NEED OF ANIMAL HEALTH COOPERATIVE SERVICES IN INDIA FOR SUSTAINABLE LIVESTOCK FARMING
In order to better support its large number of livestock keepers, India must strive hard towards moving all livestock services (closer) to farmers’ doorsteps. This would mean (i) moving away from a system of stationary veterinary dispensaries and hospitals and (ii) partnering with other agencies and individuals (cooperatives, NGOs and private entrepreneurs) in extending the outreach of services to farmers. Many of the required outreach services can be provided by para-veterinary staff. The many states have rich experience with delivery of services with the help of Animal Health Workers (AHW), either private such as Gopalamitras (with appropriate technical and input supply support from the state) or those employed and supported by NGOs. In general, farmers appreciate the services rendered by these service providers as they are able to reach much closer to the farmers than the AHD. But, there remain concerns about service quality, specially the impact of some undesirable practices in the long run.
In the recent years the cooperative movement has emerged as an effective people’s movement for achieving socio-economic transformation of the rural areas with focus on poverty alleviation. The movement has already completed more than 100 years of its eventful existence and covers 100% of the villages and 71 % of the rural households. This movement has developed more than 5 lakh cooperative societies in various sectors of Indian economy with a membership of 230 million. The cooperatives have established themselves in various segments of economy like credit and banking, fertilisers, dairy, sugar, marketing, housing, fisheries, fertilisers, handlooms, handicrafts, etc. It is well known that dairy cooperatives in India have ushered in milk revolution in the country. IFFCO and KRIBHCO are the two global fertiliser cooperatives which have churned out profits year after year. Due to their extensive reach, wide network and strong rural base, cooperatives are now considered as important organizations for forging collaborations by the public and profit-driven private enterprises. The democratic, participatory, value-oriented character of cooperative organizations along with their ability to cater to poor and under-privileged sections of the society are considered important strategic parameters for collaborations based on business considerations.
In order to tackle the Animal health problems, the Government has launched different schemes for providing better Animal health for the Livestock and Pets . However, the benefits of various Veterinary health programmes have not reached the grass-root levels as desired by the government. The rural Animal health care in most of the states is marked by absenteeism of Vet doctors/health, low levels of skills, shortage of medicines, inadequate supervision, etc. The Livestock farming community is the strength of our economy. The poor farmers’ allegiance to cooperative societies in the rural areas has been the strength of the cooperative sector an area where the limitations of the public or private sector are quite apparent. The Animal health care of the Livestock cooperative farmers is very important because these farmers can not afford costly Vet.medicines. The right of the farmers to get cheap and best treatment is very important for the success of agricultural operations. Devising a Veterinary health care scheme for the Livestock cooperative farmers in which the cooperative institutions are the active players while forging partnerships with the public and private bodies can be a novel way to respect the rights of the patients through accessibility to cooperatives. Based on this thinking the Government of India, state govt ,NGOs and Pvt. Organization must come forward to adopt cooperative model for animal health services.Here are few examples of successful health cooperative model which are being run in some states in our country & abroad.
