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      by the International Co-operative Alliance ICA

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Since the first year of its existence the United Nations has been
concerned to establish a mutually beneficial partnership with the
international co-operative movement.  In its first session, in
1945-46, the General Assembly granted the International Co-
operative Alliance (ICA) the highest category of consultative
status with the Economic and Social Council of the United
Nations.   Subsequently, the United Nations and the ICA have
collaborated on many issues of common concern.   Since 1950 the
General Assembly has adopted 10 resolutions calling for the
continued support of the co-operative movement throughout the
world by Member States and by the United Nations system itself. 
The Economic and Social Council has adopted 11 resolutions on the
same theme.  Both the Assembly and the Council have referred to
the significance of co-operatives in other resolutions, dealing
with agriculture and with entrepreneurial development.  By the
end of 1995 ICA represented and served a total of 760,000,000
individual members of co-operative business enterprises world-

In its resolution 47/90 of 16 December 1992 the General Assembly
requested the Secretary-General "... to maintain and increase the
support provided by the United Nations to the programmes and
objectives of the international cooperative movement ...".  In
its latest resolution on the issue of co-operatives, 49/155 of
23 December 1994, the General Assembly requested the Secretary-
General "... to continue to provide support to the programmes and
objectives of the international co-operative movement".

The General Assembly, in both its resolutions 47/90 and 49/155
referred to the "broad significance" of cooperatives "in
contributing to the solution of major economic and social
problems".   In the latter resolution it also recognized that:

     "Co-operatives in their various forms are becoming an
     indispensable factor in the economic and social development
     of all countries, promoting the fullest possible
     participation in the development process of all population
     groups, including women, youth, disabled persons and the

Both resolutions encouraged Governments "to consider fully the
potential of co-operatives for contributing to the solution of
economic, social and environmental problems in formulating
national development strategies." 

In 1987 an Interregional Consultation on Developmental Social
Welfare Policies and Programmes, held in Vienna, adopted the
"Guiding Principles for Developmental Social Welfare Policies and
Programmes in the Near Future".  These were subsequently endorsed
by the General Assembly in its resolutions 42/125, 44/65 and
46/90.  The Guiding Principles noted that:

     "A basic principle and objective of social welfare policy
     is to provide the widest possible participation of all
     individuals and groups, and greater emphasis needs to be
     placed on translating this principle into practice.  This
     may be achieved through new partnerships in the field of
     social welfare policy, providing opportunities for a
     greater involvement of beneficiaries, individually and
     collectively, in decisions concerning their needs and in
     the implementation of programmes, including community-based
     programmes." (para. 11)

     "Health needs, especially of the most vulnerable, can be
     met most effectively when integrated with social welfare
     activities involving not only medical and para-medical
     practitioners, but also community workers and health
     workers suitably trained in prevention and promotion
     techniques. ...  Health costs may be contained by placing
     less emphasis on institutional treatment and more emphasis
     on ambulatory health care and by using simple medical
     techniques in a community context, suitably co-ordinated
     with other welfare activities." (para. 30)

     "Social welfare is the concern not only of Governments but
     also of numerous other sponsors.  Non-governmental and
     voluntary organizations, trade unions, co-operatives and
     community and social action groups are major sponsors of
     social welfare programmes that must be recognized,
     supported and consulted. ... (para. 38)

     "There are advantages to such a diversity of sponsors and
     approaches including the potential for a more precise
     identification of needs, innovation in strategies,
     generating broader participation and the involvement of
     more resources.  This may result in a need for better co-
     ordination of diverse activities and programmes and for a
     clearer delineation of areas of responsibility and function
     to achieve optimal effect. ...  (para.39)

Among the Guiding Principles themselves was the following:

     "Within the framework of national laws there is a need to
     strengthen the role and contribution of non-governmental
     and voluntary organizations, private entities and people
     themselves in enhancing social services, well-being and
     development." (49(h)).

In its resolution 44/58 of 8 December 1989 the General Assembly
noted that co-operatives were called upon to contribute to the
implementation of the Guiding Principles, and requested the
Secretary-General to follow closely national experience in
promoting co-operatives and to encourage all forms of
international co-operation, in collaboration with interested
governments, governmental and non-governmental organizations "as
an important part of the social development strategy".    It also
invited the regional commission and the specialized agencies
concerned to make further efforts with a view to promoting the
cooperative movement as an important instrument of economic and
social development "...thus contribution to the implementation
of the Guiding Principles..".

The Copenhagen Declaration on Social Development adopted at the
World Summit for Social Development in March 1995 committed
signatories to increase significantly and utilize more
efficiently the resources allocated to social development.  To
this end they would, among other things "utilize and develop
fully the potential and contribution of co-operatives for the
attainment of social development goals" (Commitment 9,(h)).

The programme of the United Nations Secretariat undertaken in
response to these requests of the General Assembly has been the
responsibility primarily of the Department for Policy
Coordination and Sustainable Development.  It includes liaison
between the United Nations and the international co-operative
movement, and specifically ICA, representation of the United
Nations on the Committee for the Promotion and Advancement of Co-
operatives (COPAC); and preparation every two years of a report
on the status and role of cooperatives in changing economic and
social conditions, made by the Secretary-General of the United
Nations to the General Assembly.   

