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Community Governance

‘Citizen Engagement and Community Governance is believed to have many important benefits for health and health care,’ according to a study commissioned by the AOHC on ‘A Review of Trends and Benefits of Community Engagement and Local Community Governance In Healthcare’ (Patzer, 2006). As the diagram below indicates there are a number of different levels at which community engagement can take place.

CHC’s strongly supports community engagement in health care at all levels and it asserts ‘community governance must respect and be guided by the dynamics of community at the neighbourhood level’ (AOHC Submission to the Legislative Assembly Standing Committee on Social Policy regarding Bill 36, the proposed Local Health System Integration Act, 2005 in Ontario). Meaningful engagement at all levels delivers the best health outcomes for a population and leads to community governance where the local citizens are empowered with decision-making on issues that affect the health of their own communities.

At the highest level, decision-making power is transferred from politicians, and government administrators and health professionals who have traditionally dominated health-care decision-making to local community members. According to David Hole, Executive Director of the Southeast Ottawa CHC, ‘The CHC Board’s role is not just to reflect the community but to reflect the community that it serves!’

Primary Health Care and Community Governance

CHCs in Ontario are community-governed primary health care organizations. The success of community governance in Community Health Centres, the most mature primary health-care organizations in Ontario, is evidenced in the creation of innovative programs, grounded in the social determinants of health, responsive to the local populations served. Community Health Centre Boards move beyond the ‘front row’ of the public – those who are actively involved in community, health and social issues to those who do not always get a chance to participate. 

Harnessing the wisdom, passion and diversity from the communities served CHCs are empowered to deliver many added benefits in terms of health outcomes of local residents. Amongst those benefits are:

  • Citizen participation in CHC decision-making resulting in responsible and flexible programs and services to meet the needs of diverse populations (Church and Colleagues, 2005)
  • Community involvement, being the key to long-term sustainability and accountability, community capacity, community ownership and community participation
  • The capacity of the community board to elicit and voice community expertise, knowledge and opinions from those who live in the community and are closest to the health and wellness issues – which results in improved individual and community health.
  • Cost savings achieved through community governance, realized through reductions in health and social service utilization
  • The connection between neighbourhoods and health (see, for example ‘Strong Neighbourhoods Report’ United Way, 2006), when communities are involved in planning for their health-care needs and resources – issues in strong, vibrant, relevant health-care organizations grounded and sustained within the community
  • The building of partnerships and integration of services which leads to decreased duplication of service and decreased costs