You are Marisol Colop, chief executive of Clínicas Raíz, a for-profit primary-care company in Guatemala's western highlands. Your anchor impact investor has frozen GTQ 4.0 million and given you ninety days to bring a plan. Before you design an offer or touch a price, you have to decide whose reach that plan is built around.
The situation
Raíz runs six storefront clinics and eighteen community health promoters around Quetzaltenango: general consultations, maternal and child care, diabetes and hypertension follow-up, basic lab work and a small generics pharmacy. In 2025 it recorded 48,000 visits and GTQ 14.4 million of revenue at a 6% EBITDA margin, a surplus of GTQ 0.86 million. 72% of revenue comes from uninsured patients paying cash, so the GTQ 300 consultation leaves a household's pocket on the day of the visit. About half the people Raíz aims to serve live hours from a clinic.
The fund's letter of 2 March 2026 freezes the second tranche until Raíz shows a plan that does three things at once: reaches more low-income patients than in 2025, puts the company on a path to operational break-even within eighteen months, and earns an external social rating good enough to open up to GTQ 6 million of blended co-financing. Without the tranche, the cash lasts five months.
The fund's scorecard puts Raíz's access index, a 0–100 composite of its reach into the poorest income quintiles, at 52, down from 61 at its previous reading. A survey found that 28% of households in the poorest quintile skipped a needed visit in the last six months because of cost. The social rating stands at 30 out of 100.
Inside the company the argument started before the letter. The finance manager wants the fee raised; the medical director wants it cut, with a membership added. Two NGOs that refer patients have asked what proof of clinical quality Raíz can show them. Each of them looks at the same 48,000 visits and sees a different company.