Community Health Centres - A Good Health Care Answer

Health care reform - a huge topic on both sides of the border these days. This Canadian is not conversant enough with the proposals and present problems of the heated debate on extending health care coverage now raging in the USA. Nor am I entirely on one side or the other about 'two tier' provisions the Canadian Medical Association is presently snarling about. What I am familiar with, however, is the effect of really good quality health care on a sparsely populated and frighteningly poor part of Eastern Ontario.

I am the chair of a community board that provides governance for a type of health care delivery called a 'Community Health Centre'. We are an incorporated board with membership from all over the county where I live. We get a global budget issued to us by the Ministry of Health and Long Term Care of the Province of Ontario and spend it to provide both primary health care and supportive services and programs, our decisions being based on the advice of our staff and the needs of our clients.

A Community Health Centre is not a communal doctors' practice, although we employ three FTE medical doctors. We also have on staff an equal number of what we call 'nurse practitioners', nurses with advanced training enabling them to diagnose and prescribe for a range of common illnesses. With these, we have a cadre of RN's, a physiotherapist, two dietitians, a chiropodist and a psychologist. That is our primary health care staff. What is unique about a CHC is that in addition to the primary health care we offer a massive set of programs aimed at prevention and wellness. To do this we employ two professionals whose title is 'Health Promoter', an awkward kind of label for people who do everything from arranging seminars and lectures through supporting 'self help groups' for chronic disease and mental illness to helping those in financial distress find the help they need to get fuel, food and warm clothing for their children. We run a walk in clinic. We run two satellite health centres in remote areas. We run a well baby program and a Day Away program for Alzheimers. Exercise for Seniors. Cooking classes for diabetics. Support groups for teen mums. A Roots of Empathy Program. A support program for depression. Among others. The list takes several pages and can be found, in not great form, here.

Our staff is all on salaries, with salary ranges set by the Province of Ontario. Our benefit program sucks, sadly, because we need the staff numbers. Our primary health care program is a good fit for doctors who wish to have set hours and back-up, for nurses who like autonomy, for people whose training and personalities demand a platform from which they can make a real difference. The primary health care team consults on a daily basis, the community team keeps a sensitive ear open to what the needs are and the board tries to juggle the money to make each penny count, as well as setting policy. Policy of inclusiveness, openness, and striving after excellence.

Back in the palmy days when the provincial government was throwing money at the health care problem, we got the money to build a nice building, with meeting rooms, lots of offices and a big parking lot. (This is pick-up truck country, with no public transportation at all.) Over the course of a few years our clientele almost tripled. We needed another doctor and another NP. We applied for increased funding and got it but we could not attract people when we could not provide office space or examining rooms. And so the board asked for more funding for infrastructure. By this time the province was tight for money and said, simply, no. We then went out to the community, this rural, low income community, and raised $500,000 for an expanded primary health care wing. We got the doctors. We expanded the parking lot too, but not by enough.

So, why is this relevant to an American health care debate? It is relevant because prevention of illness and management of chronic conditions is the only, the ONLY way, that health care costs can ever be kept from draining the pockets of a country's citizens. And these things cannot be done by an overworked GP with one nurse and one receptionist working in isolation. They cannot be done in overcrowded hospitals. They cannot be done by having a Ministry of Health Promotion put warnings on cigarette boxes. The mix of programs and services needed varies from community to community, from age group to age group, from rural to urban. A governance board of local citizens is a very useful tool in tailoring services to fit the need, and probably hard-headed enough to defend putting staff time and effort into prevention.

A CHC can cut emergency room visits, keep people out of hospital and help them become and stay healthy. And save money, in comparison with a joint doctors' practice, while doing it.

An original post for Canada Moms Blog

When she's not at meetings, Mary G can be found at Them's My Sentiments