Potential for sustained provision of health services by sector PVOs in the Dominican Republic : an economic and institutional analysis

A sample of 12 Dominican PVOs, chosen to illustrate variations in size, mission, and scope, were assessed to determine the extent, effectiveness, and efficiency with which they provide maternal and child health care and family planning services to the community. The PVOs studied were: ACEBIEN, ADOPLAFAM, BUEN SAMARITANO, CARE/DR, CIAC, COIN, FEDES, FH, FUDECO, IDDI, MUDE, and PROFAMILIA. Unlike earlier investigations of PVOs and their roles in society, this report viewed PVOs as possible alternatives to governmental units, due to the shortcomings of the Dominican Ministry of Health (SESPAS). The study takes on added significance because of USAID plans to reduce financial support for health sector activities in the next few years. These plans will adversely affect those PVO operations that are strongly dependent on USAID support, forcing them to look elsewhere for resources, to reduce costs, or to eliminate some public services. The authors interviewed the PVOs and examine internal records to determine their strategies, administration, programs, services, and beneficiaries. They also examined the management capacities of the PVOs and the success rate of their incentive systems to improve the effectiveness of semi-volunteer workers. PVO methodologies, institutional capacities (including information management systems), and coordination were also addressed. Based on the information obtained, the authors proposed options to expand or sustain the ability of the PVOs to continue their services in terms of financing and efficiency. Some of the options for PVO sustainability could be: (1) diversifying sources of revenue; (2) strengthening regional PVO consortia; (3) developing alternative links with SESPAS; and (4) reviewing the effectiveness of both current volunteers and potential incentive systems. (Author abstract)