Fit for Purpose? Do these Canada-wide health organizations do what they were intended to do?

The federal minister of Health asked two prominent Canadian health leaders in late 2017 to review seven federally funded agencies designed to improve health and health care in the country.  Are they doing the job they were created to do?

Two accomplished health leaders – one, Dr. P.G. Forest, from Alberta! – led the review, which included important recommendations on how to proceed, and other recommendations of significant relevance to IMAGINE Citizens.

Eight organizations were created between 1988 and 2007 to help respond to various health policy issues across the country. These Pan-Canadian Health Organizations (PCHOs) focused on substance abuse and addiction, drugs and technologies, health information, digital health, health-care delivery, patient safety, cancer and mental health. The organizations differ on many dimensions such as mandate, size, accountability and how they are governed. The report, Fit for Purpose: Findings and Recommendations of the External review of the Pan-Canadian Health Organizations was finished this March 2018 and answered these questions:

  • Does the work of this collection of organizations align with the national priorities for Canada’s health system?
  • In their current form are they equipped to make the highest possible contributions to the 21st century challenges in the health system?

In other words, are they the right fit for the future?

While the review was not asked to evaluate past performance of these organizations, one could conclude from the substantive recommendations for change that PCHOs have not had optimal impact on the health of Canadians.

Although the provision of health care is primarily a provincial responsibility, the reviewers identified six dimensions as enablers of better health systems that have emerged as roles assumed by the federal government – regulator, catalyst, custodian, equalizer, and capacity-builder.

Potential areas of federal government involvement include tasks that should not be performed 13 times over or that speak to deep notions of Canadian citizenship. In addition, the reviewers identified indigenous health and reconciliation as one issue not adequately addressed individually or collectively by the PCHOs. This is one example of something that, in essence, has fallen through the cracks, despite several organizations being funded to address issues of national importance.

When considered together, the review identified several issues which conclude that the current PCHOs are not able to respond to changing health system needs and pressures. While acknowledging the important work done by individual PCHOs, the reviewers attributed this to how the entire organization emerged in a haphazard manner and had never been asked to work together.

Of what relevance is this report to IMAGINE Citizens? It is for three primary reasons: First and foremost, we are Canadians and provide the means (taxes) through which our health system is made possible. Second, the health system exists to provide support for citizens as they pursue optimal health. Third, several of the recommendations in this report speak to the importance of public and patient engagement in shaping the way forward. Are we, as citizens, ready and equipped to join this renewal effort?

Readers can see the full report here. This article highlights  recommendations of specific relevance to IMAGINE Citizens:

  • Partnerships with clear goals and objectives should engage many provincial and territorial entities (defined in report) and the Canadian public.
  • PCHO suite should partner with provinces and territories to accelerate the emergence of a comprehensive, integrated publicly funded health system centered in primary care.
  • Mental health care now requires care to be integrated into the core of our health system, with bottom up leadership by all stakeholders including patient and families, working together.
  • The federal government should take responsibility for ongoing data governance and management to build systems that have fully interoperable electronic health records, which can be accessed by patients and their circle of care.
  • Standards for the basket of publicly funded services need to be modernized. The definition of medical necessity requires an ongoing pan-Canadian process informed by evidence and public engagement.

IMAGINE Citizen’s mission statement refers to building capacity of citizens to help shape the future of health care. We have identified digital health (including our own electronic health record) and primary health care as the two priorities of focus through which we believe citizens can be fully engaged in shaping the future. This report provides strong support for those directions.

By Judy Birdsell

Judy Birdsell is a founding member of IMAGINE Citizens Collaborating for Health.