The definition of primary healthcareapproved at the 1978 Alma Ata conference of the World Health Organization (p. 21) stated that:
Primary healthcare is essential healthcare based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self- determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family, and community with the nation- al health system bringing healthcare as close as possible to where the people live and work, and constitutes the first element of a continuing healthcare process.
addressed in these representations—and retention and the quality of the professional practice envi- ronment soon became priority policy areas for CNA.
CNA’s formal presentations and effective behind-the-scenes lobbying played a key role in helping to build and launch a pan-Canadian agenda in the area of nursing and health human resources still playing out in 2008. Emerging from the chaos of 1990s system downsizing, CNA approached Canada’s federal government in 1998 with its brief entitled, “The Quiet Crisis,” in which it made plain the asso- ciation’s growing concern about a looming shortage of nurses and the need to bolster the academic and practice foundations of nursing for what looked like a rocky journey ahead. CNA’s lobbying helped prompt the establishment of the new federal Office of Nursing Policy at Health Canada in 1999, mirrored in the following years by the appointment of “chief nurses” and senior nurse advisor positions in the provincial governments of Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Saskatchewan, and British Columbia. Other provincial governments also employed nurse advisors under various titles.
That agenda soon gave rise to a roster of pan-Canadian nursing initiatives unprecedented in number and scope, including the Nursing Strategy for Canada (Advisory Committee on Health Human Resources, 2000), Canadian Nursing Advisory Committee (2002), National Sector/Occupational Sector Study of Nursing (2006; “Phase II Final Report” is posted on CNA’s Web site) and establishment of a decade-long, $25 million national nursing research fund. The Nursing Strategy for Canada and Canadian Nursing Advisory Committee prompted the governments of sev- eral provinces and territories to develop comprehensive plans to address nursing human resources— and the topic of nursing recruitment and retention was established as a regular item on the federal, provincial, and territorial policy agenda for health ministers.
The importance of the broader health human resources agenda, including the issue of healthy work environments, was reflected in the 2003 First Ministers’ Accord on Healthcare Renewal wherein some $90 million in funding was directed to the issue of health human resources with particular atten- tion to healthy workplaces, interprofessional education and collaborative practice, and recruitment and retention. CNA urged a principles-based HHR planning framework as outlined in “Toward a Pan- Canadian Framework for Health Human Resources: A Green Paper” and in its position statement, “National Planning for Human Resources in the Health Sector.” CNA led the steering committee for the Diagnostic Phase for Internationally Educated Nurses national project. And to keep in close touch with policy decision makers and the larger healthcare community of key issues, CNA hosts the ongo- ing Knowledge Series, a monthly, multistakeholder policy discussion to examine specific issues related to health human resources. As a result of the ongoing leadership and collaborative actions of CNA, challenges related to the demand for nursing services and supply of nurses to provide them in 2008 are familiar not only to nurses but to employers, governments, other providers, and the public across the country.
Examples of other key areas of public policy work at the national level during this decade include: ● Primary Healthcare and Determinants of Health; Primary Healthcare Transition Fund
Initiatives—Interprofessional Collaboration
● Enhancing Interdisciplinary Collaboration in Primary Healthcare ● Canadian Nurse Practitioner Initiative
● First Ministers’ 10-Year Plan to Strengthen Healthcare
● CNA was an active participant at the first ministers’ meeting held in September 2004. In prepa- ration for this meeting, CNA collaborated with the Canadian Healthcare Association, Canadian Medical Association, and Canadian Pharmacists Association on joint policy and media relations initiatives. This work included the preparation and dissemination of the document, “Common Vision for the Canadian Health System,” media interviews, media statements, and media releases as well as on-site participation during the meeting.
● Emergency Preparedness (disasters, pandemics)
● CNA has been a partner (with the Canadian Health Services Research Foundation [CHSRF], Canadian College of Health Service Executives, Canadian Medical Association, and a consor- tium of Quebec partners represented by the Agence d’évaluation des technologies et des modes d’intervention en santé) in the creation and promotion of the EXTRA Program—created to help Canadian healthcare executives from all backgrounds use existing research to make evidence-based decisions in their day-to-day decision making.