2016 Community Health Centres Survey
Building on important findings from the 2013 Canadian Community Health Centres Survey, CACHC is pleased to share results of the second Canadian CHCs survey, which was conducted between June and September 2016.
The overarching goals of the 2016 CHCs Survey were to document the scope of services and programs delivered by CHCs across various sectors, as well as the diverse operational and capital pressures facing CHCs across the country. Survey results provide valuable new information about a critical component of Canada’s health and social infrastructure.
Community Health Centres are multi-sector health and healthcare organizations that deliver integrated, people-centred services and programs reflecting the needs and priorities of the communities they serve. CHCs vary from one community to the next based on local needs and priorities, but they are all characterized by the following five attributes:
- They provide interprofessional primary care through teams that include family physicians, nurse practitioners, nurses, dietitians, social workers and other care providers.
- They integrate primary care with services/programs in health promotion and community development.
- They are community-centred, engaging members of the community in helping identify ongoing priorities and addressing factors in the community that impact health and access to healthcare.
- They actively address the social determinants of health through direct services and programs and by advocating healthy public policy.
- They are committed to health equity and social justice.
Results from the 2016 CHCs Survey underscore the way in which CHCs integrate healthcare and multi-sector supports at a local level, helping to convert fragmented health and social systems into more navigable and meaningful services for individuals, families and communities.
Despite this impact and a growing chorus of organizations and experts across Canada who recommend further investment in existing and new CHCs across the country, there remain serious gaps in policy and funding for CHCs across the country. This includes the outstanding question of how to fund and support health organizations like CHCs that are fulfilling a mandate that is the shared responsibility of federal and provincial governments. The 2016 CHCs Survey puts these major policy and funding gaps in clearer relief. It also reveals that there is significant regional variation across the country.
Since core infrastructure is already in place at existing CHCs across the country, measures by the federal and provincial governments to correct gaps affecting existing CHCs would enable rapid scale-up of appropriate healthcare and social services for thousands more families across Canada. Investment in new CHCs would help achieve even further progress on this priority for Canadians.
102 existing CHCs participated in the survey, along with 8 community groups across the country that completed a companion survey about the status of their efforts to establish a new CHC for their community. A list of all CHCs and community groups that participated in the survey is provided at the bottom of this page.
SURVEY FINDING #1: CHCs are multi-sector health and healthcare organizations
We asked Community Health Centres:
Please indicate all of the sectors/areas in which your Community Health Centre provides direct services or programs. For the sake of deciding if you provide “direct services/programs”, the determining factor is if you: a) receive dedicated funding for these services/programs; and/or b) have paid staff participating in a lead or coordination role for these services / programs. Please indicate all that apply.
ANALYSIS & DISCUSSION:
Global evidence demonstrates clearly that a broad set of determinants affect health, of which “health services” generally rank 9th or 10th in terms of their importance in improving health. That is in large part why the World Health Organization (WHO) recommends that frontline health services, at the level of primary health care, focus on putting people at the centre of services, integrating clinical care with other services and supports that address the various social determinants that affect the individual.
Results from the 2016 CHCs Survey reveal the extent to which CHCs across Canada embody the WHO vision of primary health care. While there is significant variation among CHCs regarding the sectors in which services are focused, depending on diverse community needs and the level of funding CHCs receive to fulfill this integrated primary health care role, it is clear that all CHCs in Canada work across multiple sectors to wrap care and support around individual, family and community needs.
In fact, 79% of CHCs deliver services and programs in 5 or more sectors — healthcare, seniors services, housing, education and immigration/settlement to name just a few.
A major dilemma faced by CHCs is the fact that federal and provincial health systems in Canada are still dominated by a medical model that focuses on just small fragments of primary health care, namely clinical services (also called “primary care”).
These primary care services are typically delivered by a small set of providers –usually an individual family physician paid on the outdated fee-for-service payment model.
More challenging still, federal and provincial health systems in Canada are still largely planned and funded in isolation from other public sectors that affect health.
