Enablers that could support an effective decision-making framework include:

  • Governance structure that defines the rules of engagement for collaboration,
  • Transparent decision-making process,
  • Mechanisms for resolving conflict between public health and primary care,
  • An optimal process of resource allocation.

Governance structure that defines the rules of engagement for collaboration
At the systemic level, effective decision-making for public health and primary care sectors should have provincial ministry support. Governance structures can be designed with detailed rules of engagement for collaboration and other policy instruments, such as terms of reference, memorandums of understanding, and defining new models of primary health care delivery.

Two decision makers, one from public health and one from primary care, share their views on the need for supportive governance structures.

Transparent decision-making process
A group gathered around the table at a meeting.Decision-making processes related to systemic level changes need to be inclusive and as transparent as possible. Opportunities for opinions and voices to be heard on a topic are important in order to strengthen collaboration between public health and primary care.

As an example, immunization schedules are created by public health whereas both public health and primary care deliver immunizations in some jurisdictions. In terms of the effective collaborations for service delivery, there is value in involving provincial primary care organizations in the provincial level immunization committees.


ListenListen to an Ontario Ministry of Health and Long Term Care authority decision maker share a recent observation.


Click for transcription >>

Mechanisms for resolving conflict between public health and primary care
The responsibility for improving and maintaining health is one shared by individuals, communities, and all levels of government. Health Canada has a primary role in protecting the health and safety of Canadians at the national level (Health Canada, 2014). However it is but one component of a complex system of health protection, which includes, among others, various levels of government, government agencies, the health care and medical professions, the academic and health sciences research and development communities, consumer groups, and individual Canadians.

To explore more information on Health Canada, visit: www.hc-sc.gc.ca/ahc-asc/index-eng.php

It is important to identify potential conflicts (for example, conflicting regulations and overlapping jurisdictions of governments and related agencies), to eliminate gaps, and to ensure that health protection programs are delivered seamlessly across the country. It is also important to be specific about accountabilities, especially when there is shared responsibility.

Related IconRelated: Role Clarity



There may be times when there is a conflict between the role that some parties would like to play and the role that others would like them to play, or that they can play given legislative or other restrictions. Such situations make it difficult to clearly define and come to agreement upon respective roles and responsibilities. This conflict can be experienced on an interpersonal basis in relation to role clarity issues at the service delivery level.

Consultations can help to improve understanding of different perspectives and identify solutions that are acceptable to a majority of participants. Yet these might be costly. Proactively, effective decision-making frameworks would include mechanisms to resolve conflicts should they arise.

Some considerations to resolve systemic level decision-making conflicts/risk management:

  • Involve all stakeholders and interested parties early in the decision-making process;
  • The nature, extent, and complexity of involvement should be appropriate to the scope and impact of the decision, the potential of the decision to generate controversy, and how quickly action must be taken;
  • Role clarity, including described involvement of participants is imperative;
  • Unless there are legislative precluded restrictions, all participants should be flexible, willing to negotiate, and be prepared to listen to and learn from diverse viewpoints;
  • Positive feedback regarding participants contributions is helpful to maintain respectful working relationships;
  • Permit inclusion of minority views or dissenting opinions, as appropriate.

To explore more information on these considerations, visit: Health Canada Decision-Making Framework for Identifying, Assessing, and Managing Health Risks pdf.

Source: Health Canada Decision-Making Framework for Identifying, Assessing, and Managing Health Risks, 2000.

An optimal process of resource allocation
Having both public health and primary care decide together how to best meet the needs of the population is important. Both sectors can pool and share resources (e.g. space).

Related IconRelated: Health Service Structures the Promote Collaboration


Open conversation between two people.

One systemic level public health policy maker shares his views:

“I respect your team’s point of view. I find it easier to follow a decision-making framework where our teams could fairly negotiate an optimal way to support the costs of public health secondments in primary care. This could be done through new funding arrangements for primary care practice networks.”

Effective decision-making frameworks could provide foundations for understanding that would promote intersectoral collaboration on optimal resource allocation decisions and collaboration between public health and primary care sectors.


>'); ?>