The "Canadian model" in the international context

The focus of this commentary is on the relevance of the Canadian experience for developing countries. It highlights the growing urgency poor countries face in preserving their major human and social capital--community solidarity and family care. Developing countries face a double burden of disease--communicable and non-communicable diseases alike, with very few, and often shrinking, resources. While poorer countries will be able to learn about the essential elements of home-based care from the examples of Canada and other industrialized countries, they do need to develop their own systems based upon their economic, social, political and cultural realities. The primary health care system would seem to provide a foundation for the provision of long-term care on a sustainable and cost-effective basis. In contrast to the often-prevailing practice in developed countries, home-based care services could be integrated into the overall health and social system. Functional disability, regardless of disease aetiology or age of the care recipient, as well as the needs of family caregivers would thus become the defining elements of service eligibility. While the question remains open as to how much poor countries can learn from the experience of others, developing countries do have the opportunity to initiate a rational process where they first provide support to communities and informal caregivers and help to maintain patients in their homes and only later develop other service elements.