Delivering primary health care as envisioned

Jennifer Rayner,Wangari Tharao,Imaan Bayoumi,Laura Muldoon,Dale Mcmurchy,Kate Mulligan

doi:10.1108/jica-02-2018-0014

Abstract

PurposeFor over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a “Model of Health and Well-being” (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada.Design/methodology/approachThe MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice.FindingsThe MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes.Originality/valueAs comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

Highlights

Ontario, Canada has a population of 14,193,384, spread across 1,076,395 square km
Health care is mostly publicly funded, and primary care is mostly delivered by groups and individual physicians running private practices which conform to different payment and delivery models
Most Ontario PC delivery models would not embody the broader concept of primary health care (PHC), which is an approach to care that includes services delivered to individuals and communities with a focus on health promotion, disease prevention, health equity, and community involvement (Muldoon et al, 2010; Aggarwal and Hutchison, 2012)

Summary

Introduction

Canada has a population of 14,193,384, spread across 1,076,395 square km. Population centers vary from Toronto, with over six million inhabitants, to small hamlets and remote communities. Most Ontario PC delivery models would not embody the broader concept of primary health care (PHC), which is an approach to care that includes services delivered to individuals and communities with a focus on health promotion, disease prevention, health equity, and community involvement (Muldoon et al, 2010; Aggarwal and Hutchison, 2012). This focus on PC and not PHC exists despite many reports and position papers (Mable and Marriott, 2012; Hutchison et al, 2011) extolling the virtues of the broader PHC approach.

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