The larger goal of shifting health and social systems system across Canada from siloed, illness- and crisis-focused responses is a longer term project, and will require a concerted effort by policy makers, academic training institutions, health professional groups and stakeholders from a variety of other sectors. In the meantime, federal and provincial governments have a critical opportunity to make immediate progress by investing in CHCs as an integrated model where this transformative shift is already unfolding in practice.
of CHCs provide services and programs in 2-5 sectors
of CHCs provide services and programs in 5-10 sectors
of CHCs provide services and programs in 10 or more sectors
SURVEY FINDING #2: CHCs act as a critical federal/provincial healthcare “bridge”
ANALYSIS & DISCUSSION:
The continued impact of colonial programs and policies on the health of Indigenous peoples in Canada are coupled with barriers to care and support that result from our fragmented health and social service systems at provincial and federal levels.
These compounding factors result in a high proportion of community members requiring integrated care and support. Culture and cultural programs are a gateway to health and healing and this approach is particularly-well embedded in the approach of Indigenous community-governed CHCs.
Based of 2016 CHCs Survey responses, 34% of CHCs provide some level of direct services and programs on-reserve and on Inuit self-governing territories. This is in addition to the even larger number of CHCs providing services and supports to Indigenous populations off-reserve, in both in urban and rural communities.
It is also important to note the that there was a relatively low participation rate in the 2016 CHCs Survey by CHCs that are governed by Indigenous communities as well as by CHCs in several jurisdictions with high proportions of Indigenous populations such as the Yukon, Northwest Territories and Nunavut. Therefore, it is very reasonable to assume that data on provision of services to Indigenous populations by CHCs is under-represented in these survey results.
CACHC is committed to working collaboratively with Indigenous CHCs across Canada to improve the health and wellbeing of Indigenous peoples. This commitment is grounded in a spirit of truth and reconciliation.
ANALYSIS & DISCUSSION:
The Government of Canada goes to great lengths to ensure a comprehensive range of illness prevention, care and support services for members of the Canadian Armed Forces (CAF) and their families.
At the level of primary health care, the bulk of services are provided through CAF Health Services, Dental and Family Resource Centres. None of these CAF centres participated in the 2016 CHCs Survey, however, it is apparent that these integrated CAF centres resemble Community Health Centres, which warrants further study as they may, in fact, already be an example of federally-funded CHCs.
Nevertheless, among CHCs that did complete the survey (ie, CHCs in the “civilian” sector) it is clear that they too play an important role in making equitable and appropriate health and healthcare services available to members of the CAF and their families.
32% of “civilian” CHCs across Canada provide some level of services and programs to CAF members and their families, thereby helping the federal government to fulfill its mandate in providing health and healthcare services and programs to members of the CAF.
90% of these CHCs report that they provide services to CAF members as part of the general population accessing services, while 10% report that they provide these services and programs as part of a partnership with CAF.
Why does this federal/provincial bridge matter?
A common misconception about health care in Canada is that it is the exclusive responsibility of provinces and territories. In fact, the federal government has significant legal responsibilities in health care, including:
- Setting, administering and protecting Canada-wide standards for the healthcare system through the Canada Health Act;
- Providing funding to provinces/territories for healthcare services in alignment with the Canada Health Act;
- Delivery of healthcare services to specific groups including First Nations people living on reserves, Inuit peoples, members of the Canadian Armed Forces and RCMP, eligible veterans, some groups of refugees, and inmates in federal penitentiaries; and
- Providing other health-related functions such as regulation of food, pharmaceutical drugs, and various other consumer products.
With respect to the federal government’s responsibility for delivery of healthcare services to the population groups listed above, the reality of how, where and by whom services are actually provided is a complex web.
The various healthcare services accessed by populations for which the federal government has a specific mandate are a combination of federally and provincially/territorially funded and administered services. This holds true at the level of primary health care.
Within this matrix of services and supports, Community Health Centres act as a critical bridge, helping to ensure that individuals and families do not fall between jurisdictional cracks and have access to appropriate and equitable services. This is particularly important since many of these populations are vulnerable and have complex health and social needs.
