Working together for healthy communities ASSOCIATION OF ONTARIO HEALTH CENTRES 2009-2010 ANNUAL REPORT
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Let’s not forget the ultimate goal of Medicare is to keep people well. It seems to me that is the task before us.
The Association of Ontario Health Centres (AOHC) is the policy and advocacy organisation for non-profit, community-governed, interprofessional primary health care organisations. Our members are Ontario’s Community Health Centres, Aboriginal Health Access Centres and Community Family Health Teams as well as the Sudbury District Nurse Practitioner Clinics.
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DESIGN: BARBARA BAILEY / RED SETTER STUDIO
– Tommy Douglas
Our critical pathway MESSAGE FROM AOHC PRESIDENT, JOAN LESMOND
During my first year as President, I’ve learned that the Association of Ontario Health Centres (AOHC) is a very effective organisation. Staff and the Board are continuously in action, advancing the interests of our members, and the clients they serve. Preparing this report offers an opportunity to reflect on successes and celebrate achievements. This year we’ve had some major wins, most notably the announcement that physicians in Community Health Centres will now be back on full salary. Hard work in other areas is also yielding results. We’re at the forefront of the quality improvement agenda. We’re ahead of the curve on major issues like integration. And we’re building internal capacity and commitment amongst our members. Last but not least, our persistence at policy tables is getting results. During this past year we’ve made real progress in carving out more space for communitygoverned primary health care in our health care system. We’ve also had, and continue to have, impact on advancing healthier public policy.
care provides superior quality of care in key indicator areas like health promotion and chronic disease management. As we increase our information gathering capabilities we will continue encouraging quality improvement and do an even better job at delivering care to those we serve. When you review these pages you’ll see we are well underway.
Successes this past year point to further gains for the upcoming year. Let’s keep in mind that the full potential of community-governed primary health care in Ontario is far from realised. We must press forward on two critical pathways that will lead us to healthier communities: We must continue improving quality of care. Studies show that the Community Health Centre model of
We must continue expanding access to communitygoverned primary health care. Less than three per cent of Ontario’s population is served by a Community Health Centre. We must therefore step up efforts to demonstrate our effectiveness so decision-makers are convinced of the positive outcomes that will follow if access expands. Let’s remember the words of Medicare’s founder, Tommy Douglas, who constantly reminded us that the ultimate goal of our health system is to keep people and communities well. By working together, continuing to improve our quality of care and expanding access to community-governed primary health care, I know that we can reach it.
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Strengthening our model of care Securing increased resources Physicians return to full salary It’s a big win. Intensive discussions with Ontario’s Ministry of Health have finally resulted in the elimination of a huge threat to the Community Health Centre model of care – financial incentives for physicians. In January the Ministry announced that Community Health Centres would return to full salary. On April 1st the announcement went into effect. Since incentives were imposed, by the 2004 Ontario Medical Association agreement, they have undermined collaborative practice because non-physician members in clinical teams have so often performed the work for which physicians have received payment. This coming year we continue negotiations to ensure that the same salaried physician compensation model will be applied to physicians employed in Aboriginal Health Access Centres.
A win for Nurse Practitioners is a win for interprofessional practice
To fulfill their mandates and achieve their potential, our members require adequate resources. This year, we achieved:
AOHC worked long and hard in support of another decision that will improve interprofessional practice. Late last year Health Minister Deb Matthews approved a key amendment to Bill 179 to eliminate a cumbersome legislative process which restricted nurse practitioners’ prescribing rights. Ontario’s College of Nurses now assumes respon-sibility for deciding which drugs nurse practitioners can prescribe.
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A 2.25 per cent stabilisation fund increase to base for all Community Health Centres and Aboriginal Health Access Centres for 2009/2010
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A 2.25 per cent increase for salaries in Community Family Health Teams
Although the prescribing rights amendment represents a major breakthrough for nurse practitioners, AOHC will continue advocating for additional changes that will enable Ontario’s health care system to take full advantage of the nurse practitioners’ scope of practice.
AOHC Executive Director Adrianna Tetley (centre) greets Ontario’s new Health Minister Deb Matthews (right) and the OMA’s Naguib Gouda at a conference hosted by HOOPP, the pension plan used by Ontario’s hospitals and other institutional health agencies, that AOHC soon hopes will be widely offered to employees in Ontario’s CHCs and AHACs.
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In addition, we launched a major campaign to increase the amount of funds available to Community Health Centres and Aboriginal Health Access Centres to provide comprehensive and competitive benefits packages that include HOOPP (Healthcare of Ontario Pension Plan).
