Can we design care to better address health challenges?

Since the onset of the coronavirus pandemic, Community Health Centres have been on the frontlines of care for Nova Scotia’s most at-risk communities. This model of care is uniquely designed to take on the challenges of COVID as they intersect with everyday barriers to care.

What is a Community Health Centre (CHC)?

CHC teams operate on the principles of integrated care and health equity. The model combines frontline health services with social programming to wrap around communities with supports that go beyond the traditional medical model to address the social determinants of health, such as food security, income inequality, housing, and access to healthcare. The model has deep roots in Nova Scotia.

“North End Community Health Centre (NECHC) started almost 50 years ago by two doctors who specifically wanted to bring healthcare to African Nova Scotians. We’ve grown to a team of over 60 people who provide a whole variety of services to the entire Halifax Regional Municipality,” says Marie-France LeBlanc, Executive Director of NECHC. “We provide street health to people experiencing homelessness, housing support through Housing First, primary care and dentistry, as well as other wellness services like food programs.”

Community-governed care

Another key distinction between CHCs and other forms of healthcare delivery is that CHCs are community-governed and separate from government-run or privately-operated clinics.

“We get a lot of funding from the province, but it’s ours to direct where it is most needed,” explains LeBlanc. Another benefit of the funding model is that it allows the organization to staff doctors and health practitioners as employees instead of billing the province for each individual appointment. This allows for greater stability and predictability on the part of the CHC. It also encourages collaborative team-based care. 

“We run a collaborative clinic where doctors work with other health practitioners such as a dietitian, a social worker, and mental health workers.” By housing a multi-disciplinary team in a common space, patients face fewer barriers as they seek support for complex, intersecting health issues. 

“NECHC was created to serve Halifax’s African population, and now we generally target underserved populations with low-barrier services,” says LeBlanc. Through a federally funded Housing First program, NECHC houses up to 85 people who would otherwise be in the shelter system. The Mobile Outreach Street Health provides care to insecurely-housed people, a program made possible through donations. NECHC also brings fresh food to families in need and runs a free dentistry program. “We fundraise to cover dentistry, so it takes a lot of work to keep it running year after year,” says LeBlanc. 

Inadequate funding for CHCs

NECHC exemplifies the resourcefulness of CHC teams, and shines a light on the effort that goes into funding its various services and programs. And even with a large, dynamic organization, NECHC faces financial insecurity.

“It’s fantastic that so many CHCs are starting to come together in Nova Scotia. As it stands though, North End Community Health Centre is the only centre in the province that has been able to fully flesh out the model in practice,” explains LeBlanc.

More commonly across the province, small communities have rallied to construct buildings to house a local clinic, and through partnerships with practitioners and the Health Authority, teams do whatever they can to initiate programs and additional services. By contrast, the vision held by champions of the model is to have CHC sustained through annualized government funding and governed by community members. That way, multi-disciplinary teams can be specifically designed around barriers and needs identified by local people.

“Many CHCs in Nova Scotia are striving to get there, but this model is not funded by the province. Our centre offers a model,  but without sustainable funding , we’re just scratching the surface of what’s possible.”

In the context of the pandemic, not only have CHCs had to adapt quickly to the immediate changes in their clinics, such as increased PPE and reducing face-to-face care, but they have also stepped up to fill gaps in social services and advocate for resilient policies. 

“We had to step up and start offering a lot of harm reduction services,” says LeBlanc. “We started an Emergency Managed program, a Nicotine Replacement program, we supported the street involved population that was temporarily housed in hotels. As well, we pivoted to offer COVID testing to communities who wouldn’t otherwise have a lot of trust in healthcare workers.”

Looking “upstream” to health determinants

By focusing on the health of the community instead of just the individual patient, CHCs go beyond the medical model to consider why people are healthy or unwell in the first place. 

“Community Health Centres are often seen as spaces for primary care, but our work spans many departments. We work with Community Services, the justice system, with the Housing Department,” says LeBlanc. “The social fabric of the communities we serve is all-encompassing. It doesn’t stop at primary care.”

Through the Nova Scotia Association of Community Health Centres (NSACHC) and their partnerships with each other, CHC teams are talking about what is possible in this moment when health is at the forefront of public consciousness. 

How can we leverage what we have, and what we know to support other communities in this pandemic? CHCs like NECHC are leveraging what they already have: collaborative low-barrier care, services designed with equity in mind, and an approach that stretches into the social fabric of the communities served. 

We know that this likely isn’t the last pandemic we will face, but we can take what we’ve learned about what works and champion these approaches along the path ahead.