What are Community Health Centres?
The British Columbia Association of Community Health Centres defines Community Health Centres (CHCs) as follows:
“Community Health Centres are multi-sector health and healthcare organizations that deliver integrated, people-centred services and programs that reflect the needs and priorities of the diverse communities they serve. A Community Health Centre is any not-for-profit corporation or co-operative which adheres to all five of the following domains:
- Provides interprofessional primary care
- Integrates services/programs in primary care, health promotion, and community wellbeing
- Is community-governed and community-centred
- Actively addresses the social determinants of health
- Demonstrates commitment to health equity and social justice”.
This definition aligns very closely with the Canada-wide definition applied by the Canadian Association of Community Health Centres.
CHCs come in many shapes and sizes and are found in urban, rural and suburban communities across Canada.
CHCs are all committed to providing comprehensive, accessible, affordable, and culturally appropriate healthcare services through a collaborative team approach. They bring together healthcare providers such as physicians, nurse practitioners, nurses, dietitians, social workers and therapists to work in collaborative, interdisciplinary teams.
CHC clients receive the right type of care, from the right provider(s), at the right time. This high-quality care also makes the best use of our scarce healthcare resources and helps to overcome gaps in access to care providers.
What sets CHCs apart from other primary care services even further is the partnerships they build among community residents, and a wide variety of healthcare, social service, housing, education and other partners. These relationships help CHCs to identify the needs of their community, to design and oversee appropriate service delivery, to address the many social determinants of health, and to evaluate health service programs. In addition to high-quality interdisciplinary services, CHCs go beyond just “care”.
By integrating interdisciplinary care teams with health promotion programs, social services and community programs, the emphasis is shifted to illness-prevention, wellbeing and local socio-economic development. CHCs believe that individuals, families and communities should have equitable opportunities to achieve wellbeing and to have their health needs met, regardless of economic status, race, culture, age, geography, gender, or sexual status. CHCs work to remove inequities and increase opportunities to access health and social services.
Using health and healthcare as twin pillars for action, the active role of CHCs in local communities means that fewer individuals and families fall between cracks in various systems. Robust programs and partnerships at local CHCs help individuals and families overcome barriers to health wherever they are faced. These include housing, education counseling, skills development, peer support, and other social supports. CHCs provide the wrapa-round care and support that ensures clinical providers, case managers, program staff and partners can collaborate in supporting clients. In other words, every door becomes the right door to effective care and support.
The caring environment of a CHC also creates a desirable employment opportunity where staff are well supported in achieving personal and professional goals. For example, providing team-based primary care through CHCs is an excellent way for family physicians to achieve practice choice and to not feel isolated in providing care to patients with complex medical and social conditions. Family practice within a CHC setting provides a broad range of options and quality of-life support that contribute to a higher quality of practice, helping to prevent practitioner burnout (2).
In addition to providing care through teams of family physicians, nurse practitioners, nurses, social workers, therapists and counsellors, CHCs are also developing innovative partnerships by integrating health professionals that have traditionally been excluded from primary health care, such as midwives and dietitians. Another example is that some primary care teams across Canada have incorporated clinical pharmacists. The positive impact on both quality of client care and quality of pharmacy practice has been significant (3). Moreover, CHCs have consistently demonstrated their effectiveness at optimizing the contributions of diverse practitioners, enabling and supporting providers to practice to the full scope of their training.
The community health centre model is not new. In 1972, an extensive pan-Canadian research study, commissioned by the Canadian Ministry of Health and Welfare recommended that CHCs be established and funded across Canada as non-profit corporations within fully-integrated health systems (4).
Community Health Centres have many benefits to the community beyond simply providing health services. Participation by community members in governance of not-for-profit and cooperative CHCs helps to ensure appropriateness of services and to build relationships of trust and buy-in, especially in communities facing higher-than-average barriers to health and development. Community Health Centres also employ other tools such as community advisory committees, needs assessment and satisfaction surveys, and other community engagement processes to further involve the community in decisions, planning, evaluation and continuous quality improvement.
