Identifying the Perceived Health Issues & Needs of Francophones in Manitoba

Prepared by Consultation Deroche Consulting Inc.

Introduction

The purpose of Community Health Assessment (CHA) in Manitoba is to collect, analyze and present information so that the health of Manitobans can be understood and improved. CHA describes the health of a given population and tracks changes over time. It is one source of evidence that is used to inform health services planning. CHA is the responsibility of each Regional Health Authority (RHA). Over 46,000 Manitobans speak French as their mother tongue and nearly 104,000 Manitobans are bilingual. The Government of Manitoba’s policy on French-language services (FLS) applies to a certain number of administrative bodies, including the following RHAs: Assiniboine, Central, Interlake, North Eastman, Parkland, South Eastman and Winnipeg. Moreover, the French Language Services Regulation of The Regional Health Authorities Act requires the seven designated RHAs to submit a draft FLS plan for approval.

The Conseil communauté en santé du Manitoba (CCS) piloted a project called Setting the Stage, the aim of which was to develop a plan for primary health care in French. The priority to come out of the project was to assess the health status and needs of the Francophone community on an ongoing basis and incorporate the collection, analysis and interpretation of data on the health status and needs of Francophones into the CHA cycle.

The CCS, Manitoba Health and Healthy Living and the Community Health Assessment Network of Manitoba have worked closely to implement the priority measures identified in Setting the Stage. It was agreed that during the current CHA cycle, information would be gathered through focus groups in each of the seven designated RHAs. This constitutes an important and historic first step in getting a systemic handle on the health needs and status of the province’s Francophone community on an ongoing basis. Hence, the project Identifying the Perceived Health Issues and Needs of Francophones in Manitoba came into being, under the auspices of the Community Health Assessment Network’s Francophone Community Consultation Working Group (FCC Working Group). Consultation Deroche Consulting Inc. was hired to carry out the project in close co-operation with the FCC Working Group.

Methodology

The FCC Working Group oversaw the project’s implementation by validating the work plan, methodology and a preliminary analysis of emerging themes from the data collected. RHA representatives also helped organize focus groups in their regions.

The objectives of the project were to:

• identify the perceived health issues and needs of Francophones in Manitoba; and
• identify possible ways of addressing those issues and needs.

A focus group moderator’s guide was drafted with a view to collecting the desired qualitative data. A sampling plan was developed to ensure that the main target groups were represented.

In all, 20 focus groups were held in eight regions from March 16 to May 6, 2009. A total of 169 people took part in the groups. The eight regions included the seven designated RHAs, as well as the Brandon RHA, which was added to the project in March 2009.

Findings

Keeping in mind the data limitations, five findings are drawn from the focus group results:

a) The Francophone communities acknowledge a host of factors that have a positive impact on their current health and well-being.

For Francophone communities, the experience of health and well-being is closely linked to having opportunities to use French and connect with their culture in daily life. This is reflected in their identification of French-language activities, services, organizations and institutions in the areas of
education (particularly schools of the Division scolaire franco-manitobaine), health, early childhood (particularly day care centres, nursery schools and the Francophone early childhood and family centres), social environment (parishes and seniors’ clubs in particular) and culture (cultural committees in the rural areas in particular).

The Francophone communities also recognize the positive influence of the following on their health status and well-being: physical environment (particularly sports and leisure infrastructure, natural resources, housing and transportation), health programs and services in general, sports and leisure activities, and community support and help.

b) Manitoba’s Francophone community is heterogeneous.

While there are similarities between the province’s Francophone communities, it is also important to recognize that there are differences that must be taken into consideration in the assessment, planning and implementation of measures.

c) Francophone communities want greater access to services that will enable them to develop at various levels in their own language and culture and thereby positively influence their health and well-being.

Some of the challenges and gaps that adversely affect the health of the Francophone communities surveyed are directly related to access to services in French in the context of an evolving Franco- Manitoban community that is seeing an increase in the number of exogamous families and French speaking newcomers and a decrease in the proportion of Francophones in some communities. The changing face of the Francophone community underscores the urgency of adapting and bolstering efforts to allow the Francophone community to live in French.

Health Services

The issue of French-language health services was cited as a significant concern in a context where seven of the RHAs involved are designated to offer FLS. Even in the Brandon region, which is not designated, the Shilo focus group argued that there were substantial needs in this regard. Participants in the various regions suggested a number of measures, particularly in the following areas: recruitment and retention of Francophone and bilingual health professionals; availability and accessibility of French language health services; and active offer, in the context of the FLS plans and policies of designated RHAs. All regions, with the exception of Assiniboine and the Interlake, mentioned the importance of mental health services in French, of being able to communicate in one’s mother tongue “when you want to get something off your chest,” as well as the lack of access to health promotion programs and information in French.

The results highlight the impact of the environment in which health services are provided on the demand for and offer of FLS. When services are offered in a Francophone community or setting, people are more likely to request services in French and providers are more likely to offer services in that language.

Early Childhood Development

The availability of programs, services and resources in French for children 0 to 5 years of age and their families, including the availability of qualified staff able to provide programs and services, was a concern for most regions. It is recognized that early childhood is a critical stage of development that has long-term effects on a child’s life. The creation of Francophone early childhood centres in some Francophone communities by the Coalition francophone de la petite enfance du Manitoba [Francophone early childhood coalition of Manitoba] is a step in the right direction. This needs to be built on to ensure access to French-language programs and services in all Francophone communities.

d) Francophone communities want to innovate and help one another identify and implement measures to improve access to French-language health services.

