Accidental Entrepreneurs: Banking on Health Trains Romania’s Family Doctors in Financial Management
Romania is a model in the Europe and Eurasia region for the tremendous gains in women’s health over the past ten years. Family doctors are a major factor in the Romania success story. There are currently 11,000 family doctors in Romania. Formerly Ministry of Public Health employees, these family doctors’ practices have been privatized and most are now contracted out to provide a basic package of health care through the National Health Insurance House.
Through a process of health reform, family doctors are now allowed to provide family planning counseling, prescriptions and distribute products. Approximately 5,000 have been trained by USAID in family planning service delivery. Many of these doctors operate in rural and underserved areas. Despite their strategic role in the Romania success story, the Banking on Health project (BoH) determined that these family doctors are “entrepreneurs by accident” and are struggling to remain viable and manage within the capitated system. Banking on Health designed a technical assistance package to improve access to financing and business management skills in order to improve the viability of family doctors and help sustain the long-term gains that have been made in women’s health.
To improve the viability of their practices, Banking on Health designed a course entitled “Enhancing the Financial Health of the Medical Practice: The Key to Sustaining Reproductive Health and Other Services.” The goal of the course is for participants to be able to assess the financial health of their medical practice and project future cash flow and income to be able to make informed decisions for continued sustainability and profitability. The Romanian NGO “Society for Education in Contraception and Sexuality” (SECS) provided trainers to teach the three-day financial management course. The course was offered in each of the eight development regions of the country in 2006, and has been attended by 140 family doctors to date. There was a 36% increase in learning as a result of the course for participants.
Each course included guest speakers from local financial institutions to provide greater linkages with lending resources. With the ending of USAID funding for these activities in 2007, Banking on Health has leveraged continued funding from three commercial banks that have offered to subsidize the future roll-out of this continuing education course for doctors.
The impact of the trainings is already becoming evident. In July 2007, a follow-up survey was conducted with a subset of the family doctors who participated in the trainings. Participants were contacted by SECS and 38 out of the total 140 doctors answered a questionnaire concerning changes to their practices since attending the training course. Of those 30 doctors, eight have taken a new loan or lease since the trainings (27%), with at least $72,983 in combined financing obtained. Five other doctors said they were still preparing their loan applications for the future. Seventy-three percent of the doctors said they have started implementing all of the tools that were taught in the training (income statements, action plans, balance sheets, and cash flow). 20% said they have increased their provision of RH/FP products and services since the course, with the highest increases in the provision of oral contraceptives, condoms, and injectables. Among those family doctors offering IUDs, 17% began offering this service after attending the Banking on Health course.
