COMMUNITY HEALTH CENTERS GOVERNANCE: EXPERIENCE IN BELGIUM

Isabelle Heymans, FMM

IAHP, December 12 2013

2

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

3

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

4

Public or Private ?

*Giusti and al, 1997

5

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

6

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

7

Co-Management

Involve all the parties

Workers Users Inter-sectoral Public authorities

« Gather collective intelligence to serve the objectives »

8

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

…

9

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, …

…

10

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…

11

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

12

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…

13

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

14

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

15

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!

16

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

17

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

18

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

19

Thank You