Research on CHCs across Canada has found that CHCs “provide a wide range of opportunities for citizen participation not found in most parts of the health care system. Opportunities range from consultation to direct decision making.” (9) The same research found that among community governed CHCs, “participants felt that citizen participation in CHC decision making had led to improved programs and services and that the range of programs and services met the needs of the community” (10).
The emphasis of CHCs on individual, family and community health, as well as prevention of “downstream” and long-term health system costs means that CHCs are high-impact contributors to the healthcare system and drivers for socio-economic development. The true value of a CHC is much greater than the sum of its parts.
As a result of their “upstream” and comprehensive approach CHCs have been found by numerous Canadian research studies to be highly valuable and cost-effective, achieving better overall outcomes than other models of primary care.
CHCs offer significantly more comprehensive services (74%) than other primary care models (61-63%; P < 0.005) like Fee-for-Service practice and “clinical care only” teams (5)
When adjusted for complexity, CHCs exceed expectations in reducing hospital emergency room visits, while other models of primary care are found not to meet expectations in reducing ER visits (6)
CHCs provide superior chronic disease management. Clinicians in CHCs find it easier to promote high-quality care through longer consultations and interprofessional collaboration. This superior care has been correlated with the presence of a nursepractitioner and is associated with lower client-family to physician ratios and smaller full-time equivalent family physician groupings (7)
Clients of CHCs report higher satisfaction scores across multiple domains of analysis including accessibility, prevention and health promotion, client and family-centredness and chronic disease management compared to clients of other models of primary care (8)
CHCs have proven highly-effective in many other countries as well. In the United States, for example, there are over 1300 CHCs that are governed by independent, community-based boards of directors. They serve over 23 million Americans in all states and territories. Research has found that U.S. CHCs have been successful at:
- Preventing 25% more emergency department visits than other models of primary care (11)
- Saving the U.S. health system more annually compared to fee-for-service medicine (12)
- Acting as local economic engines, generating roughly $20 billion in new economic activity annually (13)
- Increasing responsiveness to community-defined needs by ensuring community participation in health care decision making (14)
- Including clients on governing boards to ensure focus on the scope of the care delivered, resulting in higher quality care, lower cost services, and better procedures for client complaints (15)
1. Health Council of Canada (2009). Teams in Action: Primary Health Care Teams for Canadians. p. 18
2. For excellent accounts of physician practice benefits in CHCs, see Community Health Centres: Family Medicine at its Best.
3. British Columbia Federation of Community Health Centres (2013). Beyond Dispensing: The Voice of a Pharmacist Working as a Member of an Interdisciplinary Primary Health Care Team. October 7, 2013.
4. Ministry of National Health and Welfare (1972). Report of the Community Health Centre Project to the Conference of Health Ministers.
5. Russell G et al G (2010). “Getting it all done. Organizational factors linked with comprehensive primary care”. Family Practice. 27(5): 535-541.
6. Glazier RH, Zagorski BM, Rayner J. (2012) Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10. Toronto: Institute for Clinical Evaluative Sciences
7. Russell G et al (2010). “Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors”. Annals of Family Medicine. 7(4):309-318.
8. Conference Board of Canada (2014). Final Report: An External Evaluation of the Family Health Team (FHT) Initiative.
9. Church J, et al (2006). Citizen Participation Partnership Project Report. Centre for Health Promotion Studies, School of Public Health University of Alberta.
11. U.S. National Association of Community Health Centres (2011). Community Health Centers: The Local Prescription for Better Quality and Lower Costs. Washington, DC.
13. U.S. National Association of Community Health Centers (2010). Community Health Centers: The Return on Investment.
14. Crampton P, et al (2005) “Does Community-Governed Nonprofit Primary Care Improve Access to Services?” International Journal of Health Services 35(3): 465-78.
15. Crampton P, et al (2005) “Does Community-Governed Nonprofit Primary Care Improve Access to Services?” International Journal of Health Services 35(3): 465-78.