Building knowledge, commitment and capacity Education and capacity building for members is a key priority for AOHC and is especially important as new centres open and are introduced to the Community Health Centre model. To build knowledge, commitment and capacity among our members, we relied on two new documents created in 2008: ■
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Next year for board members of Community Health Centres we plan to roll out newly enhanced Model of Care training with a focus on communicating to external audiences.
The CHC Model of Care focuses on five service areas:
the Network of Ontario’s Community Health Centres Model of Care Charter, and
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The Community Health Centre Model of Care: A Statement of Principles.
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Primary care Illness prevention Health promotion Community capacity building Service integration
In 2009-10, we built on this achievement: ■
Manager of Education and Capacity Building
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Carolyn Poplak leads dozens of sessions every year. ■
81 per cent of Executive Directors in Ontario’s Community Health Centres signed the charter.
The CHC Model of Care is: ■
Model of Care training was updated and delivered to 648 staff members working in Community Health Centres.
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Over 70 Community Health Centre board members were trained in governance, deepening their understanding of the Model of Care and enhancing understanding of governance and governance structure.
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Comprehensive Accessible Client- and community-focused Interdisciplinary Integrated Community-governed Inclusive of the social determinants of health Grounded in a community development approach
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Sophie Bart takes the lead supporting new and emerging centres.
Supporting new centres and new Executive Directors Starting a new Community Health Centre often presents challenges. AOHC provides support.
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This year we met with the Ministry on an ongoing basis to ensure improved flow of capital and operational funding.
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We also provided guidance to board members, project managers and Executive Directors of new centres as they navigated through bureaucratic waters.
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For pre-operational centres we have convened regular gatherings so project managers and Executive Directors can share experiences and problem solve together.
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We’ve also supported new Executive Directors through orientation sessions and regular network opportunities.
Tailored training AOHC prepares customised training on primary health care issues. For instance, this past year: ■
The Ministry of Health and Long-Term Care hired us to deliver interdisciplinary team training to Family Health Teams participating in a Physician Assistant Demonstration Project.
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Working in partnership with the Centre de services de santé – Peel et Halton and le Centre canadien de leadership en évaluation we delivered French language training to community volunteers. The training built understanding about Ontario’s health system and the role that board members can play in championing community-governed primary healthcare organisations.
LHIN Environmental Scan Another tool AOHC developed this year to serve our members is the LHIN Environmental Scan, an online tool to make it easier for member centres to search for information that is most relevant to them within the relatively new and rapidly evolving LHIN environment. It enables member centres to see information about their own LHIN as well as compare that information with what is happening in all the other LHINs. Some areas that are tracked include: LHIN priorities, e-health, health equity plans and stabilisation funding increases for Community Health Centres.
Demonstrating effectiveness and improving care ■ ■
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Anjali Misra is our new Manager of Performance Management.
a Clinical Management System (CMS), a Management Information System (MIS), tools to support Community Initiatives.
In February, the CHC IMS Advisory Committee released its final recommendations. When these recommendations are implemented, Community Health Centres will become the owners of the Information Management System, an exciting shift that means that systems can be tailored to meet the needs of a diverse staff serving a wide array of priority groups.
CIO and eHealth Lead for the North Simcoe Muskoka LHIN, Rodney Burns, AOHC Executive Director, Adrianna Tetley, and Executive Director of the London InterCommunity CHC, Michelle Hurtubise at a recent meeting of the Information Management System Committee.
AOHC has recently assumed leadership in developing modern information systems. Since September we’ve acted as the host agency to develop a broad Information Management System (IMS) strategy for the sector. The strategy covers the development of:
In March, the Information Management System Committee (IMSC) was established with representation from staff members of AOHC and Community Health Centres. This coming year we’ll be pressing forward so that IMS systems for Ontario’s Community Health Centres can enhance decision-making and position our sector for future growth.
Measuring and managing performance To provide members with the support they need to continuously improve the quality of care they deliver to individuals and their communities, AOHC has recently hired a Manager of Performance Management. Anjali Misra’s work will focus on the setting of performance and data standards, sector-wide reporting, decision-support, and the development of accountability agreements.
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Leading the way on emerging issues and priorities Board member Peter Szota and AOHC staff Sophie Bart and Adrianna Tetley are closely monitoring integration developments.
Clinical Management Systems Leads Brian Sankarsingh and Slavka Angelova lead our e-health initiatives.
Improving care with electronic client records As we establish an Information Management System, we are also spearheading the adoption of electronic client records (ECR). This year we developed a longitudinal survey of ECR adoption so that we can measure and track our progress with the adoption and use of ECRs.
