The Covid-19 pandemic has put health systems under immense pressure, with some stretched beyond their capacity.
Health co-operatives around the world have been working to remove some of these pressures and support public sector healthcare providers.
In Spain, medical co-op Fundación Espriu provides health services to over two million people. As soon as the Covid-19 cases started rising in March-April 2020, Fundación Espriu made itself available to health authorities, to respond to the needs of the population and avoid the collapse of the public healthcare service. The co-op was quick to mobilise by increasing capacity in its hospitals, in some cases having to triple the number of beds available for critical patients. It also allocated additional resources and professionals, bringing back retired former employees on a voluntary basis.
Fundación Espriu also set up a telephone information centre staffed by health professionals and open to the entire population, postponed payments from members affected by the crisis and offered financial aid to doctors who had to close their practices. Families of health professionals who had to be hospitalised or lost their lives to Covid-19 were also supported via a new solidarity fund. Throughout 2020, Fundación Espriu’s medical centres carried out 13 million medical consultations, easing the pressure on the public sector.
“Our co-operative identity commits us to a humanised healthcare approach, with a vocation for service and a management model that places people at the centre. This is reflected in concrete actions,” said Carlos Zarco, president of the International Health Cooperative Organisation (IHCO), and director of Fundación Espriu.
In Cameroon, medical professionals from Santé Assurée Coop Ca, a member of the Health Cooperatives Association, volunteered to conduct health screenings at the entrance into the city, to try to prevent further contamination. Two of the Association’s members, Sodimess and Sante Assurée, led an awareness campaign to help the public stay safe during the pandemic, and distributed masks and sanitisers to refugees at the Minawao camp.
In Colombia, the health division of COOMEVA co-operative treated 66,807 users with a positive diagnosis of Covid-19 and held 244,000 follow up consultations. Around 333,000 tests were carried out, and 300,596 Covid-19 calls were answered. The co-operative also provided over one million telephone consultations. Around 6,898 patients were also treated in COOMEVA’s hospitals, 1,600 of whom had to be treated in intensive care.
“The co-operative identity has been the essence that has allowed COOMEVA to act in the way it has done in the midst of the circumstances due to the pandemic,” said general director Gilberto Quinche Toro.
The pandemic also encouraged COOMEVA to revise its long-term strategy to place a stronger emphasis on providing telemedicine and new technology to provide health services.
Social co-operatives in Italy were also amongst the first to respond to Covid-19. Gulliver co-op restructured its operations and safety procedures, which resulted in zero cases of Covid-19 in its senior care home in Modena. Gulliver also redesigned some of its open spaces and closed common spaces to prevent contamination, and invested in training care providers to make sure its workers stayed safe. Of the 10 care homes managed by Gulliver, 50% remained Covid-19 free.
Gulliver’s communications and marketing officer, Alessia Bellino, says the co-op’s two founding principles guides its activities: to take care of people and be responsible. Another important element of Gulliver’s approach was organising voluntary meetings to get feedback from everyone involved in the running of the co-op, from nurses and educators to elected members.
In India, the Self-Employed Women’s Association (SEWA) has focused on enabling its member co-operatives to continue operating. A study by SEWA in November found that the average monthly household income of its members had dropped by 65% over the course of the pandemic, from INR 18,068 (£181) to INR 6,313 (£63). Lockdown measures also impacted informal workers’ access to social services such as healthcare, childcare and insurance.
To support its members, two of SEWA’s co-operatives (Abodana, a handicraft co-op, and Lok Swasthya Mandali (LSM), a health co-op) switched to the production of masks and low-cost hand sanitisers.
LSM, whose members are mostly community health workers, runs three low-cost pharmacies in Ahmedabad city and provides health education and other primary healthcare services to informal women workers. Its members also act as insurance agents, linking women and their families to VimoSEWA’s, which provides micro-insurance services and products and sells affordable Ayurvedic products produced by LSM.
Another of their activities is conducting sessions to disseminate information on maternal and child health, hygiene, and communicable and non-communicable diseases, looking at their causes, prevention and cure. When the lockdown was imposed the community health workers could no longer carry out their door-to-door activities, so they turned to digital platforms such as Whatsapp, voice messaging and audio conferencing to disseminate information on Covid-19, raising awareness about the virus.
Bhavnaben, a 38-year old health worker from Lok Swasthya Mandali shared her experience of joining the co-op in 2019 right before the start of the pandemic. “I had never stepped out of the house before joining Lok Swasthya Mandali,” she told SEWA.
She got a job at the Ayurveda production centre after her husband lost his job and could not find another one. She needed the income to support their two young sons, aged five and nine. “I also had a daughter, but she had heart problems and died young,” she said.
Her job makes her feel empowered. “Even if my husband finds a job, I will never quit this work.”
The pandemic has also highlighted the importance of collaboration between the public health sector, the private health sector and the civil society.
“Health has to be a social construction based on solidarity, complementarity and collaboration. The pandemic is showing that coexistence and collaboration between public and private healthcare favours better health outcomes,” says Jose Pérez, secretary-general of IHCO.
He adds that in some countries co-operatives complement public health, freeing up state resources. Co-ops can replace the public health sector in states which do not have the capacity to provide services or where co-operatives can do this more efficiently.
“In Spain, for example, the health co-operatives of the Espriu Foundation are considered part of private health, but they have been collaborating with public health for more than 40 years, and during the last year they have treated thousands of patients with Covid-19 derived from the public healthcare,” added Mr Pérez.
As the pandemic continues, health and social co-operatives will continue to fill in the gaps in the provision of health services.