Case Synopsis

Inaya, manager of the ‘low-risk’ project at Provincial Council for Maternal and Child Health (PCMCH), had to come up with an integrative solution for the issues encompassing maternity care in Ontario. The low-risk project aims “to design and develop effective low risk maternal and newborn strategy for Ontario (2015-2018) to ensure that all women have an equitable choice of delivery options, and access to the right level of care at the right time, no matter where they live in the province”. In response to external and internal challenges facing Ontario’s hospitals, the province has seen the closure of rural maternity programs over the last few years. The women in communities that are unable to sustain local services must travel to access distant services, and depending on the distance to the nearest referral center, may be away from their homes and communities during the critical pregnancy period and child birth. The separation of pregnant women from their families and communities can cause negative outcomes. The health and economic impacts of the inability to access local maternal programs are well documented. Different stakeholders have indicated the importance of alternative, sustainable models of interprofessional collaboration of midwifery, primary and specialty care, and the efficient allocation of human health resources (PCMCH, 2015). To create the framework of the model, PCMCH formed a leadership team and expert panel consisting of different care providers. Inaya had to identify barriers and potential solutions by engaging different care providers and exploring the challenges from their perspectives. The findings would be used to work with relevant partners, such as associations of different health care professionals, to develop potential solutions for the Ministry.

The goal of the case is to provide readers with the opportunity to apply the concept of collaboration and also explore the barriers to achieving inter-professional collaboration from the key stakeholders’ perspectives.

Case Objectives

  1. Understand the effect of different social determinants on pregnancy outcomes.
  2. Understand the importance or role of effective province-wide policies or strategies ensuring equity of maternal and newborn care.
  3. Discuss and identify barriers to accessing maternity services in rural settings.
  4. Understand the concept and importance of inter-professional collaboration for long-term sustainability of rural maternity services.
  5. Identify the key stakeholders and effectively engage with them to determine different barriers to achieving inter-professional care.
  6. Explore different maternity care providers’ perspectives to find solutions regarding issues related to inter-professional care.

Case Study Questions

  1. What is the main problem or issue discussed in the case?
  2. What are some social determinants that can potentially affect pregnancy outcomes?
  3. What are some factors or reasons contributing to the problem or closure of maternity services in Ontario?
  4. Name some important/key stakeholders in the maternity care sector in Ontario?
  5. What is collaboration or inter-professional collaboration? Do you think it is important? Why? Does anyone want to share an experience where you had to work in collaboration with people from different disciplines? How was that? If that was a bad experience, in your opinion, what was the reason behind that?
  6. What are the indicators or factors that influence inter-professional collaboration? Which one is the most important for collaboration? Why? In this case scenario, which one is the most important one in your opinion? Why?
  7. What are some key challenges or barriers for inter-professional collaboration?
  8. Name some funding/remuneration models for care providers in Ontario? What are the strengths and weaknesses of each of the models?
  9. What incentives should/could be given to different care providers to ensure effective collaboration and integrated care and to encourage them to work in rural or low volume areas?
  10. What are some other challenges that should be taken into consideration while planning and creating a framework for the inter-professional working model?
  11. Do you think communication or sharing information between two different care providers would be a challenge in this type of model? If yes, how can this problem be solved?


inter-professional care, collaboration, access, equity, rural health, maternal and newborn health, continuum of care, Ontario policy, funding models, sustainability, maternal services, care providers, Low Risk Strategy

Additional Author Information

Sabrina Haque, MBBS, MPH

Preeti Nigam, BSc, MBA, Senior Program Manager

Shannon L. Sibbald, PhD, Assistant Professor



Recommended Citation

Haque, S., Nigam, P., Sibbald, S.L. (2017). Saving the Rural Ontario Maternity Services – Can We Do It?. in: John-Baptiste, A. & McKinley, G. [eds] Western Public Health Casebook 2017. London, ON: Public Health Casebook Publishing.