An examination of citizen participation in health planning in the Northwest Territories: the Fort Providence Senior Citizens’ Home

In the 1970’s the Government of the Northwest Territories was seeking to involve communities in the decisionmaking process about the allocation, priority setting and program and facilities design issues in the sphere of health services. As a result of this desire, relationships were being forged which emphasized a sense of partnership between government at different levels and community groups. In fact, considerable bureaucratic effort was put into the determination of how the communities should provide their participation. This eventually became known, informally at least, as the "community participation methodology". During a forty-one month period (March, 1977 to August, 1980) this methodology was implemented and eventually culminated in the construction of a senior citizens' home in the community of Fort Providence. It is the concern of this thesis to examine that methodology by asking the following question: "How useful and applicable is the Northwest Territories' community participation approach in the planning and development of facilities, specifically for the elderly?" In addressing this question several issues had to be considered. First, what were the objectives of the participants and were they compatible? What were the potential obstacles to the participation process and were they reckoned with? How did the participation process actually occur if, in fact, it did occur? In other words, the efforts of the bureaucrats had to be analyzed in terms of what they hoped to accomplish, how they attempted to accomplish their goal(s) and what they actually achieved. Another problem faced by this examination was the question of theoretical framework. The thesis was a retrospective examination which meant the planners' concepts had to be discussed in terms of theoretical concepts to determine if there is a theoretical basis for the applied concepts and whether or not these strategies were appropriate to this example. It was suggested that the theories of John Foskett, Edmund Burke and Sherri Arnstein were in support of the bureaucrats' efforts. The findings of the examination were that the participants' objectives were compatible; the planners were cognizant of the potential constraints inherent in this project and endeavoured to eliminate or minimize the consequences of these constraints; and, the methodology was successful in achieving participation. With respect to the participation, the thesis concludes that the participation achieved was actually only tokenism and that true participation did not really occur. This then throws the question of utility and applicability of the methodology into doubt. The thesis concludes that everything worked this time because the assumptions of the participants were the same. The thesis closes, however, with a suggestion that the basic assumptions concerning health care are changing.

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