Health cooperatives: a global overview
The health cooperative movement is an international reality, with a presence in numerous countries in different forms, but always with one shared goal: to improve citizens’ health and healthcare professionals working conditions. According to ICA and B20 figures, some 100 million households worldwide enjoy access to healthcare thanks to cooperatives. The presence of this enterprise model has been confirmed within the health systems of 76 countries, registering more than 3,300 health cooperatives with an overall turnover of 15 billion dollars. These figures include organisations with a range of origins and structures, whether doctors’ cooperatives, cooperatives managing hospitals and healthcare facilities and institutions dedicated to disease prevention, health promotion and staff and patient training. They also include cooperatives dedicated to the distribution of pharmaceutical products and those providing health insurance. Irrespective of the form employed, all healthcare cooperatives typically have one shared goal: to bring together health professionals and users so as to reconcile misalignments between healthcare supply and demand. They generally aim to engage all stakeholders involved in healthcare, to jointly manage costs and risks and to achieve the utmost quality in care provision. Currently, there is an important debate as to the sustainability of healthcare systems when faced with such challenges as increased life expectancy and ageing population, with the corresponding increase in the demand for health services as a result of certain conditions acquiring chronic status, and the greater need for care. The increase in health expenditure as a consequence of this process places pressures on national health systems, whether public, private, or a combination of the two models, thereby jeopardising their sustainability. Over recent history, health cooperatives have demonstrated their huge capacity to adapt to new socio-economic contexts, while being the ideal structure in resolving new needs. The peculiarities of the health market mean that non-profit organisations are particularly efficient in this context. Cooperatives represent an enterprise model that competes in the marketplace like any other, but does not need to pay returns to its shareholders, and so reinvests all its profits in improving services, thereby guaranteeing sustainability. Cooperatives are capable of adapting to very different healthcare systems. This flexibility is largely thanks to the fact that their governance model focuses on the pursuit of solutions to the needs of people and of society at large. Cooperatives evolve and reinvent themselves in response to new problems. Depending on the needs they aim to address, cooperatives take on different forms:
- Worker cooperatives, the main aim of which is to generate employment on decent terms for healthcare professionals and to allow doctors freely to practise their profession subject to no economic factors that could impinge on their professional judgment. Two examples of cooperatives of this type would be Asisa and Assistència Sanitària in Spain, although they likewise exist in Argentina and Australia. • Production cooperatives: such as pharmaceuticals, which account for some 20% of the medication distribution market in Belgium, 70% in Spain and 10.5% in Italy. • User cooperatives, which, in response to a lack of public health provision, difficulties in accessing private healthcare, or a failure to care for certain groups, manage their own care services. Examples of this type of cooperative may be found in Japan, Singapore and Canada. • Cooperatives involving different groups. These are known as multi-stakeholder cooperatives, as clearly exemplified by the social cooperatives in Italy or the Scias cooperative which manages Barcelona Hospital in Spain.
The benefits of cooperatives in the health domain
Though the world has never been in better health, the gap between the current situation and the still greater potential that medicine offers has perhaps never been wider. Success in achieving Universal Health Coverage is close related with the efficient implementation of healthcare. It means making good decisions on spending. But also, as healthcare is a labour-intensive industry, doctors, nurses or other health workers, can make a big difference. Improvements in healthcare provision can be reached if resources are pooled and health professionals enjoy better working conditions. Cooperatives are good at combining workers’ skills and financial resources to respond to market failures in serving the interests of workers, producers and users and providing services and products otherwise inaccessible. Cooperatives exist when groups of individuals come together to achieve an objective that they could not make alone. They are a rational alternative to investor-owned companies when the goal is different from maximising return to shareholders. Cooperatives often come about as a response to inefficiencies in serving the interests of people, such as where services and products are unavailable or not accessible. Because the cooperative enterprises purpose is different from investor-owned businesses, these firms behave differently, pursuing long-term goals and securing sustainability. Health cooperatives have been serving to members and their communities over the past two centuries, and even in countries with universal public health systems, they never disappeared altogether. However, as the potential of cooperatives is still far from being fully harnessed, it is important to better understand their role and their competitive advantages to meet the health needs of the population. The Cooperative Health Report, a research study published by IHCO and EURICSE in 2018 to assess the worldwide contribution of cooperativesto healthcare, confirms that health cooperatives have grown in importance over the past 20-30 years in all studied countries. Their growth has been a reaction to the increase in the demand for health services and the growing difficulties faced by public authorities to manage rising health care expenditures. Independent of the health system’s characteristics where they operate, cooperatives efficiently manage to adapt and reinvent themselves over time. They evolve in relation to their membership, governing bodies and service delivery to fulfil unmet needs better. Health cooperatives also help overcome coordination failures that arise from asymmetric information that typically characterises health care services. Moreover, rather than competing with public providers, health cooperatives tend to fill gaps complementing the products and resources provided by other actors. Cooperatives prioritise addressing the needs of specific stakeholder groups, or the community at large toward improving the accessibility of health services for population groups who would otherwise be excluded. Health cooperatives can adjust to changing economic, social and political conditions more readily than conventional organizations and enterprises. They can assume various forms aligned with their surrounding cultural and socioeconomic environment. Cooperative members may include users or patients, doctors, nurses, health professionals, retailers or customers of medicines, or a combination of these stakeholders. The choice of one cooperative type over another depends upon the problem they seek to address. This may include the inability of users to pay for services, which is typically not a problem solved by conventional, for-profit firms. Other objectives may be improving the working conditions of doctors, nursing staff and paramedics; meeting the different needs of users; and striking a balance between the advantages provided by advanced technologies and the need to provide personalised services.
