Accessing basic health services in the Canadian Arctic has continued to be a challenge to meet United Nations and Canadian standards for Indigenous peoples right to access health services.
In Nunavut, part of Canada’s Arctic region, 25 remote fly-in communities exist in some of the most sparsely populated and harshest conditions on earth. Diminished access or absence of basic health services such as diagnostic imaging and staff resources in remote settings can have a detrimental effect on patient care, and health outcomes. A community-based x-ray training program, using a task shifting model was started in 2018 across Nunavut to increase capacity, access and quality of diagnostic services in the communities.
Task shifting is a process that maximizes available human resources in under serviced populations. It is used to fill staffing shortages and skill gaps in health services by redistributing workload and functions normally performed by specific healthcare professionals, to other professionals or community members that don’t carry a traditional qualification. Health services tasks can be shifted between professional groups such as specialist physicians, general practice physicians, nurses, midwives, and non-professional groups such as administrative support staff and general community members.
In Nunavut, permanent residents of a community who are already employed at the health centre receive the specialized training to provide basic x-ray services that would otherwise not be available. Training local Inuit employees in the health centres has created a sustainable health human resource solution in the communities. Training transient, contracted health professionals such as physicians or nurses to perform x-rays has proven ineffective as they end up leaving the community in the short-term and the communities are left without services once again. In the absence of services, patients are forced to fly out of the communities to access at larger centres. Health centre staff receiving the task shifting program generally hold support positions such as administrative or health service assistants, custodian, or interpreters with prior education levels from grade 6 to high school graduates.
The training program supports a model that promotes local community involvement in health services delivery to its own community members. Fully trained local staff members become part of the community healthcare team and proficient providers of high-quality x-ray examinations in the communities based on established standards. Current program results have shown improved access and quality of services.
A mixed methods study to assess the effectiveness of the task shifting training program in Nunavut was approved in 2024. The conceptual framework for the study is based on the work of Kilbourne et al. (2006) who created a conceptual framework that identifies factors for multilevel determinants of health disparities. These factors include the healthcare system, patients, healthcare providers, and the clinical encounter. Embedded in these factors include healthcare delivery models, patient beliefs, culture, provider knowledge, attitudes, and the patient experience. They further break down their framework as a process for research into three phases: “Detecting, Understanding, and Reducing” that are designed to assist in comprehension of underlying determinants of health gaps that will lead to thoughtful interventions to reduce identified health disparities.
The Health Disparities conceptual framework by Kilbourne et al. can be used to describe health services gaps in remote Indigenous communities in Canada’s Arctic. Lack of access to health services such as diagnostic x-rays can be attributed to several factors including geographical location, healthcare providers, patient culture, language barriers, and resource allocation. The model speaks to the need to identify gaps in healthcare delivery in remote settings through comprehensive examination of its healthcare system, patient population, healthcare providers and the current delivery standard. It also establishes a process for better defining and understanding the service gaps to help inform interventions for disparity reduction. In this case, the community-based x-ray training program is the intervention to help reduce the disparity challenges associated with quality and access to health services in the territory.
Data collection for the study will include quality of x-rays in the Nunavut communities by local Inuit graduates, procedure type, volumes, and access to x-ray services in the territory. Personal interviews will gather perspectives by graduates, healthcare providers, patients, and other stakeholders. Findings from the study could help inform future models of training in other health disciplines and health human resource management in other settings with similar health services disparities.
Article and photos by Greg Toffner MHS, PhD(c) - Global Health, McMaster University
References:
Kilbourne , A. M., Switzer , G., Hyman , K., Crowley-Matoka , M., & Fine , M. J. (2006). Advancing Health Disparities Research Within the Health Care System: A Conceptual Framework. American Journal of Public Health, 96(12)