The Lower North Shore consists of fourteen isolated and vulnerable communities, with a population of less than six thousand, spread over an area of 235 miles on the north east side of Quebec, about 800 miles from Quebec City. Modes of transportation include airlines, a coastal ship and ferry service (eastern communities) in the summer months and snowmobiles during the winter season. The main health center is located in Lourdes de Blanc Sablon, for most specialized needs or emergencies; patients have to travel to Sept-Iles, Rimouski, Quebec, and Montreal or to St. Anthony, Newfoundland. The language predominately spoken is English, two of the fourteen communities are mainly French speaking, and a third community speaks both French and English.
The Coasters Association has been working on the Networking and Partnership Initiative (NPI) since October 2004. The direction of the new NPI guidebook fits perfectly into the context and framework that the Coasters Association has been developing for the last nine (9) years. Networking Unit Development, representation, knowledge development, adapting services and addressing the health determinants and community leadership have been the cornerstones of our theory of change. Outlined below are some of our key successes, as well as areas of development for the next four (4) years.
The Coasters Association strategic plan has outlined the improvement of access to Health and Social Services as one of its key objectives. In the past nine (9) years the network (Lower North Shore Coalition for Health) has developed a strategic plan and sustainability plan where partners have committed to developing and maintaining a long term and sustainable Regional Health Network. In the past year four (4) years new regional sub networks have developed (i.e. Education Network, Exchange Network and the Regional Task Force for Social Development).
The LNSCH has expressed their commitment for developing and maintaining a long term and sustainable Strategic Plan and Sustainability Plan. Through the network evaluation there are areas that the network would need further development (i.e. communication, planning, structure, etc…). Over the next four (4) years the LNSCH network will implement a training component as part of their meetings to further develop the capacity of its members.
The Exchange network, which was established so that the staff of all the LNSCH partner organizations and institutions could have improved opportunity for sharing and collaboration on regional files will have to be further, developed. This network will have to implement more areas of improvement and discussions will have to be held with its members on how the network could be improved and a plan to implement these improvements.
The Education Network that acts as a sub network to manage the McGill programs will need to develop a new strategic plan and discuss areas for improvement.
The need for additional local networks (local action groups) and improved support to existing local networks to aid the Coasters Association in improving H & SS access has also been established. Therefore, additional resources are required to keep these strategies moving forward.
The LNSCH has tried to align themselves with local, regional, provincial organizations and institutions through representation and have been quite successful. The Lower North Shore has a representative on the Provincial Health Committee, Regional Access Committee, the Agency, Council Regional des Elus (CRE) Cote Nord, Unité de loisir et de sport (URLS), Carrefour Jeunesse, Regional,PLAN D’ACTION RÉGIONAL POUR LA SOLIDARITÉ ET L’INCLUSION SOCIALE DE LA CÔTE-NORD (PARSIS) committee, Seniors table for the Cote Nord Region, plus many more. This improved representation has allowed access to knowledge of programs and files and has given the Lower North Shore a voice to raise concerns and provide valuable feedback when decisions are being made.
In the next four (4) years we foresee the maintenance of the representation on these committees, as well as trying to improve information sharing from these representatives to the local groups and residents within the population. The LNSCH also has to set a strategic direction as to what they would like to accomplish at these decision and advisory structures that are identified as important decision making bodies.
Much data and information has been collected in order to measure the health and social issues of the Lower North Shore. However, the communities find it difficult to explain the actual situations to federal and provincial government agencies, due to the lack of recognition of what they want to change in regards to behaviors. Also, many of the communities lack the capacities to take the knowledge gained from these studies, plans, etc…and take them to an action/implementation phase. The LNSCH has undertaken a process called Vision 20-20, this process will include reviewing all plans, consultation, research documents, etc…and work with the community leaders to develop an action plan to “get the work done”. A research paper done in 1979 by the Parti Quebecois popularly referred to as the Payne Report, depicts a very sad reality for the Lower North Shore; unfortunately, since 1979 many of the needs of the Lower North Shore are still the same and, in some cases, the situations have gotten worse. Throughout the next four years, the LNSCH will work with all partners to develop an eco systemic approach in order to develop a collective impact initiative. Partners will also establish agreed upon indicators and systems of evaluation across sectors. Mechanisms for establishing the measurement of indicators will be done through inter-displinary teams (i.e. education, health community, municipal, etc…). This vision is to accomplish the measurable results by 2020.
