When asked what PHNs are meant to do I often find myself saying that we exist to “fill gaps in the local health system”. This satisfies most people as we seem to share a universal appreciation that while our health system is good not everyone is able to get what they need.
However, reflecting on the use of the term “gap” I became aware that it carried some major connotations:
- A gap is something that can be filled to improve a thing that is inherently sound
- A crack is something different- it implies imminent collapse!
- How many gaps do you need to call it a crack?
- If you plug just a few gaps will this stop things from crumbling if the foundations are giving way?
- If we just focus on gap-filling we may miss the opportunity to reinforce the fabric of the local health system. Reform is not about gap-filling although it may be necessary as a short-term measure.
- A focus on gaps implies a world-view that far-reaching change is not needed. We just need to sort things for the few who are missing out.
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