The 2016 CHCs Survey captured information regarding the extent to which CHCs across Canada play a role in helping the federal government meet its mandate in providing health services to certain populations under its mandate and for which it has expressed various commitments.
Within the survey, these included: First Nations peoples on-reserve; Inuit peoples on a self-governing territory; members of the Canadian Armed Forces; refugees and refugee claimants; and French-speaking persons residing in minority language settings across the country.
While CHCs continue to play this important role as a federal/provincial healthcare bridge, the lack of clear policy on shared responsibility for funding this work leaves a significant gap that CHCs do their best to straddle.
31% of CHCs report that they receive a small level of recurring or non-recurring federal funding for aspects of the work that they do in helping fulfill the federal government’s mandate in health and healthcare services. More commonly, however, CHCs provide these services and supports out of their other sources of funding: a combination of provincial and municipal funding, revenue from charitable donations, and other non-recurring grants.
Bridging gaps in Medicare:
In addition to this federal/provincial healthcare bridge it is also important to note that CHCs provide a bridge across other major gaps in healthcare coverage that exist in Canada. Our public Medicare system still does not include universal coverage for dental care, prescription drug care, eye care and a number of other aspects of care that are part of a modern health system response.
The bridge provided by many CHCs across these gaps involves piecing together programs and services from a patchwork of federal, provincial and municipal emergency coverage initiatives and leveraging organizational capacity to offer free or reduced-cost services to individuals in need but who cannot afford to pay out of pocket.
Completing the first and second stages of Medicare:
The founders of Canada’s universal healthcare system — Tommy Douglas, Justice Emmett Hall and others — described on numerous occasions how an effective Canadian healthcare system would need to evolve in two overlapping stages.
The first stage is about ensuring access to public health insurance. The second stage is about reforming the way that services are delivered within the publicly-funded health system in order to do a better job preventing illness and ensuring more timely and appropriate treatment when it is needed.
As we look to achieve the second stage we must also remember that the first stage continues to be an unfinished project as well — universal coverage of dental care, prescription drug care and eye care are long overdue.
And, as we work to complete both the first and second stages of Medicare, CHCs are an example of how practice is already out ahead of policy in parts of our healthcare system. Renewed federal and provincial attention to the need for investment in CHCs across Canada — something already recommended by the federal government’s 1972 Hastings Commission Report — could help to further accelerate action on both the first and second stages of Medicare.
ANALYSIS & DISCUSSION:
Community Health Centres (CHCs) across Canada have decades of experience providing care and support to government-assisted and privately-sponsored refugees, as well as diverse refugee claimants. The integrated primary health care services and programs provided by CHCs enable refugee newcomers to receive the care and support they require.
Support often begins by addressing immediate health and social needs, but evolves over years as CHCs become the ongoing primary health care centre for many refugee newcomers. This continuity of care and support beyond the initial settlement period is critical to ensure that, like all CHC clients/patients, refugees have the necessary resources for health including accessible care, access to affordable housing, education, employment and other inputs for health and wellbeing.
Most recently, CHCs across Canada mobilized as a pillar of our country’s response to the to 50,000 refugee newcomers the federal government has committed to welcoming by the end of 2016. Special emphasis at CHCs has been placed on receiving and supporting the large numbers of Syrian newcomers arriving in Canada. In early 2016, CACHC documented the nature and scale-up of this rapid response by CHCs across Canada through a national casebook.
The latest effort by CHCs in 2015-16 to provide a rapid response to these emerging healthcare and support needs builds on an impressive legacy of local, provincial and national emergency response by CHCs to human and environmental emergencies such as SARS; H1N1; recent flood disasters in Alberta and Northern Ontario; the 1998 Montreal ice storm; and Canada’s large-scale settlement of refugee groups from Vietnam, Somalia, Central America and elsewhere.
