Women's Health Clinic Brief
To the Standing Senate Committee on Social Affairs, Science and Technology

November 2001

NEW MODELS OF PRIMARY CARE

Women's Health Clinic strongly supports actions that reform how primary care and health promotion/education activities are delivered. Women's Health Clinic wants to emphasize that new roles for clients in the development and evaluation of programs and services need to be clearly articulated in the restructuring-something that has not occurred to date.

The language used in section 5 of your report, which uses the language of business, for example, "service industry" was initially alienating. However on reflection, in many ways it envisioned the kind of practice and vision we have at the Women's Health Clinic - one of the community health centers alluded to in your report. Reform of primary care delivery is a critical component but one we are confident can be done within the principles of medicare and broadening of public programs. Introducing the profit motive and business models merely muddies the waters and interferes with the provision of care and innovation of service delivery. Women's Health Clinic and other similar agencies, demonstrate primary care reform can be done when community, "clients", administrators and providers work together.

Patients/clients/public want more input into the kind and quality of care they receive [eg Teen clinic, evening hours, more information and education to manage their health care and give consent] Women's Health Clinic experiences show that the public is very interested in receiving service from a variety of health care providers-not just doctors or clinical nurse specialists and when educated about their condition and treatment options, they tend to be conservative about treatments and new drugs and devices. For example controls on the use of electronic fetal monitoring technology or use of lumpectomy arose out of well informed consumers demanding evidence based practice guidelines.

Women's Health Clinic strongly supports restructuring the system with a framework for women-centred health care services, that would be more responsive and accessible to the needs of women. Such a framework would recognize the impact of income on the health of women.

Two successful models of Women Centred Care, specifically Vancouver/Richmond Health Board, and our Winnipeg Women's Health Clinic model are described in detail in the Women, Poverty and Health in Manitoba: An Overview and Ideas for Action, prepared by Women's Health Clinic, and attached for information. The key elements of the Vancouver/Richmond Health Board model³ are summarized as essential components that must be included in the framework.

• The need for respect and safety: Women want to be listened to and they want providers to accept the validity of their opinions, taking the diversity and complexity of their lives into account. Respect and safety also needs to be reflected in services accessible to those with different needs, such as disabilities, language barriers, child care, past experiences of violence of abuse, etc.
  
  
• The importance of empowering women: When people have a sense of control over their life situation, health status improves. Women who have a core sense of self, the ability to take action based on that sense of self, a sense of control over one's life, and being connected with others, reflect empowerment. When these components of empowerment exist, women are more likely to participate and take action in their communities.
  
  
• Involvement and participation of women: Women's participation in health service and program planning, implementation, evaluation, policy and research, can be limited by social roles and limited financial resources. Only by encouraging full and equal participation by diverse women in these activities, will women's perspectives and needs be incorporated.
  
  
• Women's patterns/preferences in obtaining health care: Women's multiple roles as homemakers, paid workers, caregivers and family caregivers often mean that they will minimize their own needs because there are others to take care of. Other factors limiting women's access to services include poverty, lack of independence because of disabilities, abuse, isolation, language, physically unable, etc., and many women's preference to see women practitioners,
  
  
• Women's forms of communication and interaction: Gender socialization encourages women to be gentle, compassionate and nurturing, thus influencing their patterns of communication and interaction. Cultural differences can also have an impact on communication and interaction.
  
  
• The need for information: Women's learning styles are influenced in part by their forms of communication and interaction. They ask for information more than men, obtain information from other women, and often pass on information to others. Nevertheless, literacy rates and immigrant/refugee women's unequal participation in English as a Second Language training, often affect women's access to information.
  
  
• Women's decision-making processes: Women make health decisions not so much from an individual perspective, but in consideration of their families, their caregiving and interpersonal relationships, and the social and economic environments in which they live and work. All options need to be presented and support provided to women in making informed decisions within the context of their lives.
  
