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UBC Theses and Dissertations

The community health representative in Alberta : a program evaluation Gerein, Nancy Marian

Abstract

The Indians of Alberta sustain levels of health and well-being well below that of the average Canadian. Recognizing that the traditional health care system required modification for the special needs of Indians, Medical Services Branch of the Department of National Health and Welfare set up their first training program in 1962 to prepare Indian public health auxiliary workers, called Community Health Representatives. The hope was that the program would, among other things, allow Indians to be more involved in their own health care, extend the coverage of the health services and act as a vehicle to further community development of Indian reserves. To evaluate this program, the general objectives of the program and the job description of the CHR's were used to derive short-term objectives which were examined on visits to reserves. Quantitative data were not available for assessing the achievement of objectives, but interviews and observations allowed a qualitative assessment of the program's effectiveness. The activities of CHR's and Medical Services in this program were examined in the context of their "environment" - the geographic, biological, psychological, sociological and anthropological factors which are both the cause and the effect of the health status of. a people. From this very broad standpoint, a critique of the effectiveness, and the policy and direction of the program was offered. The CHR's were found to be functioning in varying modes, with varying levels of effectiveness. Most carried out traditional public health nursing, acting mainly as assistants to the nurses. A few had a more political bent and were involved with committee work, the Band Council and general development on the reserve. Health services may he extended by this program, but the goals of community development and community involvement in health care are achieved to a markedly less extent. Several situational and policy variables which may account for this are put forward. The program is seen to be too small and too isolated from wider events in the political and health spheres to have had any great impact on Indian development and health. The resources available to the CHR program from within Medical Services have been scant, and the program has developed few relationships with outside agencies, especially a similar provincial program. The political and social isolation of Indians in Canada is echoed by the isolation of this program within the Department of National Health and Welfare and the province. The program's potential of improving Indian health, of acting as a lever to general development, of encouraging Indians to train and work in the health field to eventually have Indians in control of their health service, has not nearly been met. The political uncertainties surrounding Indian affairs make it difficult to foresee the results of any decisions. However, if the Indian health service and this program eventually become the responsibility of the province, the scope and circumstances under which it will be operating will broaden. The advantages of having the large provincial service's resources available to the program will be great, and the possibility of closer integration with Indian and regional development will arise. The most precious asset of the program, its flexibility, its ability to adapt to individual communities, must be carefully maintained. Thinking about these potentials and preparation for such changes should start now.

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