CATALINA ESCOBAR

Colombia,

Catalina Escobar has forged a unique three-way partnership among her citizen organization, key public hospitals, and the private sector to attack serious health problems in infants, children, and young mothers living in the most poverty stricken areas of Cartagena. Catalina’s program has already achieved astounding results in the reduction of infant mortality and is ripe for replication throughout Colombia.

This profile below was prepared when Catalina Escobar was elected to the Ashoka Fellowship in 2011.

INTRODUCTION

Catalina Escobar has forged a unique three-way partnership among her citizen organization, key public hospitals, and the private sector to attack serious health problems in infants, children, and young mothers living in the most poverty stricken areas of Cartagena. Catalina’s program has already achieved astounding results in the reduction of infant mortality and is ripe for replication throughout Colombia.




THE NEW IDEA

Under Catalina’s direction and vision, the Juan Felipe Gómez Escobar Foundation is providing integral healthcare services to the most tragic and disenfranchised communities in Cartagena. The foundation provides world-class care to impoverished young mothers, infants and children; sectors that are particularly vulnerable to health crises and do not have regular access to adequate healthcare, regardless of its quality, at public hospitals. Modeled after the award-winning neonatal units at hospitals in Anaheim, California, the foundation’s medical professionals and administrators care for patients with respect, dignity, professionalism, and quality treatment—a medical experience unlike any other available to them and establishing a new patient paradigm for healthcare in Colombia. In less than ten years, Catalina has lowered infant mortality rates in Cartagena from among the worst in the world, at 48 deaths per 1,000 births—twice the Colombian average—to a mere 8 per 1,000, a 79 percent reduction. To achieve these incredible results, she only spends US$300 per child, compared to US$1,500 per child spent by Colombian public hospitals.

Catalina can supply such world-class care by relying on an innovative three-way partnership among the public, private, and citizen sectors to sustain the foundation and facilitate its work in the public hospitals. The foundation is a social enterprise, and Catalina administers it with classic business techniques, methods and measures, which help her engage interested investors to bankroll the project. Recognizing the value of providing quality care to the base of the pyramid in Cartagena and detecting Catalina’s incredible impact, businesses have clamored to grant donations for corporate social responsibility and philanthropic ends and to invest capital into the foundation. Meanwhile, the public hospitals under strains of over-crowding and under-funding can send the foundation patients they cannot attend. These hospitals are also fast adopting the healthcare techniques that Catalina has brought to their own public clinics. The three-way partnerships have established a support network that gives the foundation the resources necessary to address the gravest public health challenges in Cartagena and Colombia.

Moreover, the partnerships that Catalina has coalesced have been crucial to scale the foundation’s impact. Originally tackling the high levels of infant mortality in Cartagena, Catalina has been able to expand her services to children as they grow older but remain at high risk, and to their young mothers. Through more private investment the foundation has instituted new integral healthcare outreach techniques to care for infant patients while also beginning to build other stand-alone facilities. Catalina has thus far been operating the foundation as a completely autonomous organization which operates inside the public hospitals. Her partnerships are successful case examples in Colombia of win-win collaborations between private and public entities for a social cause. Catalina hopes to replicate in other cities, considering the distinct health and social circumstances of each community to forge new partnerships that will nurture other foundation activities.




THE PROBLEM

A seaside city known for beautiful beaches and luxurious resorts, Cartagena nonetheless suffers from extreme social cleavages. As a result of the long-lasting violence which has devastated Colombia, Cartagena has received the second highest level of displaced persons and refugees in the country, which caused the municipal population to triple over recent years. These internal refugees have arrived and reconstructed their lives in areas of devastating poverty without basic utilities. Public services have collapsed; trying in vain to handle this onslaught of need, especially medical care. According to UN figures, Cartagena had an infant mortality rate of 48 per every 1,000 births, a rate alarmingly high compared to the national and regional average, and fatalities by children under the age of four represent a quarter of the deaths in the city. These levels of infant mortality, along with high rates of teen pregnancies, especially affect the poorer classes who are vulnerable to disease and exploitation. They have swollen a hospital system without the capacity or resources to provide basic care. 

The public hospital system is practically bankrupt, and in order to finance any medical services, the hospitals must charge high fees to patients, even those purportedly covered by government health insurance plans. Of course, the poorest patients—and those who require the most medical services—cannot afford these charges, so hospitals must turn them away for want of funding. They further lack any budget for prescription drugs and basic medicines that could treat many of the avoidable child deaths that Cartagena sadly experiences daily. The problem, though, does not lie with the public health expenditures: In fact the local government allocates sufficient money for hospital upkeep and maintenance. However, corruption by local officials and organized crime has so permeated the political system that most of the public appropriations are siphoned off by municipal leaders, crime bosses, and bureaucrats before reaching the hospital facilities. The government ensures little oversight and accountability in its financial reports, aggravating the issue even more.