In their suggestions aimed at increasing the availability and accessibility of French-language health services, the Francophone communities showed keen interest in thinking outside the box, building on previous gains throughout the province and maximizing the use of limited resources. Any action taken in the future would require co-operation between Francophone communities, French-speaking professionals and the RHAs. The communities stated they want to be an integral part of the process to find solutions.

Suggestions related to service delivery models included a mobile multidisciplinary team that travels throughout the province and uses Telehealth, the purchase of services across regions, satellite clinics within regions and the expansion of French-language/bilingual primary health care centres. Participants were also very interested in a strategy for recruiting, retaining and training Francophone and bilingual health professionals, and this, of course, is also the focus of efforts by the CCS and its partners. Such a strategy would have to be multi-pronged and include such things as an assessment plan, the promotion of health careers, post-secondary training, recruitment and retention. The FLS plans and policies of the designated RHAs is also a concern. The Francophone communities want to work and continue to work with the Province and RHAs to find realistic ways of implementing the FLS plans in order to ensure active offer of FLS in their communities. Action is needed both in terms of offer of and request for French-language health services. Promotion and awareness-building efforts geared to the public and health service providers and managers must continue.

The Brandon region is starting at square one. The question there is how the Brandon RHA can work with the Francophone school and daycare centre in Shilo to begin addressing the most basic needs such as identifying the services that are available in French.

e) The community development approach used contributed to the successful planning and implementation of the project.

The success of the Identifying the Perceived Health Issues and Needs of Francophones in Manitoba initiative is largely attributable to the community development approach that was adopted.First, it was the designated RHAs that came together to create the FCC Working Group and that soughtthe support of Manitoba Health and Healthy Living. The FCC Working Group also collaborated with theCCS, which represents the Francophone community in health and social service matters, to help get theproject started.

Second, participants were recruited through existing organizational structures and community networks in the target Francophone communities, which helped to ensure community participation in the focus groups. The co-operation between the RHAs and the communities in organizing the focus groups was exemplary.

Lastly, the focus group participants expressed gratitude for the RHAs’ commitment to consult them for recommendations, ideas, opinions and perceptions in this first historic study, which gives the RHAs in question a starting point for reflection.

Recommendations

Based on the study’s findings, recommendations to the FCC Working Group are as follows:

1. Read the final report and determine what needs to be done next;
2. Release the final report at the provincial level;
3. Share the findings of the final report with each region;
4. Use the results of the study in the planning, delivery and evaluation of health services in the RHAs involved;
5. Meet with the CCS to conduct the necessary follow-up;
6. Determine what changes need to be made in preparation for consulting the Francophone community as part of the next CHA cycle.

Conclusion

The Identifying the Perceived Health Issues and Needs of Francophones in Manitoba project indicates that the Francophone communities consulted benefit from a wide range of factors that have a positive impact on their current health and well-being. Francophone communities want greater access to services that will enable them to develop at various levels in their own language and culture and thereby positively influence their health and well-being. Measures must take community differences into account. Francophone communities want to innovate and help one another identify and implement measures to improve access to French-language health services. They are grateful for the commitment shown by the designated RHAs to consult them for suggestions, ideas, opinions and perceptions in this first historic study, which gives the RHAs in question a starting point for reflection.

Acknowledgements

The project Identifying the Perceived Health Issues and Needs of Francophones in Manitoba was carried out with the help of a number of individuals and organizations.

We would like to thank the members of the Francophone Community Consultation Working Group of the Community Health Assessment Network of Manitoba who sponsored the project and oversaw its planning and implementation:

• Jody Allan, Assiniboine Regional Health Authority
• Paul Beaudin, Winnipeg Regional Health Authority
• Michelle Berthelette, North Eastman Health Association
• Ingrid Botting, Winnipeg Regional Health Authority
• Shelley Buchan, Regional Health Authority-Central Manitoba
• Sonia Busca Owczar, Manitoba Health and Healthy Living
• Lori Carrière, Interlake Regional Health Authority
• Maggie Campbell, Parkland Regional Health Authority
• Judy Coleman, North Eastman Health Associatio
• Suzanne Dick, North Eastman Health Associatio
• Tannis Erickson, Interlake Regional Health Authority
• Bunmi Fatoye, North Eastman Health Association
• Claudette Lahaie, Regional Health Authority-Central Manitoba
• Richard Loiselle, Manitoba Health and Healthy Living
• Dana Mohr, Winnipeg Regional Health Authority
• Ales Morga, South Eastman Health
• Stacy Oliver, Assiniboine Regional Health Authority
• Jan Roberts, South Eastman Health

We also wish to thank Nancy McPherson, Fiona Jeffries and Megan Kelly from the Brandon Regional Health Authority who organized a focus group in their region.

Thank you to everyone who helped recruit focus group participants. Special thanks to the Central and South Eastman Regional Round Tables, the manager and officers of Réseau communautaire, staff from the regional health authorities involved and the members of the participating Francophone communities.

Thank you to all the recorders who took notes at focus group meetings.

Special thanks also to Manitoba Health and Healthy Living’s translation services department.

Finally, thank you to everyone who took the time to participate in the focus groups. Your contribution was crucial to the project’s success.