Canada’s health care cooperatives just marked their 70th birthday this year, spurred on by a wave of growth as the agencies move into interesting new areas of public service.
They have much to celebrate because they have come a long way since the first health care co-op was started in Quebec City in 1944. That was Services de santé de Quebec (SSQ) and it still covers the entire province. More than 100 health care co-ops now operate across Canada, providing everything from ambulance transportation in Quebec to pre-natal care for refugee women in Alberta.
Shortly after the first co-op was established, the Health Care Credit Union was formed in London, Ontario, in 1949. To this day, the credit union, which has about 3,000 members and just over $1 million in assets, offers a full range of financial services largely directed at members of the health care community. Its existence drives home once again the natural relationship between financial services cooperatives and other groups owned by membership.
The health co-ops themselves took root in Western Canada in 1962 when pro-Medicare doctors and their supporters founded the Community Health Services Association (CSHA) in Saskatoon while the rest of the province’s doctors walked the streets to picket provincially funded health insurance. Saskatoon’s CHSA has more than 10,000 adult members and provides clients with family physicians, physical and occupational therapy, nutrition counselling, mental health services and health information. These services are available to both members and non-members. The agency has a budget of about $10 million, with some of that funding coming from the province.
Each jurisdiction has its own policy regarding funding health co-ops, according to Vanessa Hammond, volunteer founding chair of the Health Care Cooperatives Federation of Canada. She adds that Quebec, Manitoba and Saskatchewan are the most generous when it comes to these organizations.
As for Saskatchewan, it now has five publicly-funded cooperative health care associations, co-evolving to serve an increasingly diverse client base and struggling to meet the demands placed on them, says Lorna Knudson. She is executive director of the Regina Community Clinic, which has 4,200 active members and 10,000 clients. Members of health care co-ops generally pay a yearly fee of $100 and may be assessed for more, depending on a co-op’s annual revenue.
A time of upheaval
“Cooperative health care was born in a period of tremendous political upheaval in the province,” Knudson says. “In 1959, Saskatchewan Premier Tommy Douglas announced that his government would begin preparations for the first provincial public medical care insurance scheme in North America. This announcement sparked the beginning of Saskatchewan’s greatest medical crisis.
“On July 1, 1962, after talks between the government and the doctors broke down, the doctors withdrew their services and went on strike. Cooperatives are formed out of a need. On the Sunday evening of June 24th, 1962, about 70 Regina citizens met to form a cooperative health centre,” she says.
The new health co-op later became better known as the Regina Community Clinic. In some ways, she says, the co-op is overwhelmed by its own success and by community needs.
“One of the biggest challenges facing our clinic is capacity,” she says. “Our clinic is funded by the Saskatchewan Ministry of Health through a service agreement. Within that agreement we are provided funding for a certain number of doctors, nurse practitioners, nurses and other health-related staff. We direct the resources to meet the needs of our patient population. However, the demand for services is greater than what we can deliver. As a result, we are basically a closed clinic where we are only serving our current patients and clients. We have made an exception to one group of clients: governmentsponsored refugees arriving to Regina. We are seeing these patients for their care and have interpreters on staff,” she says.
In the early years, the number of health care cooperatives grew relatively slowly, but it began accelerating in the 1990s. At this point, the vast majority of home-care and ambulance co-ops are in Quebec, but many other types of health care co-ops are found across Canada that provide health and employment services to a wide array of clientele.
At the Coopérative de services à domicile de l’Estrie, founded in 1989 in Sherbrooke, Quebec, workers who do home care are protected from the kinds of exploitation that takes place in “black market” unregulated home care. The cooperative’s goal is to help seniors to continue living at home and to create stable, reliable jobs for underprivileged people.
Responding to needs
In other regions, co-ops were often a solution to an urgent community problem.
Port Alberni, on Vancouver Island, is a town that has suffered dramatically in the economic downturn. In 2002, during a wave of hospital amalgamations and cutbacks, the community hospital lost a quarter of its acute care beds. Registered nurses were replaced with practical nurses and care aides.
The town had trouble attracting and keeping doctors. Between 1998 and 2005, seven family practitioners retired and new medical school graduates were intimidated by the high start-up costs of establishing a new practice in a small community. Port Alberni’s residents responded by creating the Pacific Rim Health Services Cooperative in 2006.
They established a cooperatively-run family clinic called the Alberni Family Medicine Clinic, which quickly attracted two new family doctors and a general surgeon.
A boon to small communities
Vanessa Hammond says she is proud of the work that the community health care co-ops do for Canadians. Good examples include Care Connection in Mission, B.C., as well as Mud Creek Medical Co-op in Wolfville, Nova Scotia. She says these agencies and many more like them across the country are important health care providers in small communities.
Hammond has been involved in co-op groups since she was 13. When she was a girl living just outside Bantry, Ireland, in the 1950s, she was a member of a co-op of egg farmers and sold eggs under its rules. She says co-ops succeed because of the time and energy invested in them by their members.
