MACH’s Strategic Priorities
MACH’s strategic priorities focus on improving health and healthcare in Manitoba by: building on existing community-based networks and knowledge; alleviating pressure on hospital emergency departments; connecting people to appropriate care; and improving health and healthcare services in rural Manitoba.
In late 2015, MACH sent an election survey to each of the six parties running in the 2016 Manitoba Provincial Election, asking three questions based on our strategic priorities:
- How do you see the Community Health Centre (CHC) model of “providing the right care, by the right providers, at the right time” impacting ER wait times?
- How would you support Community Health Centres to address health equity and access in rural communities throughout Manitoba?
- How can CHCs’ expertise influence policy and decision making in current and emerging healthcare issues?
MACH was pleased by the great uptake of community health messaging during the Manitoba 2016 election campaign. We appreciate everyone who embraced and shared our social media presence including quick facts, profile pictures and joining the conversation via #communityhealthmatters.
We now look forward to working with the new government to advance these important strategic priorities so that, together, we increase equitable access to health care and improve health and wellbeing for individuals, families and communities across the province.
Strategic Priority 1
Strategic Priority 2
Strategic Priority 3
System-responsiveness/Access to care
Partner with the Manitoba Association of Community Health and other relevant stakeholders to establish a primary care council, at which key contributors assist with system transformation and responsiveness.
Work together to develop robust and mutual accountability agreements and to streamline funding from different levels of government, similar to the successful Red Tape initiative through the Province of Manitoba.
Support robust funding for existing CHCs to extend hours, create or increase walk-in capacity, and establish new CHC satellite locations in high needs areas to divert non-emergent clients from the emergency room.
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.
The provincial government of Manitoba is required to make good decisions related to the health of the provincial population. As such, it relies on key organizations and individuals to advise on health- and healthcare-related issues.
Because the CHC model harnesses ideas and energy from community residents and a vast array of healthcare and social service professionals, CHCs come to the table with: a client-centred perspective; a health equity lens; an awareness of cross-sectoral priorities for health; and, access to primary health care networks that may not be currently represented in decision-making.
Adding this depth of knowledge and experience to decision-making and advisory bodies in Manitoba can help to unburden government and ensure transparency and accountability for services that are being funded and provided.
Including CHCs in discussions around changes to primary care would acknowledge that the existing gaps within the health sector are often linked to broader issues and complex questions.
Community health and social support organizations have established relationships of trust with the communities that we serve. This provides CHCs with a depth of understanding and systemic knowledge of required services and gaps. This is especially true with marginalized communities and individuals with complex-care needs.
Underlying much of CHCs’ work is the innate understanding of how inequities affect health. For example, marginalized clients that fall through cracks in the health system can become high and repeat consumers of emergency departments.
Current relationships could be further strengthened by working together to develop service purchase agreements that include deliverables related to broader priorities.
There are many opportunities to grow this relationship by working together to identify gaps and further promote health equity. The expertise of CHCs in interdisciplinary care will help to move provincial health systems toward sustainability.
The existing Community Health Agency Network is an ideal forum for consensus building and discussing Primary Care issues and initiatives at all organizations, which we believe could be further formalized and supported.
Hospitals, long-term care facilities, individual physicians and nurses, and other sectors within the health system participate in such activities via their sector specific or profession-specific associations. In fact, they are often mandated and financially-supported to do so. By not including CHCs in these important conversations, an opportunity for quality improvement in healthcare for Manitobans is missed and perpetuates an inequitable double-standard within the health system.
Overcrowding in Emergency Departments arises from a number of factors, including limited community-care resources and a lack of integration between community-based and hospital resources.
Currently, the healthcare system in Manitoba and across Canada is fragmented, resulting in many clients obtaining care in the wrong setting, and often too late.
Evidence shows that having access to a CHC helps to alleviate pressure from non-emergent use of emergency rooms.
The interdisciplinary care model of CHCs ensures that clients are able to access the appropriate level of care when it is needed.
This model also includes access to preventative clinical care as well as other points of support, such a health promotion programs and community health initiatives. These help to further ensure that clients are in a circle of support that facilitates early detection and triage rather than just at moments of episodic illness or crisis.
Pursuing the CHC model for more Manitobans would mean scaling up this proven model of comprehensive, interdisciplinary care and support.
There are a number of ways that the provincial government and existing CHCs can partner to update our outdated primary health care “system”, such as:
- Supporting existing CHCs by expanding hours of operation and services available to leverage existing capacity;
- Working with existing CHCs to expand their reach and the number of Manitobans they serve via satellite locations, similar to what has been done in Ontario and other jurisdictions; and
- Establishing new, strategically positioned and staffed CHCs, to support non-emergent clients, near existing hospital emergency departments.
This would immediately improve access to care for Manitobans, reduce pressures on other more costly health and social services, and catalyze local economic development.
Without the integrated approach of CHCs that place individuals and families at the centre of a circle of care and support, the province risks exposing greater gaps in health and social services.
The programs and partnerships offered through CHCs help prevent individuals from falling through cracks once their immediate encounter with a clinical provider has ended.
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; and,
- 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 setschedule, 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 health 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.