About Kaiser Permanente | CEO Corner

February 22, 2007

Kaiser Permanente CEO Shares Health Care Lessons from Uganda

New Book by George C. Halvorson details micro health co-ops established in African Villages

In Uganda, where per capita income is $270 per year, infant mortality rates are among the highest in the world, and the population faces the daily threat of AIDS, dysentery, malaria and parasitic infections, a group of intrepid American health care experts, including George C. Halvorson, set out to create micro health co-ops in villages. The experience and lessons learned from this effort are described by Halvorson in Health Care Co-ops in Uganda: Effectively Launching Micro Health Groups in African Villages, published in December by The Permanente Press. The book is part narrative of the experience, and part textbook on how to create a micro health care co-op. 

A group of Minnesota health care professionals were challenged to create health cooperatives in Uganda by Land O'Lakes, a Minnesota dairy co-op that had successfully established Ugandan dairy co-ops, and recognized their tremendous need for health care. 

Starting co-op health plans proved to be a daunting challenge in a country where the total annual health care spending averages $12 per person. With no government health plan and only one doctor for every 18,450 patients, the problems were immense. Nonetheless, the health care team that went to Uganda was convinced that affordable health care with predictable costs, and local governance and control could be achieved.  There were practical issues:  actuarial, administrative, training, marketing, cash flow, care delivery, communications and continuity of care. Into this environment the American health care providers brought concepts of prevention, insurance, risk sharing, pre-payment, cooperative infrastructure, and buying groups. Could it work?  The answer was a resounding yes from Ugandans with a desire to find health care for their families and by the caregivers who desperately wanted to provide affordable care. 

Asaph Tumwesigye, a Ugandan co-op member, can attest to the profound needs that are now met by his village co-op. Like many Americans, he wants affordable medical care in order to keep his family healthy.  Tumwesigye enrolled in a health cooperative in 1999 and has since learned the value of prepayment, enjoying the security of knowing that when family members fall ill unexpectedly, the cost of the health care will not force him to sell his land and his goats.  In addition, he is has learned how to prevent malaria, the basics of water purification, how to run and maintain the health co-op, and even how to market the concept to his village neighbors.

The author, George C. Halvorson, is a seasoned thinker on managed care, and international health care issues. He is uniquely qualified to discuss health care cooperatives because he has seen how successful the model has been in Minnesota as the CEO of HealthPartners. It was his experience in traveling to Uganda and his participation in the creation of health care co-ops that inspired him to write this book. Today Halvorson is chairman and CEO of Kaiser Foundation Health Plan and Hospitals. He is the author of numerous articles and books on health care, including Epidemic of Care, published in 2003, and Strong Medicine.