Ministry Reports

A Strategic Review of the Community Health Centre Program

Prepared for the Community and Health Promotion Branch,
Ontario Ministry of Health and Long-Term Care
by Dr. Chandrakant P. Shah and Dr. Brent W. Moloughney

Executive Summary

This is a report of the strategic review conducted on the Community Health Centre (CHC) Program in Ontario. The objectives of the project were to :

  1. Situate future development of CHCs within an overall plan that is aligned with key ministry strategies and government directions, including reform of the primary care system.
  2. Assess the strengths and limitations of the existing CHC Program in terms of its ability to contribute to the achievement of Ministry's strategic priorities and government directions.
  3. Identify service approaches in use within CHCs in Ontario for which clear evidence of effectiveness and/or efficiency has been documented in similar programs operating in other jurisdictions.
  4. Describe adaptations in program design consistent with the core business and service philosophy of CHCs that would strengthen the CHC Program's ability to deliver on Ministry priorities.
  5. Identify and assess factors to be considered in developing an implementation plan.

The review was conducted by assessing existing CHC program documentation; assessing pertinent Ministry strategies; conducting site visits of seven CHCs; targeted literature reviews; analysis of CHC approaches for selected health conditions and issues; documents and interviews with program staff; and reviewing primary care strategies in other jurisdictions in Canada and selected other countries.

There are 56 CHCs in Ontario with a core budget of just over $100 million. An additional $30 million is received from other sources to broaden the range of services provided. CHCs have a long history of working with disadvantaged people whose needs go beyond basic health care. These include those who have low income, street youth and homeless, isolated elderly, newcomers without an adequate base support in their new home communities, and those in rural and remote communities. 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.

The health service needs of clients do not occur in isolation of the broader determinants of health - including the socio-economic environment of the community. Many services are provided not just to individuals, but also involve family members and members of the community. Centres utilize comprehensive approaches, including multi-disciplinary teams and integration of services, to meet the needs of clients. This review found that CHCs effectively address the key attributes of primary care: accessibility, comprehensiveness, coordination, continuity of services, accountability, and attention to the needs of a specific community through specific health programs and services. The needs of CHC client populations extend beyond direct primary health care services. CHCs use a variety of strategies including outreach, home visiting, delivery of additional on-site services, and partnership with other service agencies to provide more comprehensive services.

CHCs are extensively involved in improving the capacity of individuals and communities. This includes minimizing the impacts of poverty in accessing health services but also improving language and employment skills; finding, maintaining and improving shelter; increasing access to nutritious foods; supporting healthy child development; and increasing community involvement and leadership.

There are a number of government strategies in which CHCs are actively involved. CHCs support healthy child development in a number of ways. In addition to their own core funded programming, they frequently provide space for Healthy Babies, Healthy Children staff improving opportunities for collaboration and service integration. Many CHCs are sites for the provision of the provincial Preschool Speech and Language Program and in Ottawa, a CHC functions as the lead agency for program implementation. In Toronto, a CHC delivers a Better Beginnings, Better Futures program.

Many CHCs are actively involved in supporting the provincial Diabetes Strategy. In Ottawa, a consortium of CHCs provide diabetes education in multiple languages. Other CHCs provide tailored diabetes education for groups who have difficulty accessing services due to language and literacy barriers. For many CHCs, individuals with chronic and persistent mental illness are a substantial proportion of their client population. As part of mental health reform, some CHCs host Assertive Community Treatment teams and mental health case managers. Several CHCs have made arrangements for shared care in which a psychiatrist provides consultation and support to the primary care providers.

In reviewing the services that CHCs provide, there are three key roles that these organizations fulfill. They provide comprehensive primary care services utilizing inter-disciplinary teams to meet the needs of their clients. By working with individuals, families and groups from a determinants of health perspective, they contribute to increasing individual and community capacity. They are also a key source of community infrastructure from which they deliver a range of integrated community-based services.

Primary care reform in Ontario intends to have 80% of family physicians practicing in Primary Care Networks (PCNs) within the next three years. The objectives of this initiative are: improve access; improve quality and continuity of care; increase patient and provider satisfaction with the health care system; and increase cost-effectiveness of the services. The PCNs will have enrolled populations and the physicians will be paid primarily through capitation. The extent to which PCNs will utilize other health care providers such as nurse practitioners (NPs) is unclear. These initial reforms to the current fee-for-service system will not alter the need for CHCs. There will continue to be a need for a primary care delivery model that has an explicit mandate to comprehensively address the health needs of higher risk populations.

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A Strategic Review of the Community Health Centre Program
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May 2001

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