Opinion: How a cooperative model can transform global health care

Health care worker cooperatives is a model that puts the focus back on quality care and worker well-being.

Doctors at a protest over the poor state of health care and to push for reforms in Nairobi, Kenya. Photo by: SOPA Images Limited / Alamy Live News

Imagine a health care system where decisions are made consultatively by the people providing care in consultation with patients — and not by distant shareholders often solely focused on profit margins. This is the transformative promise of health care worker cooperatives.

This model, which is gaining traction globally, prioritizes sustainable financing of health care, patient care, and employee satisfaction.

In an era where health care systems face unparalleled resourcing challenges, magnified by the COVID-19 pandemic, the quest for sustainable solutions has never been more urgent, especially for low- and middle-income countries.

Consider that in Africa, only South Africa and Cape Verde have met the threshold outlined in the Abuja Declaration. This is a 23-year-old rallying resource mobilization tool that saw African governments commit to increasing their national health budgetary allocation to a minimum of 15% of their annual budgets. Although statistics from 2021 point to a 6% increase in the continent’s health spending since 2020, it still falls short of the requisite baseline. In fact, in the same year, Africa’s budgetary deficit to meet the 15% spending threshold was approximately $263.4 billion.

This means that the public health systems on the continent continue to fail to meet the demands of their citizenry, placing pressure on private and faith-based health institutions.

In Kenya, the government only meets 50% of health care services provision needs. Even then, this statistic is only sometimes met due to inadequate resourcing. Last month, the Kenya Medical Practitioners, Pharmacists, and Dentists’ Union issued a strike notice that potentially has damaging consequences for patients. Ultimately Kenyan nationals and residents are exposed to the consequences of inaccessible health care due to financial constraints.

Health care worker cooperatives could help bridge this gap as the model harnesses health care workers’ collective power and expertise. This enables them to address systemic market failures by prioritizing long-term sustainability, equity, and community-centric care over the short-term profit motives often seen in private health care companies.

The value of these cooperatives extends to fostering a sense of ownership and accountability among health care workers, allowing them to contribute meaningfully to the health and well-being of their communities.

Health workers experience firsthand the disparities and inefficiencies that plague our health care systems while suffering these effects themselves. These include falling into poverty brought about by illness and failing to achieve financial stability due to extreme wage disparities when compared to more developed nations.

The example of Chad highlights challenges health care workers in LMICs often face: low wages, inadequate resources, and high illness burden, which detrimentally affect their well-being and service. Supporting health care workers through fair pay and increased funding to improve quality of service provision and their welfare is crucial for a stronger health care system globally.

Successful health cooperatives

Critics argue that cooperatives are not a viable alternative as they cannot compete with larger health care providers on level of care, innovation, and adaptability. There is, however, evidence from successful cooperatives worldwide.

In Argentina, health care cooperatives have played a pivotal role in improving access to primary health care post-economic crisis, demonstrating remarkable resilience and adaptability. Similarly, in Australia, general practitioners have banded together in cooperatives to maintain their autonomy and ensure high-quality health care provision, showcasing the competitive edge and innovation cooperatives can achieve.

Health cooperatives in Kenya and other LMICs could focus on delivering primary health care services, disease prevention, and health promotion, to address gaps in health care delivery, especially in rural and underserved areas.

To do this, they could use innovative techniques such as solar energy to power clinics. This can showcase cooperatives’ commitment to environmental sustainability but also demonstrate how innovative solutions can enhance health care provision while being economically efficient and ecologically responsible.

The path to establishing a health care workers’ cooperative is structured and demands commitment, but is grounded in a clear vision for equitable and community-focused health care.
Establishing health care cooperatives

The process begins with recognizing a community’s specific health care challenges, followed by gathering a committed group of health care professionals ready to embark on this transformative journey. Together, they need to craft a detailed business plan that outlines the cooperative’s objectives, governance structure, and financial strategies, ensuring the model’s sustainability and growth.

Central to the success of health care cooperatives is the deep involvement of the community they serve. Engaging local populations in the planning and decision-making processes ensures that the services provided meet the actual needs and preferences of the community. This enhances both the relevance and effectiveness of health care delivery.

This model’s strength lies in its ability to unite support and collaboration from various stakeholders, leveraging technology and innovation to extend its reach and impact, making health care more accessible and inclusive.

Establishing health care worker cooperatives represents a critical step toward reimagining and revitalizing our global health care systems. Health care worker cooperatives offer a glimmer of hope, letting communities build sustainable and equitable health care systems that prioritize the well-being of all.

The global health sector needs to embrace the potential of health care worker cooperatives. By supporting policy changes, investing in pilot programs, and engaging in open dialogue, health care workers, investors, and development partners can help build a health care future where everyone has access to affordable, high-quality care delivered by patient-centered professionals.

Delaying this transformation means perpetuating the cycle of underfunded systems, overworked and underpaid professionals, and ultimately, millions continuing to lack access to the essential care they deserve.

Adapted from Devex article: https://www.devex.com/news/opinion-how-a-cooperative-model-can-transform-global-health-care-107179

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