COMIXMUL Health Services Fund | Jan. - June 2013 | Issue 2 THE CASE FOR IMPACT INVESTMENT BRIEF PARTNER DESCRIPTION: COMIXMUL is a savings and credit cooperative based in Siguatepeque, Honduras, with approximately 25,000 women members. Almost 50% of COMIXMUL members live in rural areas, and the same number live under the poverty line. COMIXMUL works hand in hand with a not-for-profit foundation called FUDEIMFA to deliver training, technical assistance and health services, with the goal of incenting members to invest smarter in their micro-enterprises and also to boost their level of satisfaction with membership in the cooperative. In Honduras, 78% of all health expenses are the cost of medicines, placing them out of reach financially from many who need them. This program not only makes medicines more accessible economically, by charging half the margin found in the commercial market, but also saves families money in transportation by establishing a point of sale closer to home.
DoĂąa Chila is one of COMIXMULÂ´s volunteer community pharmacists serving rural communities.
INNOVATION: COMIXMUL and FUDEIMFA began the community pharmacies program several years ago, but has never achieved full financial sustainability due to a faulty cost-revenue model and a steep learning curve on the supply chain side. In addition to an inventory of essential medicines, community pharmacists will be equipped and trained to deliver nebulization services, which will help families respond in a more timely way to acute respiratory infections, the leading cause of morbidity for children under 5 in Honduras. In order to incent performance in sales, quality and transparency, community pharmacists will retain 10% of gross earnings. INVESTMENT: Global Partnerships has disbursed $130,000 since December 2012, with the goal of achieving operational and working capital sustainability across 201 community pharmacies. These pharmacies collectively serve a population of 34,000 people in rural Honduras with essential medicines. If this first phase of investment is successful, future phases could include building out a COMIXMUL-owned network of basic clinics to deliver preventive and primary care services, as well as leveraging both the rural pharmacy and clinic touch points to deliver key preventive health information.
REACH / SCALE
A snapshot view of progress (access to basic medicines)
SUSTAINABILITY January - June 2013
15000 12000 9000
100 80 60
40 20 0
Unique people served
Number of purchases (multiple purchases per unique person served)
Access to Basic Medicines
Revenue generated covers total costs over reporting period
201 pharmacies are fully stocked and have been functioning for almost one full quarter.
Sales results are still early – increasing on average but still below target.
Profile and preparation of the community pharmacist seems to be the most important factor in achieving consistent sales results.
HEALTH CARE SERVICES ACCESS TO BASIC MEDICINES Who’s covered: 34,000 community residents, primarily in rural areas What’s covered: Prevalent conditions, including respiratory and diarrheal illnesses, parasites, etc. Delivery channel: Selected members of COMIXMUL serving their respective communities as community pharmacists
BUSINESS MODEL COSTS Medicines purchase, staff and transportation costs for replenishment and supervision, and community pharmacist training
REVENUE Margin charged over cost of medicines