CIMIGEN 

Organizational Vision

In 1986, Ashoka Fellow Dr. Carlos Vargas Garcia observed that the existing health care system in Mexico was not responding adequately to the reproductive health care needs of poor women. So when philanthropist Antonio L. Silanes asked Vargas to convert a dilapidated polio treatment center into a reproductive health clinic and hospital, he vowed he would create a cost-efficient way to impart quality services. Silanes gave him only 10 percent of the budget for the first year of operations, and Vargas set out to make CIMIGEN pay for itself. Today, there are 28 self-sustaining CIMIGEN urban and rural centers across central Mexico.

Citizen Base Strategy

Vargas recalled a lesson from the early days of his personal and professional experience. He had been taught that clients want to have a sense of financial co-responsibility when they receive services precious to them. He remembered that in his rural hometown of Villa Madero, Dõna Ricarda—the legendary midwife, had always been remunerated by even the poorest with whatever they could give her in place of cash. Years ago, as an unpaid intern, fresh out of medical school, he too had received compensation in appreciation of his work. Later on, he saw for himself how free health care led doctors to treat patients like beggars, and how, in turn, patients felt like they were receiving handouts. He concluded that clients need to understand that good treatment is a product of their effort, and care providers are simply facilitators. So he developed his cardinal rule for CIMIGEN: “The norm here is that people pay,” he says.

To make the clinic sustainable, Vargas devised a sliding scale of rates to fit different family income levels. At CIMIGEN, a first-time visitor is interviewed by a nurse and quoted a price based on family financial circumstances. Visitors who insist that the cost is too high receive a house call from the evaluator, and expenses are adjusted accordingly.

Those whose incomes are the equivalent of 1 or 2 monthly federal minimum wages (US$ 100-200) make up 15 percent of CIMIGEN’s clients. Some 80 percent earn from two to five times the minimum wage (up to US$500). The remaining 15 percent fall into a third higher-income bracket. Fees from the higher tier income brackets subsidize the costs of the lower-income patients. The evaluator explains to the client the comparative fees for treatment at CIMIGEN and other facilities. All payments are received as donations, since CIMIGEN is a nonprofit organization; therefore, they are tax-deductible for clients and tax-free for the center.

Another way that CIMIGEN sustains its client and resource base is by offering packages of services. The package covers 5 pregnancy consultations, delivery, hospital recovery, 10 laboratory studies, 1 ultrasound, 2 post-partem appointments that include birth control counseling for parents, and 5 baby checkups during one year. The cost for a family in the middle-income group is about US $450. The service contract requires a down payment and, depending on client preference, monthly or twice-monthly payments. Although the social value for promoting the package deal is to assure that families get well-rounded care and to reduce risk, its business advantage is equally important. It costs patients 15 percent less than if they pay on a per-visit basis, but it allows CIMIGEN to calculate its expected receipts and adjust outlays accordingly. Fifty percent of CIMIGEN clients opt for the package.

Results

Starting with 1 doctor’s office and 5 employees, the first center now has 10 rooms for medical consultation and more than 100 attendants. Its coverage has grown from 1,000 outpatient appointments and 15 childbirths in 1988 to 30,000 consultations and 1,000 deliveries last year.

Read a profile about Carlos Vargas Garcia, Ashoka Fellow.