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					Medical Healthcare Services
 by Japanese Agricultural
 Cooperative Movement


              Masahiro Matsuda
                   JA-Zenchu
              Key Words

- Together with Farmers

- Prevention Is Better Than Treatment
1. History

The first medical healthcare service was
launched in November, 1919 by a multi-
purpose primary agricultural cooperative in
Shimane prefecture in order to dissolve
non-doctor village and to provide medical
service at low rates. After that, this service
spread throughout the country.
2. Legislation concerned

Medical healthcare services of agricultural
cooperatives are set forth as “Medical
facilities” and “Facilities related to the welfare
of elderly people” in Article 10 of Agricultural
Cooperative Law.

Carrying out medical service needs an
approval by a prefectural governor under
Medical Care Act.
A prefectural welfare federation of
agricultural cooperatives (PWF) organized by
primary agricultural cooperatives (JAs) in
each prefecture was approved by the
Minister of Health and Welfare in 1951 as a
founder of public medical institution as set
forth in Article 31 of Medical Care Act.
3. Present situation

21 prefectural welfare federations of
agricultural cooperatives (PWFs) are running
117 hospitals and health clinics in those
prefectures.

12 PWFs are carrying out only health check
activities.
4. Facilities
                                      (2009)
PWFs are running the following facilities;

-Hospital               117 (with 37,011 beds)

-Health clinic           64 (with 32 beds)

-Mobile health clinic    11
 for remote areas
-Elderly care facility    26
-Visiting care station   109
-Support center for       16
  home care
-Area comprehensive      13
  support center
-Rural health check      23
  center
-Mobile health clinic    208
 for lifestyle related
 diseases
5. Major activities

(1)Promotion of good health

PWFs are tackling the prevention of lifestyle
related diseases widely and carrying out
health promotion activities such as cancer
detection, health check in workplace and
comprehensive medical check to protect the
health of local residents.
(Persons checked in 2008)

Health check for lifestyle   2,926,162
related diseases

Comprehensive medical         460,095
check
(2)Medical services

PWFs are offering medical services aggressively
especially in rural and mountain areas as public
medical institutions.

                                    (2008)
No. of out- patients   19,687,000

No. of in-patients     10,995,000
(2)-1 Medical services for remote areas

21 hospitals of PWFs, which are designated as
core hospital for remote areas, are providing
medical services by mobile health clinic and
dispatching doctors to health clinics located in
remote areas.
(2)-2 Clinical training

97 hospitals of PWFs, which are designated
as clinical training hospital, are providing
clinical training services and playing
important roles as public hospitals located
in local cities.
(2)-3 Emergency medical services

105 hospitals of PWFs, which are
designated as emergency hospital, are
accepting emergency patients. Especially
for severely ill patients who need hospital
care, 9 hospitals set up emergency medical
care centers which can accept patients for
24 hours and provide advanced medical
treatment.
(2)-4 Disaster medical services

33 hospitals of PWFs, which are designated
as core hospital for disaster, are improving
medical preparedness enable to accept and
evacuate disaster victims.

(2)-5 Nurses’ training school

PWFs have established 15 training schools for
nurses which run 3-year course. The number
of total trainees is 2,145.
(3)Elderly care services

Hospitals and clinics of PWFs are
providing not only medical services such
as short-term nursing care and visiting
care and rehabilitation but also support
services such as home care planning,
visiting care and bathing support for
elderly people.
6. Healthcare system at city/village level

A primary society is organizing a “council for
promotion of healthcare and elderly care”
with
- a hospital of PWF,
- medical society,
- public health department,
- municipal government,
- agricultural extension office in the area
in order to support healthcare of members
of primary society effectively.
7. Outlines of Saku General Hospital of
Nagano Welfare Federation of Agricultural
Cooperatives(example)

