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Redefining Policy Making Taking Action to Influence Policy Policy for Rural Women
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Promoting Women’s Health through Public Consultation Marléne Dallaire, Le Centre d’excellence pour la santé des femmes – Consortium Université de Montréal
Most of the projects undertaken by the Centre of Excellence for Women’s Health, Université de Montréal (CESAF), are designed to achieve practical objectives and, in some cases, develop direct interventions to enhance the health of the Centre’s three target groups: women formal and informal caregivers, Aboriginal women and immigrant women.¹ Our goal to bring about concrete improvements to practices and services and to promote the empowerment of women has been supported, in part, by the commitment of a regional health board to provide a training program for home support services staff that will start this fall 2001. Following from a lengthy consultation between CESAF and the health board, the program will teach nurses and social workers at the Local Community Health Centres on the island of Montreal about the special situation of women caregivers, promoting an approach that will directly involve caregivers in decision making. When CESAF and its partners entered into public consultation with the island of Montreal regional health board, they did so from a knowledge base of five years of research on caregiving. A total of eight research projects have been conducted by CESAF and by partners that include the Montreal Informal Caregivers’ Association, the Caregivers’ Support Centre at the René Cassin Local Community Health Centre and feminist researcher, Nancy Guberman. One CESAF project that examined the policy documents of regional health boards, the Quebec Health and Social Services department and the Local Community Health Centres, revealed that scant attention has been paid to the situation of caregivers. These government agencies have adopted a utilitarian model—giving support to informal caregivers only to forestall burnout and maintain caregivers’ involvement in work. Respite care may be given, or some financial aid, but this limited model fails to acknowledge the complexity and emotional demands of caregiving.Government is transferring the responsibility for caregiving to families, but our studies show that the resources it is allocating to homecare are plainly inadequate. This scarcity of resources is all the more acute when significant problems are encountered. All of the women caregivers in one CESAF study expressed a negative perception of their own health. They described work overload, stress, isolation and dislocation in every aspect of their lives. Caregivers share common needs for respite, moral support, health information and financial support, but as two other studies demonstrated, their needs also differ. Daughters who are caretakers are at even greater risk than wives are of being perceived as unpaid “resources” by health and social services, yet fewer solutions are adapted to their needs. In a survey of studies, it was found that new immigrants also face unique risks. Although the experience of caring for a sick or dependent relative is similar for families in many different communities, the difficulties of reconciling multiple responsibilities and tasks slows down the process of new immigrants’ integration into the host community. Caregivers develop their own strategies to deal with the difficulties inherent in providing care. These can take the form of religious or spiritual practices, and contact with support networks on an ad hoc basis. The often individualistic nature of these strategies, however, can exacerbate certain kinds of problems, such as the imbalance of power between men and women within the family— between spouses, or between daughters and parents, for example, when the wife or daughter is the caregiver. This problem arises more frequently in situations of isolation. It is clear that women’s personal resources cannot be a substitute for a collective commitment to provide care, but health system restructuring as it is currently proceeding in Quebec does not augur well for collective responsibility. In the spring of 1998, when the regional health board for the Island of Montreal proposed to improve health services, CESAF and its partners took part in the public consultation. In our presentation we noted that “Women caregivers, immigrant women and Aboriginal women are accorded little place in the regional board’s proposal, although their living conditions and health status warrant special attention.”² The introduction to the board’s revised Plan ³ reflected our perspective, stating that “It is desirable to make specific reference to the female gender in all programs and services.” However, the Plan did not set out any concrete measures for reflecting gender, nor recommend any strategies to improve the living conditions of women caregivers. CESAF asked for a meeting with the follow-up committee. In June 1999, CESAF and interested partners from the research community, the community sector and the health network, presented a joint document of seven recommendations to the committee that included concrete suggestions for implementation. 4 Apart from the findings of the research projects, the document was based on a consultation with caregiver associations from across the province. (In November 1998, 250 people attended a daylong meeting on the situation of informal caregivers that was organized by the Montreal Informal Caregivers’ Association and funded by CESAF.) Because regional health boards fall under the purview of the Quebec Health and Social Services department, our recommendations were explicitly in keeping with the department’s Status of Women Plan. The Plan talks about the necessity of assessing the impact of health care reform on women, particularly as paid and unpaid caregivers, but the Montreal Regional Health Board was ignoring this direction. A limited working group made up of health board managers and CESAF representatives was established to examine the short-term feasibility of the recommendations. After discussions with the services involved, and a long consultative process with CESAF and its partners, the board is now prepared to apply one of the proposed measures—a training program for the home support services staff of Local Community Health Centres. To begin this fall 2001, the program will train staff, including nurses, social workers and the Centres’ own homemakers to: involve caregivers in decisions about service plans; help caregivers assess their ability to offer care and determine if they have consented to give care; and learn to recognize and respect their caregiving limits. The health board will make the program available to all 29 Community Health Centres. It’s our hope that every Centre will offer it to their staff. Stepping into the realm of public consultation required vigilance and the support of many CESAF partners, in concert with other advocacy organizations. This coalition of groups, the research studies carried out by CESAF and consultation with caregiver associations, provided a means of taking action to influence public policy for the practical benefit of women. NOTES Le Centre d’excellence pour la santé
des femmes – Consortium Université de Montréal |
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