Call for expansion of CHCs in Nova Scotia – Take rural health to next level

“Community Health Centres (CHCs) are internationally recognized as the most holistic way to provide care for patients. At community health centres, physicians work with a team of health-care workers including nurse practitioners, social workers, mental health workers, dietitians and others to ensure all of a patient’s health-care needs are being met. This means the right care by the right providers at the right time.”

“Every Nova Scotian should expect same or next day access to a doctor or primary health provider.”

That was one of the conclusions of a Dec. 10, 2014 report evaluating the role of Collaborative Emergency Centres in the province. The former NDP government brought in CECs as a way to tackle frequent emergency room closures in rural areas. The review, led by health consultant Mary Jane Hampton, found that CECs succeeded in keeping emergency rooms open, but that this was a symptom of a larger problem of a lack of regular access to family physicians and health providers.

Now the Liberal government is considering opening six new CECs. While CECs have improved much-needed access to health providers in rural communities, Hampton is clear that six new centres will not provide the ability for everyone to see a health provider on the same or the next day.

This is the next step in the evolution of our province’s health-care system, and something that all citizens should demand as our right. We need to be thinking of ways to provide timely access to a doctor or nurse for everyone in Nova Scotia, regardless of where he or she lives. How much would we save if, instead of waiting until the point of emergency (and the most expensive point of the health system), patients could nip problems in the bud?

Most rural areas have shortages of doctors, and long wait lists for the physicians they do have. So the task of recruiting enough doctors for same or next-day care for everyone is a huge one indeed.

Fortunately, we have other options. Nurse practitioners are extremely qualified and cost-effective — they can treat 80 per cent of the cases that a physician deals with, for a fraction of the salary. Surely we need to increase the use of these skilled professionals.

The biggest advancement our health system could make is in creating team-based collaborative care. CECs did this well, by combining doctors, nurses and paramedics. We can go far beyond this. The best model for comprehensive team-based care is a community health centre.

Community Health Centres (CHCs) are internationally recognized as the most holistic way to provide care for patients. At community health centres, physicians work with a team of health-care workers including nurse practitioners, social workers, mental health workers, dietitians and others to ensure all of a patient’s health-care needs are being met. This means the right care by the right providers at the right time.

CHCs are not-for-profit, and democratically run by the local community and the patients registered at the centre. CHCs focus not only on treating patients when they are sick or injured, but on keeping people healthy in the first place. Their democratic structures and community engagement allow them to address the social determinants of health, such as poverty, education, housing and support networks. These deter-minants are the most influential factors in our health.

Countless reports and studies have recognized the importance of addressing these determinants as a means to reduce costs and improve health outcomes, both for individuals and society as a whole.

Over 700 CHCs currently provide care to over two million Canadians. While they flourish in other parts of the country, there are only nine in Nova Scotia. Still, the few we do have are accomplishing incredible work.

The Rawdon Hills Community Health Centre is an excellent example. After years without primary health services in the area, Rawdon residents came together, pushed local government and donated countless hours to making the centre a reality.

The health centre opened in a temporary location in 2000. Community members fundraised for eight years before the centre could finally open at a permanent location in June of 2008. Today, the clinic offers a wide range of services, including blood collection, a foot care clinic, mental health services, occupational therapy, the Hants County Community Access Network for people with disabilities, and several programs for seniors. On top of that, it has created a vibrant and close-knit community.

Unfortunately, most of the nine community health centres in the province receive no core funding from the province. District Health Authorities pay for the salaries of physicians and nurses, who pay rent to the health centre.

CHCs seek services and providers to elevate the issues caused by the social determinants of health affecting the population they serve. Yet, in Nova Scotia, they receive no core funding for this. If this government wants to improve health outcomes and cut health costs, then this needs to change; the Department of Health and Wellness needs to adequately fund CHCs, and start opening up more.

CHCs provide the highest levels of care at the lowest cost, with maximum patient and community participation. They are the model for the future of public health care. Ontario and Saskatchewan are already leading the way.

Hampton’s review makes it clear: CECs are good, but not necessarily the best investment. So at a time when our health system is strapped for funding, why wouldn’t we choose the best return on our investment? CHCs will provide the highest quality of care to the most patients, for the best price. It should be a no-brainer.

James Hutt is provincial co-ordinator of the Nova Scotia Citizens’ Health Care Network.
Kathy Blois is chairwoman of the Nova Scotia Federation of Community Health Centres.

Original file from the Chronicle Herald

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