(Excerpt from a file made by Saku General Hospital)
In Brief

Appellation: Saku General Hospital, Nagano
              Prefectural Federation of
             Agricultural Cooperatives for
              Health and Welfare
Location : 197 Usuda ,Saku-shi, Nagano
Founded : January 12, 1944
Founder : Hidemitsu Takizawa, Board
Chairman : Syusuke Natsukawa, M.D.
Director
Saku General Hospital’s Ideals

Following out the spirit of “Together With
the Farmers,” the Saku General Hospital
aims at protecting the lives of local
residents, thus adding to the realization of
communities whose residents may be able
to live a life worthy of living and at
contributing to the development of
international health and medical care.
No. of Beds:          Total 1,193

General floors                   600
ICU                               20
Psychiatric & Neurological       112
   floors
Communicable disease floor         4
Comprehensive medical             45
    checkup
Care-taking & rehabilitation      40
    floor
  (Sub-Total )               (   821 )
Koumi Branch                        99
Misato Branch                      120
Health Care Facility for Seniors    94
Koumi Health Care Facility          59
    for Seniors
Staff                                 2006.8   2010.8

Physicians                              204     212
Midwives, Public health nurses           68       95
Nurses                                  753     805
Pharmacists                              31      36
Laboratory technicians                   61      73
X-ray technicians                         32     37
Occupational and Physical therapist       47      64
Acupuncture                                6       4
Dental technicians                        10       3
Orthoptic trainers                        5         7
Speech therapists                          3       7
Care and Welfare specialists             48       81
Clinical engineers                       13       23
Clinical Psychologists                     3       3
Dieticians and Cooks                     23        33
Clerks                                  143      163
Medical social workers                   19        22
Others                                 248       265
Total                                 1,717    1,933
Attached and Related Facilities

・Misato Branch, Saku General Hospital
・Koumi Branch, Saku General Hospital
・Koumi Clinic Attached to Saku General Hospital
・Saku Hospital Nursing School
・Health Care Center, Nagano Prefectural Federation of Agricultural
 Cooperatives for Health and Welfare
・Saku Institute of Oriental Medicine
・Saku Health Care Facility for Seniors
・ Koumi Health Care Facility for Seniors
・Home Care Support Centers (8 )
・Home Nursing Stations (5)
・Comprehensive Community Support Center
・ Japan Institute of Rural Medicine
・Rural Health Care Training Center
・Nobeyama Special Nursing Home for the Aged
・Yachiho Home
  Accreditations for Community Medical Services
  (Center hospital of Saku District Health System)


Hospital accredited for training of residents (medical)
Hospital accredited for training of residents (dental)
Core hospital for isolated communities
Core cooperation hospital for cancer treatment
Key hospital for cardiac diseases
Life saving and emergency care hospital (Oct.1,1983)
Medical center for local accidents and disasters
(Sept.1,1997)
Center for senile dementia
Pivotal hospital for AIDS treatment
Medical institution designated for infections
District Perinatal Medicine Center
60 Years in Rural Medical Care




      All hospital staff, 1946
Medical care in a “doctor-less”
         village, 1947
Mass health screening at Yachiho, 1959
First Group of TB patients( 1950 - )
“Summer University” Course
 on Rural Medicine(1960~)
Venue for an international congress of
        rural medicine, 1969
  Prevention Is Better Than Treatment
Ever since Saku General hospital
was founded, Health care and
disease prevention has been
concentrated. Reflecting its
experience Saku General hospital
has had in the comprehensive
health care program for all over 15
hamlets in Yachiho Village that
started in 1959, the Health Care
Center for the Nagano Prefectural
Federation of Agricultural
Cooperatives for Health and
Welfare was established on the
                                      Mass Health screening at
compounds of the Saku General         Yachiho Village (1963)
Hospital in 1973.
Today, the health screening for around 100.000
local residents are implemented in Nagano
Prefecture per year.

