Addressing rural and Indigenous health inequities in Canada through socially accountable health partnerships

Abstract

Background: There are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia. This was achieved using partnerships in British Columbia, Canada, where the health system features inequities in service and outcomes for rural and Indigenous populations. Social accountability is achieved when all stakeholders come together simultaneously as partners and agree on a path forward. This approach has enabled socially accountable healthcare, effecting change in the healthcare system by addressing the needs of the population.

Innovation: Our innovative approach uses social accountability engagement to counteract persistent health inequities. This involves an adaptation of the Boelen Health Partnership model (policymakers, health administrators, health professionals, academics and community members) extended by addition of linked sectors (eg, industry and not-for-profits) to the 'Partnership Pentagram Plus'. We used appreciative inquiry and deliberative dialogue focused on the rural scale and integrating Indigenous ways of knowing along with western scientific traditions ('two-eyed seeing'). Using this approach, partners are brought together to identify common interests and direction as a learning community. Equitable engagement and provision of space as 'peers' and 'partners' were key to this process. Groups with varying perspectives came together to create solutions, building on existing strengths and new collaborative approaches to address specific issues in the community and health services delivery. A resulting provincial table reflecting the Pentagram Plus model has fostered policies and practices over the last 3 years that have resulted in meaningful collaborations for health service change.

Conclusion: This paper presents the application of the 'Partnership Pentagram Plus' approach and uses appreciative inquiry and deliberative dialogue to bring about practical and positive change to rural and Indigenous communities.

Keywords: change management; clinical governance; health policy; human resource management; international health services.

Figure 1

Partnership Pentagram.

Figure 2

Partnership Pentagram Plus.

Figure 3

Scapegoats for collective failure.

Figure 4

Application at a microlevel.

Figure 5

Breathing and weaving.

Figure 6

Application at a macrolevel. FNHA, First Nations Health Authority; RCCbc, Rural Coordination Centre of British Columbia.

Figure 7

Application at a mesolevel. FNHA, First Nations Health Authority; RCCbc, Rural Coordination Centre of British Columbia.