Structural Barriers and Equity Considerations in Supporting Immigrant Access to Healthcare: Building Capacity with Local Immigration Partnerships (LIPs) in Ontario

Abstract

Meeting the healthcare needs of immigrants is crucial to ensuring their wellbeing and successful integration. In the late 2000s, Canada deployed a novel approach to settlement governance and coordination by creating Local Immigration Partnerships (LIPs), starting in Ontario. While evidence exists on LIPs' role and capacity in improving settlement services, more research is needed to understand their contributions within the health sector. This thesis aims to advance knowledge of the LIPs' role in facilitating immigrants' access to primary healthcare services. The study relied on a mixed quantitative-qualitative methodology and applied an integrated Social-Ecological Model and Health Equity/Access to Care framework. A scoping review was undertaken to investigate if and how 'non-medical' settlement coordination organizations support access to healthcare services; a quantitative questionnaire was administered to LIPs in Ontario to examine their capacities to support diversity, equity and inclusion considerations in access to healthcare efforts; and a qualitative case study comprised of interviews, a focus group, and a complementary document analysis was undertaken to uncover the experiences of an established Ontario LIP within the health sector. The findings are presented in an article-format thesis. Our scoping review found 10 publications that revealed local settlement coordination organizations support access to primary healthcare services for immigrants at the individual, relationship and community level. Survey findings suggested that 18 of 22 global health competencies were relevant to LIPs; participants had higher confidence in competencies that involved communication skills, leadership, building coalitions, creating opportunities to access local communities and authorities; they, however, had lower confidence in technical tasks such as analyzing policy, planning, implementing and/or evaluating health programs, and creating opportunities to access higher-level decision-makers. Case study results identified four themes outlining areas where the Ottawa LIP supports healthcare access: cross-sectoral coordination and collaboration; advocacy and policy influence; engaging and empowering communities; and building capacity and informing service delivery. Findings demonstrated the challenges around resource constraints, governance and organizational structure, and relationship management. LIPs support access to primary healthcare services by addressing structural barriers and equity challenges. Including LIPs in collaborative actions towards improving equitable healthcare access may provide more scope to respond to healthcare gaps.