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Coordinating emergency response
Shaping the integration agenda AOHC stays ahead of the issues that shape our members’ future. This year we moved ahead in swiftly developing a position on integration. Our intent is to positively influence Ontario’s integration agenda, help avoid mistakes and produce optimal results. We also want to ensure that as integration moves ahead, all the attributes in the Community Health Centre Model of Care are affirmed and protected. Our first step is to establish a discussion paper that will, in turn, inform a position paper to be developed later this year.
Effective response to emergencies is another important role for AOHC and we did just that during the H1N1 emergency last fall. Our intervention ensured that vital health services reached vulnerable populations. Planning began last summer when we flagged that the province’s plans for the looming pandemic offered no clear roles for our members. We quickly arranged meetings with the Ministry of Health and the Ontario Agency for Health Protection and Promotion. The discussions were fruitful. The Ministry’s Emergency Management Branch (EMB) recognised a formal coordinating role for AOHC during the emergency.
A unique role Perhaps the most important outcome of AOHC’s collaboration with the EMB was the pre-deployment of the anti-viral Tamiflu to the Community Health Centres and Aboriginal Health Access Centres. This ensured that clients and other members of the public treated at the centre and diagnosed with H1N1 did not have to pay for, or go to a pharmacy, to access the medicine. No other primary health care agencies in the province were assigned this vital role. Ministry figures released after the pandemic had run its course showed that altogether 66 Community Health Centres and nine Aboriginal Health Access Centres dispensed anti-virals to 1,300 clients. Following the emergency, AOHC submitted a series of recommendations to the Emergency Management Branch (EMB) and also hosted a conference where over 60 representatives from Community Health Centres, the Ministry of Health and Long-Term Care and Public Health Units explored lessons learned during the pandemic. If another pandemic hits, our member centres will benefit greatly from our capacity building efforts.
Sandra Wong and Carolyn Poplak were constantly on call during the H1N1 emergency.
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Promoting Aboriginal community health We are now well underway in making optimal use of the federal/provincial Aboriginal Health Transition Fund (AHTF), a two-year, $520,000 grant. By Fall 2010 we anticipate that all Aboriginal Health Access Centres (AHACs) will be: ■
collecting and using completely harmonised client and health services data;
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implementing electronic client health records;
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moving forward with the same organisational (BHO) accreditation used by Ontario’s Community Health Centres;
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actively participating in routine primary health care alignment discussions with the Ministry of Health and Long-Term Care and LHINs, as well as increased participation in provincial health strategies.
A powerful new report AOHC has also laid the groundwork for a powerful new report to be released later this year, which, for the first time ever, will present aggregate data spotlighting the many services that Aboriginal Health Access Centres provide as well as their positive impact across the province. This report will be a vital tool in advocating for a concerted, provincial Aboriginal primary health care strategy and will be released at a critical moment. There are strong indications from the Ontario government that it is about to formalise its relationship with AHACs and provide equitable funding. AOHC will continue pressing the government to ensure follow through.
Karen Smith from Tilbury District Family Health Team is the Community Family Health Team representative on the AOHC board.
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Making the case for Community Family Health Teams
AOHC addressed the many challenges that Community Family Health Teams (CFHT) have faced this year. In May 2009, we presented Looking Back: Looking Forward to the FHT Action Group. The report affirmed the merits of the CFHT model, especially community governance. Follow-up meetings produced some breakthroughs on information technology issues and the make-up of health
teams. It also appears that some recruitment and retention issues for physicians are being addressed. But substantial issues remain and AOHC will persist in seeking improved policies and plans with respect to funding, capital approvals, locum support, benefits, recruitment and team salaries, enrolment issues, and the provision of tele-health services. We will also maintain a special focus on reducing an incentive approach to compensation.
Advancing healthy public policy
To build healthier communities we need healthy public policy, so this year we have intervened at a wide range of policy tables. Supporting poverty reduction Our budget submission reiterated our support for the government’s poverty reduction strategy and asked for assurances the strategy will not be downgraded. We argued that the power of the public purse can be mobilised to enhance food security, mental health services and social assistance. Targeting nutritional support to those most in need Our budget submission responded to the government’s new EatRight Ontario’s program. We argued dollars should be re-allocated to ensure EatRight puts an increased effort on connecting services with low income individuals and families. We’ll soon meet with the Minister of Health Promotion to propose stabilised funding for food security and food literacy programs. Protecting the Special Diet allowance We have played a key role in a coalition advocating to protect the Special Diet Allowance. Our budget submission expressed our concern for the future of the
program and the need to ensure that Ontarians do not go hungry – especially those on low income supports coping with debilitating illness. We have also collaborated in a media relations and postcard campaign as well as letters to the Ministers of Community and Social Services and Health and Long-Term Care. Next year watch for increased efforts on this issue. Advocating for strong programmes to improve the health of low-income families Through the past many months, AOHC has been supporting our member centres in their collaboration with local Public Health Units in the creation of high quality proposals. Serving on the Low-income Dental Stakeholders’ Advisory Council, AOHC is playing a key role in ensuring the voice of poor Ontarians is being heard. While we could not support the Ministry’s decision to focus only on children, we are paying close attention to the roll-out, first infrastructure and then program funds, and reminding the Ministry, as it assesses and approves proposals, to ensure adherence to the Lowincome Dental Guidelines for implementation. Those criteria include the requirement of serious community engagement, the creation/cultivation of partnerships, and building on existing services with Community Health Centres and Aboriginal Health Access Centres named as the preferred vehicles of implementation.
