Concerns over gender and geographical imbalances at the decision-making levels must be addressed. Women at the meetings were concerned about the lack of women appointed to the regional health authority (RHA) boards. This was noted in Dauphin, particularly, where only four women were appointed to the board of the Parkland RHA. Various formulas were suggested to ensure gender parity on the boards. Some felt that RHA boards should have been elected, but that in any event, 50 percent of the available positions should have been guaranteed to women. There was also a concern expressed about the lack of diversity in the composition of the boards in terms of racial, cultural, ethnic and socio-economic representation. Addressing these concerns will require communication with not only RHA boards but government members as well.

In both regions, a keen interest was shown in establishing a women's health advisory committee in each RHA and at the provincial level. It was noted that the WHRWG had requested that this be included in the legislation and regulations governing the regional health authorities.

The reality of participating on such committees, or RHA boards and councils, however, did not escape the participants. Without adequate financial and networking support, many women will be excluded from participating because of their inability to assume the very real costs associated with their participation (ie. day care; one more uncompensated activity to add to an already full schedule). There was also concern expressed that if provisions were not made to compensate women for these costs, only the voices of a privileged few would be heard during the health reform process.

The participants recommended that women consumers representing cultural, racial, and socio-economic diversity, as well as those demonstrating gender sensitivity and an ability to focus on prevention and health promotion, be selected for appointment.

The lack of gender representation on the RHA boards and the lack of guarantees that equal representation would be provided for in the composition of advisory councils resulted in the participants expressing a certain amount of cynicism regarding the provincial government's intentions. They questioned its ability to move progressively with a reform of the health system that would integrate preventive health initiatives with traditional acute and long term care to more fully meet the needs of the community.

During small group discussions, it was noted that most health care cutbacks more directly affect women because of the numbers employed in health services as nurses and nurses' aids, or in mental health and social services. This was seen as contributing to the loss of women's voices in the health reform process.

Privatization and for-profit services were not perceived to offer the same quality of care and access. In many cases, cutbacks and hospital closures, without an offsetting increase in community services, placed an additional burden on the family and, in particular, on women in their caretaking role.

Representatives from the Immigrant Women's Association reported that immigrant women are especially vulnerable because of language barriers and cultural/familial isolation. An example was given at the Thompson workshop of an immigrant woman, with very limited English language skills, whose child's serious illness was misdiagnosed for a year because she and the physician could not communicate clearly with each other.

In assessing the outcomes of the two workshops, it was apparent that once women focussed on the global issue of health reform they shared the perspective of the Winnipeg-based WHRWG as expressed by the group's four goals (see p. 4). The fact that both rural and urban women recognized the need for increased outreach, networking, education and dialogue on the subject of health reform indicates that women throughout the province share similar levels of awareness about the health reform process and its implications.

The difference between rural and urban women is in their ready access to organizations and support groups that can assist them in meeting their goals. Not only does distance/geographic isolation make it difficult (and often costly) for women in rural and northern Manitoba to access information, but established channels with a female-focus do not exist to the same extent as they do in the province's urban centres. Urban women have more ready access to "female friendly" groups, and often they can more easily access those familiar with the health system whether they be health professionals or government staff.

The workshop process itself underscored the importance of providing the community with information/education about health reform and regionalisation. During both sessions, the initial focus of the participants was on what was lacking or what needed improvement with respect to health care. As the meeting progressed, though, the focus gradually changed to a more global perspective -- specifically what was required to ensure that the newly developing system would accommodate the needs of women. Without a basic awareness of the elements of the health reform process, it is difficult for people to contribute knowledgeably to a reshaping of the system.