Worldwide examples
Cooperatives are present in the health sector of many countries. In Argentina, for example, cooperatives are mainly engaged in primary health care, nursing and pharmaceutical services, arising as a response to the social and economic context, in which nearly 50% of the population has no access to healthcare. Mention should also be made of one particular phenomenon in the country. Following the 2001 economic crisis, numerous health facilities faced financial difficulties, and their owners entered insolvency proceedings. Many of these companies were revived as cooperatives, set up by the professionals who work there. (Companies Revived by Workers) In Australia, general practitioners practise on a self-employed basis, or grouped together at small enterprises. In the 1990s, a number of large-scale investors and multinationals broke into the healthcare market, buying up medical practices. Doctors reacted to this phenomenon by coming together as cooperatives so as to be able to compete in terms of scale and efficiency, while maintaining their independence and their ability to practise in accordance with their professional judgment, free of outside pressures. In Brazil, cooperatives account for much of the market, with Unimed the largest medical care network in the country, and the largest medical cooperative system in the world. Cooperatives, which has a presence across 85% of national territory, represents 32% of the private health market. The success of Brasil’s health cooperatives is down to their high level of acceptance among society; the better pay they offer and their rating among professionals; a good relationship with non-governmental organisations and public bodies; and the showcasing of cooperative principles and values, which are highly appreciated by Brazilian society. Particular mention should be made in Europe of the example of Belgium’s pharmaceutical cooperatives. There are 616 cooperative pharmacies, 12% of all pharmacies in Belgium, grouped into 15 cooperatives supplying 20% of the non-hospital pharmaceutical market. Their key mission is to provide consumers with pharmaceutical products of the highest quality and at a fair and affordable price. They date back to 1880, and enjoyed substantial development over the course of the 20th century. They now generate an annual turnover of around 600 million euros, and handle the supply of medication, medical devices, and other health products for 2.2 million people. They employ over 3,500 people either directly or indirectly, including 1,000 pharmacists. In Spain, pharmacy cooperatives developed at the beginning of the 20th century, aimed at facilitating pharmacy offices’ access to all pharmaceutical products under equal conditions and without distinctions depending on the size or geographical location of the pharmacy. Today cooperatives control the 70% of the pharmacy market share in the country and continue ensuring the accessibility to medicines. A notable example of worker cooperatives in the health sector is La Coopérative des techniciens ambulanciers du Québec (ambulance cooperative), established in Québec in the 1980s when several organisations transformed their corporations into cooperatives following the desire of workers to undertake more responsibility and acquire greater control in the workplace. Ambulance coops generally follow the worker model of cooperatives, in which members are both owners and employees who control all of the cooperative’s operations. Health user cooperatives aim to fill gaps in health service delivery, including developing prevention services and improving wellbeing. They often ensure access to treatment and provide services tailored to at-risk user groups, for example in marginal and sparsely populated areas where access to health services is problematic. In Canada, for instance, clinics following the consumer model type have developed special health services for seniors, indigenous peoples and people with chronic illnesses. Cooperatives have a long tradition in the Japanese health system, and their function and activities have been covered by national legislation since the 1940s. Health and wellbeing cooperatives, as they are literally referred to in Japan, are essentially organisations that group together users living in a geographical area or a community with the aim of managing their members’ healthcare provision. This is a different model from those seen in Brazil and Australia, where the initiative comes from the professionals. In Japan, although these days professionals belong to such organisations, cooperatives emerged as an organisational formula for citizens to resolve their individual health care needs. HeW Coop, Japan’s federation of health cooperatives, is made of 111 health and welfare member-owned organizations which bring together 2.92 million members. Federation’s