community health centers governance: experience in belgium
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Community health centers governance: experience in Belgium. IAHP, December 12 2013. Isabelle Heymans, FMM. Community Health centers in Belgium. Inter-professional Teams: family physician, nurse, physiotherapist, receptionist, Social worker, dietician, psychotherapist Health promoter - PowerPoint PPT PresentationTRANSCRIPT
COMMUNITY HEALTH CENTERS GOVERNANCE: EXPERIENCE IN BELGIUM
Isabelle Heymans, FMM
IAHP, December 12 2013
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Community Health centers in Belgium Inter-professional Teams:
family physician, nurse, physiotherapist, receptionist,
Social worker, dietician, psychotherapist Health promoter
Missions: Primary Health care, Accessibility, Medico-Psycho-Social approach Heath promotion and community development Data collection, quality development Participation of patients
Capitation Public accreditation
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Community Health centers in Belgium
Since 1972 - increasing number since 1990
Today: 120 centers 3-8 new centers a year 5% of GP’s, 30% of GP’s <40 2% of population 15% in some places
Private, not-for-profit
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Public or Private ?
*Giusti and al, 1997
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Public Purpose : 5 criteria’s *
Social perspective concern for people’s well-being, autonomy, human promotion,
dialogue, taking the context into account Non-discrimination
with regard to race, gender, religion, political affiliation, social status, income level, … (sometimes positive discrimination for a kind of population or a specific disease with vertical program)
Population-based to take responsibility for, and be accountable to a defined population
Government policy guided a concern to comply with government health policies and to fit in
broader master plan (with discussion, agreements with authorities) Non lucrative goals:
Concern not to reduce the purpose of the service to profit making. Good working and living conditions are a right for the staff. After that,
profits should be reinvested in the service or other activities of social interest
* Giusti and al, 1997
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Our experience
Governance, oriented to supporting the public purpose? Some lessons from our experience
Co-Management : involving all the parties Participation: strategy or objective ? Mode of financing of the services and
agents Support organizations for quality
development
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Co-Management
Involve all the parties
Workers Users Inter-sectoral Public authorities
« Gather collective intelligence to serve the objectives »
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Co-Management
Workers In the team, on the field: NO hierarchy
To support active participation of each one Better for the quality
In the places to decide Not only « representation », or « consultation »
Co-decision for the aims, missions, priorities, strategies, finances
Know what they need to make a good job,
See the evolutions on the field
Hear the needs of the population
…
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Co-Management
Users From their place in the services
… to their place in the decision-making organs Patients committee with representation in the GA,
“professionnal patient”, one “patient in the board, … Many intermediaries: Suggestion box, complaints office,
mediation service, regular focus groups, Mediation process….
Representativeness?
Espress their needs and demands
Evaluate quality : relation, organization, …
…
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Co-Management
Partners in the field Other associations / services … In the GA / Board / special consultative
committees…
Know what they need from us
Also see the evolutions on the field
Collaborate on different actions
Give feedback on quality
Control the pursuit of the aims…
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Co-Management
Public authorities : National, regional, local (! Consistency) Accreditation : recognition, missions given by the authorities,
financing Some agreements for additional activities / research/…
Dialogue : co-elaboration of the rules and criteria : objectives of authorities – knowledge of the « real work » on the field
Democratic legitimacy Financing the service
Control the use of the public fundingDefinition of quality criteria
Can support this kind of service
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Co-management
Dialogue public – private : Example : « ASI » Missions = Accessibility, opening hours, inter
professional coordination, data collection, quality development, health promotion and community development
2014 : new law to support the launching of centers – thanks to our advocacy
Presence of the local administration in the GA ? Yes, but…
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Balancing co-management
Place and Proportions… Right place for each group ! too few minorities
Concrete example: not-for-profit cooperative model (Scic–fr) /
One possible more category: the « guarantor »
• 30% voices
• 20% voices
• 30%• 20%
W P
A/FS
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Managing Co-management
Real conditions for democracy: Managing the meetings, help everybody (or every group) to
have info and understand, to have a voice, … Need somebody to work for, and everybody to pay attention
to Co-decision of workers for the HR management:
collective = ok. Individual= hard… Representativeness of the users in the organs The role of a director? Leadership!
To facilitate collective decision-making, and to implement the decisions
Need education
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Participation: strategy or objective ?
Strategy means… only because it serves the quality of care
Objective! Citizenship education can begin everywhere
–> and there. Awareness of the aims and challenges Coherence
everyone is looking out for the aims !
It takes time, energy, means …= investment!
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Funding
Mixed Financing of the CENTERS Needs-based capitation Function (Health promotion, coordination, …) Fee for service Target (a little)
Mixed financing of the AGENTS Salary + fee for service
Some Freedom in allocation of the finances for the allocation of means at a local level not only to apply the top-down programs Ex: community health action
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Support organizations
Example: Our Federation: A charter : Values and objectives : Solidarity,
universal social security, equity, accessibility for all, support of autonomy of individuals and communities
Missions: Support quality development (from quality of care to
health promotion) Support stewardship for public purpose and citizenship
education Advocacy for Primary health care and community
orientation
MM/WGC KCE report 2005*
*https://kce.fgov.be/fr/publication/report/comparaison-du-co%C3%BBt-et-de-la-qualit%C3%A9-de-deux-syst%C3%A8mes-de-financement-des-soins-de
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Support organizations
KCE report 76 «Quality development in general practice in Belgium: status quo or quo vadis?»* : An independent trustworthy body to :
Collect and analyze the data ; Provide feedback reports to the practices; Offer coaching and support for the practices; support the formative processes and reinforce learning activities; Issue accreditation certificates;
They communicate aggregated and anonymous data to the Health Authorities, and for research purposes
Separate support and control ! *https://kce.fgov.be/sites/default/files/page_documents/d20081027319.pdf
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Thank You