CLSC Hochelaga-Maisonneuve
The place of the CLSC (Centre local de services
communautaires - Local Community Services Centre) in civil society: an
academic or Byzantine debate perhaps, but a significant one for those involved
in CLSC resource management and allocation, or for those interested in the
relationship between a local provider of primary-level healthcare and social
services, and the community it serves.
A network of CLSCs was created in Québec, a daring and original
idea combining individual and collective social services with healthcare and
nursing. But who, exactly, "created" it? In fact, it took local
communities fifteen years of battles with the Ministry for the very idea of the
CLSC to be accepted; for fifteen years, the Federation of CLSCs fought to
counter the Ministry’s reductionistic vision of these centres as simply a
network of home care and local health clinics.
Against the backdrop of Québec government decisions to
nationalize whole sectors of civil society, especially schools and hospitals (in
the 1960s and 70s) administered by religious authorities under criticism and
poorly adapted to the demands of the "modern world", it is tempting to
think of the CLSC as the brainchild of the state; entire market segments came
under state control as well, Hydro-Québec being the flagship of this "economic
arm". But the CLSCs were not nationalized as such - the institution did not
yet exist! - most likely because communities held much more sway over these new
local establishments than they ever did over schools or hospitals.
Naturally, not all CLSCs are very "open and democratic".
In the last election, some directors general were proud of having only as many
candidates as they had positions to fill, - candidates hand-picked by them -
making an election unnecessary, and ensuring a compliant and co-operative Board.
To be sure, community organizations are not always models of
democracy, or of inclusive and representative membership. And although no
justification is intended, it does allow the problem to be seen another way:
democracy is not an end unto itself, but more frequently a means of managing a
group, a partnership, an organization, a state.
Similarly, the CLSC is not held to be a model of flexibility,
inventiveness, warmth in the provision of services, outstretched hands and co-operation,
even though some do aspire, however imperfectly, to these goals. This provides
an opportunity for discussion and, more importantly, openness, which is not
necessarily a matter of representation. The quality of service a CLSC (or any
organization serving the community, for that matter) can provide is predicated
more on the competence of the individual service provider than on democratic
representation; the establishment is first and foremost a service provider, not
a vehicle for representation. It is probable, however, that in its beginnings
and at a critical juncture in the institution’s evolution, the aspect of
representation was of primary importance.(1) And actually, are we not now at one
of those "critical junctures"?
If the quality of service depends on the staff, it is the end
users who can best assess its depth and relevance. This assessment happens
directly, in the relationship between users and service providers (the success
of the interpersonal connection in education, teaching, care and counselling
hinges largely on the creation of this warm and consensual relationship).
Regular direct contact with the individuals, families and other
groups in communities served plays a major role in influencing resource
allocation and other staff decisions. Except under exceptional circumstances (those
"critical junctures"), this influence is greater than any the Board of
Directors of the institution could bring to bear, but no doubt less than the
state - or insurance company, in another context - might exert as patron with
the power to withdraw, ‘uninsure’, the service or extend it.
These primary-level healthcare, education, support and social
development services must supplement resources and values already in place in
the family and in the environment. This conjunction cannot be taken for granted;
it develops over time and is built by the actors involved.
The "question of civil society" for the community
development movement
Through its interactions with the State, the community
development movement can act as a strengthening force for society, but it may
also weaken it.
CLSCs, schools, small municipalities and Neighbourhood Councils
of large cities are all examples of local institutions whose place in society is
being re-examined. The idea of ‘simply’ vertically integrating these bodies
into state policies or ministries has been promoted by some, but there are many
negative consequences to this approach. For one, it strips real power away from
the decision-making organs of these institutions, removing all meaning from the
political spaces linking these establishments with the publics they serve. The
vertical management schema reduces autonomy, liberty and initiative, reducing
professionals to mere technicians, decision-makers into mere "underlings".
The internal dynamic and types of political action undertaken by society’s
local institutions touches first and foremost the actors of community
development in their joint effort to serve a common public. The institutional
partner’s room to maneuver and its ability to co-ordinate action with
community groups depend in no small part on the degree to which it is integrated
into the state.