“The people involved want to have an equal say. They like co-op principles and want things run on democratic principles. Why would anyone want to take on the whole load of running an organization when there are people prepared to share the burden? With a co-op, there’s more openness. It’s not a secret how decisions are made and the money is spent.”
According to Hammond, health care co-ops often serve people who have multiple barriers to employment: these include people with disabilities, immigrants, refugees and others who have traditionally struggled to find a place in a workforce not designed for them. “That’s a huge, huge issue,” she says. “There are wonderful co-ops that either provide employment or help people find employment, like Team Werks in Thunder Bay, Community Opportunity and Innovation Network (COIN) in Peterborough, Coo Café and Cedar Opportunities cooperative in Nanaimo, Healthy Minds and Breakthrough Counselling cooperatives in Halifax, and Y’s Owl Maclure Cooperative Centre in Ottawa.”
Keeping the lights on
But many co-ops struggle in small towns to provide services that might not be available if co-op members didn’t work hard to provide them. In the little village of Canso, Nova Scotia, a co-op provides a building and keeps the heat and lights turned on so the doctor, accountant and lawyer can visit.
“Those are basic services that a community cannot live without,” says Hammond. She says her group was founded at the beginning of the century to showcase the work of community health care co-ops and help share information and support among them.
“In about 2000, a bunch of us were yakking one day. We said we should put on an open house,” she recalls. Then the activists talked to the United Church, which was very supportive. “So we held the open house, then did focus groups and found that the two things that people were most interested in were food security and health,” Hammond says.
It’s not surprising that the health care cooperative movement has received a great deal of support from credit unions, says Hammond, and Kate Dunford, community investment portfolio manager at Vancity agrees.
“We have made an exception to one group of clients: government-sponsored refugees.” —Lorna Knudson, executive director, Regina Community Clinic
Vancity ($17 billion in assets under administration), Assiniboine Credit Union in Manitoba ($3.4 million assets under administration) and Saskatchewan’s Affinity Credit Union ($2.7 billion assets under administration) were all quick to recognize the value of a united health care co-op front. They contributed a total of $60,000 in core funding to help establish the Health Care Cooperatives Federation of Canada. Vancity, among many others, has also provided direct grants to health care co-ops and it isn’t alone. They include Saskatchewan’s Synergy Credit Union ($1 billion in assets, 28,000 members), which has helped fund such co-ops directly, too.
Corey Mohr, community development coordinator of Winnipeg’s NorWest Community Health, works for a co-op with 90 staff. In April 2013, the facility, which had just celebrated its 40th anniversary, moved down the street into a new health and social service centre called Access NorWest. Situated in the northwest corner of Winnipeg, NorWest is the only health co-op in Manitoba.
It has expanded its services in hopes of accepting 2,500 new clients this year in addition to its existing 4,000 client base. In the first six months after the move, NorWest’s primary care team alone accepted 1,000 new clients. NorWest has 500 co-op members and is hiring a membership development staff to engage the members of the health care co-op.
“We strive on focusing on the most highrisk populations in our community with a true community-based approach to health and social services,” Mohr says. “We would say poverty is a big challenge and uphill climb, as well as adequate housing for our community members.
“There are also challenges with respect to some populations,” he says, adding that they face “adjustments to city life from relocating and moving from a northern community and/ or a reserve into an urban setting.” As well, there can be difficulties for many newcomer families who are settling into a brand-new country and climate, he explains. That’s where health care coops can help.
Filling a niche
Co-ops fill service niches across Canada. Many of Quebec’s ambulance cooperatives are made up of owner-employees of the ambulance services. They account for about a third of the ambulance services in Quebec. Most earn their funding by charging a flat rate, plus mileage, to people who use their services. In most cases, clients are not charged if they are involved in workplace injuries, road accidents, or are low-income seniors or recipients of social assistance benefits.
There is also a rural ambulance co-op in Carbonear, northeast of St. John’s, Newfoundland and Labrador. “The people who live there were sick of four-hour waits for ambulances so they set up their own service,” Hammond says. Then there are the health care co-ops that serve immigrants. Multicultural Health Brokers Cooperative in Edmonton works in 22 languages.
There’s a surprisingly large migrant worker and refugee population in Edmonton. A lot of the practitioners are people from abroad whose foreign qualifications are not recognized in Canada. The co-op was started in 1998 as an initiative to improve infant and maternal health among ethnic groups. It now provides health education, translation of health care materials, linguistic-cultural interpretation of health education materials and home visits. It also connects women and their families with social services, and advocates for better care at the provider and institutional levels.
“Health co-ops are becoming important parts of their communities,” Hammond says, “and their growth across the country shows that people who want to work in a cooperative environment where they are both owner and boss can really get things done.” ◊