Our Manager of Policy and Government Relations, Lee McKenna, maintains close links with Ministry officials.
Pressing for improved policies on mental health AOHC continues prioritising the need for improved mental health services. Last summer, Minister Caplan’s Summit on Mental Health provided us with a major opportunity to press our case. We responded with Every Door and the Community Health Centre Model of Care: A Dynamic Synergy. The paper details how perfectly positioned our members are to play a key role in future plans to improve mental health services. Now that a new Minister of Health has taken the helm, we continue to monitor this file closely.
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Getting serious about poverty
Poverty is the single most important determinant of health and this year AOHC made poverty eradication a cornerstone of our efforts. Our June conference, At the Intersection of Poverty and Health, re-ignited energies to continue and enhance our work on poverty.
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We’ve mobilised health promoters and a poverty eradication working group to join our efforts.
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The conference we have planned for this June is focused on health equity. It will explore solutions to the unacceptable situation that far too many people on low incomes face barriers to accessing health services or enjoying good health because of their living circumstances.
During the conference we released A journey through poverty, the compelling story of six people who live with poverty and who have found support at Community Health Centres and Aboriginal Health Access Centres. At the Annual General Meeting that preceded the conference our members passed a resolution committing AOHC to a more pro-active role on poverty eradication. As a result:
Rhonda, a single mother of three beautiful girls, attended Food for Thought, a programme offered by Oshawa CHC. Her story is one of those featured in A journey through poverty.
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We’ve launched a mini-site at www.aohc.org/ poverty called Get serious about poverty. It will provide updated poverty eradication resources to members on an on-going basis.
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We’ve made our case at a wide range of policy tables and participated in a wide range of coalitions calling for a robust poverty reduction strategy.
The Honourable Deb Matthews, Ontario’s Minister of Health and Long-Term Care spoke at AOHC’s 2009 conference, At the Intersection of Poverty and Health.
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Increasing your recognition Danielle Kurchak (left) and Mary MacNutt (right) focus on raising the profile of our member centres.
Thanks to an Ontario Trillium Foundation grant, we are about to roll out a whole suite of communication products that we have prepared this past year to promote CHCs. ■
A new video called Ontario’s Community Health Centres – Every One Matters. produced by the award-winning production company CineFocus Canada has just been completed.
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To turn up the volume on our health equity message, we’ll harness the communication power of social media at our June conference.
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Later in the year we’ll launch a new website equipped with Web 2.0 applications that will enable members to share ideas and news with each other and external audiences.
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We also have plans to produce materials to enhance and give enriched meaning to the brand identities of our member centres.
This was also the year the AOHC board decided to be more pro-active about Community Health Day, the last Friday in April. Results were impressive. Many municipalities read lengthy proclamations referencing our health equity theme and media coverage frequently repeated our members’ shared commitment to better health for all.
A growing number of Ontario’s Community Health Centres are adopting the blue “C” logo as their one and only logo. This means brand recognition and the opportunity for shared storytelling will increase.
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Welcome to new members ■
Central Community Health Centre (emerging group member)
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Social Services Network (associate member)
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South East Grey Community Health Centre (emerging group member)
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Strategy to End Poverty (emerging group member)
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Sudbury District Nurse Practitioner Clinics (full member)
Lisa Tisdel responds to members’ concerns and requests.
2011 conference will spotlight CHC benefits in U.S. and Canada
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Details will be released soon for a landmark conference co-sponsored by the Canadian Alliance of Community Health Centre Associations and the National Association of Community Health Centers, which represents CHCs throughout the United States. Be sure to save the dates: June 9th and 10th, 2011 – Toronto Don’t miss the opportunity to learn what lies behind President Obama’s doubling of the Community Health Centre program in the U.S. and network with others from across the United States and around the world who support community-governed primary health care.
