Priority 3: Rural healthcare
ISSUE: How can we improve health and health care services in rural Manitoba In particular, what long-term solutions can address the challenges of recruitment and retention of health care professionals in rural Manitoba?
Expanding access to CHCs in rural communities is a critical step to overcoming longstanding challenges related to recruitment and retention of health professionals, and to ensuring continuity of client care and support. Over a decade ago, the Canadian Ministerial Advisory Council on Rural Health warned that, across Canada, “health care restructuring has centralized, reduced or eliminated hospital-based services without community-based services being enhanced.” The fundamental concerns and recommendations expressed by the Council in 2002 are just as relevant today. To improve health in rural communities, the Council urged governments to:
- provide integrated health services that “put rural health in rural hands”
- take a broader determinants of health approach, working across sectors
- strengthen health promotion
- build local infrastructure and help to foster community-led capacity-building
- support sustainable health human resources strategies
- improve rural health research.
Community Health Centres provide a critical solution by providing a community hub from which comprehensive services and supports can be planned, coordinated and sustained. As integrated organizations, CHCs take administrative responsibility for recruitment and retention of physicians, nurse practitioners, nurses and other professionals. This enables effective planning over the long-term so that communities are not left orphaned as a result of individual practitioner decisions. In addition to this administrative role, the team-based, interdisciplinary model of care means that CHCs are able to optimize limited supplies of diverse practitioners in rural communities. Community Health Centres do so by:
- Providing a fertile and continuous practice environment for cadres of practitioners who are otherwise left without stable primary care practice opportunities (e.g. nurse practitioners);
- Distributing care and follow-up responsibilities across the team of providers so that the most appropriate care is provided by the most appropriate provider(s) at the right time; and,
- Maximizing impact of all providers by supporting practitioners to work to the full scope of their training and regulation.
Ontario’s extensive CHC network has described how CHCs are improving access and continuity of care in rural and northern Ontario communities, in many instances just some kilometres from the Manitoba/Ontario border:
“The likelihood of recruiting health care professionals increases substantially for northern and rural communities that have a CHC. When health providers considering a new position in a rural or northern community know they are going to be part of an interdisciplinary team whose members support each other managing a high demand for their services, they are more likely to commit to a practice. In addition, a strategically located CHC can play a vital role in easing shortages of health professionals system wide.”
In addition to improving recruitment and retention of healthcare providers, CHCs in rural communities are also able to harness their organizational capacity to deliver programs that overcome geographical and other barriers to care and support. An example of this is found in Thunder Bay, Ontario, where a CHC’s mobile unit brings interdisciplinary care, on a set schedule, to eight small communities of fewer than 1000 people, each located over 100 km away from Thunder Bay. The mobile unit also brings care and support to Thunder Bay’s homeless shelter.
Unfortunately, there is little research on innovative rural healthcare in Canada. However, robust research from the United States clearly demonstrates the major impact that CHCs have in reducing barriers to care and improving health outcomes in rural communities. When compared against other primary care models in rural America, this study from 2013 found that:
- Rural CHC clients experience lower rates of low birth weight than clients of other providers in rural communities;
- Female clients of rural CHCs are significantly more likely to receive Pap smears compared to rural women nationally; and,
- Even after adjusting for population density, rural counties with CHCs exhibit 25% fewer uninsured Emergency Department visits than non CHC rural counties.
This research also found that CHCs act as local economic engines for rural communities throughout the United States, yielding more than $5 billion annually in economic returns through the purchase of goods and services and by generating employment.
Ensuring access to appropriate and timely integrated healthcare services in rural Manitoba is a challenge. While training and hiring more doctors, nurse practitioners and other providers is vital to ensuring all Manitobans have access to care, the CHC model can meet this need and provide a medical home for rural Manitobans and for their practitioners. MACH can assist the provincial government to support and engage communities outside Winnipeg and gauge interest in the CHC model.
With the assistance of MACH, engage communities outside Winnipeg to identify priority opportunities to invest in new CHCs as a means to fulfill and go beyond the ‘physician for everyone’ promise in rural Manitoba.