1 CHC Development - History Community Health Centres (CHCs) are a distinctive primary care delivery model in that they are governed by community boards, deliver programs and services within a population health framework and have extensive community involvement, including volunteerism (Shah and Moloughney, A Strategic Review of the Community Health Centre Program, May 2001). In Ontario, Community Health Centres date back to the early 1960s and 1970s, generally as the result of community activism to improve access to health care. The Sault St. Marie and District Group Health Association was the first health to open as a group practice due to the mobilization of mine workers in the area. Although its model is based on a different funding formula, it has been a source of inspiration to the further development of CHCs. In 1972, a study and report prepared by Dr. J. Hastings promoted the CHC model for a national plan of primary health care delivery, but, in the end, did not obtain the necessary political support to be implemented. However by 1976, there were 15 CHCs in existence in Ontario. In 1983, the Ontario provincial government, under the leadership of Larry Grossman, M.P.P. for the Spadina riding and Treasurer of Ontario, recognized the CHC model as a viable option for community primary health care. Although a couple of CHCs were funded in 1983/1984, it was not until the mid-1980s that the elected Liberal provincial government made a commitment to double the size of CHCs. Currently, there are a total of 73 CHCs serving 110 communities in Ontario. This is the result of the announcement, in November 2005, by the Ontario government to expand the provincial CHC network through new funding of 21 new CHCs and 17 satellites by For ongoing updates and information on CHCs, please refer to CHCs provide primary care services and health promotion programs with an emphasis on priority populations which require improved access to care and/or have a higher disease burden requiring additional resources. Problems of access may be the result of socioeconomic status, geographic isolation, or cultural or language barriers. Illness burden may be related to age, socio-economic status, or environment factors. In general, CHCs delivery of services and programs include three key components: Illness treatment Health promotion and prevention of disease, and Community capacity building. CHCs have the following qualities: Use a population needs-based and determinants of health approach to plan, develop and provide primary health care services, including treatment, health promotion programs, illness and injury prevention and public health education; Encourage individuals, families and communities within a specific population, defined by either geographic boundaries or communities of affiliation, to take greater responsibility for their health and well being;
2 Create inter-disciplinary teams of salaried staff, who provide coordinated services 24 hours a day; Maximize the outcome of services provided by involving clients and community in resource allocation decisions; Integrate culturally appropriate services (e.g. provide native healing and medicines in centres with an Aboriginal focus or settlement services for immigrant communities); Are not-for-profit corporations, governed by volunteer, community based boards of directors that encourage healthy community by working in partnerships with organizations in other sectors, such as justice, education, recreation and economic development. CHC Program The Ontario CHC Program began as a pilot in the 1970s when the Government of Ontario funded 10 CHCs. In 1982, and until April 2007, the CHC Program was established as an ongoing Ministry of Health and Long Term Care program. During 2007 the CHC program of the Ministry of Health and Long Term Care was transferred to the Local Health Integration Networks (April 2007). The objectives of the CHC program remain: To promote equity in access to health services; To strengthen the role of the individual and the community in health and health care delivery; To encourage linkages among health services and with social and other community services; To develop coordinated primary care services which make the most efficient use of health care providers and health resources; and To promote health and prevent illness to enhance the health status of the communities served. The CHC Model of Care The following has been adopted by the AOHC and all CHCs. Each CHC has signed the document, thus ensuring the commitment of all Board, Staff and volunteer members to this model of care. The CHC Model of Care: A Statement of Principles is a formal appendix to the funding agreement with the Waterloo Wellington Local Health Integration Network (MSAA Multi-Sector Service Accountability Agreement): The Community Health Centre Model of Care: A Statement of Principles: CHCs offer a range of comprehensive primary health care and health promotion programs in diverse communities across Ontario. Services within CHCs are structured and designed to eliminate system-wide barriers to access such as poverty, geographic isolation, ethno- and culturo-centrism, racism, sexism, heterosexism, transphobia, language discrimination, ageism, ableism and other harmful forms of social exclusion that can lead to an increased burden or risk of ill health. The CHC model of care focuses on five service areas: Primary care
