Primary health care accessibility challenges in remote indigenous communities in Canada's North

BACKGROUND: Despite many improvements, health disparities between indigenous and non-indigenous populations in Canada's North persist. While a strong primary health care (PHC) system improves the health of a population, the majority of indigenous communities are very remote, and their access to PHC services is likely reduced. Understanding the challenges in accessing PHC services in these communities is necessary to improve the health of the population. OBJECTIVE: The objective of the study was to document and analyze the challenges in accessing PHC services by indigenous people in remote communities in Canada's Northwest Territories (NWT) from the perspectives of users and providers of PHC services. METHODS: Using explorative, qualitative methods, our study involved 14 semi-structured interviews with PHC service providers (SPs) and service users (SUs) in 5 communities across the NWT which varied according to population, remoteness, ethnic composition and health care resources. The interview guide was developed after key informant consultations. RESULTS: Both SPs and SUs understood the constraints in providing equitable access to PHC services in remote communities. The provision of emergency care was found to be particularly challenging, because of the lack of qualified staff in the community and the dependence on aeromedical evacuations. Wider dissemination of first aid skills among community members was seen to cover some gaps and also increase self-confidence. For non-emergency care, the need to travel outside the community was generally disliked. All recognized the need for more preventive services which were often postponed or delayed because of the overwhelming demand for acute care. As long as services were provided in a community, the satisfaction was high among SUs. SPs appreciated the orientation they received and the ability to build rapport with the community. CONCLUSIONS: Northern SUs and SPs generally acknowledge the health consequences of living in remote communities. The generally high level of satisfaction attests to the overall effectiveness of PHC in the region despite geographical remoteness. Many improvements could be made in terms of upgrading the clinical skills of SPs and community members, improving staff retention, extending the frequency and duration of community visits and providing more attention to preventive services.