These days, 600,000 residents are without general infrastructure or a healthcare safety net comprised of medical clinics and emergency treatment centers. 68 percent of Cartagena residents live in poverty, and 51 percent in grave situations of poverty. The growing poverty and economic inequality sparks social problems like family violence, another contributor to higher child deaths and teen pregnancy. The cycle of poverty exerts greater pressure on an already exhausted public system that must refuse service to additional patients, triggering the multiplication of the scenario on a larger scale. Cartagena is certainly not the only city in Colombia suffering from high infant mortality, a surge in displaced persons, harsh poverty, and failing institutional capacity to handle the demands on public services, but the challenges there may be the most difficult.




THE STRATEGY

Catalina has addressed the public health crisis and the institutional hospital collapse in Cartagena with her innovative public-private-citizen partnerships that comprise the work of the Juan Felipe Gómez Escobar Foundation. The foundation was named in memory of Catalina’s 16-month-old son, who died tragically and was one of two life-changing experiences which spurred Catalina to begin this major new effort. Over the past ten years, Catalina has carefully studied the health situation in the local region and consolidated her long-term planning to craft a profoundly different and robust program with a broad array of medical services that can generate sustained, integral results. Currently, the foundation operates in three different locations, each featuring different aspects of the administration of the project. In Cartagena, forty-eight employees are responsible for execution of treatment and medical care, all working under the strategic direction of Catalina and her supervisory staff of nine, based in Bogotá. Catalina also oversees a small team based in Madrid, Spain, that operates as a European fundraising unit of the foundation. She collaborates with an influential and professional Board of Directors composed of executives from major multinational corporations working in Colombia and former political officials who maintain an instrumental role in advising Catalina as she manages her vision for the foundation.

Catalina believed that the only way to combat infant mortality in Cartagena was by offering the best quality care to the poorest segments of the population. After a year of analysis and planning, she launched her pilot, the Saving Lives Program, at the Rafael Calvo maternal health clinic in one of Cartagena’s most overwhelmed public hospitals. She secured donations of medical equipment from the Spanish government and invited experts from a private Anaheim-based neonatal treatment center to train staff in their practices and protocols. To finance the initial operating costs, Catalina received support from private local businesses that saw the urgent need to improve infant medical care in the community. The public hospital contributed its dilapidated neonatal unit within the hospital, which the foundation refurbished with the Spanish equipment. Catalina and the hospital administration agreed that the foundation would operate the neonatal unit, pay for all its expenses, implement best infant care practices, and receive overflow patients from other hospitals needing infant and maternal health treatment for a set time, and then transition the operations to hospital officials. Helping combat the corruption that is rife in the hospital system, the administrators have facilitated the effort to a more transparent structure to manage and assess resources. That transition is now complete, and the hospital has wholly adopted the foundation’s world-class healthcare techniques with its stellar evidence of impact. In the first five years since the foundation assumed responsibility of the Rafael Calvo clinic, the facility experienced a dramatic reduction in fetal and neonatal deaths from 724 in 2001 to 225 in 2005, or a decline in infant mortality rate from 48 to 8 percent. Catalina attributes this impressive impact to the high quality of care supported by the successful alliance of the foundation, the public clinic and hospital administration, and the business investors.

Once achieving this partnership and evidence of accomplishments, Catalina began to introduce additional treatment practices in the foundation’s work to provide integral healthcare to the babies, children and mothers. The foundation now treats newly born patients from various hospitals in Cartagena and reaches out to additional patients who have not been hospitalized or received medical care with chronic or potentially fatal ailments. The foundation’s direct medical activities have treated some 2,227 children in Cartagena, of which just 46 died (a 2.71 percent fatality rate). Each child patient is given follow-up care for five years at the Juan Felipe IPS Medical Center, a foundation-sponsored business unit, where they receive pediatric and nutrition services. Teenage mothers between the ages of 12 and 18 also receive gynecological and obstetric care at the foundation clinics as well as comprehensive reproductive health education. In the past ten years, the medical center has intervened with more than 10,500 patients, all family members of the children treated. In addition, through its Sponsor a Child Plan, the foundation accepts donations to sponsor not just a child patient but all of the physical equipment and stake in the hospital needed to care for children who will later pass through that crib, enabling each baby to have all of the care and resources for his or her survival on a longer term. Catalina understood that she needed to broaden her focus to include care for younger children and teenage mothers. Now, she has instituted an integral treatment model with the foundation that has in total provided treatment to 65,525 patients, 80 percent being children under the age of five.

Businesses in Cartagena are loath to enmesh themselves in the corrupt public health system, but Catalina has made the foundation an appealing intermediary between investors and the government hospitals.  Besides running the foundation like any traditional profit-seeking venue, with open and transparent finances and assessment of impact through available measures, Catalina channels investment and grants in the centers to maintain operations, not program overhead. Her seven cost centers located in Cartagena, Bogotá and Madrid deliver annual budgets and impact evaluation for review by her and the Board of Directors. Catalina oversees the precise cash flow of each cost center in coordination with her managers, but each center is an autonomous, self-sustainable entity with a particular strategic plan. Every two months, each investor in the project is entitled to receive a complete operational and financial appraisal of any program organized by the foundation. Furthermore, an external evaluator, the Chief of Pediatrics at the University of Cartagena, guarantees an objective assessment of results in reporting to investors. This meticulous dedication and accountability in concert with a successful social mission has won the confidence of the private sector in Colombia and overseas.