3 Illness prevention Health promotion Community capacity building Service integration COMMUNITY HEALTH The CHC model of care is: Comprehensive: CHCs provide comprehensive, coordinated, primary health care for their communities, encompassing primary care, illness prevention, and health promotion, in one to one service, personal development groups, and community level interventions. Accessible: CHCs are designed to improve access, participation, equity, inclusiveness and social justice by eliminating systemic barriers to full participation. CHCs have expertise in ensuring access for people who encounter a diverse range of social, cultural, economic, legal or geographic barriers which contribute to the risk of developing health problems. This would include the provision of culturally appropriate programs and services, programs for the noninsured, optimal location and design of facilities, oppression-free environments and 24 hour on-call services. Client and community centred: CHCs are continuously adapting and refining their ability to reach and to serve their clients and communities. CHCs plan based on population health needs and develop best practices for serving those needs. CHCs strive to provide client-centred care. Interdisciplinary: CHCs build interdisciplinary teams working in collaborative practice. In these teams, salaried professionals work together in a coordinated approach to address the health needs of their clients. Depending on the actual programs and services offered, CHC interdisciplinary teams may include physicians, nurses, nurse practitioners, dietitians, physiotherapists, occupational therapists, social workers, Aboriginal traditional healers, chiropodists, counsellors, health promoters, community development workers, and administrative staff. Integrated: CHCs develop strong connections with health system partners and community partners to ensure the integration of CHC services with the delivery of other health and social services. Integration improves client care through the provision of timely services, appropriate referrals, and the delivery of seamless care. Integration also leads to system efficiencies. Community governed: CHCs are not-for-profit organizations, governed by community boards. Community governance ensures that the health of a community is enhanced by providing leadership that is reflective of its diverse communities. Community boards and committees provide a mechanism for centres to be responsive to the needs of their respective communities, and for communities to develop a sense of ownership over their centres. Inclusive of the social determinants of health: The health of individuals and populations are impacted by the social determinants of health including shelter, education, food, income, a stable eco-system, sustainable resources, antioppression, inclusion, social justice, equity and peace. CHCs strive for improvements in social
4 supports and conditions that affect the long term health of their clients and community, through participation in multi-sector partnerships, and the development of healthy public policy, within a population health framework. Grounded in a community development approach: CHC services and programs are responsive to local community initiatives and needs. The community development approach builds on community leadership, knowledge and life experiences of community members and partners to contribute to the health of their community. CHCs increase the capacity of communities to improve community and individual health outcomes. CHC Information Management Systems (IMS) The current information management system environment in the CHC sector is complex and in development. CHCs have defined an IMS strategy which supports the overall strategic directions of Ontario CHCs which in turn are guided by the CHC Model of Care. Currently, CHCs are focusing on five works streams: Clinical Management System (CMS), Ontario Health Reporting Standards (OHRS), Community Initiatives (CI), Non-operational Reporting and Analytics (NORA), and Electronic Client Record (ECR) adoption. This strategy evolved from work conducted in the 1990s by the Community Health Program of the Ministry of Health and Long-Term Care to develop an evaluation framework for the Ontario CHC program, recognizing the need to include the three elements of the CHC model: primary health care, community health (community capacity building) and health promotion initiatives. From 1995 to 2007, the Ministry of Health and Long-Term Care, CHC Program Unit, in partnership with the Association of Ontario Health Centres (AOHC) and CHCs, worked to develop an implementation protocol for such an evaluation system. The implementation process for this unique evaluation system was complex and difficult. It required the standardization of information systems and technology for all the CHCs, data collection and reporting mechanisms, a unique software program, as well as appropriate human resources at the CHCs level. The software program was developed by York-Med and Purkinje, generally referred to as the Purkinje program, specifically for the use of CHCs. While the Purkinje program was initially developed as a scheduling and data collection tool, over time, it became necessary to improve the tool to allow for the capacity to manage electronic client records, clinical data as well as clinical performance indicators. CHCs have defined a process to establish a satisfactory tool to meet the current needs of the sector. This work is in progress. AOHC (Association of Ontario Health Centres) The Association of Ontario Health Centres (AOHC) is the policy and advocacy organization for non-profit, community-governed, inter-professional primary health care organizations. AOHC members are Ontario s Community Health Centres, Aboriginal Health Access
5 Centres and Community Family Health Teams as well as the Sudbury District Nurse Practitioner Clinics. AOHC engages in research, develops policy, provides leadership and advocates in support of the community-centered primary health care model. AOHC was incorporated in November 1982 by Letters Patent under the Corporations Act of Ontario. The Association is also a registered charity under the federal Income Tax Act. The AOHC is dedicated to its mission and vision, whose actions are driven by these key values: AOHC S Vision All Ontarians have access to non-profit, community-governed, interdisciplinary primary health care. AOHC s Beliefs AOHC accepts the definition of health adopted by the World Health Organization (WHO): Health is the extent to which an individual or group is able, on one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacity. and that: Effective primary health care must address the determinants of health, including shelter, education, food, income, a stable eco-system, sustainable resources, social justice, equity and peace. It therefore encompasses primary care, illness prevention, health promotion, health education, and community development, social action, building healthy public policy, and creating supportive environments; Community governance