Providing low-barrier care in a pandemic
Across the province of BC, households, businesses, and communities are starting to adjust to a new way of life. For months now, Community Health Centres (CHCs) have been on the forefront of the clinical response to COVID-19. Through an integrated approach, our members have also been working hard to address the challenges that come along with social distancing and economic turbulence. We’re reflecting on the experiences of CHCs in BC and highlighting key learnings for the next key phase of the fight.
CHCs are community-governed non-profit organizations designed around the complex needs of their clients and patients. By integrating frontline health and social services, this model of care nimbly supports communities who otherwise face barriers to care—communities that have been particularly at risk in this pandemic.
“We have clients that are on the OAT therapy [for opioid addictions], patients we are working with regarding HIV, HEP C, high risk moms,” says Shobha Sharma, Executive Director of Central Interior Native Health in Prince George, BC. “In the time of COVID, where we're moving to virtual health, it's been hard to provide low barrier care.”
In many cases, CHCs have been forced to shift to online models of service delivery, but some are falling through the cracks because of challenges like poverty and racism, as well as a lack of social support, transportation, or communication.
“Often the education around a pandemic is going to happen verbally. Our team takes the time to explain to patients what's going on and why it's going on so that patients and clients don't automatically just feel stigmatized,” explains Sharma.
Beyond the medical model
As COVID-19 highlights, individual health is determined by more than genetics and gym habits. Health depends on the resilience of communities and their access to the right care from the right provider at the right time. Using a team-based approach, CHCs provide a range of services from health professionals as well as counsellors, social workers, cultural navigators.
“We need to be able to spend time with patients and clients to try and sort out their needs. And those needs may be outside of healthcare, so we connect them into other community resources,” says Bobbi Turner, Executive Director at Island Sexual Health.
Unfortunately, a fee-for-service model undermines this wrap-around design. Without core funding, CHC teams must patch together programming budgets year-to-year through grant-writing, fundraising, and piece-meal supports. COVID-19 has further strained this dynamic, as primary care providers are seeing fewer patients and generating less income for the organization as a whole. As teams have stepped up to fill gaps in care, there is a clear contrast between what CHCs are capable of and what they are resourced to do.
“I'm seeing how fast and how seriously the other entities are working to really wrap around with supports, whether it be around housing or reaching out to be able to provide low-barrier care. But at the same time, they're not doing that work day in and day out, and it is very specific work,” says Sharma. “We have for so long taking care of our own needs because no one else is there to do it, but at this point it's pushing back and saying ‘We can do this better than you and we need the resources to do it.’”
Advancing the CHC model
As a province, we will be faced with important decisions in the coming months and years about how we will reorganize and rebuild our communities in the wake of the pandemic. As Community Health Centres, we anticipate critical opportunities to reshape our health system around effective, community-based solutions.
“There's a growing understanding of what a Community Health Centre actually is. I think there's a real appeal, especially right now with the lack of family physicians in our province. This is an opportunity to expand services in an affordable way.”
There has never been a better time to prioritize community health.