The case study is about the city of Valparaiso, Chile (South America), which covers an area of 402 square kilometres and has approximately 253 580 residents (as of 2012).
Following the election of Jorge Sharp as mayor of the City in December 2016, a project started in 2017 for the creation of a ‘Red de Servicios Populares de Salud‘, a network of community pharmacies that provide services sold by the City’s health department at reduced prices (up to 70% less than the market price). The service is granted to members (together with their families) of citizens’ associations and labor unions and to all people who live, work or study in the city who only have to present the operators with a prescription and a valid ID card.
The project includes not only the creation of pharmacies, but also optics, a municipal health center, orthopedics, and in the future, the creation of a “popular laboratory”.
With the support of the Central Abastecimiento Nacional (CENABAST), the national entity for the distribution of medicines as a partner, the pharmacy wants to guarantee access to medicines to all the members of Valparaiso. Moreover, the Municipal Pharmacy is planning to create a User Association to co-manage the service, aiming to promote a network of medication distribution at the neighborhood level, arraigning the importations of high-cost medicines, and incorporating the Chilean Municipal Association.
The experiment is juxtaposed with Imbroscio’s idea of a ‘solidarity economy’, a concept that reflects the desire to fight poverty and invest in the stability and prosperity of communities. In fact, the research is based on the conception of urban resources and city space as common goods, affirming the existence of a common stake and interest in shared resources with other inhabitants, as a way of resisting the privatization and/or commodification of these resources.
Considering the urban institutional framework of the city of Valparaiso, we can say that Chile’s Constitution’s centralist approach does not permit much autonomy to City councils. Even today, most of the relevant issues, such as the control of financial resources and the authority over determinate areas of urban governance are still managed by the central State. With the establishment of the Valparaiso network of community pharmacies, there has been a call by the health department of Valparaiso City Council to create at the State level, a public health fund to help Cities that might want to invest in the creation of such institutions.
The five dimensions endogenous to our design principles that define a Co-City were assessed: Collective Governance; Enabling State; Poolism; Experimentalism; and Technological Justice. The design principles are analyzed to better understand whether it is possible to consider the city of Valparaiso a collaborative and inclusive space, and with what intensity each principle is present: weak; moderate or strong.
Collective governance (co-governance) refers to the presence or absence of a self-, shared, collaborative, or polycentric organization for the governance of the commons in cities and it is a strong variable in this case. The Network of Community Pharmacy of Valparaiso project is a multi-stakeholder collaboration providing low-cost healthcare for city residents. All the project actors of the quintuple helix system project are involved: active citizens and community groups, non-governmental organizations, and public authorities.
The Enabling State is present to a moderate extent. The State support to the project has been positive and a certain degree of autonomy has been conceded to the City and the citizens’ associations. However, the presence of non-standard, informal procedures for cooperation are still missing. It is the project principle that expresses the role of the State in the governance of the commons and identifies the characteristics of an enabling state that facilitates collective action for the commons and can be a key factor for the success of community projects on the urban commons.
Social and economic pooling is a strong design principle here, which aims to identify the presence of forms of pooling. The experience of the Valparaiso community pharmacy network seems to be ascribable to the ‘community economy’ subgroup of the pooling economy because it is essentially collectively owned and publicly managed; thanks to the involvement of the public (the City of Valparaiso and organs of the central State) and private (associations) entities; it also involves a transfer of resources from the private or public actor to the collective group and is aimed at realizing the goals of the right to the city, in particular universal access to public health services.
The project is not particularly innovative. However, it is very practical and replicable on a larger scale, and other cities in the world that do not yet guarantee the right to free access to health services; indeed the idea is based on a process that can be exported and adapted to different contexts and is replicable by following the same steps. Experimentalism is a moderate variable. Building a network of community pharmacies was an unprecedented case for Chile, but surely not for other Countries in South America or the world.
Technology may constitute the weaker element in the project. A strong technological innovation and a push towards reachability via the internet could have been a step forward in terms of the quality of the project both for efficiency and universality.
In conclusion, we can say that the Valparaiso network of community pharmacy is a laudable example of how the empowerment of local communities and a strong coordination, can lead to substantial and tangible improvements in the lives of citizens.
The Chilean National Statistical Institute predicts that by 2035, in 82% of cities, people over 65 will outnumber those under 15. This will lead to an increased demand for medical care and health services. Against this background, it is difficult to see how the older generation will manage to conserve their health without being able to afford the right medications.
The project might bring temporary alleviation from these problems and set an example for other cities in a similar situation. The project still needs to improve from a methodological point of view, especially about the Enabling State and Experimentalism variables, which are present to a moderate extent, and the Tech Justice variable, which is almost completely absent.
Either way, even though this case has still space for improvement, it certainly constitutes a full example of communities that work together for common well-being towards a common good dimension.