cooperatives manage 75 hospitals, 337 primary health care centres, 70 dentistry offices, 28 nursing care homes and 210 helper stations, generating 37,437 jobs. They also target the needs of elderly populations and have helped innovate medical practices in rural areas. It is also relevant in the health sector the development of multi-stakeholder cooperatives, which the main feature is the participation in their membership or governing bodies of different groups of interest (medical doctors, nurses, other health professionals, patients, local governments, etc…) who share a general-interest goal. This joint endeavour strengthens the links that cooperatives have with the local community and their ability to meet its needs. Singapore has developed this cooperative model; its health community cooperatives manage centres that guarantee health and elderly care and provide an integrated suite of services. Also noteworthy are Italian health cooperatives, which tend to involve a plurality of stakeholders, including volunteers, in their governing bodies and are, hence, distinguished by a strong local anchorage, while at the same time are well integrated into the Italian healthcare system. Confcooperative Sanità represents 11,000 cooperatives active in the healthcare sector in Italy, with a turnover of close on 15.3 billion euros and over directly employing 368,000, mainly long-term workers, most of whom are women. There are examples in Africa as well. In Lesotho, the Village Health Workers Cooperative aims to enhance and sustain village health by delivering basic primary health care services to all individuals within their designated villages through a savings and credit scheme. Established in 2012, Tubusezere Cooperative provides care and treatment for women living with HIV and AIDS in Rwanda. What makes this cooperative unique is that services are provided for former sex workers, by former sex workers. The women’s cooperative emerged from a group of former sex workers seeking information on group support for social and health treatment for HIV and AIDS, and reaching out for resources, support and organizational know-how. One NGO in particular, the Society for Family Health, provided the women with skills and knowledge on HIV and AIDS treatment and prevention, and encouraged them to establish a cooperative. The partner NGO provided care and cooperative management training throughout the process of cooperative incubation and start-up. Many experiences worldwide demonstrate that cooperatives have some competitive advantages in the health domain compared with other forms of organization. They are linked to health cooperatives’ ability to respond to new needs that emerge in society and to attract resources that otherwise would not be dedicated to health and wellbeing. Furthermore, their flexibility encourages innovation in design and experimentation with new organizational structures, while making them particularly resilient to the economic and social crisis. Moreover, health cooperatives are usually the consequence of the joint commitment of all those involved in healthcare services, which builds a relationship of trust between them that helps to improve the accessibility and the quality of services. All these features position health cooperatives as a great contributor in achieving the UN Agenda 2030.
Cooperative Hospitals In Kerala
In Kerala medical cooperatives were set up under the government patronage. However, at present the hospitals are grappling with various problems. They are facing tough competition from the public sector health services, and the emergence of private hospitals. The hospitals face numerous problems in different areas of their operations. These areas are casualty and emergency services, outpatient services, diagnostic services, nursery, pharmacy, transport, etc. The political reasons like lack of autonomy, government interference, etc have their own significance. The vast potentiality of the health care industry in the state of Kerala is enormous. The cooperative hospitals must visualise ways to forge partnerships with government, private sector, NGO’s, etc. The hospitals must constitute governing bodies which must include representatives of all sectors. In the operational areas the hospitals must develop partnerships with the private sector. The hospitals must develop comprehensive health care programmes. As Kerala is cooperatively more developed state as compared to other states, the successful cooperatives must pour in financial resources and pool expertise from all quarters to revitalise the hospitals. In the wake of increasing accessibility of the poor to the cooperatives the cooperative hospitals must strengthen their programmes focusing on rural poor. The cooperatives in Kerala in general have played an important role in poverty-alleviation in the recent times.
