Co-operative Clinics Set the Pace in Medical Care

     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

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

"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

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
Adekambi says once her group receives training in co-operative
management, the next step will be to expand the Sikecodji clinic.