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Project Assistance Completion Report –PACR
Cooperative Agreement No. 520-A-00-98-00045-00
I. PROJECT SUMMARY
Date of Authorization: July 16, 1998 
PACD: December 31, 2001
Implementing Agency: Management Sciences for Health
Total Amount Authorized: US$991,398.00 
Total Amount Obligated: US$991,398.00
Total Amount Spent1
: $969,800.44 
Counterpart Contribution: 0 (not required) 
II. PROJECT DESCRIPTION
On July 16, 1998, USAID/G-CAP signed a Cooperative Agreement with 
Management Sciences for Health (MSH) to provide technical assistance to the 
Asociación Pro-Bienestar de la Familia (APROFAM) in a variety of institutional 
strengthening areas. The specific objectives of the Cooperative Agreement 
were as follows:
· Objective 1: MSH will assist APROFAM in the development, promotion 
and implementation of strategies to increase coverage and improve the 
quality of its health services [clinics and health promoters] in underserved 
areas, especially in the highlands of Guatemala.
· Objective 2 MSH will assist APROFAM in the development and 
implementation of integrated strategies to improve women’s and 
children’s health, especially in the rural highlands of Guatemala. The 
integrated strategies will include both the integration of women’s and 
children’s health care services and linkages between clinic-based and 
health promoter information and services.
· Objective 3: MSH will assist APROFAM in the design and 
implementation of culturally acceptable marketing and educational 
strategies to improve women’s and men’s knowledge of reproductive 
health and to ensure that increased knowledge translates into increased 
use of reproductive health services. Assistance will include training, 
supervision and motivation of health workers to participate in a wide 
range of outreach activities, with emphasis on regular home visits.
 
1 According to Financial Status Report submitted by MSH on January 24, 2002 for expenses 
through December 31, 2001 (not final).
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· Objective 4: MSH will assist APROFAM in the development of its 
strategic planning, health care management/administration [including 
supervision], monitoring and evaluation capabilities, and decentralization, 
in both the rural and clinic programs. A strong emphasis will be placed on 
the development of administrative and decision making capabilities of 
clinic managers and jefes de campo in support of decentralization and 
improved local supervision, monitoring and evaluation, and bottom-up 
planning.
· Objective 5: MSH will assist APROFAM in the development of other 
management and administrative skills that will directly impact program 
performance.
In this context, MSH assisted APROFAM in systematically developing an entirely 
new management infrastructure that included:
1. Strategic and operational planning;
2. Re-engineered financial, administrative, planning and evaluation and 
human resources policies, systems and procedures;
3. Development of new, integrated management software;
4. Development of a Management Information System for decision-making;
5. Development of management and quality indicators;
6. Development of an employee performance evaluation system;
7. Development of supervisory systems;
8. Development of a Marketing Department to ensure client-focused 
services; and
9. Development of a business planning model.
The results of these interventions, tied to the objective they supported, are 
described in the following section.
III. RESULTS ACHIEVED
See Appendix A for a summary of results achieved under each corresponding 
Agreement objective.
IV. FINANCIAL REPORTS AND AUDITS
Financial monitoring of the Cooperative Agreement consisted of a review of the 
quarterly Financial Status Reports (Form 269A) submitted by MSH, as well as
projected accrued expenditures, to assure that obligated funds did not exceed
forward funding guidance. Under the Cooperative Agreement, MSH was subject 
to the audit requirements found in OMB Circular A-133.
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V. End Use Checks
End use checks as such were not required given that MSH did not procure
equipment under the Agreement. Verification of receipt of technical services
was performed by the CTO in charge.
Appendix A
Planned Management Assistance Activities/Results
Objective Activity Results
Intermediate Result 1 More Rural Families Use Quality Maternal and Child Health Services
Objective 1 MSH will assist 
APROFAM in the development, 
promotion, and implementation of 
strategies to increase coverage and 
improve the quality of its health 
services (clinics and health 
promoters) in underserved areas, 
especially in the highlands of 
Guatemala.