One of its functions is to identify areas where there appears to
be a significant potential for a further mutually beneficial
collaboration between the United Nations system and the
international co-operative movement, and then to promote contacts
between the movement and those elements of the United Nations
system likely to be concerned.  It is in the context of this
function that the Department has prepared this paper, in close
collaboration with ICA.

The purpose in preparing this global review is to clarify
prerequisites for further development of the health and social
care component of the international co-operative movement,
largely by use of its own resources, but with the possible
support of relevant agencies of national, regional and local
governments and of the relevant specialized agencies and bodies
of the United Nations system.  

It should be emphasized that this paper is not based on any
comprehensive evaluation of individual health or social care co-
operatives.  Rather it is based upon insights arising from
consideration of the rather limited literature available,
identification of what appear to be common problems, and
evaluation of certain solutions already tried or under
consideration.  However, it also draws upon the wider experience
accumulated by the United Nations of the promotion of
partnerships between intergovernmental and governmental
organizations and the international co-operative movement.  

Because this may be the first comprehensive review of the matter,
and because information is highly dispersed and not likely to be
accessible to many readers, it was thought appropriate to include
a considerable amount of information descriptive of the actual
situation and the processes whereby this has developed.  This is
set out in Chapters II, III and IV.  While every effort was made
to undertake a comprehensive review of all known health co-
operatives, this was not done for social care co-operatives, in
respect to which information is intended to be illustrative only.

The United Nations Secretariat wishes to acknowledge the very
substantial support provided in the form of information and
specialist comment by many organizations and individuals during
the preparation of this global review.  Its preparation was
possible only with the close collaboration of ICA under the
direction of the Director-General, Mr. Bruce Thordarson.  Through
its UN/Development Liaison Officer, Ms. MariaElena Chavez, and
its Documentation Officer, Ms. Alina Pawlowska, ICA provided
information from the data bases maintained at its headquarters
and at its regional offices; invited a representative of the
Secretary-General to participate in the International Forum on
Co-operative Health and Social Care which it organized at
Manchester, United Kingdom in September 1995; circulated a first
draft of the global review to other participants at this Forum,
to members of the Steering Group responsible for preparing the
establishment of the International Co-operative Health
Organization, to be one of ICA's specialized organizations, as
well as to other member organizations and specialists; and
channelled comments and information received from them to the
Secretariat;  requested information from all relevant co-
operative organizations world wide via the INTERNET and
channelled responses to the Secretariat.  The organizer of the
International Forum, Dr. Arsenio Invernizzi, commented on and
made suggestions for revision the first draft.

Mr. Hans Dahlberg, Chief Executive Officer of the International
Co-operative and Mutual Insurance Federation (ICMIF), a
specialized organization of ICA, made comprehensive comments on
the first draft, which he circulated also to those members of
ICMIF's Insurance Intelligence Group responsible for development
of information and research in health and social care.  ICMIF
also provided the report of its 1995 Conference, held at
Manchester, United Kingdom, as well as papers presented at a
seminar held at the Conference on "social welfare provision - a
fitting opportunity in an opening market?"

Most of those co-operative enterprises active in the health and
social care sectors, including co-operative insurance
enterprises, as well as co-operative research institutions and
university departments of co-operative studies, whose activities
are referred to in the review, provided annual reports and other
published materials and specially prepared comments and
information, as well as, in some cases, comments on a first
draft.   Substantial comments were made, and information
provided, by Professors Roger Spear and Johanan Stryjan, Chairman
and one of the Vice-Chairmen of ICA's Committee on Co-operative
Research respectively; Dr. Yehudah Paz, Director and Principal
of the International Institute (Histadrut), Israel; Mr. Iain
Williamson, Chief Information Officer, Co-operative Union Ltd.,
United Kingdom; Mr. Peter Walker, Chief Executive, the United
Kingdom Co-operative Council; Mr. K. Blomqvist of the Swedish co-
operative insurance enterprise Folksam on behalf of ICMIF; Mme.
Jeanine Devuyst of the Association of European Co-operative and
Mutual Insurers (ACME); M. Didier Wafflard of the Belgian co-
operative insurance enterprise P & V Assurances; and Dr. Manuel
Canaveira de Campos, President of the Institute Antonio Sergio
do Sector Cooperativo in the Presidency of the Council of
Ministers, Portugal.  

Mr. Shoji Kato, Chairman of the Medical Co-op Committee of the
Japanese Consumers' Co-operative Union (JCCU), commented
extensively on an early draft.  Dr. E. Castilho, President of the
Brazilian National Confederation of Healthcare Co-operatives
(Unimed) provided comprehensive material on this organization and
the development of health co-operatives in Latin America. 
Christine Kushner of the University of North Carolina provided
preliminary versions of a number of research papers on the
development of health co-operatives in the United States.  Dr.
Jose Espriu, founder and President of the Espriu Foundation,
Barcelona, provided information on the concept of integrated
health co-operation and the development of health co-operatives
in Spain.  Professor Johnston Birchall of Brunel University in
the United Kingdom, editor of the Journal of Co-operative
Studies, prepared especially for this the Global Review a note
on the history of co-operative involvement in health and social
care in the United Kingdom.  Professors Yvan Comeau and Jean-
Pierre Girard of the Chaire de cooperation Guy-Bernier at the
Universite du Quebec a Montreal kindly provided advance copies
of a study on health co-operatives in eleven countries which was
published later in 1996 by the University.  The Co-operative
Branch of the International Labour Organization (ILO) supplied
information on its interregional programme on the promotion of
social services through social economy.