A balanced bottom line ASSOCIATION OF ONTARIO HEALTH CENTRES’ FINANCES
AOHC has a robust financial picture with a total revenue in 2009-10 of $3.2 million. Revenue consisted of funding from membership fees, centre development fees, our annual conference and workshops. In addition, AOHC received funding from the Ministry of Health and LongTerm Care and three grants and projects. AOHC had another balanced budget with an additional $27,000 being added to the reserve for a total of $101,000. The AOHC has set a target for a reserve fund of $150,000 by March 2012. Membership fees continued to grow, increasing from $490,000 to $619,000 in 2009-10. This increase was due to the continuing growth of our membership with new Community Health Centres (CHC) and Community Family Health Teams (CFHT) joining AOHC and becoming operational. In addition, the overall membership fees were increased for our mid and large sized CHCs as approved by the 2007 AGM. With the increase in membership fees, AOHC now has the capacity to provide increased communications support, policy and government relations and support for new CHCs and CFHT members. As well, we are able to provide support to the CHC Executive Directors Network and its committees.
Through a grant we continued to build our capacity to increase support to the Aboriginal Health Access Centres (AHAC) and the AHAC Executive Directors Network. With the Ontario Trillium Foundation grant, AOHC is increasing its capacity with a new interactive website and data base. This website will be launched in September 2010. As well, a video on CHCs is being produced along with workshops for boards on the CHC Model of Care. In 2009-10 AOHC increased its capacity to provide education and capacity-building support for our member centres through workshops for boards on governance and the role of LHINs, as well as professional learning groups which are mini-conferences for nurse practitioners, data management coordinators, executive directors and so on. Finally 2009-10 marked a shift for AOHC as it took on the responsibility to manage the Information Management Systems and strategies on behalf of the CHCs. Audited Statements are available upon request.
Board treasurer David Orman and Almaz Reda, member of the audit committee, monitor AOHC’s finances.
The Ontario Trillium Foundation provided valuable support.
The Ontario Trillium Foundation is an agency of the Government of Ontario.
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Working together for healthy communities Our staff
Our board Joan Lesmond President and Member-at-Large Board Chair – Regent Park CHC
Jocelyne Maxwell Francophone Constituency Rep Executive Director – CSC du Temiskaming
Administration
Communications
Adrianna Tetley, Executive Director
Mary MacNutt, Manager, Strategic Communications and Campaigns
Sandra Wong, Office Manager Anita Cameron Vice-President and Aboriginal Constituency Rep Executive Director – Wassay-Gezhig NaNahn-Dah-We-Igamig (Kenora AHAC) Margaret Hedley Secretary and South Central Constituency Rep Board Member – Guelph CHC David Orman Treasurer and Eastern Constituency Rep Board Member – Lanark Health & Community Services Almaz Reda Member-at-Large Board Member – Black Creek CHC Cate Melito South West Constituency Rep Executive Director – Woodstock and Area CHC Janet Bowes Eastern Constituency Rep Program Director – Carlington CHC Jill Marzetti Central Constituency Rep Board Chair – Four Villages CHC
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Karen Smith Community Family Health Team Constituency Rep Board Member – Tilbury District FHT
Lisa Tisdel, Administrative Assistant
Lynda Roy Member-at-Large SexAbility Coordinator – Anne Johnston Health Station
Education and Capacity Building
Mary Ellen Parker South West Constituency Rep Board Chair – West Elgin CHC Notisha Massaquoi Central Constituency Rep Executive Director – Women’s Health in Women’s Hands Peter Szota South Central Constituency Rep Executive Director – Grand River CHC
Danielle Kurchak, Communications Coordinator
Corinne A. Christie, Administrative Assistant Alison Brett, Administrative Assistant
Policy & Government Relations Lee McKenna, Manager, Policy and Government Relations
Carolyn Poplak, Manager, Education and Capacity Building
Centre Development Team
Heidi Schaeffer, Trainer
Sophie Bart, Centre Development Team Lead
Information Management Brian Sankarsingh, Clinical Management Systems Lead
Mary Chudley, Centre Development Project Lead Aboriginal Health Access Programs
Performance Management
Scott Wolfe, Manager, AHAC Programs
Anjali Misra, Manager, Performance Management
Slavka Angelova, AHAC Clinical Management Systems Lead
Ron Ballantyne Central East Constituency Rep Executive Director – Brock CHC Vincent LaCroix Northern Constituency Rep Board Chair – CSC du Grand Sudbury
Association of Ontario Health Centres 970 Lawrence Ave West, Suite 500, Toronto, ON M6A 3B6 Tel: 416-236-2539 Fax: 416-236-0431 mail@aohc.org www.aohc.org