Tag Archives: social innovation

Care by communities: Greece’s shadow zero-cash health care system

You enter the Metropolitan Community Clinic at Helliniko from a nondescript parking lot in suburban Athens, in an area that hosts a decommissioned American military base. It does not look like much. But it is. It is a very big deal indeed.

The MCCH saves people. It provides health care to down-on-their-luck Greeks who have no access to public health care and no money to pay for private clinics. There are many such people, because in Greece access to the national health service is tied to employment. When Greeks lose their jobs, they have a grace period of one year: they’d better find another job within that period, because if they don’t they are out of health insurance. If they fall sick, they have to come up with something, or die.

It’s not just Greeks. It turns out in every European Union countries but the United Kingdom and Italy, employment is a pre-requisite for access to health care. But Greece was it hardest by the 2008 crisis: many more people than elsewhere have turned into long-term unemployed. Everyone is struggling: “We had poor people ten years ago, too – shrugs Maria, a psychologist volunteering at MCCH – but at that time people could fall back on their families, or their neighbors, for help. Not anymore: their families and neighbors are themselves in trouble, and there’s little they can do. People are getting desperate.”

In 2011, some senior doctors started comparing notes, and they saw a perfect health care storm brewing at the horizon. “We knew something very bad was coming, and people would die – says Maria – so we decided we must do something.”

“Something” in this case turned out to be the MCCH itself. This is a very strange animal as health care providers go.

  • It has no legal existence. Its literature proudly proclaims: “ MCCH is a volunteer organization without Legal or Taxable status and it is not a ‘Non-Profit-Making-Organisation’.” Maria: “We are technically illegal”.
  • It does not accept donations in money. It does accept donations in kind: medicines, equipment, blood sample analyses.
  • It operates from a building that belongs to the Municipality of Helliniko-Argyropoulis. Though none of its employees works in the building, the Municipality still pays the electricity and phone bills that the MCCH generates. My heart goes out to the anonymous “bureaucrat hacker” that entrusted a government building to an informal group of citizens, which by definition cannot sign contracts or participate in tenders.
  • It is very autonomous with respect to institutions and power. MCCH was recently proposed for the European Parliament European Citizen’s Prize 2015, but they very publicly turned it down. Reason: “Europe is an important cause of the problem we exist to address. Don’t give us award, change your policy”.
  • It treats only people who have no access to the public health care system. One exception: low-income families with many children, who are living hand-to-mouth on 450 euro a day and simply cannot afford to buy medicines (Maria: “It happens”).
  • On top of diagnosis/prognosis, MCCH supplies free medicines, baby food and nappies.
  • It has 300 volunteers, of which a little over half are doctors of various specialisations and pharmacists.
  • It operates with practically no hierarchy and no management. People decide by themselves what role to play, by joining one of several groups (about 10 members to a group) which exist to carry on specific tasks (like onboarding new patients). An organising committee does its best to keep people on the same page. A weekly meeting votes on general issues. A mailing list deals with specific matters.
  • When they are not volunteering with MCCH, volunteers exchange services and small favours through a time bank: two massages against one hour of English lessons etc.

There are now 68 such clinics in Greece. Take a moment to think about what this means: in four years, thousands of enterprising Greeks with no money, no command structure and who do not even know each other have created a parallel health care system that succeeds where the public health service and private sector services both fail: it keeps reasonably safe the poorest strata of the population. Notice that the Greek health care budget in 2011 was over 6 billion euro.

Wait. Self-organised people with no money and no organisation that beat credentialed, moneyed professionals at their own game? We’ve seen this before. It was Wikipedia outcompeting Encyclopedia Britannica. It was OpenStreetMap pushing to the curbs Garmin and TomTom. It was Facebook groups coordinating disaster relief after the Nepal 2015 earthquakes and the Tbilisi 2015 flash flood, way before the government and NGOs could get their act together. It was Internet-coordinated young newcomers changing the rules of the political game, and even bringing down entire regimes who seemed to have all the power and all the money, in Egypt, Tunisia and Ukraine.

We have a word for these phenomena: we call them disruption. They are associated with supplying goods or services in a new way, that substitutes collective intelligence and distributed effort for vertical organisations. This new way happens to be vastly more efficient than the old ones.

I think the time has come for disruption in health care, and in care services in general. Why? Because, as the OECD pointed out, per capita health care expenditure grows much faster than GDP. In 1970, health care absorbed a respectable 5.2% of the GDP of the average OECD country. In 2008, it absorbed 10.1% (source). The system is under strain, and often – like in Greece, it reacts by denying care to those who most need it.

Per capita health care expenditure in some OECD countries, 1970-2015

This is morally unacceptable, wasteful and stupid – especially when the Metropolitan Community Clinic at Helliniko and so many other experiences like it, in the world of care and outside it, has proven how much farther communities can go in taking care of their members when they are enabled to do it.

