HEALTH CARE CO-OPS IN UGANDA – Effectively Launching Micro Health Groups in African Villages, by George C. Halvorson, The Permanente Press, Oakland, CA; Portland, OR, © 2007,  ISBN-13: 978-0-9770463-1-7, 175 pp, $19.95, 

Reviewed by Del Meyer, MD

Before accepting a position with the Kaiser Foundation Health Plan, George Halvorson was the President and CEO of HealthPartners. Why did HealthPartners, a multi-billion dollar United States health care plan head quartered in Minnesota decide to help set up tiny health care co-ops in Uganda? Because HealthPartners is, itself, a health care co-op—the largest health care co-op in the world.

Land O’Lakes, a sister co-op for dairy farms also headquartered in Minnesota, has a long history of going into developing countries to set up local dairy co-ops. Uganda is one of more than a dozen countries that have benefited from the Land O’Lakes outreach initiative over the past two decades. 

Uganda is a poor country full of brave people. Per capita income is a mere $270 per year. AIDS, dysentery, malaria and parasitic infections are common. The infant mortality rates are among the highest in the world. The health care infrastructure is tiny, fragile, unevenly distributed, and functionally uncoordinated. Almost no one is insured through the private sector, and the government simply can’t afford to provide care to every person who needs it. The tiny health care co-ops HP set up in Uganda were really the only available form of health coverage in the communities served.

About eight years earlier, members of the Land O’Lakes African dairy co-op were doing well—functioning cooperatively—collecting its milk together, processing it together, protecting the quality together, and selling the milk together at a good price. Farmers working together had better incomes. The local market had better milk. The co-op was also importing carefully selected bull semen from the United States to upgrade the local herds and increase the milk production levels of its cows. Antibiotics were also being made available by the co-op to help ailing members of the tiny cattle herds. The cows in that Ugandan village had never been so healthy or so productive.

One of the farmers at the meeting said to the Land O’Lakes staff, “We now have good veterinary care for our cattle. Is there any way we can also get medical care for our children?”

That question intrigued the Land O’Lakes staff. When they returned to Minnesota, they called HealthPartners and asked that same question. Could it be possible to set up health care co-ops in a third world country, maybe starting with a foundation of small, local dairy co-ops?

HealthPartners decided to explore that possibility. A team from HealthPartners went to Uganda to meet with the co-op leaders. Two doctors and two administrators made that first trip. They met with dozens of rural Ugandan co-op leaders in half a dozen locations, and they concluded that it was worth a try.

Halvorson describes in this volume what the staff from HealthPartners has learned and accomplished since that time. There are now working health care co-ops in Uganda. They are serving thousands of people in a dozen villages and rural communities. People are getting care that they wouldn’t have gotten without the co-ops.

It was the cooperative thing to do. Co-ops tend to be a bit evangelical in their approach to the world. People who understand the co-op mentality know that the Land O'Lakes efforts to support developing nations’ dairy farmers are very much in keeping with the worldwide tendency of co-ops to help other co-ops get started.

The approach HealthPartners is using in Uganda will not solve Uganda’s health care problems. It will make life better for some Ugandans, however. Much better. Women will have prenatal care. Kids will survive dysentery and malaria. Disease will be prevented for some people and cured for others. Some people will be healthier. Not everyone—but some.

Is that enough?

One of Halvorson’s favorite stories is of a man walking down a beach early in the morning. As he looked down the shore, he saw another man in the distance walking toward him. The other man was regularly stooping over picking something up, and throwing it into the ocean.

As the men drew closer, the first man saw that the stranger was picking up shellfish and throwing them out to sea.

“What are you doing? He asked. “Why are you throwing those shells into the water?

“Because the tide invariable catches some shellfish and washes them ashore,” the stranger replied. “They die on the shore, so I throw them back into the water.”

The first man looked down the shore in both directions. There were shells far up and down the coast.

“It’s hopeless,” the first man said. “There are huge numbers of them. You’re just one person. You can’t possibly make a difference.”

The second man bent over and picked up another shellfish. He held it for a second and then he threw it far out to sea. He looked at the first man and said softly, “Hey, it made a difference for that one.”

What’s the value of one human life? What’s the value on one surviving child? What’s the value of one mother being healthy enough to care for her family? What HealthPartners is doing in Uganda won’t change the world. But it is making a difference. A real difference in real lives. That’s good enough.

Before Halvorson finished writing about what happened, he left HealthPartners to move to Kaiser Permanente, the nation’s largest non-profit health maintenance organization (HMO). With other priorities, he put the draft on the shelf. After two years, as more people were asking about the Ugandan co-ops and if there anything in writing, Halvorson took the draft and wrote this book.

This is more than a story of what happened in Uganda or how co-ops work. It is an excellent study of how health care works in many adverse circumstances, including when budgets are meager. The chapter on trying to reach a ten-cent Target was another illustrative example of “LEAN” as it is now progressing to health care, especially in Non-Profit Health Care, as in Kaiser Permanente, and being attempted in For-Profit HMOs. LEAN having been successful in industry is now involving health care reducing costs without loss of quality.