In 2010, the foundation functioned with a US$1.3M annual budget and has even begun to create a small endowment for the organization. Of this total, Catalina procures about US$1M in revenue from corporate entities either as philanthropic or corporate social responsibility investments. Demanding accountability in their growing philanthropic ventures, national and international corporations have been especially active with the foundation due to Catalina’s emphasis on transparency. She has accessed the corporations through their corporate social responsibility platforms with the goal of establishing close alignment between the businesses’ activities and the foundation beyond just receiving their donations. Many members of her Board are partners from the private sector in Cartagena and Colombia, such as Johnson & Johnson Medical, ExxonMobil and Electricaribe. All corporate investments or grants are allocated to foundation activities; overhead and administrative expenses Catalina funds with proceeds from prestigious fundraising events. In all, the foundation generates its own revenue to support 27 percent of its budget.

As the foundation has accomplished a deeper and more integral impact among the families of the infant patients with such dramatic program success, in 2007 Catalina began construction on a new stand-alone medical complex. Built in the heart of one of the poorest areas of Cartagena, this 10,000 square meter property will feature medical treatment centers, outreach programs into the communities, patterned after Ashoka Fellow Vera Cordeiro’s RENASCER program, administrative offices, spaces for maternal health workshops, and recreational zones. It is also LEED certified with cutting-edge ecologically sound architecture. The complex will vastly accelerate the foundation’s reach and impact by providing to any patient, regardless of income, the same innovative, world-class neonatal and maternal healthcare treatment as public hospital clinics. Catalina also hopes to offer proactive prevention services and public health outreach into poor communities by hosting workshops for teen mothers and training them in basic vocational skills and income generation. Such projects seek to prevent the conditions that foster the environmental risks associated with infant mortality and serve to increase Catalina’s reach within the Cartagena population.

Catalina has taken care to consolidate her program, administer a successful business enterprise and deepen her impact in Cartagena before embarking on broader national expansion, but she is keen to soon reproduce the foundation’s accomplishments. The partnerships between the organization, businesses and local public hospitals are extremely replicable, once contextualized for the varying public health circumstances in other cities. Her impact will continue to galvanize other public clinics into inviting the foundation to begin operating their hospitals and adopt their techniques. At the same time her precise evaluation and financial reporting, coupled with its social mission, will attract assorted business partners.  Catalina has started initial analyses to launch efforts in Bucaramanga, and the local Chamber of Commerce of Cali has also reached out to her to explore possibilities for a partnership after observing her accomplishments in Cartagena. To meet this blossoming demand, Catalina may devise a social franchise model that will accelerate her replication around the country. With such a successful prototype of partnering businesses and public hospitals for a social end, Catalina can potentially appeal for far more investments that will fortify a powerful transformation in the public health sector around Colombia. 




THE PERSON

Catalina’s life changed forever after the death of her 16-month-old son Juan Felipe. Just three days prior, Catalina had tragically experienced the death of another child, a 12-day-old baby who passed away in her arms while she was volunteering at the Rafael Calvo neonatal clinic. The baby’s mother had not been able to afford the US$30 needed for medical treatment, a modest sum of money that Catalina later realized she had in her purse at the time of the baby’s death. Devastated with grief over experiencing such painful loss, Catalina quit her lucrative job and dedicated herself to planning and launching a social initiative, Saving Children’s Lives, that later became the Juan Felipe Gómez Escobar Foundation, named after her deceased son. 

A member of a widely recognized family of business entrepreneurs in Colombia, Catalina grew up in a household that strongly inculcated the values of entrepreneurship and philanthropy. As a child she had observed her father’s dinner-table conversations of business deals, but she also learned that respect for all and volunteering for social causes was a paramount responsibility. He once had told her that, “the social return should be superior to any business return,” a motto that she has lived by since. Catalina did her undergraduate degree in management at Clark University in Massachusetts, where she also studied abroad in Osaka, Japan. Although she did not speak Japanese and her host family spoke no English—a second language that Catalina had to master at college—Catalina strove to integrate in a completely foreign land, and she came to adopt the attitudes of discipline embedded in Japanese culture. Returning home to Bogotá, she began working in finance and completed an MBA, later rejecting the earnest offers of her father to work in his large business so that she could achieve her dreams of being “self-made.”

After moving to Cartagena with her husband, Catalina established an international trading company that imported and merchandized nutritional supplements. She spent three years directing this enterprise until the sudden death of her son, at which time she sold her business and began to design the foundation.  Today Catalina brings to bear fifteen years of experience in the private sector to address a social challenge.  As the director of the foundation, she is blending the two passions that she developed as a child, in business and in social welfare, to follow her family’s path and become the first in her family to be a true social entrepreneur. Catalina now enjoys impressive success and publicity for her work to combat infant mortality in Cartagena. For the grand opening of the foundation’s complex, she secured the participation of leaders from public agencies, multinational corporative executives, and even the President of Colombia to inaugurate and honor this new reference in the public health sphere with amazing growth potential.




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