ensures that the health of a community is enhanced by providing leadership through effective partnerships of individuals and community and the staff of health centres. Community governance allows the skills, expertise, knowledge, and life experience of all partners to be shared to contribute to the health of their community; Interdisciplinary teams of health professionals are the most effective and efficient means for providing quality services in an appropriate manner. These multidisciplinary teams include physicians, nurse practitioners, nurses, dieticians, health promoters, counsellors and other staff and volunteers who contribute to the health of the community. AOHC s Values As an Association dedicated to its mission and vision, the actions of the AOHC are driven by these key values: Advocacy - AOHC actively promotes healthy public policy, community-governed interdisciplinary primary health care grounded in the social determinants of health. Anti-oppression AOHC commits to increase access, participation, equity, inclusiveness and social justice by eliminating systemic barriers to full participation;
6 promoting positive relations and attitudinal change by creating a climate where discriminatory or oppressive behaviors are not tolerated; and fostering an Association that is reflective of its membership and inclusive of racialized and minoritized groups, consistent with grounds identified under the Ontario Human Rights Code. Aboriginal AOHC values Aboriginal peoples cultures and languages and fully supports access to culturally relevant primary health care, incorporating both western and traditional healing practices for all Aboriginal people in Ontario. AOHC recognizes Aboriginal core values of respect, humility, love, care, courage, honesty, truth and knowledge. French Language Services - AOHC values Canada's francophone heritage and fully supports the efforts of francophone member centres and emerging groups to protect and improve access to French language health and social services as guaranteed in Ontario's French Language Services Act. Equity - AOHC ensures that each member has the opportunity for equitable participation in the Association. Diversity - AOHC engages the widest possible variety of views, backgrounds and abilities of its members to promote creative and effective programs, policy positions and decision-making. Accountability - AOHC is open, transparent and responsible to its members. Collaboration - AOHC's work is carried out in a spirit of cooperation and shared leadership among members and others who share the Association's vision. Mentorship - AOHC staff and members support the Association's mission by providing guidance and assistance to other members, groups emerging as potential future members, and others who share the Association's vision. For more details, check Communication and Planning Among CHCs The Association of Ontario Health Centres (AOHC) plays an important role in coordinating and sharing information among CHCs, but the following mechanisms have been established to ensure ongoing opportunities for strategic planning, information sharing, advocacy as well as consistency: Regional meetings of CHC Executive Directors. Each region forms a network of Executive Directors. The Waterloo Wellington Executive Directors Network meets monthly (except during the summer). Provincial meetings of CHC Executive Directors. These meetings take place quarterly at different locations in Ontario to accommodate the diverse CHCs located in various areas across Ontario. It aims at dealing with issues at the strategic level CHC Current Issues Primary Health Care Transformation Alignment What are the issues facing Community Health Centres today? The following is a general outline of the issues currently affecting CHCs: Primary care transformation agenda government initiatives regarding:
7 establishment of Local Integration Networks geographic boundaries that separate natural CHC networks development of new CHCs and CHC Satellites (announced in 2005) - inadequate allocation of budgets and resources place of CHCs within the primary health care reform and LHINs: since April 1, 2007, Community Health Centres are devolved to a Local Integration Network (as per a geographic LHIN map) - Four Villages is located within the TCLHIN (Toronto Central Local Health Integrated Network) MSAA (Multi-sector Service Accountability Agreement) changes in funding allocation and reporting mechanisms funding for the satellites incomplete transfer process from Ministry of Health and Long Term Care to LHINs; unique role of CHC, in the health care system, as primary health organization to ensure accessibility to services for populations who face barriers to services; demands for services and programs lack of a structure for increase in funds to address gaps and service demands Capital funding and approvals continue evolving within the mandate of the Ministry of Health and Long Term Care, with potential transfer to LHINs. The process is very lengthy and inconsistent due to frequent changes in Ministry s staffing. Electronic client records change from paper charts and implementation: investments required (human resources and funds) Several initiatives have and are being undertaken by the CHCs and the AOHC to deal with these issues. These include: efforts, since 1992, to participate in the discussions around primary health care reform to position the CHC model within that context. advocacy and strategic capacity building campaigns coordinated by the AOHC: physician compensation salary model new salary grid established funding for new CHCs and satellites addressing issues relating to IMS (information management system) Campaign to address CHC capital needs AOHC work regarding performance indicators for the sector Review of funding accountability agreement (MSAA) to: ensure that CHCs model is taken into consideration assist Board members and Executive Directors in their review before signing first agreement CHCs have always been supportive and aligned with the goals of primary health care reform. Examples: extended hours and on call services 24 hours, seven days per week; focus on illness prevention and health promotion, multi-professional teams of providers and accountability.