persons      Trends in Mass Health Screenings in Entire Nagano Prefecture
120000

                                                                                          Examinees in total
100000


 80000
                                                                              Residents (agri. co-op members)
 60000


 40000
                                                                                              Businesses in general


 20000

                                                                                                                      Agri. co-op staff officials
      0
                                                                                          2
                                                                                              3
                                                                                                  4
                                                                                                      5
                                                                                                          6
                                                                                                              7
                                                                                                                  8
                                                                                                                       9
                                                                                     年度
             49
                  50
                       51
                            52
                                 53
                                      54
                                           55
                                                56
                                                     57
                                                          58
                                                               59
                                                                    60
                                                                         61
                                                                              62

                                                                                   H1 3




                                                                                                                      10
                                                                                                                           11
                                                                                                                                12
                                                                                                                                     13
                                                                                                                                          14
                                                                                                                                               15
                                                                                                                                                    16
                                                                                                                                                         17
         度




                                                                                      6
      8年
     S4
   Helping Remote Hamlets and Getting Among Farmers
              Delivery of Front-line Medical Care
                               National Health           Misato
Dispatching physicians            Insurance              Branch
and nurses to many local     Scheme (NHIS) Clinic
                                 in Asashina
hospitals and clinics and                                  Saku General
establishing close                                         Hospital
coordination with them,
Saku General Hospital                                       Koumi Branch
                                                            Koumi Clinic
deliver front-line medical                                          Kitaaiki
care.                                                               Outreach
                                                                    Clinic
                             Minamimaki Village Clinic             NHIS Clinic in
Emphasis is put                                                    Minamimaiki
particularly on the                                                   Village
delivery of medical care     Nobeyama Clinic for
in general, health care      Remote Communities                   NHIS Clinic in
                                                                  Kawakami
and home care in                                                  Village
remote hamlets in the
mountains.
 Emergency and Hi-Tech Care

The primary call from
community residents is the
availability of emergency
care just in case they are
seized with a sudden illness.
Under the motto of “right
treatment at the right time,”
the hospital’s Life-Saving
and Emergency Care Center
takes the lead in providing
emergency care around the
clock with all staff workers
mobilized.
Doctor-chopper

Doctor-chopper came into
operation in 2005, covering
all around Nagano
Prefecture. Annual number of
dispatch reaches 300. In
order to ensure the delivery
of quality medical care, we
always endeavor to brush up
on our technological skills
and equip ourselves with
high-tech medical technology,
while we are prepared around
the clock to cope with the
given conditions of patients
         Japan’s First Health Care Facility for Seniors
The hospital’s Health Care Facility
for Seniors, the first of its kind
designated as a model by the
Ministry of Health and Welfare in
1987, evolves a wide variety of
activities to sustain medical care
for seniors as a kind of facility that
comes in between a hospital and a
family.

The Health Care Facility for
Seniors intends to develop itself
into a place of living where seniors
may be able to enjoy life of the sort
they find worthy of living.
A Sense of Security for All Community Residents

The hospital is also stepping up
the formation of a network of
coordination with primary
agricultural cooperatives,
municipalities, social welfare
organizations, volunteers’
groups and citizens’
organizations. It has been 10
years since a community health-
care seminar was started to train
leaders in the community
health-care and welfare
activities.

                                       Home nursing
With the nation swinging into
an aging society, it is
increasingly necessary to
reinforce home care and
welfare activities. The
hospital’s Department of
Community Care, Home
Nursing Station and Home
Care Support Center are
playing the lead in grappling
with community care
services.
Fostering Consideration and Determination of
Protecting Rural Communities
                   As part of its educational activities for
                   locals, the hospital has performed an
                   annual open-house hospital festival
                   on the same days as the local town’s
                   traditional festival since 1947.

