Community Health Centres – The best kept secret in health care?

Ontario’s Minister of Health and Long Term Care, Deb Matthews, has called them “a bit of a secret in health care”. The Honorable Roy Romanow is a big supporter of them.  They are Tommy Douglas’ “Second Stage of Medicare” in action.  Are Community Health Centres (CHCs) the best kept secret in health care and, if so, why?

Keeping people and communities well are what Community Health Centres are all about.

CHC clients receive inter-professional clinical care from doctors, nurse practitioners, nurses, dietitians, social workers and other kinds of clinical health providers. Health promoters, community workers and others respond to health problems triggered by social, environmental or economic problems with customized services, community programs, and advocacy.  Community Health Centre staff work together to not only provide primary care when people get sick, but to help keep people well in the first place.  In Ontario alone there are over 70 Community Health Centres and there are dozens more in communities across Canada.

Community Health Centres are especially effective in providing care to those populations that have, for whatever reason, traditionally faced difficulties in accessing health care. CHC services are specifically structured to eliminate system-wide barriers to access such as poverty, racism, heterosexism, and other harmful forms of social exclusion.   Their approach helps to close the health equity gap, which I will look at further in a future blog post.

Every Community Health Centre is unique. Because their differences reflect the great diversity of the communities they serve, they have learned to customize their programs and services to meet the specific needs of their clients and communities. But, despite great diversity, every CHC applies a common model of care that holds much promise and potential for primary health care.

The newly released Ontario’s Action Plan for Health Care talks openly about the need for better access to community-based primary health care, as well as the need to emphasize prevention, wellness, and health promotion.  An early leak from the forthcoming Drummond Report mentions that a mere 1 per cent of the population of Ontario accounts for fully half of all hospital spending, or about one-third of total health expenditures.   One has to look no further than the social determinants of health, such as poverty and housing, to understand the huge role they play in downstream health care costs, as I highlighted in my previous blog “Poverty and Health”. The Community Health Centre model of care is an excellent example of one kind of community-based primary health care that is needed to address many of these larger systemic issues.  Continued expansion of Community Health Centres across Ontario and the rest of Canada should be part of an upstream, long term investment to help address many of our complex health care and health equity issues.  As a staff person at a Community Health Centre, I will continue to do my part to tell our stories and successes and I hope you will, too.  No more secrets!

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  • Lori Kleinsmith says:

    I had the pleasure of hearing your presentation at the AOHC Conference, Bob, and I frequently refer to the work of the Wellesley Institute. Your work around the Social Assistance Review and health inequity is particularly helpful and relevant – everyone should check it out – http://www.wellesleyinstitute.com/news/when-do-we-talk-about-health/ – Thank you for your support!

  • Lori Kleinsmith says:

    I agree, Kathy, CHCs are often overlooked by the FHT model – much of this comes from government spin and it is very frustrating. Holistic care comes from not only providing “team-based” care but in a manner than addresses health inequities and injustices. Our staff are salaried and we spend much more time dealing with these issues in a meaningful way. CHC staff work with clients who are often rejected from “mainstream” primary care, turned away because of their complexities. It is very hard to put a price tag on the work we do, much of it is qualitative. I’ve heard more than one client say we are the best thing to happen in our community in a long time and we are making a big difference in their lives, how do you put a price tag on that?!

  • kathy hardill says:

    so nice to see someone highlighting the CHC model – quebec has a system of CLSCs which is even more comprehensive – as someone who spent years working in the CHC system, i think it is hands down the best model of primary care – having said that, i have little optimism that there will be a massive influx of funding in ontario for new CHCs – in the short term they seem expensive compared to other (inferior) models and the preponderance of mcguinty’s family health team (FHT) model is a case in point – i used to call FHTs “CHCs lite” but they are so not even that, sadly – it is interesting that the health quality monitor report on ontario’s health care system indicates that while there have been some improvements in access to primary care (percentage of ontario adults without a primary care provider has dropped from 8.2% to 6.5% from 2008 to 2011), patients do not have great access to care when they need it ie when they become ill, and there is a persistent lack of teamwork and inefficient use of staff – which in my opinion is because the ontario government with its FHTs tried to superimpose a flawed model of “team” care overtop of the fee for service model – and while you can call anything you want a “team” – that don’t necessarily make it so.

  • Bob Gardner says:

    i totally agree. There is considerable international and comparative research showing that increasing access to primary care is one of the most important health system levers to improve the health of disadvantaged and marginalized populations. The proven CHC model demonstrates the potential of comprehensive, whole person-centred, multi-disciplinary and high quality care grounded in local community conditions and needs. I had the privilege — and fun — of speaking to an AOHC conference on CHCs as a crucial component of driving health equity into action. http://www.wellesleyinstitute.com/blog/healthcare-reform-blog/health-equity-pushing-the-boundaries/


Lori Kleinsmith


Lori Kleinsmith is a health promoter at Bridges Community Health Centre (CHC) in the Niagara region of Ontario.

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