ANALYSIS & DISCUSSION:
Survey results show that CHCs play an important role in providing primary healthcare and social services to French-speaking populations located in minority settings (outside the province of Québec). In total, 4% of CHCs identify as Francophone CHCs (operating primarily in French) and another 8% of CHCs have official bilingual designation. A further 45% of CHCs indicate that they serve significant numbers of clients who identify as Francophone and/or prefer to receive services in French.
Despite the relatively small number of CHCs that currently exist across Canada, they are nonetheless playing a very significant role in increasing access to appropriate health and social services for French-language minority communities across the country. Far more still could be accomplished through investment in new CHCs over the years to come.
Together, the Canadian Association of Community Health Centres and Société Santé en français have been working to document access to appropriate primary health care for French-language minority communities across Canada. The associations commissioned a 2015-16 study and report that provides multiple recommendations on next steps for action. This includes harnessing the strong potential of CHCs to fill major gaps in access to appropriate health and social services for Francophone individuals and families in these communities.
SURVEY FINDING #3: CHCs across Canada are facing major operational and infrastructure pressures
We asked Community Health Centres:
Does your Community Health Centre currently face significant operational pressures impacting your ability to fulfill your mission and mandate? If so, please indicate all areas of operations where these pressures are experienced.
We asked Community Health Centres:
Do you currently require capital funding to repair or expand your physical space?
We asked Community Health Centres:
If you receive this capital funding, will it enable you to serve additional individuals and families who currently do not have access to appropriate primary health care?
Analysis and Discussion:
CHCs are a critical component of Canada’s healthcare and social service tapestry. In addition to supporting federal and provincial governments to fulfill their overall mandate to improve the health and wellbeing of Canadian families and communities, they are a critical resource for individuals and groups that face greater than average barriers to health and access to other health services. Despite this vital role, CHCs across Canada face major policy and funding gaps. In some provinces this funding gap is approaching crisis levels (see survey finding #4, below). Results from the 2016 CHCs Survey reveal that:
– 94% of CHCs face significant operational pressures affecting their ability to meet local demands for services.
– 69% of CHCs currently require capital funding to repair or expand their physical space.
The particular funding challenges facing CHCs vary from one community to the next based on a variety of factors and needs faced by the community. The good news is that because these existing CHCs have an infrastructural base and capacity that can be leveraged, federal and provincial governments have a prime opportunity to rapidly increase access to health and social services for individuals and families across the country by correcting these funding gaps.
76% of CHCs indicate that capital funding to address space shortages and repair backlogs would enable them to extend services to more Canadians. And, allocating increased operational funding for CHCs from within existing federal and provincial health and social services budgets would further enable CHCs to expand access to vital health and support services for Canadians.
SURVEY FINDING #4: There is significant regional variation in funding of CHCs
We asked Community Health Centres:
Do you currently receive recurring, core operational funding from the provincial government (includes regional health authorities)? Please indicate which response best characterizes the funding you receive from your provincial government.
Analysis and Discussion:
Many of the systemic issues underlying operational pressures at CHCs are common across Canada. A chronic challenge in most regions of the country, for instance, is the lack of a policy framework (provincial or federal) articulating the role of comprehensive, team-based primary health care (ie, CHCs) and what funding for these services and programs should look like.
Nonetheless, some provinces have established practical mechanisms to provide core, operational funding of these services.
Results from the 2016 CHCs Survey provide further substantiation of the operational funding gaps affecting CHCs in many provinces. In Nova Scotia, for example, 0% of CHCs receive core operational funding from the provincial government for their integrated services and programs. This is only slightly better in British Columbia and Alberta, where only 8% and 25% of CHCs, respectively, receive core operational funding for their integrated services and programs.
In many instances, CHCs are compensating for this lack of support through a variety of other funding strategies. 60% of CHCs engage actively in charitable fundraising and 27% have been able to secure non-recurring grants from foundations and other granting agencies.