1. Development of a Quality 
Assurance Program for the Rural 
Development Program of 
APROFAM
1.1 Assessed status of 
efforts to monitor and 
control quality, 
including protocols, 
standards, instruments 
and information system.
1.2 Supervision 
standards and indicators 
established and 
implemented.
1.3 Prototype integrated 
Rural Health Promoter 
Model developed and 
tested.
2. Development of an Incentive 
Program to Reward Employee 
Performance 
2.1 Incentive plan 
finalized and applied to 
employee evaluation 
cycle.
3. Development of Systems and 
Procedures Manual for Staff 
Training, Client Education and 
Service Publicity
3.1 Mission and goals 
for each of the three 
areas/departments 
established.
3.2 Systems and 
procedures redesigned 
for three 
areas/departments. 
Objective 2 MSH will assist 
APROFAM in the development and 
implementation of integrated 
strategies to improve women’s and 
children’s health, especially in the 
rural highlands of Guatemala. The 
integrated strategies will include 
both the integration of women’s 
and children’s health care services 
and linkages between clinic-based 
and health promoter information 
and services.
1. Assess problem of 
referrals/counter-referrals 
between clinics and rural 
program
1.1 Problem assessed; 
draft procedures and 
instruments developed 
and implemented in 
selected sites.
Objective Activity Results
Objective 3 MSH will assist 
APROFAM in the design and 
implementation of culturally 
acceptable marketing and 
educational strategies to improve 
women’s and men’s knowledge of 
reproductive health and to ensure 
that increased knowledge 
translates into increased use of 
reproductive health services. 
Assistance will include training, 
supervision, and motivation of 
health workers to participate in a 
wide range of outreach activities, 
with emphasis on regular home 
visits.
1. Development of a 
Comprehensive Marketing 
Program and Department 
1.1 National market 
research completed and 
reviewed. 
1.2 Long-term 
institutional marketing 
plan finalized. 
1.3 Marketing 
department restructured. 
2. Development of a Long-term 
Institutional Business Plan 
2.1 Business Plan 
developed with long￾term institutional 
financial goals, income 
needs and income and 
expense scenarios. 
Intermediate Result 2 Maternal and Child Health Programs Are Better Managed
Objective 4 MSH will assist 
APROFAM in the development of 
its strategic planning, health care 
management/administration 
(including supervision), monitoring 
and evaluation capabilities, and 
decentralization, in both the rural 
and clinic programs. A strong 
emphasis will be placed on the 
development of administrative and 
decision-making capabilities of 
clinic managers and Jefes de 
Campo in support of 
decentralization and improved 
local supervision, monitoring and 
evaluation, and bottom- up 
planning.
1. Re-engineering of the 
Department of Planning, 
Evaluation and Statistics
1.1 New, formal 
procedures to guide the 
department, new job 
descriptions and new 
reporting formats 
developed.
2. Development of Management 
Software Support Manuals and 
Additional Modules
2.1 Software support 
manuals for eight basic
management software 
modules completed. 
Objective Activity Results
3. Management Development 
Program for Rural Development 
Program Managers 
3.1 Year-long 
management 
development program 
completed and 
evaluated; additional 
training needs assessed 
and prioritized.
Objective 5 MSH will assist 
APROFAM in the development of 
other management and 
administrative skills that will 
directly improve rural program 
performance
1. Development of an Employee 
Evaluation System and 
Accompanying Support Software
1.1 Employee 
evaluation policies, 
procedures and 
instruments developed 
and field-tested.
1.2 Employee 
evaluation system 
implemented and staff 
trained in use of 
instruments.
2. Development of an Operations 
Manual for the Computer System 
2.1 Operations manual 
completed. 
3. Development of a Human 
Resources Operations Manual 
3.1 Operations manual 
completed.
4. Final Management Assessment
of APROFAM
4.1 MOST process
undertaken for each
major management
system and results
analyzed and discussed.