Tracking a Health-Care Experiment in Uganda

A novel experiment to bring health care to poor Ugandans has been under way for several years. The idea was to set up HMOs within already existing agricultural co-ops. How are things working out?

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In 2001, NPR's Joanne Silberner went to an isolated village in Uganda to look at a new way of delivering health care. Recently, she sat down with the people who devised the plan. She wanted to know if they have done what they have set out to do - make medical care available and affordable in a place that had next to nothing. And here's what she found out.

JOANNE SILBERNER: Health care has always been a problem in Uganda. But that fact really came home to George Halvorson when he heard this story from a nurse who worked in a small town in the western part of the country.

Mr. GEORGE HALVORSON (CEO, Kaiser Foundation Health Plan): What had happened was a woman came into the hospital for a C-section, and the hospital gave her the C-section. And then when they passed the C-section, they turned to the husband and they said do you have enough money for the sutures so we can sew her up? And they said no, they don't have enough money. And so they said, well, we can't sew her up until you bring the sutures in.

SILBERNER: In such a situation, a woman can bleed to death. The husband bicycled back to his village. He borrowed a baby goat, rushed back to town and sold it. But it was too late. Without the sutures, his wife had already died. This story stunned Halvorson.

Mr. HALVORSON: And the question was why would this happen? I mean how could a hospital so heartless as to not do that? And what the nurse explained was that the hospital only have a couple of sets of sutures, and if they give them away free to the next two patients, then every patient after that would die.

SILBERNER: Today, the situation has much improved in the small town of Buhweju, where Halvorson heard that story. There's something new there called a health cooperative, or co-op. If the woman had been a member, she would have gotten the sutures. That's because her co-op would have been making regular payments to the hospital, so the hospital could have kept its supply cabinets stocked. And this may sound odd, but the health co-op idea in Uganda came about because of some American dairy farmers.

In the late 1990s, they were helping Ugandan dairymen improve their farm co-ops. The Ugandans wanted help not just with their cows but with their health care. The American dairymen sent them to George Halvorson, an executive who ran the Mid-Western health co-op used by the Americans. Soon the U.S. government kicked in some money and the project was off and running.

The first step in setting up the health co-ops was to hire Joy Batusa, a young Ugandan.

Ms. JOY BATUSA (Ugandan Health Cooperative): People have given up waiting on government to come to their rescue so they have to take care of things themselves.

SILBERNER: Still she was dubious about the co-op idea.

Ms. BATUSA: As a Ugandan, I wasn't very sure that this would even work. At that point it sounded complicated - very, very complicated.

SILBERNER: But Batusa and her American colleagues worked out a plan that turned out to be quite simple. They asked already existing farm co-ops, like the dairy co-ops, to pool money for health care. The farmers were already used to getting together to buy things like milk refrigerators. Why not medical care?

Today there are 30 health cooperatives up and running in small towns in Uganda. One is even big enough to have celebrated the opening of its own medical clinic.

Unidentified Group: (Singing) (Speaking foreign language)

SILBERNER: Each co-op collects its own money. Each decides what care it will pay for. One decided not to pay for routine labor and delivery much to the surprise of one of the Americans on the project, Scott Abisher(ph), and Joy Batusa.

Ms. BATUSA: That is not a sickness so you can't have it covered. You have had nine months to think about it. So...

Mr. SCOTT ABISHER (Ugandan Health Co-op Project): That's the one that stand out.

Ms. BATUSA: ...it looked like a dumb decision, but it was their decision.

Mr. ABISHER: It was their decision.

SILBERNER: Members of that co-op eventually changed their minds, and Joy Batusa says the co-ops have actually given women more power over their health care.

Ms. BATUSA: If it's a husband that has to make the choice on when she is to go to hospital, you bet she will not have that opportunity. What community health financing is able to do, the decision to seek health care is shifted to the wife because now she is able - she has the ability to go to that local hospital because the health care has been prepaid.

SILBERNER: The Ugandan government has been generally supportive of the co-ops. Still, the numbers aren't as big as initially projected says Scott Abisher -7,000 members right now.

Mr. ABISHER: We were shooting for 14,000 by 2006, so we're halfway there.

SILBERNER: Among the problems - no good phone service, frequently impassable roads. And co-ops face plenty of other challenges, like what to do about people who have HIV-AIDS. Then there's the question of how to extend the programs to cities which don't have farmers' co-ops.

Still, George Halvorson, now head of the giant HMO Kaiser Permanente, says the system has proven something very important.

Mr. HALVORSON: It's created a model for how to deliver health care in very, very poor areas that's not reliant on charity.

SILBERNER: In fact, he says, in parts of Uganda, doctors and hospitals are now asking to be part of the co-ops because of the financial stability they provide.

Joanne Silberner, NPR News.

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