In November, Linked Foundation’s advisor, Kim Wilson, traveled to Guatemala to get a first hand look at the health store model, TISA, a program Mercy Corps and Linked initiated in 2009. Having worked in microfinance for over two decades as an advisor, lecturer and consultant for a multitude of national and international organizations focusing on marketing and microfinance, we looked forward to her insights. Currently a Senior Fellow at the Center of Emerging Market Enterprises at Tufts University and head of the Fletcher’s Leadership Program in Financial Inclusion, Kim’s expertise in microfinance is sought after around the globe.
At the Linked Fdn. and GP workshop in Antigua on Nov.11th – 12th, Kim spoke about the health store models she visited. The following are reflections of her visit:
A Tale of Three TISAs
Along a road edging the main graveyard of the tiny town of Chilcal in the province of Huehuecastinango, Guatemala, a proud TISA sign marks the entrance to a path dividing a field of maize, acacia, and banana. At the top of the path stands the home of the Mazariegos where Yoeny and Yadira live with their siblings, in-‐laws and mother.
A large breezeway, its front lined with pots of red geraniums, cuts through the center of the house. The kitchen and bedrooms are to the left. To the right is the Tienda de Salud, the TISA pharmacy, its ceiling decorated in a blue tarp and cheerful white streamers. One end of the room holds a bed and a few comfortable chairs and the other, a counter, behind which are several rows of wooden shelves. At any given time, the shelves support about ninety different medicines and health products. Treatment for colds, nausea, infections and fevers, wounds, arthritis, and rashes can all be found here. The room is open to visitors twenty-‐four hours a day, seven days a week.
More than a year ago, the Mazariegos learned about the opportunity to convert spare living space into a medicine shop. Sr. Eric, a local representative of TISA (Tiendas de Salud) held an open house at the local community center where they invited any residents of El Chilcal with extra space in their homes to apply for a TISA franchise. In return for training, operating guides, use of the TISA brand as well as help in financing a beginning inventory of medicines and health supplies, the selected franchisee would promise to keep the space available on a 24/7 basis.
The sisters thought becoming a TISA franchisee would give them extra income while helping residents shave 20 kilometers from a typical run to the nearest pharmacy. So, they jumped at the opportunity associate with TISA. Their father and brother had moved to Florida to earn money to send back home. But, the brother had fallen seriously ill and remittances soon dwindled. Earning extra money seemed like a good idea.
Since the Mazariegos opened for business in the summer of 2014, they have built monthly sales to roughly Q2,600 ($339) in monthly profits to Q670 ($87.52). The tidy registers on the pharmacy counter reveal client patterns. Most spend far less than a dollar per visit. Products are sold capsule by capsule, swab by swab. Miguel Ramirez came this past week and bought seven tablets of Ampicilin for Q19 (about $2.50). Daria paid Q1.25 (about 16 cents) for a single capsule to relieve his flu. Oleganio, the register shows, stocked up this past March. He purchased five packets of Alka Seltzer for a total Q7 (about 90 cents), and very small quantities of pills and tubes of ointments to ease the pain of flu and arthritis. The Mazariegos women say that his arrangement is typical before the rainy season when showers are heavy enough to cause mudslides, making the roads dangerous and impassable.
Clients are extremely poor in this mountainous district that borders Mexico. They farm potato and maize, consuming most of what they produce. Better off households grow coffee. The main market in the city of Huehue is at least 50 kilometers away. Most families don’t grow enough food to justify the trip to the bigger market. The Mazariegos are pleased that they can charge their clients the same price for medicines available in Huehue. They can do so because TISA, and its key provider of technical assistance, Mercy Corps, have negotiated excellent prices with key medical suppliers.
The Mazariegos are one of about fifty TISA franchises in Guatemala. With the help of Mercy Corps, TISA trains franchisees in basic health and business management, and provides its brand in the form of signage and other uses of the TISA trademark. It offers franchisees low prices for quality medicines, a step-‐by-‐step operational guide and health reference manual, as well as regular monitoring and support visits.
About an hour away from the Mazariegos’ home, a valley covered by banana, pine and oleander lowers into the town of Chejoj. It here along the main street that we glimpse another TISA. Clad in a frock and white apron, Señora Maribel greets visitors at the entrance of her gated courtyard. She guides them past two thick palmettos along a path bounded by pomegranate and fig trees. Her TISA room is part a well-‐kept out-‐building separate from Maribel’s main home. On the gleaming tiled floors in a corner of the TISA room is a friendly bed.
Chejoj has about 2,000 inhabitants, enough for Maribel Palacios to do a brisker business than the Mazariegos. Her TISA shelves brim with antibiotics and pain relievers, vitamins, syringes, bandages, bottles of disinfectant and tins of menthol balm, each no bigger than a nickel. Here as in Chilcal, clients purchase in small quantities, but in Chejoj, Señora Maribel can enjoy monthly sales of Q4,000 ($552) and profits of more than Q2,206 ($288.16). Her best sellers are ampules of Vitamin B12 and syringes. “The vitamin injections help with the aches and pains of so much hauling, carrying, and stress in our rural lives.”
Sra. Palacio is grateful for the income. Her son has attempted to enter the U.S. three times in search of work and three times he was turned back at the U.S. Mexican border. “Here we have so much beauty,” she says. “But no money.”
Canton Plaza lies 80 kilometers from the city of Huehue. Plots of corn and bean hopscotch from the river valley up a flank of the Cuchumatanes range until they reach a high ridge where their steep fields flatten into pastureland. Local families ranch sheep and goats and grow potatoes.
The cold, muddy village of Canton Plaza has a humble community center with a small hut next to it – it is the TISA store. Sr. Eric introduces the owner and his daughter, Leandro, a nurse. The father-‐daughter team has operated the store for years but until recently did not stock medicine. Now, a cabinet placed next to shelves of small toys, sells candies, sugar, rice, soaps, shoe polish, and salt, displays antibiotics, tablets for the flu, bandages, aspirin, and ointments of various kinds. Small jars selling for one quetzal apiece contain hand-‐made mixtures of petroleum jelly and herbs, a best selling ointment for rubbing on the cheeks of children. Its popular this time of year and helps ward off the sting of chilly winds.
Sales from the store are just Q 1,800 a month ($235), and about a third of that is profit. As we leave customers, cue up at the front counter, exchanging their coins for a few packets of medicine. They also buy candies and one pays for a candle. It’s easy to see how this local medicine chest saves hours of walking or hitching rides to the nearest pharmacy in the valley. One customer is now so used to the service that, “I can’t remember what is what like before we could get medicines here.” May she will never need to recall such a moment. The store, bustling with activity, seems to solidly occupy a permanent place in the village.
TISA embodies the ingenuity and effectiveness that characterizes high performing businesses serving the last mile. TISA owners are dedicated to stocking high quality medicines that address about 80% of local needs. Working with Mercy Corps, TISA is able to bring these health products to very rural areas at a price similar to those found in the big cities. TISA is one of several chains of health stores and clinics emerging in Latin America now experimenting with ways to distribute life-‐giving supplies, services and information to populations who need them most, when they need them most, and where they need them most.
Contributions were made by Hugo Caal, Mercy Corps.
Kim Wilson, November 18, 2015