I first began to work formally with Community Health Centres (CHCs) in 2004,  when I accepted a role with the Association of Ontario Health Centres (AOHC), Canada’s largest provincial CHCs association. However, my encounters with CHCs date back even further, as I would come to learn.

In 2004, I had returned to Canada from work in global health with the World Health Organization (WHO), Pan American Health Organization (PAHO) and the International Association of Providers of AIDS Care (IAPAC). Having worked internationally for several years, the opportunity to contribute to health and development at home, in Canada, was an exciting new chapter, but in accepting a role with AOHC, I admit that I wasn’t completely clear about what these Community Health Centres were and how they function.

I suppose that, like the majority of Canadians who work in health care or social services but not directly in contact with CHCs, I had a vague sense that these so-called CHCs are community support hubs that help marginalized individuals and groups, provide primary care services, and there’s something not quite “mainstream” about them.

Thankfully, in my initial conversations with the Ontario CHCs association, the way that values were communicated and our extensive discussions about connections between healthcare and social justice made it clear to me that we were on the same page.

What I very soon came to discover in working directly with Community Health Centres across Ontario is that they were actually putting into practice the sorts of solutions that, in my international work, we had always said are necessary to achieve global health and development goals. What’s more, they were integrating multiple solutions into an integrated model and approach.

CHCs in Ontario were acting in a coherent and coordinated way to address many of the important, but fragmented and siloed goals being pursued by the World Health Organization, other United Nations agencies and global NGOs around the world. These goals and priorities included such things as:

• Advancing integrated primary care teams, where practitioners with different skill sets and scopes of practice work collaboratively to wrap services around patients;
• “Task-shifting” in primary care, including the use of community health workers and peer educators as core contributors within the health system;
• Addressing the lived, social realities of individuals, families and groups as core determinants of their health;
• Increasing inter-sectoral action and coordination to make meaningful inroads in addressing social inequities; and,
• Improving civic and community participation in building healthy and inclusive communities, including helping to guide local service planning based on local priorities.

During my time in the international arena, goals such as these were hot topics. They were the focus of numerous WHO World Health Reports, the UN’s Millennium Development Goals, and various priorities at UNAIDS. They seemed ever-present. However, these goals were most often articulated and acted upon in isolation. Where they were brought into a whole, it was generally as a theoretical vision or framework. There was little focus on coordinated and integrated action mechanisms for achieving all of these goals on the ground.

In returning to Canada and beginning to work with CHCs, what was still missing from my conceptual frameworks and vocabulary was a way to discuss and describe what it looks like when these complementary pieces of the puzzle are actually brought together on the ground. It took my encounter with CHCs in Canada for an “aha moment” to occur.

Working with CHCs here in Canada, it began to dawn on me that CHCs were actually integrating and coordinating action around most of those global priority areas described above. It took seeing this in action, and coming to know it by a specific name – the « Community Health Centre » – for this to sink in. Giving name to this approach and understanding it more fully also caused me to reflect and re-consider some of my previous global health experiences.

It became clearer and clearer to me that I was not actually coming into contact with something new via CHCs in Canada. I just had a proper name, conceptual framework, and vocabulary for this model and approach, the « Community Health Centre ».

Many of my experiences in the international arena now started to come back to me in new light.  I realized that there was an actual name and way to describe some of the multi-faceted local health and social initiatives I had witnessed around the world. Unbeknownst to me then, I had been witnessing “Community Health Centres” in action. They had simply not been called a “Community Health Centre” nor was this used as a frame of reference. But that’s what they were.

I could now see that the inspirational work of Project Reach Out Mbuya, in Kampala, Uganda, with its integrated focus on primary care (priority on HIV prevention and care), micro-finance and poverty-reduction, community gardens and food security, and advocacy with local government, was a “Community Health Centre”. Reach Out Mbuya had never been described as a CHC during my visits with them, but that’s what it was.

I could also see that the cervical cancer screening and treatment work that I had done in Peru, via the PAHO-coordinated Project TATI was grounded in a Community Health Centre approach. This project had documented the impact of community participation in directing health services and peer-led health promotion in improving uptake of cervical cancer screening and treatment. It recommended these be embedded in primary health care service organizations.

It really is amazing how giving name to something and identifying a model/framework can bring things together. Giving a name to this successful model of community-based primary health care was a pivotal development for me, and something that enabled me to find coherence between my previous global work and my work with Ontario’s CHCs. It has provided me a clarity of vision and purpose, and has helped me to better connect local, national and global action on health and human development.

Fast forward to 2013. I feel very fortunate that in my current role with the Canadian Association of Community Health Centres (CACHC) not only are we focused on increasing access to CHCs for Canadians, but also working collaboratively with global partners to share innovative practices among CHCs in different parts of the world.

Both in Canada and globally, the fact that Community Health Centres remain a well-kept secret in health care is something that confounds those of us who have experienced CHCs.

In the U.S., our colleagues are fond of saying: « there are two types of folks, those who love CHCs and those who don’t yet know CHCs ». In Canada, we often call CHCs « Medicare’s best kept secret. » We are working hard to let the secret out, fueled by evidence and lived experiences all pointing to the fact that the Community Health Centre model holds immense potential to make inroads on many of our most pressing health and social challenges across Canada.

The idea of Community Health Centres is far from new and it is not isolated to one country or region. The first CHC in Canada — Mount Carmel Clinic, in Winnipeg — was actually established in 1926. In the U.S., a national network of CHCs was born out of two CHCs that were established in the 1960s as part of the war on poverty, inspired by CHCs in South Africa.

Community Health Centres can be also found in China, India, throughout Europe,  Brazil and elsewhere. Historically, CHCs have been rooted in the concepts of social medicine and community-oriented primary care. There is some lineage to be traced between CHCs in one region and another, including the import of the CHC concept to the United States from South Africa, and to Belgium from Québec. However, the CHC vision and model have most often sprouted in one region isolated from CHCs sprouting up elsewhere at approximately the same time. This is surely one sign of a great and virtuous idea. It seems to me that this can be attributed to the basic fact that healthcare and community stakeholders in different jurisdictions are working earnestly to do what they can with what limited resources they’ve got, and ultimately arrive at a similar conclusion: that an integrated and inter-sectoral model of healthcare and social supports, addressing people’s diverse health and social needs in an integrated way, is the best and most sustainable way to improve health outcomes and build better societies.

The global movement of Community Health Centres is something that CACHC and our international partners are excited to be bringing to the world stage in 2013. We are currently preparing for launch of the new International Federation of Community Health Centres (IFCHC) and look forward to sharing important updates over the coming months. Stay tuned and please start connecting via the IFCHC website and Twitter accounts (English: @IFCHC and French/Spanish: @FICSC).

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Scott A. Wolfe is Executive Director of the Canadian Association of Community Health Centres and Global Coordinator of the International Federation of Community Health Centres