Beyond vectors and vessels: reflections on women and primary health care reform in Canada.

1 An earlier version of this paper was prepared for the National Workshop on Women and Primary Health Care, which was held in February 2004 and was sponsored by Women and Health Care Reform (formerly the National Coordinating Group on Health Care Reform and Women), funded by Health Canada, and organized by Women and Health Care Reform and the Prairie Women’s Health Centre of Excellence in Winnipeg, Manitoba. 2 British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada. Send correspondence and reprint requests to: Ann Pederson, Box 48, Room E311, 4500 Oak Street, Vancouver, BC, Canada V6H 3N1; telephone: 604-875-2633; fax: 604-8753716; email: [email protected]. 3 Consultant, Winnipeg, Manitoba, Canada. The future of primary health care (PHC) has been the topic of intense debate and discussion in Canada. In 2003, Canada’s First Ministers (the Prime Minister and the Provincial and Territorial Premiers) adopted the Accord on Health Care Renewal (1). PHC was one of five priority-action areas named in the Accord. However, the Accord was adopted by a federal Liberal government that was subsequently replaced, in early 2006, by a minority Conservative one. The new government did not identify PHC renewal as one of its top priorities, despite the existence of the Accord. The Primary Health Care Transition Fund (PHCTF), initiated in 2000 to support innovations in PHC practice, also completed its funding of projects in 2006. Evaluations of those projects and the overall initiative are underway. These developments raise questions about the future of PHC reform in Canada at the level of the federal government; however, they do not diminish the importance of PHC reform to the provincial and territorial governments, which are constitutionally responsible for the delivery of health services. Further, the issues that the Accord was intended to address—challenges to the PHC, stimulating innovations, and naming PHC as a cornerstone of the Canadian health care system—remain concerns of health care providers, patients, and managers alike. Moreover, the question of concern here—the lack of gender sensitivity in overall package of reforms—remains a problem despite the change in government. The Accord on Health Care Renewal (1) states, in part: “The key to efficient, timely, quality care is primary health care reform. First Ministers agree that the core building blocks of an effective primary health care system are improved continuity and coordination of care, early detection and action, better information on needs and outcomes, and new and stronger incentives to ensure that new approaches to care are swiftly adopted and here to stay.” Given the prominence of PHC in the Accord, this paper examines the PHC vision and reforms underway in Canada, and specifically, the implications for women and women’s health. It is our contention that the current approach to PHC reform has not given gender-related issues adequate importance. The particular model of PHC being promulgated, a lack of understanding of genderspecific PHC needs, and a limited view of women’s roles in health and health care are at the crux of its shortcomings. Opinión y análisis / Opinion and analysis