204,545 in external funding to cover start-up costs. The system is projected to become financially self-sustaining in 3 years after the entire UCRAPROBEX population is enrolled. PROFIT proposes a one-year pilot test of the system among 2,000 families. After full enrollment is achieved, the system would be expanded and improved by adding coverage for secondary and tertiary services, centralizing the purchase of medicines, and establishing referral clinics at selected cooperatives. (Author abstract, modified)