It is reasonable to expect that organizations delivering important public services will pursue a diversity of revenue sources. However, it is unacceptable that vital health and social service organizations like CHCs should depend on continued fundraising to maintain their core operations when a large majority of other healthcare services — fee-for-service physicians, hospitals, and other service providers — receive core operational funding from provincial and/or federal governments.
In provinces where there has been more progress on comprehensive funding for CHCs this is still a qualified success. There continue to be major gaps in access to CHCs within these provinces; in Ontario, Saskatchewan and Manitoba, for instance. In these provinces only a small number of total CHCs is currently being funded relative to the overall needs of the population.
Ontario is arguably the most advanced province in terms of the number of CHCs funded by provincial government and the nature of funding received. All CHCs in Ontario, for example, benefit at least from a core, operational funding package that covers a basket of primary care, health promotion and community health services. Despite this progress there are still only enough CHCs being funded in Ontario to reach 4-5% of the population. By contrast, conservative estimates show that at least 15% of the Ontario population is in urgent need of access to CHCs. This gap in access to CHCs is equal or greater in proportion in other provinces and territories.
The following CHCs and communities participated in the 2016 CHCs Survey
Listed alphabetically by organization name
Existing Community Health Centres
- ACFA Régionale de Calgary / Clinique francophone de Calgary (Calgary, AB)
- Access Alliance Multicultural Health and Community Services (Toronto, ON)
- Anne Johnston Health Station (Toronto, ON)
- Antigonish Women’s Resource Centre (Antigonish, NS)
- Atira Women’s Resource Society (Vancouver and Surrey, BC)
- Barrie Community Health Centre (Barrie, ON)
- Belleville and Quinte West Community Health Centre (Belleville, ON)
- Black Creek Community Health Centre (Toronto, ON)
- Boyle McCauley Health Centre (Edmonton, AB)
- Bridges Community Health Centre (Fort Erie and Port Colborne, ON)
- Carlington Community Health Centre (Ottawa, ON)
- CSC Chigamik Community Health Centre (Midland, ON)
- Central Community Health Centre (St. Thomas, ON)
- Central Miramichi Community Health Centre (Doaktown, NB)
- Centre de santé Saint-Boniface (Winnipeg, MB)
- Centre de santé de Clare (Meteghan Centre, NS)
- Centre de santé communautaire de l’Estrie (Cornwall, ON)
- Centre de santé communautaire de Kapuskasing et région (Kapuskasing, ON)
- Centre de santé communautaire Sudbury-Est (Noelville, ON)
- Centretown Community Health Centre (Ottawa, ON)
- Chatham-Kent Community Health Centres (Chatham, ON)
- Clinique Communautaire de Pointe Saint-Charles (Montréal, QC)
- Community First Health Co-op (Nelson, BC)
- Cortes Community Health Centre (Mansons Landing, BC)
- Country Roads Community Health Centre, Portland, ON)
- CUPS Calgary (Calgary, AB)
- Davenport Perth Neighbourhood and Community Services (Toronto, ON)
- De dwa da dehs nye>s Aboriginal Health Centre (Hamilton, ON)
- Dr. W.B. Kingston Memorial Community Health Centre (L’Ardoise, NS)
- East End Community Health Centre (Toronto, ON)
- Flemingdon Health Centre (Toronto, ON)
- Four Neighbourhoods Health Centre (Charlottetown PEI)
- Fredericton Downtown Community Health Centre (Fredericton, NB)
- Fundy Health Centre (Blacks Harbour, NS)
- Gabriola Community Health Centre (Gabriola Island, BC)
- Galiano Health Centre (Galiano Island, BC)
- Gateway Community Health Centre (Tweed, ON)
