VERS UNE REDÉFINITION DES SERVICES DE SANTÉ EN MILIEU RURAL

Par Lynn Corby, Kasia Seydegart et Gabriele Ferrazzi

(Sommaire)

Actuellement, beaucoup de Canadiens et Canadiennes remettent en question les méthodes des services primaires de santé et s'opposent aux philosophies qui les sous-tendent. Face à l'escalade des coûts de santé et à l'insatisfaction grandissante que provoquent la gamme et la qualité des services offerts, la population s'interroge sur les relations sacro-saintes entre médecins et patients.

Pour remédier à cette situation, l'Ontario Rural Learning Association a lancé un projet de "centres communautaires de santé". L'objectif? Créer un réseau de groupes intéressés à ouvrir en milieu rural de tels centres de santé.

Les centres s'éloigneront de l'approche traditionnelle, qui est curative plutôt que préventive, et hiérarchique plutôt qu'égalitaire. Ils fonctionneront de manière démocratique: ceux qui fournissent les services de santé et ceux qui en bénéficient auront également leur mot à dire. Ils auront un rôle éducatif, voulant avant tout prévenir la maladie. Et si la maladie frappe, elle sera considérée dans un contexte non seulement médical mais aussi personnel, social et professionnel.

RELEARNING RURAL HEALTH-CARE DELIVERY

by Lynn Corby
Kasia Seydegart
Gabriele Ferrazzi

Many Canadian women are questioning traditional methods and philosophical premises underlying the provision of primary health care. Escalating costs and inadequate services have led many people to reconsider time-honored relationships between physicians and health-care consumers, and seek more effective, cost-efficient alternatives. The Ontario Rural Learning Association, a board and membership devoted to fostering local initiatives for social and economic development in rural communities, recognizes this problem and seeks to address it in the 1984-85 project, "Community Health Centre. The goal of the RLA is to promote Community Health Canters and Community Multi-Service Centers by building a network of interested groups throughout rural Ontario, and to provide a consulting service to those communities interested in establishing centers.

THE PROBLEM

For a number of years health care reformers have been questioning the efficacy of the disease-oriented approach to healing. This model seeks to eliminate the deviant cog in the otherwise healthy machine.

Presenting symptoms are often treated without consideration of the wider implications. A common example is the enormous quantities of valium prescribed to women coping with the stress of their daily lives. In this case, the disease model lacks the correct perspective i.e., sociocultural.

A REALISTIC RESPONSE: THE COMMUNITY HEALTH CENTRE OR MULTI-SERVICE CENTRE

The Community Health Centre or Multi-Service Centre provides an alternative approach. Established and directed by the community, centres are devoted to a democratic, teamwork approach to health and social services with equitable in-put from providers and consumers. Centres are situated to provide maximum access to all community members. Active referral and consultation, with an emphasis on health promotion and prevention, are cornerstones of the concept. Centres embrace a systemic health- care model, in which the individual is influenced by a dynamic network of life experiences. When a mechanical failure occurs, that is, a physical pathology appears, it is considered symptomatic of a problem in one of the physical, emotional, social, or occupational areas of the system. Services are determined by such demographic variables as the age, sex, ethnic, SES, and occupational make-up of the community.