D. Joint-user & Provider-owned Primary Social Care Coops

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  REVIEW OF NATIONAL EXPERIENCE IN PROMOTING AND SUPPORTING
   THE CONTRIBUTION OF CO-OPERATIVES TO SOCIAL DEVELOPMENT:
 
  CO-OPERATIVE ENTERPRISE IN THE HEALTH AND SOCIAL CARE SECTORS
      A GLOBAL REVIEW AND PROPOSALS FOR POLICY COORDINATION
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CHAPTER II.    

D.   JOINT USER- AND PROVIDER- OWNED SOCIAL CARE PRIMARY CO-
     OPERATIVES [TYPE 1.2.2.]

In most countries with developed market economies which have had
well established welfare state structures, public programmes
formerly catered for the needs of most persons in need of care. 
As these structures have retracted, scope for the formation of
jointly-owned co-operatives has expanded. "Multi-stakeholder"
social care co-operatives of this type are known to exist in El
Salvador, France, Italy, Portugal, Spain, Sweden and the United
Kingdom.  

In El Salvador in 1980 a group of young women and men with
disabilities established the "Independent Group for Integral
Rehabilitation" (GIPRI), registered as a co-operative association
in 1981 under the name ACOGIPRI.  Some members produce finely
glazed and finished pottery, subsequently exported, and a main
source of income.  By the early 1990s the co-operative operated
a transport service for those persons with mobility-constraining
disabilities, produced a newsletter for a wider readership of
persons with disabilities in El Salvador, and was active in the
development of national policy for persons with disabilities.  
At various phases of its development it was supported by the
Canadian co-operative movement and by UNESCO 58/.

In France parents of children with severe mental disabilities
have established the Syndicat National des Associations des
Parents d'Enfants Inadaptes, representing a large number of co-
operatively organized societies throughout the country. 59/ 

In Italy this type of co-operative is particularly well
developed.60/  In 1986 there were 500 such co-operatives, at the
end of 1988 there were 1,242 and in 1990, 2,125. In September
1995 it was reported that there were about 2,000 "social" co-
operatives, of which, in June 1993, 1,826 were affiliated with
either Lega Cooperative or Confcooperative. They employed about
40,000 persons as well 15,000 volunteers, and provided services
to about two hundred thousand persons.  In 1993 about 13 per cent
of public spending on the health and social sectors was used for
financing social co-operatives. 

These include co-operatives providing only health services, or
both health and social care services. However, in a sample of 549
studied in 1992, only 13 per cent provided health services. 
Clients included elderly persons, persons with disabilities, drug
addicts, children and young persons, persons suffering from AIDS,
ex-prisoners and prisoners, and immigrants: many provided
services to several types of client.   Some comprised disabled
persons' sheltered work places.

There are numerous social care co-operatives whose members are
simultaneously users or beneficiaries and providers of non-
professional services. In some cases members who are young
persons with problems, including alcohol and drug abuse, operate
as providers of social care to persons with disabilities and the
elderly, also members of the co-operative. In return, older
persons act as counsellors and as vocational trainers to the
young members. Most members are not beneficiaries of social care,
but are voluntary or paid para-professional and professional
workers. Membership is in fact highly diverse, including clients,
providers, volunteers and suppliers of finance, including local
governments, and other supporters.

In Portugal during the second half of the 1970s, in response to
the insufficiency of provision for children and young persons
with mental disability, care-providers and other concerned
persons established the "Movimento Cerci" (Cooperativas de
Educacao e Reabilitacao de Criancas Inadaptadas).  At first these
co-operatives focused their attention on children and young
persons of school age, for whom the then education system offered
no acceptable pedagogic or social response.  Subsequently, it was
increasingly felt necessary to create new conditions appropriate
to the different stages in the development of users, whether
children, young people or adults, whereby their integration in
society might be realized fully and effectively. To meet this
need there were created Centres for Professional Training,
Centres for Occupational Support, Residential Units, Early
Intervention Units (Unidades de Intervencao Precoce), Centres for
Protected Employment and Shelters. 61/ 

In Spain, parents of persons with mental disabilities have joined
with professionals to establish "sheltered workshops".  By 1991
about 40 such co-operative work centres, employing 3,900 persons
with mental disabilities, were members of the Catalonia Workshops
Co-ordinating Body.62/  

In Sweden parents have become members of a number of the day-care
co-operatives established by providers. 63/  In the United
Kingdom members of a number of worker-owned co-operatives have
decided to employ, as part of their corporate employment policy,
persons with mental, physical or social disabilities (in the case
of one co-operative, the proportion of such persons within the
total work-force was up to half).  This is termed an "integrated
employment policy".  These co-operatives function in a normal
manner, achieving and maintaining their viability within the
market by means of their effective operation.  They produce a
wide variety of goods: for example, wooden murals, bulk quality
foods, and bakery products.  Persons with disabilities who have
been supported by inclusion in the work-force of such co-
operatives include not only those suffering from physical or
mental handicap, but those with a "social" disability, such as
ex-prisoners, persons addicted to drugs or alcohol, single
parents, victims of domestic violence, homeless persons and
persons who have been unemployed for long periods.

The persons with disabilities who are employed participate fully
in management, it being co-operative policy to help build their
self-confidence by not placing restrictions on their
opportunities to participate fully in the life of the co-
operative. They are recruited primarily with a view to their
ability to carry out tasks in the same way as any other employee,
although such worker-owned co-operatives also have a policy of
making operations as flexible as possible, in order to help
persons with disabilities to carry out their work effectively. 
Although only a small number of such co-operatives have so far
been established, they have been relatively successful in
integrating persons with disabilities within the labour force.64/