An innovative way of financing
The experiment was formalized within the legal framework of Article 51 of the Social Security Financing Act of 2018, which allows deviations from common law, in this case fee-for-service financing. Juliette Parnot, advisor in charge of health policy, childhood inequalities and the status of women at DIPLP, explains that the 26 selected SECs were already, at different levels, working on community health, some were not aware of it and did not formalize it in their health plan. ” Many of the actions and time devoted to the participatory approach in SECs, and especially in MSPs, are voluntary and are carried out by a few health workers who are aware of the topic, sometimes accompanied by the beneficiaries involved. », she adds, before adding that participatory health in these structures is not sufficiently financed, with very diverse envelopes. Therefore, it was a question of maintaining this funding and encouraging all healthcare workers in these structures to collectively engage in a participatory approach.
In addition to the experiment, a budget of 30 million euros was allocated to 26 SECPAs, divided for each structure into 4 allocations. The latter are intended to finance only human time, not equipment or land, even if the employment made possible by the experiments was sometimes a problem in terms of available space on the premises.
Four allocations relate to funding:
- “Participatory” activities carried out by non-health professionals, such as social workers, health mediators, specialized admissions agents, coordinators, sports instructors, etc.;
- Participatory approach carried out by dedicated healthcare professionals and the time they devote to care for uncertain patients, in addition to their strictly caring activity;
- Professional translation, necessary for qualitative participation in relation to residents and patients in neighborhoods where many have an immigrant background;
- Psychologists need to respond to the significant mental health problem that exists in these priority neighborhoods.
What do we mean by participatory approach?
The concept, Didier Ménard admits, has quite different definitions, depending on the point of view one takes. Juliette Parnot also states that the scope of the experiment was deliberately flexible so that everyone could implement projects that specifically meet the needs of their patients and the expectations specific to their territory. Training on the participatory approach, carried out by members of the 6 initial SECPAs, including Didier Ménard, was nevertheless provided to the coordinators of the 20 other SECPAs, at the School of Advanced Studies in Public Health (EHESP). The result? For Dr. Ménard, it is about going beyond the more or less well-organized representation and participation of residents and users. The first act of the caregiver in participatory health is to harmonize the standards of professional practice with the specific standards of the users. This particularly requires checking the therapeutic feasibility of the treatment offered to the patient – which can bring to light issues that are not always within the caregiver’s purview, such as social, professional, cultural, linguistic, etc. These may be difficult to answer within a solitary medical practice, but solutions emerge more easily thanks to the multiprofessionalism specific to coordinated practice structures, which can also be enriched by community resources brought by the residents themselves. Participation is a change in culture, where we think differently and where patients are a resource to improve caregiver practice. Therefore, healthcare professionals must open up, participate in citizens’ actions, learn about their territory, its history, its resources, its associational and political networks, its functioning, etc. “The experiment is successful on a scale we are not necessarily used to working on: living space, as close as possible to the needs of the residents. These participatory coordinated exercise structures are ultimately very modern in their vision because they use tools, such as prevention and citizen participation, and methods of team organization that integrate the concept of well-being, according to the definition of the World Health Organization. In this sense, these are ambitious projects that create a link with the population of a certain territory. », greets Alexis Vervialle, Care Procurement Project Manager at France Assos Santé.
Specifically, what form can community health take? Let us cite the case of the Health Center inhealth and wellness association in Saint-Denis, integrated into the experiment, where breakfast is held every Monday morning with residents. We talk about everything and nothing, and often also neighborhood problems in order to find a way to solve them. Community health can then consist, for health structures, of partnering with residents, particularly to force landlords to improve unsanitary housing conditions. For doctors, it is no longer about being caregivers, but about health as a whole. The circle is also closed with the Poitiers initiative, where a the health center was directly created and supported by the residents of the 3 Cités district.