Yeshasvini Rural Cooperative Health Scheme
The cooperative farming community is the strength of our economy. The poor farmers’ allegiance to cooperative societies in the rural areas has been the strength of the cooperative sector an area where the limitations of the public or private sector are quite apparent. The health care of the cooperative farmers is very important because these farmers can not afford costly medicines. The right of the farmers to get cheap and best treatment is very important for the success of agricultural operations. Devising a health care scheme for the cooperative farmers in which the cooperative institutions are the active players while forging partnerships with the public and private bodies can be a novel way to respect the rights of the patients through accessibility to cooperatives. Based on this thinking the Government of Karnataka introduced a health care scheme called Yeshasvini Cooperative Farmers’ Health Care Scheme on 14th November, 2002. At present any member who is a member of cooperative society in Karnataka can get the necessary treatment and have access to expensive medical procedures by paying Rs. 120 per annum. The public-private partnership model can be seen from the fact that the plan administration relies on various actors, the Government of Karnataka for partial subsidy benefit, the Karnataka State Cooperative Department for communication of the plan, cooperative societies enrolling members, cooperative banks to assist in premium collection, Family Health Plan Ltd for the administration of claims and a network of hospitals to deliver the benefits. The Government provides a quarter of monthly premium paid by members of the cooperative societies, which is Rs 10 per month. The network of hospitals under the scheme covers private hospitals too where the facilities are of high quality. This is itself an attraction for enhancing the membership of the scheme. The incentive of getting treatment in a private hospital with the government paying half of the premium attracts more members to the scheme .The Government has given key access to cooperatives as the Department of Cooperatives has been entrusted with the duty to popularise the scheme through its network of cooperatives. The Secretary of the primary cooperative society is the main person who motivates the farmers to become members of the scheme. A review of the functioning of the scheme indicates that there is no discrimination with the patients under this scheme in the hospitals. This itself indicates that the rights of the patients who are the farmers are not neglected which is quite heartening. The services provided by the hospitals are generally satisfactory though there is still need for lot of improvement in this area. The farmers considered the hospitals as ‘temples’ in which they had complete faith. This fact clearly indicates the triumph of the cooperative spirit when it is nurtured well with the collaboration of other agencies which have faith in the cooperative principles and values. The scheme though targeted to the poor has not been without deficiencies. The poor farmers are not covered for all health-related issues but only for out-patient care and expenses connected with surgery. This shows that the principle of ‘right to health’ of the poor farmers has not been given due prominence as this right can be guaranteed only if all health-related issues are governed by this scheme. Some of the members of cooperatives are rich and they are also availing the same facilities as the poor farmers. A policy decision to render services to the poor members of cooperatives rather than services to all the members will not only enhance the reach of the scheme but will also remove partiality and introduce equitable standards of governance. In the recent years the cooperative officials have not been given ample professional opportunities of training. This is mainly because cooperatives have not been able to effectively collaborate with other non-cooperative bodies in those functional areas of training which have wider relevance. The secretaries of the primary level cooperative societies must be well trained so that they take more initiatives to popularise the scheme. This scheme has been limited to only members of agricultural cooperative societies. Widening the ambit of the scheme to cover the members of all types of cooperatives in the rural areas will be very important in this regard. In this respect the other types of cooperatives must contribute some premium amount so that the financial viability of the scheme is not affected.