- Grand Bend Area Community Health Centre (Grand Bend, ON)
- Grand River Community Health Centre (Brantford, ON)
- Guelph Community Health Centre (Guelph, ON)
- Hamilton Urban Core Community Health Centre (Hamilton, ON)
- Hants Shore Community Health Centre (Kempt Shore, NS)
- Hay River Health Centre (Hay River, NT)
- Hornby Denman Community Health Centres (Hornby Island, BC)
- Island Sexual Health (Victoria, BC)
- Kingston Community Health Centres (Kingston, ON)
- Klinic Community Health (Winnipeg, MB)
- LAMP Community Health Centre (Toronto, ON)
- Langs Community, Health, Wellbeing (Cambridge, ON)
- London InterCommunity Health Centre (London, ON)
- Mary Berglund Community Health Centre (Ignace, ON)
- MFL Occupational Health Centre (Winnipeg, MB)
- Mid-Main Community Health Centre (Vancouver, BC)
- Montague Health Centre (Montague, PEI)
- Mount Carmel Clinic (Winnipeg, MB)
- Niagara Falls Community Health Centre (Niagara Falls, ON)
- Nine Circles Community Health Centre (Winnipeg, MB)
- North End Community Health Centre (Halifax, NS)
- North Hamilton Community Health Centre (Hamilton, ON)
- North Lambton Community Health Centre (Forest, ON)
- North Queens Community Health Centre (Caledonia, NS)
- Norwest Community Health Centre (Thunder Bay, ON)
- NorWest Co-op Community Health Centre (Winnipeg, MB)
- Pender Harbour Health Centre (Madeira Park, BC)
- Pinecrest-Queensway Community Health Centre (Ottawa, ON)
- Port Hope Northumberland Community Health Centre (Port Hope, ON)
- Queens North Community Health Centre (Minto, NB)
- REACH Community Health Centre (Vancouver, BC)
- Regent Park Community Health Centre (Toronto, ON)
- Regina Community Clinic (Regina, SK)
- Rexdale Community Health Centre (Toronto, ON)
- Rideau Community Health Services (Merrickville, ON)
- SEARCH Student-Run Health Centre (Regina, SK)
- SWITCH Student-Run Health Centre (Saskatoon, SK)
- Sandy Hill Community Health Centre (Ottawa, ON)
- Saskatoon Community Clinic (Saskatoon, SK)
- Scarborough Centre for Healthy Communities (Scarborough, ON)
- Seaway Valley Community Health Centre (Cornwall, ON)
- Somerset West Community Health Centre (Ottawa, ON)
- South East Grey Community Health Centre (Markdale, ON)
- South-East Ottawa Community Health Centre (Ottawa, ON)
- Southwest Ontario Aboriginal Health Access Centre (London, ON)
- South Riverdale Community Health Centre (Toronto, ON)
- St. Joseph’s Community Health Centre (Saint John, NB)
- Stonegate Community Health Centre (Etobicoke, ON)
- The Alex Community Health Centre (Calgary, AB)
- Tri County Women’s Centre (Yarmouth, NS)
- Umbrella Multicultural Health Cooperative (Vancouver, BC)
- Vaughan Community Health Centre (Vaughan, ON)
- Victoria Cool Aid Society (Victoria, BC)
- Victoria Cooperative Health Centre (Victoria, BC)
- Wellfort Community Health Services (Brampton, ON)
- West Elgin Community Health Centre (West Lorne, ON)
- Western Kings Memorial Health Centre (Berwick, NS)
- Whati Health Centre (Whati, NT)
- Windsor Family Health Team (Windsor, ON)
- Women’s Health Clinic (Winnipeg, MB)
- Women’s Health in Women’s Hands Community Health Centre (Toronto, ON)
- Woolwich Community Health Centre (St. Jacobs, ON)
- Wynyard & District Community Health Centre (Wynyard, SK)
- Youville Health Centre (Winnipeg, MB)
New Community Health Centres in Development
- NEW Community Health Centre (Bowen Island, BC)
- NEW Community Health Centre (Lake Country, BC)
- NEW Community Health Centre (Vancouver, BC)
- NEW Community Health Centre (Dartmouth, NS)
- NEW Community Health Centre (New Waterford and District, NS)
- NEW Community Health Centre (Markham, ON)
- NEW Community Health Centre (North Bay, ON)
- NOUVEAU Centre de santé communautaire (Fort McMurray, AB)