Delivering on Social Accountability: Canada’s Northern Ontario School of Medicine

 Limited availability of cultural and linguistically appropriate services (e.g.Aboriginal, Francophones), which impacts access and outcomes  Scarcity of resources (e.g.health human resources, infrastructures, technologies, etc.) and varied enablement of health professionals to work at the full scope of practice limit the capacity of the system to deliver care at an acceptable standard -although the Panel recognizes that many rural and northern practitioners practice to their full scope of practice, policy, infrastructure and other tools are needed to enable this more consistently in rural and northern areas  Inconsistent implementation of potential interprofessional models across local communities, which are considered an important element of improved access to local health care (e.g.varied levels of investment in primary care models such as Family Health Teams across local communities) Availability of transportation (emergent, inter-facility and non-urgent) in some northern, remote and rural areas is limited  Travel distance can make access to services difficult, and influences which services individuals seek. Lack of rural perspective applied in planning at the provincial or LHIN levels, and the need for increased flexibility at the local level to drive innovations related to scope of practice, funding and system integration  A recognition that the health care access challenges and needs in rural communities differ between southern Ontario and northern Ontario, and that challenges are typically accentuated in the north  The historic trend toward centralization in health system design, which limits local responsiveness and reduces access; need to create local capacity to focus on synergies across the continuum of care and sectors  Inter-sectoral and cross-jurisdictional challenges and fragmentation of the funding, management and coordination of different components of the health system (e.g.emergency medical services, public health) Limited sharing of health records and information across professionals within the system Identifying Services that Improve AccessEqually important to identifying challenges is understanding the current programs and strategies already in place to improve access to rural, remote and northern Ontario.As part of the Panel's work, an inventory of current programs that the MOHLTC funds to address access issues in rural, remote and northern communities was established, which range in the types of services funded, including: disease-focused programs, health professional recruitment and retention, interprofessional care models, local community or population specific initiatives, travel grants and technology-enabled access solutions.While a specific review of these programs was not conducted by the Panel, there was general acceptance of the contribution that these provincial commitments have toward improving access in rural, remote and northern Ontario. Stage 1 Rural and Northern Health Care Framework/PlanBased on the inputs and insights gathered through its planning process, the Panel is proposing the following Stage 1 Framework/Plan, which outlines a vision, guiding principles, planning standards and decision guides, strategies and guidelines for the MOHLTC and LHINs. Stage 1 Rural and Northern Health Care Framework/Plan Guiding Principles

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