Unfortunately, it seems obvious that the ministerial officials and designers of the electoral program of the Coalition avenir Québec (CAQ) never took cognizance of the Alma-Ata Declaration of 1978 sponsored by the Europe regional office of the World Organization of health. In short, it is a founding text concerning the planning of primary health care on a global scale which cannot be ignored if one prides oneself on wanting to preside over the organization of care on a national territory. .
Since the Declaration of Alma-Ata, it is now universally recognized that a health system must be managed in a decentralized manner following planning requiring the participation of citizens at the local level, so that they can express their priority health needs freely, not only with regard to infrastructure, but above all with regard to actions to promote health, clean up the living environment, protect and provide care.
However, the latest announcements by the Minister of Health and those of the CAQ in an electoral context suggest a rather centralizing orientation. First, the minister recently informed us of his desire to present a legislative amendment splitting his ministry into two parts, including an independent executive branch under the responsibility of a non-elected person bearing the title of CEO. This would be a dangerous initiative that would deprive the National Assembly of direct control of half of the state budget and, as such, it would be a major democratic deficit for Quebec. What is more, the centralized management of the health system would be reinforced, in contradiction with the prescriptions of Alma-Ata, which are nevertheless globally consensual and guarantee sound health management.
Secondly, by abandoning his direct responsibilities on the network, the minister seems to be declaring his inability to restore smooth operation on the ground and possibly to abandon it to the private sector. Moreover, making changes to the functioning of a ministry, while the problems reside in the network, would it not be letting go of the prey for the shadows? Wouldn’t it be better to strengthen the first line by guaranteeing accessibility to professionals and by restructuring the network of CLSCs, first by giving citizens a voice in the planning and management of these establishments, by substantially increasing their budget and by involving the regional county municipalities (MRC)?
The role of municipalities
Why MRCs? Because municipalities are already major players in health through their responsibilities for environmental sanitation, drinking water supply and fluoridation, through their essential role in housing, protection and the well-being of the most disadvantaged. A few years ago, several of them voluntarily joined the “Healthy Cities and Villages” movement, thus demonstrating their desire to actively participate in the well-being of the population. And as if by chance, outside the major centres, the CLSC territories are almost identical to the MRC territories, which reduces the difficulties of a marriage by the same amount.
Even if these comments are addressed to only one of the political parties in the electoral race, allow me in closing, to evacuate any appearance of political bias, to point out that, apart from QS which offers universal dental insurance (although it is an election promise and not a program, therefore wind more than concrete!), the health program of all the parties is unbelievably poor given the problems experienced.