What are Community Health Centres?
As reflected in the ByLaws of MACH as well as the Canadian Association of Community Health Centres (CACHC), a Community Health Centre is any not-for-profit corporation or co-operative which adheres to all five of the following domains:
They provide interprofessional primary care
They integrate primary care, health promotion and community health services
They are community-governed and community-centred
They actively address “social determinants of health”
They are committed to health equity and social justice
In contrast to solo practitioner models, Community Health Centres offer high-quality primary care through a collaborative team approach. Family physicians, nurse practitioners, nurses, dietitians, chiropodists, dental hygienists, therapists and other clinicians provide services in a team environment, based on patient needs.
Community Health Centres are multi-sector health and health care organizations. CHCs integrate team-based primary care with health promotion programs, illness prevention programs and community development initiatives, in keeping with the World Health Organization’s definition of primary health care.
Factors affecting health and healthcare vary from community to community. That’s why CHCs focus on the most appropriate services and programs for the local community they serve — whether that means a geographical catchment or a community group. CHCs engage members of the community in helping to identify priorities and strategies for services. This includes volunteer Boards of Directors comprised of community members.
As part of their integrated approach, CHCs support individuals, families and communities to achieve health by actively addressing “social determinants of health” such as poverty, access to shelter/housing, education, language barriers and other factors that have a direct impact on health, including access to appropriate healthcare services. In this way, CHCs help tackle the root causes of illness, working “upstream” to prevent illness and progression of illness.
CHCs recognize that many differences in health status among segments of the population are socially and institutionally structured. As such, these differences are avoidable and unfair. CHCs work to eliminate these health inequities. CHCs are also committed to social justice, meaning the fair distribution of the fruits of economic growth. CHCs advocate these principles to be embedded within the various institutions of public policy and society.
In their words
A broad range of reports, organizations and leaders across Canada recommend increased investment in Community Health Centres.
“Adopt a national strategy for expanding Community Health Centres across Canada, with new federal dollars targeted specifically for that purpose.”Romanow Commission Report on the Future of Health Care in Canada (2002)
“Implement evidence-based, community-based primary health care, with inter-professional delivery models at the local level.”Health Action Lobby (2014). The Canadian Way: Accelerating Innovation and Improving Health System Performance
“Develop a national strategy for expanding access to Community Health Centres across the country.”Canadian Index of Wellbeing (2012). How are Canadians Really Doing? The 2012 CIW Report.
“Accelerate new delivery models. Governments have been slow to support new delivery models even when they have proven successful. There are numerous innovations with positive evaluations, for example, organizations such as the Women’s Health Clinic in Winnipeg and in the community health centres in Quebec. These and other models go a long way to realizing the ambitions and goals of the 2003 Health Accord, but they are the exception rather than the rule. They should be pursued aggressively and a forum for sharing innovative practices would support more widespread change. Health Council of Canada (2005). Health Care Renewal in Canada: Accelerating Change.
“We recommend development by the provinces of a significant number of Community Health Centres, as described in the Report, as non-profit corporate bodies in a fully integrated health services system.”Canadian Ministry of Health and Welfare (1972). Hastings Commission Report on the Community Health Centre Projectto the Conference of Health Ministers
Community Health Centres are multi-sector health and healthcare organizations that deliver integrated, people-centred services and programs reflecting the needs and priorities of the communities they serve.
Canada’s first Community Health Centres (CHC) was established right here in Manitoba, in 1926: Mount Carmel Clinic, in Winnipeg. CHCs are often known by different names across Canada, but they all have several essential attributes. CHCs are all multi-sector health and healthcare organizations that deliver integrated, people-centred services and programs that reflect the needs and priorities of the diverse communities they serve.
CHCs bring healthcare providers such as physicians, nurse practitioners, nurses, dietitians, social workers and therapists, to work together in interdisciplinary teams. Using the CHC model, clients receive the right type of care, from the right provider(s), at the right time. This high-quality care also makes the best use of our scarce healthcare resources and helps to overcome gaps in access to care providers.
What sets CHCs apart from other primary care services even further is the partnerships they foster and build among community residents, and a wide variety of healthcare, social service, housing, education and other sector partners. These relationships help CHCs to identify the needs of their community, to design and oversee appropriate service delivery, to address the many social determinants of health, and to evaluate health service programs. In addition to high-quality interdisciplinary services, CHCs go beyond just “care”.
By integrating interdisciplinary care teams with health promotion programs, social supports, and community programs, the emphasis is shifted to illness-prevention, wellbeing and local socio-economic development. CHCs believe that individuals, families and communities should have equitable
opportunities to achieve wellbeing and to have their health needs met, regardless of economic status, race, culture, age, geography, gender, or sexual status. CHCs work to remove inequities and increase opportunities to access to health services.
Using health and healthcare as twin pillars for action, the active role of CHCs in local communities means that fewer individuals and families fall between cracks in various systems. Robust programs and partnerships at the CHC help individuals and families overcome barriers to health wherever they are faced. These include housing, education counseling, skills development, peer support, and other social supports. CHCs provide the wraparound care and support that ensures clinical providers, case managers, program staff and partners from other agencies can collaborate in supporting clients. In other words, every door becomes the right door to effective care and treatment.
