Working Conditions and Health Care in a “recuperated” clinic in Cordoba, Argentina

Abstract

Argentinean economic reforms introduced in the 1990s were characterized by structural adjustments which increased both job insecurity and barriers to health care. In Córdoba, some individuals found themselves without health coverage. Conversely, many private practices, also in crisis, were forced to close with a resultant loss of heath care jobs. Rather than accepting layoffs, the employees of the private Junin Clinic took over the facility and reorganized it as a cooperative. They wanted both to keep their jobs and to provide affordable health services primarily to the uninsured. We hypothesized that the quality of their clinical jobs would impact on the care they provided. We undertook to examine how changes in the organization of the clinic affected working relations and working conditions . We undertook a descriptive, correlative survey of 25 employees chosen via a multi-stage process to be representative of the clinic. Four percent worked under contract; eighty percent were professionals who split their earning 50/50 with the cooperative. The remaining workers were cooperative members. Fifty percent of those interviewed earned less than the basic minimum wage. Forty-four percent worked alone; the remaining workers were part of teams. Eighty-eight percent felt that their job was appropriate for their level of training. No one reported any occupational accidents. Eighty percent reported satisfactory hygienic conditions in their workplace. While the division of labor at the clinic had not changed since the take over, administrative structures were different. Cooperative decisions are made in large meetings. Since most professionals are not members of the cooperative, they do not participate in these meetings. However, we observed that relations and exchanges among the workers were less hierarchical. This work was undertaken to inform the debate on the relationship between working conditions and the provision of health care. We found that the work environment impacts on health care workers as they try to provide a more equitable form of health care.