The organization of district health councils in Ontario
This action research project with district health councils (DHCs) in Ontario, Canada, took place between 1976 and 1980. The purpose of the research was to identify the most effective forms of organization for DHCs, bodies set up to provide a local focus for planning and coordination of health services in the Province. The research method was based on social analysis, a method developed over thelast thirty years through applications in industrial, commercial, health, education and social service settings. The first DHC was created in 1974 to serve the Ottawa-Carleton Region and there are now 25 DHCs covering 88% of the provincial population. Councils are generally regarded as community bodies, consisting of interested local citizens who serve on a voluntary, unpaid basis. The members comprise a mixture of 'providers', 'consumers' and local government representatives. The intensive research work was carried out in collaboration with three DHCs (Hamilton-Wentworth, Kenora-Rainy River and Ottawa-Carleton) and the emerging research findings were tested in a wide variety of settings including a number of the other DHCs. The first two chapters attempt to set the DHCs in an organizational and political context. Chapter 1 looks at the development of DHCs vis a vis other social developments, particularly regionalisation and decentralisation. Chapter 2 examines the political context in which DHCs emerged and identifies the policy tensions that are inherent in their work. In Chapter 3 a detailed account is given of the three intensive research settings and the organizational developments that took place during the course of the research. This chapter is in effect a summary of the whole research project. Chapter 4 is concerned with the nature and composition of councils, the roles of DHC member and chairman, and relationships among the DHCs. The research findings on alternative models of DHC structure are in Chapter 5 and 6, respectively concentrating on the Council and its committees and on the executive staff of council. The focus lengthens again in the concluding chapter to examine the potential for making overall judgements about the effectiveness of DHCs and the implications of this organizational study for other experiments in community-based health planning.