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Health Status Health Services Health Care Reform Diverse Communities of Women
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Moving in the Right Direction? Regionalizing Maternal Health Services in British Columbia Cecilia Benoit, Department of Sociology, University of Victoria, Dena Carroll, BC Ministry of Education, and Pat Kaufert, Department of Community Health Science, University of Manitoba, with the assistance of Beverly MacLean-Alley
Canada has devoted substantial resources to the specialized medical fields of obstetrics and gynecology and on the maintenance of large hospital maternity wards, particularly within the past fifty years. Despite important reductions in maternal and infant mortality rates, significant service gaps remain for maternity clients. Concern has been expressed about a range of issues, such as the narrow provision of services covered under provincial health plans, lack of choice in service providers, limited accessibility for marginalized women, cultural-insensitivity of health professionals, and patriarchal employment practices. Provincial health care systems have been seen as spending health resources inefficiently and failing to address these problems. For true health care reform to take place, focused attention must be given to the appropriate provision of quality maternity care services for all women, as well as to ways to increase the efficient use of health care resources. Health care reform has preoccupied policy makers in provinces across Canada. A favoured reform strategy for most areas of the country (Ontario being a notable exception to this trend) has been regionalization. The model under way in British Columbia (BC) involves many of the strategies adopted elsewhere across the country: decentralization of health care planning; devolution of decision-making powers; and the creation of newlydeveloped regional health authorities/community health councils. Apart from reducing waste and inefficiency, it is anticipated that regionalization will give residents in their geographic communities greater voice to discuss their health care needs and concerns and, ultimately, foster the delivery of health services closer to people’s homes. The study asks two central questions:
Although non-urban maternity clients noted some potential benefits of regionalization, they also expressed concern about a reduction of maternity care services close to their homes. Two respondents, who had recently given birth when interviewed for this study, noted a decline in the level of care they received by nurses in both the local hospital and at the public health clinic. In determining this, they compared their most recent maternity experience with that of an earlier child born before the local Health Board was established. Both respondents agreed that the decline in service was partly a result of the hospital’s Early Maternity Discharge Program, designed to help reduce hospital costs by sending new mothers and their babies home within 48 hours post-partum. Respondents were particularly concerned that the stress levels of new moms had increased, and that more babies were becoming dehydrated and subsequently re-admitted into the hospital due to inadequate nursing. According to respondents, hospital nurses have less and less time to give advice to new moms regarding the art of breast-feeding and newborn care. Participants in the two focus groups mentioned above largely echoed these themes suggesting a decline in the quality of maternity care at the local level. Maternity respondents also expressed dismay that regionalization had not been able to address the lack of physicians in non-urban areas, despite the over-abundance of physicians per capita in the province. Respondents spoke of the trauma associated with having to leave their communities to give birth, putting them at a distance from valuable support networks. While respondents said that they were pleased to learn that midwives are now legal and funded by the Ministry of Health, they doubted that non-urban health regions would gain access to midwives in the near future. They noted that they knew of no midwives practising either in their own community or in the surrounding health region. Respondents went on to say that, much like physicians, most BC midwives within the provincial health care system are located in either the Vancouver or Victoria metropolitan areas. Advantaged regions of the province are securing midwives to compliment the oversupply of GPs and obstetricians who also deliver maternity care. In the face of this, respondents expressed concern that their local hospital was about to have one of their two resident obstetricians retire from active practice, while the other was leaving the community because of better job options elsewhere. Government advisors and health professionals interviewed as part of the study had mixed reviews about whether regionalization was actually achieving its initial goals. Regionalization, according to most of them, brings with it the potential to revitalize health care services through innovative health policies and greater opportunities for local people to help shape change. Respondents noted as well that because the Regional Health Boards are made up of local people, public concerns will be more tangible and the people will have more of an opportunity to have their voices heard. In addition, Health Authorities will have an opportunity to become innovative in developing region-specific health policy and services. One respondent suggested the health care system might also become more transparent; another noted that the newly regionalized system might help to flatten out the Ministry of Health’s top-down hierarchy. However, decentralized health care delivery is accompanied by challenges at each system level. Government advisors and health professionals interviewed expressed a number of their concerns:
This study provides a snapshot of how maternity clients are affected by many of the policy changes that are taking place at provincial and local levels. Further, it points out how policy advisors and health professionals themselves are concerned about the long-term effects of many of the changes now under way. More research on the impact of regionalization on core health services, including maternity care, is urgently needed to ensure that policy and practices address the needs of the communities they serve, and that equity in access to quality maternity care is not compromised. Studies of the impact of regionalization in other provinces would add significantly to the findings of this preliminary project. For further information contact: |
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