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The Context

Since the beginning of the decade, there has been increasing concern on the part of government, the medical profession and consumers about the sustainability of funding and services in the health care system. Preserving the uniquely Canadian and broadly supported Canada Health Act and its five principles (universality, accessibility, comprehensiveness, portability, and public administration) was a challenge that could not be overlooked by federal and provincial governments.

In many regions of the country, health reform became the byword for "saving" the health care system. In several provinces, health reform came to mean regionalization with the intended goal of bringing health care decisions closer to those affected, i.e. the community.

Regionalisation was expected to facilitate a new approach to health care that would improve health services delivery while doing so with greater economic efficiency. Proponents of regionalization pointed to the following as some of the anticipated benefits of the new approach:

• better integration of the system so that decisions are no longer made in isolation;
  
  
• a move towards a holistic approach to health care;
  
  
• a shift in emphasis from a treatment-based system to a preventative one;
  
  
• a better fit between services and the needs of the community; and
  
  
• a reduction in the use of high cost acute care services in favor of community based services.

In Manitoba, the first policy position developed by the Manitoba government on health reform appeared in Quality Health for Manitobans - the Action Plan: A Strategy to assure the future of Manitoba's health services system in 1992. This was followed by the establishment of the Northern and Rural Health Advisory Council which reported to the Minister of Health in December 1995 on issues related to renewal of health services in rural and northern Manitoba. In June 1996, Bill 49 (The Regional Health Authorities and Consequential Amendments Act) was released for public comment and came into effect on April 1, 1997.

From a woman's perspective, the reshaping of the health system offers both potential opportunities and problems. Individual women and women's groups have long been concerned that issues related to women's health were down-played, overlooked or disrespected in the traditional health care system. For women, reshaping the face of health care is a two-edged sword. A "new" system offers the opportunity for a different philosophical approach that should be open to exploring the specific needs of women. On the other hand, there is the risk of women's special health needs once again getting lost in the shuffle.

The fact that the governing bodies of the regional health authorities are comprised of community members makes it possible for women to have direct input into decisions that will affect them. On the other hand, a system in the throes of change runs the risk of focussing more on process than outcome. If this were to happen in health reform, some of the gains made in women's health could be lost.

Depending on the composition of the governing and advisory boards and the prevailing attitudes of the community in each region, women run the risk of losing services or having their needs overlooked (for example, in the area of reproductive services).

A number of women's groups/organizations -- Manitoba Women's Institute (MWI); Manitoba Women's Advisory Council (MWAC); United Nations Platform for Action Committee (UNPAC); Provincial Council of Women (PCW); Women's Health Clinic -- have had a long history of advocating for woman-sensitive, community-based services and working on a variety of women's health issues such as midwifery, new reproductive technologies and smoking cessation.

To women who had been involved in women's health issues in Manitoba, it became increasingly obvious by 1996 that the provincial government was moving ahead quickly with its plans for radical changes to health services in the province. These women recognized it was imperative for women to have a voice in the change and any subsequent decision-making structure(s) which would evolve from the reform process. In order to have an effective voice, women needed to become informed about the implications, both positive and negative, of the intended health care reforms and, specifically, regionalization.

(C)1997,1998 by The Women's Health Clinic Of Manitoba

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