The caring environment of a CHC also creates a desirable employment opportunity where staff are well supported in achieving personal and professional goals. For example, providing team-based medical care through CHCs is an excellent way for family physicians to achieve practice choice and to not feel isolated in providing care to patients with complex medical and social conditions. Family practice within a CHC setting provides a broad range of options and quality-of-life support that contribute to a higher quality of practice, helping to prevent practitioner burnout.
In addition to providing care through teams of family physicians, nurse practitioners, nurses, social workers, therapists and counsellors, CHCs are also developing innovative partnerships by integrating health professionals that have traditionally been excluded from primary health care, such as midwives and dieticians. Another example is that some primary care teams across Canada have incorporated clinical pharmacists. The positive impact on both quality of client care and quality of pharmacy practice has been significant. Moreover, CHCs have consistently demonstrated their effectiveness at optimizing the contributions of diverse practitioners, enabling and supporting providers to practice to the full scope of their training.
As a result of their “upstream” and comprehensive approach CHCs have been found by numerous Canadian research studies to be highly valuable and cost-effective, achieving better overall outcomes than other models of primary care. For example:
- CHCs offer significantly more comprehensive services (74%) than other primary care models (61-63%; P < 0.005) like Fee-for-Service practice and “clinical care only” teams [Russell G et al G (2010). “Getting it all done. Organizational factors linked with comprehensive primary care”. Family Practice. 27(5): 535-541.]
- When adjusted for complexity, CHCs exceed expectations in reducing hospital emergency room visits, while other models of primary care are found not to meet expectations in reducing ER visits. [Glazier RH, Zagorski BM, Rayner J. (2012) Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10. Toronto: Institute for Clinical Evaluative Sciences]
- CHCs provide superior chronic disease management. Clinicians in CHCs find it easier to promote high-quality care through longer consultations and interprofessional collaboration. This superior care has been correlated with the presence of a nurse practitioner and is associated with lower client-family to physician ratios and smaller full-time-equivalent family physician groupings. [Russell G et al (2010). “Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors”. Annals of Family Medicine. 7(4):309-318]
- Clients of CHCs report higher satisfaction scores across multiple domains of analysis including accessibility, prevention and health promotion, client and family-centredness and chronic disease management compared to clients of other models of primary care. [Conference Board of Canada (2014). Final Report: An External Evaluation of the Family Health Team (FHT) Initiative.
Community Health Centres have many benefits to the community beyond simply providing health services. Participation by community members in governance of not-for-profit and cooperative CHCs helps to ensure appropriateness of services and to build relationships of trust and buy-in, especially in communities facing higher-than-average barriers to health and development. Community Health Centres also employ other tools such as community advisory committees, needs assessment and satisfaction surveys, and other community engagement processes to further involve the community in decisions, planning, evaluation and continuous quality improvement.
Research on CHCs across Canada has found that CHCs “provide a wide range of opportunities for citizen participation not found in most parts of the health care system. Opportunities range from consultation to direct decision making.” The same research found that among community-governed CHCs, “participants felt that citizen participation in CHC decision making had led to improved programs and services and that the range of programs and services met the needs of the community.” [Church J, et al (2006). Citizen Participation Partnership Project Report. Centre for Health Promotion Studies, School of Public Health University of Alberta]
CHCs have proven highly-effective in many other countries as well. In the United States, for example, there are over 1300 CHCs that are governed by independent, community-based boards of directors. They serve over 23 million Americans in all states and territories, and research has found that CHCs have been successful at:
- Preventing 25% more emergency department visits than other models of primary care. [U.S. National Association of Community Health Centres (2011). Community Health Centers: The Local Prescription for Better Quality and Lower Costs. Washington, DC]
- Saving the U.S. health system more annually compared to fee-for-service medicine. [U.S. National Association of Community Health Centres (2011). Community Health Centers: The Local Prescription for Better Quality and Lower Costs. Washington, DC]
- Acting as local economic engines, generating roughly $20 billion in new economic activity annually. [National Association of Community Health Centers (2010). Community Health Centers: The Return on Investment]
- Increasing responsiveness to community-defined needs by ensuring community participation in health care decision making. [Crampton P, et al (2005) “Does Community-Governed Nonprofit Primary Care Improve Access to Services?” International Journal of Health Services 35(3): 465-78]
- Including clients on governing boards to ensure focus on the scope of the care delivered, resulting in higher quality care, lower cost services, and better procedures for client complaints. [Crampton P, et al (2005) “Does Community-Governed Nonprofit Primary Care Improve Access to Services?” International Journal of Health Services 35(3): 465-78]
The emphasis of CHCs on individual, family and community health, as well as prevention of “downstream” and long-term health system costs means that CHCs are high-impact contributors to the healthcare system and drivers for socio-economic development. The true value of a CHC is much greater than the sum of its parts.