Project assistance completion report : LAPROMED component of project no. 520-0339, immunization and oral rehydration therapy (ORT) for child survival -- contract no. 520-0339-C-00-2234 with PATH

The project was implemented by Program for Appropriate Technology in Health (PATH), LAPROMED, and the Ministry of Health (MOH). PATH fully supported LAPROMED and completed the tasks related to its contract. PATH remodeled facilities, procured and installed equipment for production, trained LAPROMED staff to secure high quality of production, implemented standard operating procedures, developed a manual for ORS quality control, developed a quality audit protocol, and established a mechanism to develop annual action plans. Currently, LAPROMED's production facilities could compete, in terms of ORS production, with any national or international laboratory. To date, LAPROMED has produced a total of 2,093,567 ORS packets and sold 1,981,518 of them, earning Ql,509,189.60. On the down side, promotion and distribution of ORS at the community level is still low. The MOH distributed 67,300 packets to the health areas in 1995, but only 77,000 as of 4/30/1996, and some 30,000 packets remain in the DGSS's warehouse. Distribution and marketing of ORS is currently one of LAPROMED's major problems. The MOH's decentralization of its procurement mechanisms has overly complicated the ORS procurement process, with responsibility now in the hands of 27 health areas instead of one central office. During the first 10 months of 1996, the health areas have not shown any interest in buying from LAPROMED. Instead, it seems that health area chiefs are buying from other vendors at higher prices. This is due to three problems. First, LAPROMED lacks the facilities to transport the product to each of the 27 areas. Second, LAPROMED is not registered as a qualified provider with the Ministry of Finance (MOF), because LAPROMED is part of San Carlos University and is not an owner -- the first condition for obtaining MOF approval to become a provider to the public sector. Third, the MOH is not honoring its agreement with LAPROMED to buy 80% of LAPROMED's production. LAPROMED will require TA to develop its marketing and negotiation skills and find other potential clients to ensure project sustainability. In an effort to expand its client base, LAPROMED is selling ORS to the Guatemalan Social Security Institute (IGSS), which has become LAPROMED's most important client. However, this is not enough to allow LAPROMED to reach its break even point and thus secure its sustainability. LAPROMED will continue producing ORS for ADAMED (a private sector firm) and is taking some steps to sell ORS packages to NGOs.