Loan fund for physicians : Philippines -- final evaluation report, March 1995-December 1996

The subproject, part of the Promoting Financial Investments and Transfers (PROFIT) project, was implemented through the Bankers' Association of the Philippines Credit Guaranty Corporation (BCGC), a local lending institution, in collaboration with the Philippine Medical Women's Association (PMWA) and the Philippine Academy of Family Physicians (PAFP). PROFIT discovered through baseline research that: Government of Philippines expenditures on health care were low (2.5% of GNP) by developing country standards; there was little financing available to fund the expansion of private health services; and the cost of the limited financing available discouraged many private practitioners from borrowing. Most Filipinos had poor access to health services, a situation exacerbated by the fact that significant numbers of trained doctors and nurses continued to emigrate in order to practice abroad. However, there was a high level of interest among physicians in additional training in basic, nonsurgical family planning (FP) and reproductive health, and in basic business skills. In addition to the loans, the physician borrowers were provided with training in these areas. The training was mandatory and was provided at no cost to the borrowers. The program encountered a number of obstacles, most of them related to religious objections to FP by the largely Catholic population. As a result, the leaders of the participating associations were reluctant to promote the loan fund; the BCGC, the lending institution, kept a low profile for the subproject; and among targeted physicians there was a limited demand for the loans. Because of these obstacles and a revised Mission strategic objective that de-emphasized expanding the capacities of private physicians, PROFIT halted implementation in July 1996. The project was terminated in December 1996. PROFIT learned several lessons from this subproject. (1) Working with medical associations is a good way to reach physicians, but it is not necessarily appropriate to involve them directly in the implementation of projects without financial compensation, particularly if they are staffed largely by volunteers. (2) Traditional financial lending institutions are inherently risk-adverse. Projects that require these institutions to take on additional financial risk to serve a social objective must address this inherent conflict directly with the financial institution or must identify an alternative mechanism for the project's financial management. (3) Building upon the current structure and capacities of existing institutions can significantly speed the start-up of a project. (4) Doctors are only willing to participate in training programs that they consider necessary, even if competency-based exams show a higher level of need for training. (5) Private doctors are interested in and need business management training, particularly in financial management. (6) Attracting young doctors to participate in a loan fund can be difficult. Their level of interest in such a program and their potential concerns about participating should be fully explored before such a project is launched. (7) Training and financial support can help increase the number of high-quality private physicians that offer FP services. However, increasing the supply of FP services does not necessarily result in increased demand for those services. The success of any FP project, even a small pilot project, is critically affected by prevailing political, religious, and cultural attitudes toward the provision of FP services. (Author abstract, modified)