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, http://xnet.kp.org/permanentejournal/permjournal.html http://xnet.kp.org/permanentejournal/tpjstaff.html
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
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
“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 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.