Self-Employed Women’s Association[ Sewa]
Most of India’s work force is engaged in the informal economy and are poor, vulnerable and illiterate. It is well known that women are the poorest and most vulnerable, and their work is always at the cost of health as they are exposed to various health hazards. Can through formation of cooperatives their work and health-related problems be addressed in an effective manner? SEWA which is a union of 2,50,000 women workers of the informal economy has very successfully ventured in this area and has built up its own reputation. SEWA has today grown to include a bank with 1,30,000 depositors and more than 80 cooperatives of various kinds, all owned and managed by themselves. SEWA has been working hard to improve its members’ health or health security. SEWA has identified and trained health workers who are performing the function of doctors in their unique way in their own communities. SEWA’s midwives and health workers have formed their own cooperatives which are run democratically and are sustainable both in financial terms and activity-wise. These cooperatives make drugs available to SEWA members at low cost through outlets run by local women. The health expenditure of the women is brought down by these cooperatives as the accessibility of poor women to these cooperatives helps them in solving the health-related problems. These cooperatives’ partnership with the government can be seen from the fact that they have been entrusted to run RCH diagnostics and screening camps, especially village-based mobile RCH clinics under the programme of Ministry of Health and Family Welfare. The partnership has resulted in widening the levels of services to women and their families thus enhancing their level of accessibility. The cooperatives are also playing an important role in developing health education amongst the rural women. Providing health education and information through cooperatives is a way of empowering them so that they can take control of their lives without depending on others. The cooperatives being empowering institutions can best empower the rural women through health education. An analysis of SEWA’ s health and social security systems for the poor shows that SEWA has very well developed an initiative to protect poor women from burgeoning medical costs and other risks. Each member has the option to join the programme by paying Rs. 60 per annum and is provided limited cover for risks arising out of sickness, maternity needs, accidents, floods, etc. SEWA started out this scheme in partnership with a public sector company. The cooperatives are playing an important role in educating the rural community on understanding the concept of insurance. Developing wide linkages in the case of SEWA’s health programmes is very important. Regular interactions with the professional doctors and training of the health workers in collaboration with other bodies are the measures which need to be taken in this respect. Operationalising more government programmes will provide more accessibility to the rural women. In the case of medical insurance the scope of the scheme should be enlarged and the coverage must be increased. Design of the products catering to the lower income group at a reasonable cost is the biggest challenge, and in this respect the partnerships should be forged with the government /private bodies which must catalyse the new products for poor and low middle class at low costs.
Strategies
The presence of cooperatives in the Animal health sector in the country is nil. Based on the example of Kerala definite measures to popularise the concept of cooperative vet. hospitals have yet to be undertaken. There may be the idea of setting up cooperative vet.hospitals on the ground that they may not be economically feasible or profitable is not based on sound reasoning. If primary animal health care has to be provided in inaccessible areas and to tribal and to tribal and weaker sections, profitability can not become the yardstick for performance. The service viability of the cooperatives becomes important here. The ability of cooperatives to work for the welfare of the communities becomes paramount here. The profit yardstick can not be applied every where more particularly in a setting where the livestock of poor being exposed to health hazards have very few choices before them. The cooperative sector in fact has not been able to undertake strong advocacy to popularise the cooperative model in the health sector. Lack of quality research studies has been a big hindering factor in this respect. Strong advocacy, research and lobbying must be the catch-words in this respect. Effective lobbying with the government must be undertaken so that the government policies and programmes lay emphasis on setting up cooperative veterinary hospitals, or the animal health schemes with focus on cooperatives like Yeshaswini Cooperative Health Scheme in Karnataka. The success of Yeshaswini Cooperative Health Scheme is an eye-opener as it has clearly indicated that the cooperative institutions in the rural areas can be the most reliable institutions which can take the lead in popularising a health scheme in partnership with public and private bodies. The accessibility of poor to the health schemes through cooperatives should be the key strategy for the success of any health scheme in the country. This is simply because the people mobilisation efforts through cooperatives is enormous as compared to other organizations.
At a time when public-private partnership has emerged as a vital strategy for improving the socio-economic conditions in the country the cooperatives have all the inherent strengths and are quite capable to emerge as key players for improving the animal health scenario of the country. In rural health the cooperatives can effectively partner with the public sector and the other civil society organisations. It is high time that the cooperative policy-makers should work seriously for devising health policies with a clear-cut vision so that the image-building of the cooperative sector gets a huge boost. The accessibility of poor livestock farmers to veterinary health services through the medium of a livestock cooperative can concretise in a big way if cooperative model of animal health is popularised all over the country.
EDITED & COMPILED BY- DR. RAJESH KUMAR SINGH
REFERENCE-ON REQUEST
