PREFACE

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- wide.

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 elderly."

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.


 

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