What is a clsc?

From: Jacques Fournier [clscoues@microtec.net]

Here is a translation of the text written by Jacques Fournier, editor of Interaction communautaire and sent last Friday to all the ICCD participants.

Interaction communautaire is a quarterly published by the RQIIAC which is the organisation of community action professionals working in the local centres of community and health services (CLSC in french) of Quebec (Canada).

Introduction

The following text is a presentation of CLSC. CLSC are a very original health and social services institution created in this beautiful country of Quebec (which we wish you will be visiting in june 2000, while coming to the International Conference on Community Development (ICCD)).CLSC were created in 1972 following a report from the Castonguay-Nepveu inquiry commission. This commissison indeed suggested many big changes in Quebec's health and social services system.

First: health and social services, taken in charge by two different ministries, should be merged. Why? : Researchers had shown the relationship between health and social problems such as poverty.

Second: a para-governmental institution should be created in order to establish the relationship between the two aspects of the problem. Indeed, other public institutions were only in charge of one aspect of the problem: either health or social problems (for instance hospitals or centres of social services for children).

A para-governmental institution

Therefore, CLSC are para-governmental institutions entirely financed by Quebec's government. There are 146 CLSC in Quebec, each one providing services to about a pool of 50 000 persons in average. The whole territory of Quebec is covered.

Preventing and curing

CLSC have both prevention (vaccination, prenatal course, community action, local development…) and curation (medical, psychosocial consultation, services to elders…) objectives.

Practioners working in CLSC are not payed for each consultation but receive monthly salary. A study of Marc Renaud and al. has shown that consultations in CLSC are longer and involve in depth study of the patient, also more practical ways to cure oneself are suggested compared to the consultations in private clinics.

About 15 kinds of professionals are working in CLSC: doctors, psychologists, social and family workers for elders, handicaped or sick people, nutritionists, ergotherapists, inhalotherapists, physiotherapists, hygienists, community organisers, social workers… Interdisciplinary and team work are encouraged.

Programs and Services

A few services offered by a CLSC:

- medical and psychological consultation - laboratory tests and analyses - vaccination for children - early diagnosis of visual and auditive problems - nursing and social services in schools - clean seringes and condoms distribution - 24 hours/day, 7 days/week info line on health - stay in home services for elders, handicaped, sick people - information and references about local resources

A few programs offered:

- prenatal course for mothers at risk (due to poverty, lack of schooling…) - distribution of food supplement (eggs, milk, oranges) for mother at risk - workshops to improve parents-children relationship - dental hygiene program in school - clinic for 12-20 years-old: STM-aids and unwanted pregnancy prevention - health at work - mental health program - breast cancer early diagnosis - community action: support local milieu dynamism, the creation of community organisations and social economy enterprises, local development project, milieu oriented approaches…

Administration Council:

Each CLSC are managed by an administration council of 11 persons. Five of them are elected every three years by the residents of the territory of each CLSC. These five then call upon two other members (coopted members), three members are elected by the staff and the Director of the CLSC.

Stop the mergers!

Recently, about half of the clsc have been merged with long term housing and medical services centres for elders (CHSLD) and even hospitals. The Ministry of Health and social services thinks both the CLSC and CHSLD are forefront facilities, whereas many people think that CHSLD are secondfront, and thus they should not be merged with CLSC. Nothing is perfect of course… The Ministrie's technocrats know little about the real on-field conditions; this prevent us from having the necessary tools to work with and for the population.

On this theme you will find the excellent text (in french) of Paul Lamarche at: http://www.csn.qc.ca/Pageshtml116/CLSCCollCSNLamarche.html

Under Financement

CLSC have a budget of $800 milions out of a total of $12 billions for the entire health and social services system. They have therefore 7% of the budget while they should get 10 to 12% to complete the mandate given by the Ministry. However, the social and health cuts are making CLSC more and more popular.

History:

See http://www.clsc-chsld.qc.ca/clsc/CLSChistoire.html (in french)

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CIAC 2000
5700, chemin de la Côte-des-Neiges
Montréal, Québec
H3T 2A8
CANADA
tel: (514) 731-8531
fax: (514) 731-9600
e-mail : ciac@cam.org