__________________________________________________________ This document has been made available in electronic format by the International Co-operative Alliance ICA ---------------------------------------------- October 1995 ************************************************* Co-operative Clinics Set the Pace in Medical Care ************************************************* by Melvis Dzisah (IPS) reporting from Benin It started as an idea that, according to the doomsayers, was not going to work. But four years on, a group of formerly unemployed health workers operating from a rented bungalow in Sikecodji, a suburb of Benin's capital, Cotonou, are dispensing health care to more and more people in the area. The members of the Sikecodji Co-operative Health Clinic are the nucleus of a private co-operative clinic project initiated by the government about four years ago with financial help from the World Bank. The project is aimed at providing jobs for unemployed health workers and helping to improve the availability of health care in the West African republic. Edwige Adekambi, a doctor at the clinic, graduated from medical school in the mid-1980s with a grim future staring her in the face. The government, in the midst of implementing a structural adjustment programme (SAP), had frozen all public service recruitments. Not that there was an overabundance of health professionals in Benin. In 1990, the country had just one doctor for 14,290 people and one nurse for 2,460, according to UN Development Programme figures. "I could not imagine what I was going to do, especially when relatives who had helped finance my education were expecting so much from me," - said Adekambi. While she waited for years for what she calls 'divine intervention', the Government came up with a lifeline. It suggested to unemployed health workers that they form co-operative clinics. "The idea seemed so strange and impractical from the beginning, but we decided to go along since we had no option," Adekambi told IPS here. Under the project, each co-operative clinic must have at least a medical doctor, two midwives, two nurses and two health assistants. Each institution gets seed capital in the form of a loan of 9,200 to 13,000 US dollars. Adekambi and other health workers took up the challenge and started their clinic in May 1991. Since then, nine other clinics have opened in various parts of the country. The government's target is to bring the number to 15. The Sikecodji area has a population of 20,000. Records at the clinic show that average daily attendance has jumped from four in 1991 to 20 last month and the clinic has received 19,175 outpatients~ visits since its establishment. Patients pay a small fee since "our income is determined by revenue," says Adekambi. "We earn less than our colleagues in the public sector, but here we are building a future for ourselves, working with the knowledge that this clinic belongs to us." She and her team also make house visits to patients and train health assistants. Jountehegbe Marrianne (24) is one of 15 now undergoing training at the Sikecodji clinic. She says she chose it because it was cheaper than others. "In the public hospital, I was asked to pay 150,000 CFA (about 278 US dollars) for the course. Here we pay only 50,000 CFA (93 dollars)." The Ministry of Health sources says the two objectives set under the programme continue to be met. "The establishment of the private co-operatives has helped improve the country's health care system considerably while health workers who were jobless are now working", said a Ministry official. "Medical care services are reaching more people than before as these clinics get installed across the country, creating jobs for themselves and training more health hands," he added. Despite its poverty (per capita gross domestic product was about 248 US dollars in 1994, according to African Development Bank figures) Benin has been able to improve its health indicators. In its 1991 global population report, the UN Population Fund (UNFPA) put Benin"s infant mortality rate at 85 per 1,000. This year's report says 79 per 1,000, less than the African average of 85 per 1,000. Access to basic health care is now 99 percent, according to the UNFPA, up from under 30 percent in the mid-1980s. While the clinics have helped improve health coverage in Benin, they still have a hurdle to clear. Says Adekambi: "We are still grappling with co-operative management, something we did not learn in school". In response to this need, the International Co-operative Alliance (ICA) plans to provide training for members of co-operative health clinics in Benin. According to Sendra Ratsimandresy-Toure, Human Resource Officer at the ICA Regional Office for West Africa, located in Abidjan, Cote d'Ivoire, more than two million CFA (about 3,700 US dollars) have been set aside for the programme. "All the necessary negotiations have being completed and the training programme is to start in Cotonou very soon," she told IPS. Adekambi says once her group receives training in co-operative management, the next step will be to expand the Sikecodji clinic.