  
• A gender-inclusive approach to data: Gendered statistics requires that all official data include a breakdown by sex including differences in health status, outcomes, success, utilization, etc., and be analyzed carefully to reflect the influence of gender issues. Qualitative methods of data collection also provide a particularly valuable perspective as women's voices are an important part of evidence.
  
  
• Gendered research and evaluation: Major health research gaps exist for populations of women such as lesbians, bisexual and transgendered, Aboriginal women, immigrant/refugee women, women of color, and women with disabilities, particularly research that reflects their priorities and needs. We need to improve our existing knowledge of health problems specific to women and gain a better understanding of sex and gender differences in those illnesses that affect both women and men.
  
  
• Social justice concerns: Many women are affected by levels of poverty and injustice and hence providing advocacy around socio-economic issues and access to service are necessary. Assisting and supporting efforts that address the broader determinants of health such as income assistance, disability benefits, safe housing, are critical.
  
  
• Gender sensitive training: Provide a comprehensive gender-sensitive training program that can be adapted and integrated into all levels of services and program delivery. Models of training need to include consumers as full partners in developing and implementing the programs.

The Women's Health Clinic strongly supports a women-sensitive approach to service planning and delivery that utilizes a population health approach, including the following approaches from our model of care:

• Women centred services: The woman, in the context of her community is the center of service and planning. Sufficient time is taken with each woman to gain an understanding of how her unique background and life situation impacts upon her health. Interventions and educational strategies are flexible and varied and may involve linkages beyond the formal health care system.
  
  
• Develop a partnership between the woman and care giver: Programs and services are based on the assumption that the woman brings a valuable perspective of her life situation and her body and that in order to make informed decisions about her health and health care she must feel empowered. Staff and volunteers de-emphasize differences between woman and care provider, and seek to develop a partnership with her in addressing her health issues.
  
  
• Most appropriate care giver and services: Efforts are made to ensure that women receive the most appropriate service, provided by the most appropriate service provider, in the most appropriate location. Services and approach offered may include information, education, support through groups or individual counseling, medical treatments, health screening, advocacy, community action as well as linkages with the secondary, tertiary, rehabilitation and long term care or other sectors.
  
  
• Team approach: Interdisciplinary teams of health care providers working collaboratively, including professional, paraprofessional and volunteer staff are most effective in meeting women's needs.
  
  
• Empowerment: Programs and services are designed to enhance the understanding, self-care, self-help and self-advocacy abilities of women. This is achieved by: providing a wide range of accessible information and educational services, as well as support and training services based on adult education principles; facilitating the development of understanding and skills through social action groups around issues of concern to women and a system of participatory management and involvement of community members in agency decision making and evaluation processes.
  
  
• Use of peer volunteers: Peer volunteers play a key role in promoting the empowerment of clients through modeling self-help skills, demystifying medical information, and bringing community perspectives to the design and delivery of services. Training to women of various backgrounds in order to enable them to develop informal and formal helping and leadership skills in the provision of health information.
  
  
• Community involvement: Working in partnership with various communities concerned about the health of women, building on the strengths and interests of partners, including volunteers, clients, service providers or other members of the community are important approaches.
  
  
• Evaluation and cost effectiveness: Women's Health Clinic recognizes the importance of ongoing review and evaluation of the approaches and service strategies used including sound information and evidence about how programs, services and approaches meet the health needs of diverse women.
  
  
• Innovative program development: Continuous development and re-focusing of services approach based on new understandings of women's needs and issues includes collaborating with community women and researchers, and integrating newly gained knowledge
  
  
• Advocacy for system change: Identifying critical emerging issues for women's health and bringing together key stakeholders to develop innovative policy recommendations which are responsive to women's needs and concerns is another approach of the Winnipeg Women's Health Clinic model.

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³ Women's Health Clinic, Women, Poverty and Health in Manitoba: An Overview and Ideas for Action