Scaling a budget from $3M to $10M via a few simple steps

The Project

We helped Integrate Health transform its finance operations, at a time when funds increased and tighter management was needed.


The Client

Integrate Health works alongside governments and the local community to implement and study an integrated approach to strengthening primary healthcare delivery in order to achieve universal health coverage.  By integrating professional community health workers with improved care in public clinics, this approach creates a patient-centred health system that is accountable to the community and dramatically reduces mortality in severely resource-limited settings.

Since the organization was founded by Peace Corps volunteers in 2004, they’ve been able to improve access and care quality, especially in cases of childbirth and the treatment of children.

For example, 49% of local births now happen at facilities, and 96% of childhood illnesses are treated in the first 72 hours. Preliminary data shows a 50% reduction in child mortality over three years in the areas where the Integrate Health approach was implemented.


The Problem

As their impact increased, they saw a surge in fundraising, including a number of multi-year grants. Soon, plans were made to increase their $3 million budget to $5 million by 2022, which would allow them to ramp up healthcare provision and expand into new territories.

Inevitably though, these extra funds came with conditions and a higher level of scrutiny, and this proved to be a problem for their outsourced accounting partners. This firm struggled with new requirements, like tracking and monitoring expenses that were covered by restricted grants. So the management and board decided something had to change.

They needed a tighter, more transparent way to manage and monitor their financial affairs and turned to Jasmine Social Investments for advice.

They recommended Vanreusel Ventures, knowing of our experience in finance operations and development.


The Solution

After an initial call, where we discussed high level problems, we asked them to offer more detail by completing a scorecard. Then armed with their responses, we were able to assess their financial and operating foundations – which, along with their goals, formed the basis of a customized action plan.

It started with recruitment. Having decided to end the contract with their outsourced accountants, their first priority was to hire a Finance Manager – someone based in the US, who would oversee their regional finance team in Togo.

We helped to define the job description and scope of responsibilities. Then after they produced a shortlist and carried out the first round of interviews, we conducted the second round alongside their COO.

We asked each candidate about the main challenges ahead:

  • Working in a start-up environment
  • Scaling from $3M to $10M
  • Introducing new financial systems
  • Managing external audits
  • Working with a remote team, and developing their skills

On completing this process, we began to focus on other critical tasks.

The next step was to develop a reporting package for the finance committee, so they could review past performance and future indicators in a clear and concise presentation.

Up to this point, their accountants had supplied standard QBO extractions of the P&L and balance sheet and the full report package included a lot of duplicate information. So we introduced our own templates and developed a robust new package that included:

  • A Balance Sheet
  • Profit & Loss Statement
  • Monthly Expense Tracking
  • Restricted Assets Release
  • 3-Year Fundraising Matrix
  • 24-Month Liquidity Forecast

We then turned our attention to internal controls. Having reorganized their finance operation, it was vital to ensure compliance by setting transparent protocols in a Table of Authority. So we proposed spending limits, and set everything out in a template we designed for ease of reference – so approvers could see their own limits and escalation paths, while auditors could easily check that spending was authorized.

With all these measures in place, our last task was to make sure our new processes and procedures took hold. So we supported the Finance Manager to review and update the Finance Manual, to reflect the new reporting package and Table of Authority. This became a tool for performance management and succession training.


The Result:

The disparate steps in this project combined to give Integrate Health a more stable financial platform.


  • Their new US Finance Manager has used our templates and materials to improve operating efficiency in Togo.
  • The board has a transparent set of reports that meet the needs of stakeholders and external auditors.
  • They have tighter internal controls, with a Table of Authority that protects against fraud and misspending.
  • Their new Finance Manual reduces scope for error, speeds up staff induction, and acts as a failsafe against sudden change at management level.

As a result, they’ll be able to scale from a $3M company with ad hoc financial management to a $10M company with a solid platform, ready for future growth.

“Working with James and Guillaume, we were able to tackle key questions that enabled our organization to lay a strong foundation for financial management. Their scorecard was very helpful and their advising on core components, such as when to bring accounting functions in-house, proved deeply valuable. Their support has enabled our team to feel confident in the strength of our finance operations.”

Jennifer Schechter / CEO, Integrate Health