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 experienceGovernance, 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 demandsEvaluate 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 usAlso see the evolutions on the field

Collaborate on different actionsGive 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 PA/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