While a terrific money-saver, centralization has hamstrung health care in many small towns. Now what? Not much, unless residents do it themselves. In Port Alberni and Nelson, B.C. citizens have translated health care problems into opportunities, rallied local resources, and used co-operatives to create the local solutions that health bureaucrats cannot.
"... the larger, more centralized the health system, the less likely it is to be responsive to local needs. Competing demands tend to lead to incomplete solutions, 'good enough' for a large health authority that needs to move on to its next crisis.
"Where local priorities differ from those of the health care authority, it is up to the local community to resolve the differences. No-one else will or can. To do that, community members have to look upon problems or gaps in their health services also as opportunities. They need to identify the resources available to them, to tap into those opportunities, and to create an organization to co-ordinate their actions. Lastly, they have to be ready to learn as they go, and go as they learn, and reflect on both their wins and their losses so they can do even better next time."