So, we are getting involved. Edgeryders has partnered up with five world-class organisations in research (University of Bordeaux, Stockholm School of Economics, ScimPulse Foundation), welfare policy-making (City of Milan) and digital fabrication (WeMake) to find, learn from, and enhance the experiences like MCCH all around the world. Our goal is a model of community-driven care services, based on modern science and open technology, but with the low overhead and human touch that communities can provide and large bureaucracies cannot. Our project is called OpenCare; the European Commission has generously agreed to support it through its Collective Awareness Platforms programme.

Whoever you are you are welcome to join us. After all, if you are human, you have considerable experience of giving and receiving care, and that makes you an expert. If you want to participate, or simply to know more, start here.

Photo: Theophilos Papadopoulos on flickr.com

Living social in Brussels: growing the family

“Wait a minute: is this a co-living space?” I was asked this question a few weeks ago by designer Ezio Manzini, who was in town to present a recent book of his and had come over for dinner. We were standing in the courtyard of our new home, just a week or so into the moving. All I could do was stare at him. To me that was just home, but he was right: we do live in a co-living space. How did that happen? We are hardly commune material.

Here is the back story: a few years ago, Nadia and I tried the life of a migrant nuclear family, and hated it. Upon moving to Brussels in 2012, we decided to rent a larger apartment than we needed, and look for flatmates. Eventually a young couple, Kasia and Pierre (expats, like us), moved in with us, and we really enjoyed their company. When our landlord reclaimed his flat, we decided to stay together, and went about looking for a new home that could accommodate the four of us. And then we thought, wait a minute. This is working out quite well, so maybe we should consider growing the family: find an even bigger place, and look for two extra housemates.

So, I wrote a post on this blog, telling the full story of why we enjoy so much living with Kasia and Pierre. And then two wonderful things happened.

The first one was that we bumped into a creative real estate agent, Isabelle Sandbergen. We needed that, because, guess what: the real estate market does not serve people with non-traditional familial constellations. It is heavily geared towards the nuclear family or the swinging single; you can find large dwellings if you are prepared to pay a high rent, but they typically do not accommodate the need to mix socialisation and privacy; for example, at least in Brussels, they tend not to have enough bathrooms. Good luck finding anything with three or four bathrooms. Isabelle called us on an intuition: the same landlord, she said, was renting out two newly renovated lofts facing each other. They were individually too small for us, but how about we take both? They were separated by a simple fence, but that could be taken down to allow unimpeded access to both lofts for everybody. And we would have a very nice, huge private court on top of two open spaces (one kitchen-living, one office), four bedrooms, two bathrooms, two toilets and some extras. Were we interested? We were. We signed the contract after a week from that call.

Living room and courtyard

The second wonderful thing was finding two more great flatmates. They are both Italian, and both lived abroad before moving in with us: Giovanni in London, Ilaria here in Brussels. Ilaria lived here for a long time, and is practically a local; Giovanni is a total newcomer. She works in the Eurospace; he is currently focusing on a startup company. Ilaria planted a herbal garden in the courtyard, and Giovanni’s tiramisu became the everyone’s favourite treat. There’s even more diversity in the home. How did we find them? In the usual way, through the Internet. When they showed up, they told us they had been inspired by my post, so they had at least an idea of what to expect. This reassured us they were likely to have the flexibility necessary for Living Social in Brussels; and flexibility we are going to need, a lot of it, because the journey is fascinating but there are no maps for it.

With six people, you might think we could get tired of the crowd. But the opposite is true: we have different lifestyles, plenty of space (about 200 square meters, plus the courtyard and a huge hallway) and we end up not seeing much of each other – not enough, in my opinion. In fact, I am trying to make a point of organising “family dinners” with the six of us at least once a month, because they are great fun but do not happen without somebody passing word around to save the date – though sharing a meal in smaller numbers, three or four, is far more common.

Ezio told me that his group at Politecnico di Milano was involved in designing some co-living spaces, but he had never been in one that actually worked. He was fascinated in discovering that real life had somehow overtaken R&D, and that we – not knowing that co-living is very difficult to do successfully – had gone out and simply done it. We do not think of what we do as design, but we are aware we need to learn how to live together and enjoy each other’s company over the long run. So, we experiment: we use plenty of hacks like shared documents, an online calendar, spreadsheets for shared expenses and so on; we try stuff, keep what works, discard what does not. It’s a lot like life.

Thank you for all your messages of sympathy, and for sharing our posts on the various social media: you helped Ilaria and Giovanni find us, and so enriched our life. And if you find yourselves in Brussels, come over for coffee, or a glass of wine!

God’s network

For a few months now I have been thinking about the Benedictine movement in terms of complex adaptive systems, and to Saint Benedict’s Rule as a protocol. The more I think about it, the more sense it makes.

So, when prominent innovation journalist Riccardo Luna asked me to tell the story of the unMonastery at Next (it’s a sort of televised innovation festival run by Repubblica, Italy’s top daily newspaper), I ended up rambling about that. Focusing on monasticism in sixth century Europe might seem at odds in such a temple of innovative technology and startups, but then innovation has been with humanity well before Silicon Valley. And if you look at Benedict from Nursia through the lens of social innovation, what you see is… surprising. My presentation is below. It’s in Italian: if you don’t speak the language, you can still check out this beautiful videoclip (largely wordless) that makes up its middle part.