Bill 15 offers no serious remedy for the virtual disappearance of citizen power within our network of health and social services (RSSSS). Remember that this virtual disappearance did not happen unexpectedly. We have thus gone from public management of front-line services by local community service centers (CLSC) to private management in the hands of physicians from Family Medicine Groups (GMF), over which the population has no control. . Not to mention the almost complete disappearance of the exercise of a “certain form” of democracy within the establishments of the RSSSS.
Unlike the FMGs, which focus essentially on curative treatment, the CLSCs, when they were created, had been given a community intervention mandate to ensure the prevention and health promotion component. The population was involved in the identification of the various social, economic or other causes having an impact on health and was supported in its efforts to counter these obstacles. The members of the CLSC Boards of Directors (CAs) were elected by the employees and the population of the territory served. Collective management of health was thus promoted and the community had a voice to intervene in the organization of services.
We know what happened next: questioned shortly after their creation, both by the government and by the structures representing physicians, the mission of the CLSCs was considerably eroded so that community intervention is no longer properly talk about the mission of CLSCs.
Moreover, the reforms experienced by the RSSSS led to the exclusion of the population from governance structures due to the abolition of the CAs of various establishments such as CHSLDs, rehabilitation centres, hospitals, youth centers.
As for the CAs of the CISSSs and CIUSSSs, out of the twenty members appointed by the Minister of Health and Social Services, only one is currently appointed by and from among the members of the users’ committee. We are a long way from a mandate of representation entrusted by the population to members of the Boards of institutions.
At first glance, we could assess that Bill 15 gives more space to users with regard to the CAs of future territorial establishments (the current CISSSs and CIUSSSs), since there will be 5 of them out of 11 members. However, it should be noted that the role of these CAs will be limited to advising the CEO of the establishment whereas currently, the CAs have full powers of administration and the CEOs execute their decisions.
But it is not only the lack of participation of the population in the bodies that poses a problem from the point of view of the right to health.
In general, the population does not have explicit recognition of its ability to identify different issues that have an impact on health; nor with regard to the development of policies, programs or action plans likely to remedy it.
However, for the United Nations Committee on Economic, Social and Cultural Rights, the participation of the population in taking all health decisions is one of the essential aspects of the right to health. This implies the effective association of the community in the definition of priorities, in the planning, in the implementation and in the periodic and transparent evaluation of any strategy aimed at improving the health situation, which leads us well beyond the curative aspect alone.
The Committee also recalls that the participation of the population concerning the implementation of services and facilities makes it possible to take into account the issues of discrimination and to counter any form of systemic discrimination.
As with all human rights, the right to health imposes three categories of obligations on States: to respect, to protect and to fulfil. Consequently, the State must put in place measures to promote the participation of the population in decision-making. Among these measures, it must ensure access to all information that is crucial to protect health. The population must also have its say on the different forms that this participation should take and the State must provide it with the tools necessary for this participation.
Clearly, our health system does not meet these conditions and Bill 15, which is essentially geared towards network performance, will not allow the population to take part in the vast project currently being implemented by the government. It is not insignificant that 55 organizations denounced on May 23 the democratic deficit and the lack of consultations surrounding PL15 and the health plan. This will have an impact on the ability to ensure that policies, programs and action plans take into account the issues faced by the population and various communities in our society, issues related to the various social determinants of health.
To read on June 12: “Privatization in health: the need to re-establish the terms of the debate. »