A restructuring process will also be undertaken for the management structure of certain initiatives (i.e. Quebec en Forme, Réunir Réussir (R2), Avenier d’enfants, Senior Day Centers, etc…). Through this restructuring we hope to obtain better collective results.
Adapting Services and addressing health determinants
In the past nine (9) years the networking table, Lower North Shore Coalition for Health (LNSCH), has grown and their dossiers have expanded. In 2012, the LNSCH revisited its priority areas and established six (6) priorities based on the clinical projects of the CSSSBCN (Seniors and those with loss of autonomy, Youth and families, Mental health, Physical disability, Intellectual disability and development disorders, and Dependencies). The Coasters Association and LNSCH have been working diligently to improve access in these six (6) areas. This was done mainly as a way to better serve the population and look at integration of physical and public health philosophies in all the work that is being carried out by the LNSCH.
There have been many successes in the last nine (9) years in terms of establishing programs and services in the communities throughout the Lower North Shore. Now that the structures and platforms (i.e. Senior Day Centers, Daycares, Basse Cote Nord en Forme, KIDS Summer Camp programs, training, Health Prevention Promotion Programs, etc…) are in place to better serve the population, the partners have to gain understanding of some of the underlying health determinants affecting our population.
In the next four (4) years the LNSCH will work with local foundations to establish a sustainable structure for the established programs and ascertain the gaps that currently exist in regard to programming and adapted services. The gaps identified will be addressed and sustainability of existing programs will be established.
The LNSCH has accepted to support, and in some cases manage, various programs and initiatives (i.e. Senior Day Centers, Avenir d’enfants, Community Health Education Program, Networking and Partnership Initiative, Health Prevention and Promotion, KIDS Summer Camp Program, McGill program, Réunir Réussir (R2), Quebec en Forme). As a partner on the LNSCH the acting fiduciary is the Coasters Association. The combined, on average, of funds managed annually is approximately $670,000.00. The LNSCH and the Coasters Association have decided on a path that determines communities will need to be implicated in the management of these programs to become sustainable. In order to further develop the management structure of advisory and local action groups, their leadership skills have to be strengthened.
In the last year, great strides have been made to increase the capacity of our local Regional Foundations (i.e. Uni Aide Foundation and Dr. Camille Marcoux Foundation) to be able to better serve the population of the Lower North Shore. Many accomplishments have been made through the development of these networks and foundations (i.e. Financial and training assessment of all the community organizations on the territory, new regionally formed board for Uni Aide Foundation, etc…).
Strategic plans have to be put in place for the LNSCH and Uni Aide Foundation. A Financial Sustainability Plan will need to be finalized and implemented for the establishment of a Social Program Fund, that will support vulnerable social programs (i.e. KIDS Summer Camp, Senior Day Centers, Youth Centers, etc…), groups and services throughout the territory.
In the last two (2) years the LNSCH has been working with the TAMARACK organization in order to understand the poverty issues on the Lower North Shore and create benchmarks in behavioral change. TAMARACK offers support to communities with poverty statuses through an initiative called Vibrant Communities of which the Lower North Shore Exchange Network will become a member. The Vibrant Communities initiative will provide valuable support to initiate and move forward the efforts of those who wish to improve the health and social services system on the Lower North Shore. The LNSCH and Exchange Network have realized that community leadership, support and cooperation are necessary in order to succeed and create sustainable results. This next step would mark a significant milestone in the creation of behavioral change benchmarks and indicators in order to monitor the implementation of the LNSCH Strategic Plan.
Through research and community consultations, it is become obvious that action must be taken to build lasting community leadership capacity that continues to involve the community, and to prepare a strong developmental evaluation framework that will yield lasting healthy behavioral changes within the population.
As the network moves forward, the goal is to better understand the dynamics that poverty plays on the communities of the Lower North Shore and addresses the deep-rooted behavioural changes needed to make lasting healthy lifestyle changes.
As a result of the revised situation it is evident that ongoing resources and support are required to further advance the above mentioned immediate results to yield long term and sustainable commitments to improve the Health and Social Services of the Lower North Shore.
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