Relations between community movements and the State are
generally tense - that is healthy and inevitable. But when relations between
society’s institutions and community movements are tense as well, there is a
problem.
The discourse and practice of community action - often the first
place where civic values are learned and expressed - either shows the
institutional makeup of civil society to be part and parcel of the state (subject
only to democratic parliamentary mechanisms), a closed space excluding direct
citizen participation, or it plays a pivotal role in reinforcing those
institutions as autonomous and civic in nature. In the latter case, society’s
institutions must become public spaces for the active participation of the
citizenry, allowing them to take their rightful place in democratic society.
Naturally, community-based organizations are themselves part of
society, and thus curtailing state control over the sphere of civil society is a
key component of the struggle for autonomy led by community movements vis-à-vis
a state wishing to recognize and support, but also define and delimit, their
powers.
To work for the vitality of civil society is to define and affirm
the existence of limits on state power, these limits not being confined to
community-based movements.(2) If civil society is reduced simply to community
and labour union-based movements, because everything named ‘institution’ is
placed under state control, the result is a rather small society dominated by a
rather large state with passive and muzzled institutions, manipulated from above
and afar. Are there really so many public spaces that some should be eliminated?
Institutionalization of community action?
Is state control the necessary end result of
institutionalization?
On the eve of policies of fiscal accountability and public
interest in community resources, the question is an especially important one.
What can be learned from the long and bitter process waged over
15 years for CLSCs to be recognized? Must the process invariably lead to
elimination of local-regional autonomy in the name of applying national policies?
Who defines these policies, and in the name of what cause?
Stable funding policies allow more permanent positions to be
created, more qualified, experienced and professional human resources to be put
in place.
But would community resources entrenched in national policy and
applied regionally by each ministry lead to networks resembling Local
Development Centres or Carrefour Emploi Jeunesse (the youth employment
network), which are even less autonomous than CLSCs? How can the establishment
of national programs and norms be prevented from stunting the creative and
innovative capacity of these organizations? Would they be forced to yield over
all responsibility for resources and services as they became institutionalized,
all in the name of preserving flexibility in innovation? Or would
community-based networks learn to innovate, promote democratic vitality, and
professionalize their workforce?
In this context, how should the learning and empowerment goals
and processes at work in these same community groups be viewed: expression,
speaking out, taking a stand... but also learning to interact with other people
and organizations; developing an individual action plan - but also negotiating
the recognition of one’s interests, and individual goals taken up by others?
In other words, taking power immediately in and over one’s own organization,
but also connecting with more distant networks to reach over the environment as
a whole. Empowerment is also multiplying individual efforts with those of others,
though existing mechanisms and the influence wielded by larger institutions and
organizations; by recognizing what’s at stake, the interests, undercurrents
and agents at work in accessible and relevant public spaces; by building or
reforming the institutions of civil society.
Leaving room to maneuver on the local, regional and sector level
is necessary but insufficient to encourage and maintain empowerment on the level
of community action. In addition to action potential on the local (or sector)
level, - autonomous leadership - the partnership between service providers and
end users, upon which rests most of the ability to create and innovate community
resources, is of utmost importance. It is this most precious partnership which
suffers the most when collective central authorities gain more financial and
organizational power in the accelerated institutionalization process.
Paradoxically, the preservation of the partnership between users
and providers depends on each party’s autonomy being recognized: professional
and sector-based groups, union organizations on the provider side of the
equation... but also support for users who risk becoming mere consumers through
jobs being made permanent.
The establishment of autonomous public spaces, of new democratic
spaces, will allow the development of new rules, the institution of norms for
newly recognized actors. What must be avoided at all cost is that the codified
norms which are an inevitable part of the institutionalization process be drawn
up behind closed doors.
Sunday, April 16, 2000.
(1) Although in the case of a network of
establishments which the State extended to the entire province, the idea of
representation was never an issue in those communities which did not ask for the
institution to be placed there, much less try to define or defend it.
(2) Could it not also be said that civil society participates in
curtailing otherwise "unlimited" market forces?