                   Then it has made it a practice to hold
                   an annual “summer university”
                   program for participants coming in
                   from across the nation. The Rural
                   Health Care Training Center gives
                   refresher programs for workers
                   engaged in the delivery of health and
                   medical care.
     Training of medical workers

The hospital also concentrates
itself on the training of medical
workers, focusing on the
features of local communities,
beside the founding of a
nursing college in 1960 and the
training of interns and residents
as a ministry-designated
teaching hospital.
    Focusing on Peace of Mind, Safety and Health building
       Saku General Hospital’s Research Activities

                                  Established in 1973, the Japan
                                  Institute of Rural Medicine has
                                  taken up a broad range of
                                  themes in rural medicine, such
                                  as farm machinery accidents,
                                  agricultural ergonomics,
Chemical analysis at the Japan
                                  organic farming and
Institute of Rural Medicine
                                  environmental issues, to say
                                  the least of research on
                                  pesticide poisoning with
                                  animal tests and chemical
                                  analyses.

Research of pesticide poisoning
& farm accidents
8. International Cooperation Activities of
Saku General Hospital

(Excerpt from a document made by Dr. Kijo Deura,
Department of International Medical and
Healthcare of Saku General Hospital)
1. History

Saku General Hospital has implemented
exchange programs, under strong leadership
of late Dr. Shunichi Wakatsuki, who was
awarded Magsaysay award, with concerns
working for rural medical healthcare in
developing countries through International
and Asian Associations of Rural Medicine
since 1950s.
In 1970s, exchange programs with concerns
working for rural medical healthcare in
China and South Korea had expanded.

Since 1980s, Saku General Hospital has
started accepting trainees and visitors
concerning with Japanese Organization for
International Cooperation in Family
Planning (JOICFP) and Japan International
Cooperation Agency (JICA)
In 1994, Department of International
Medical and Healthcare was established
in Saku General Hospital and
international cooperation activities have
expanded more than ever.
(2) Outlines of international cooperation activities

(2)-1 Acceptance of trainees

The number of trainees and visitor from abroad since
1950s exceeds 1,300 from about 100 countries.
                         Middle-     N-
                    Latin East     America,et
                   America 7%         c
                    12%              2%


          Africa
          18%

                                   Asia
                                   61%
The main subjects are (1)Establishment
and management of regional healthcare
system, (2)Roles and management of
regional hospital, and (3)Health control
activities with the consent of the all
village residents in cooperation with
better-living activities and health
promotion activities.
(2)-2 International cooperation projects

Through network with ex-trainees, after the
example of “all village health control activity,”
“Healthy Village Campaign” projects have
been implemented in the Philippines, Laos
and Sri Lanka.
This “all village health control activity” is
the world first program started in Yachiho
Village of Nagano prefecture in 1959 and
It is said that this activity is a prototype of
WHO’s same name campaign and
“Millennium Village campaign.”
(2)-2-1 Philippines

This cooperation project has been
implementing in cooperation with 2 rural
health units in Benguet and Mountain
provinces and 3 municipal governments
and 4 agricultural cooperatives.
The concrete activities are
(1)Participatory Mass Health Screening,
(2)Community based Health Promotion
Program,
(3)Community Health Outreach Program,
(4)Social Health Insurance Program,
(5)Drugstores run by agricultural cooperatives
and village offices.

The project was awarded by Department of
Health and Senate of the Philippines.
(2)-2-2 Laos

45 persons concerns with the maternal
and child health project (KIDSMILE
Project) and Ministry of Health of Laos
visited Saku General Hospital and the
strong network was established.
As a result, after a joint study, the
cooperation project has been
implementing in 2 provinces of the
northern region in cooperation with
provincial health departments.

An activity which concept is as same as
Saku Hospital Festival was introduced in
KIDSMILE Project.
(2)-2-3 Sri Lanka

Provision of used medical equipment to
Ministry of Health of Sri Lanka and
cooperation to “Friendship House project”
has started last year.

The objectives of “Friendship House
project” are to establish “Healthy Village”
through construction of a multi-purpose
community house with health center.
Thank you!

				
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