In 2014, Sioux Lookout First Nation Health Authority (SLFNHA) and Dignitas International (DI), a leading Canadian medical and research organization, launched a partnership to support the development of First Nations-led solutions to health inequities experienced by people living in remote SLA communities. Based on the complementary knowledge and experience of both organizations, SLFNHA and DI co-designed and are presently implementing a CHW pilot program in four communities: Kingfisher Lake, Kitchenuhmaykoosib Inninuwug, Slate Falls and Kasabonika Lake (2,400 total population). This three year project (2014-2017) was funded by the Ontario Ministry of Health and Long Term Care’s Health System Research Fund Capacity Awards.
CHWs in the pilot program are employed by First Nation Band Councils and supported by existing Health Canada programs – Community Health Representatives (CHRs) and Aboriginal Diabetes Initiative Workers (ADIs).
CHW is a catchall term for any layperson working in health care. A CHW is a community health aide that is selected from the community in which they serve. They do not have formal training like clinicians (MDs, RNs, RPNs, etc), but they do have some training, and often work as frontline workers in health care. They frequently act as advocates and as agents of social change. CHWs are used globally for a variety of programs. For more detailed information about CHWs, see our Global Case Studies.
Key Elements of the Pilot Program
Delivery of evidence-based diabetes care within a multidisciplinary team environment at the community level that emphasizes the role of CHWs within the patient’s circle of care providers;
Developing locally-customized, community-governed approaches to the implementation, evaluation and knowledge-sharing of the program.
- 2014: The CHW pilot program was launched with an initial phase of gathering best practice evidence from seven leading global CHW programs.
- August 2015: Findings were shared with SLA community health leadership and were used as a framework to develop a customized pilot program and training curriculum.
- February 2016: Implementation of the SLA CHW pilot program began with the training of CHWs from the four pilot communities on the customized Diabetes Treatment Support curriculum.
Future Plans to Scale Up
Over the next 5 years, SLFNHA and DI plan to enhance and expand the CHW Diabetes Program by:
- Implementing the Program across all 33 SLA communities and using it as a foundation to develop a regional diabetes strategy
- Recruiting and building the capacity of new community-based human resources to support CHW supervision, training and mentorship, and land-based education
- Expanding the Program training curriculum and on-the-job tools so CHWs can provide more holistic support to people living with diabetes, guide community health promotion initiatives, and contribute to building community data management and reporting systems
The CHW Diabetes Program will be supported by scientific evaluation and knowledge transfer and exchange (KTE) activities that generate evidence-based learning, which is fed into the Program to support continuous improvement throughout the scale-up process.