CHC partnerships

Like midwives, Community Health Centres (CHCs) are funded to care for Ontario's residents, regardless of immigration status. It can be very useful for midwives and CHCs to work together to support uninsured clients.

Some midwifery practices have established formal partnerships with CHCs, with a Memorandum of Understanding (MOU). These MOUs state the nature of the referral relationships and the responsibilities of the midwives and the CHC.

There are several models by which midwifery practice groups can establish partnerships with local CHCs:

  • reciprocal referral model
  • cross referral model
  • ad hoc CHC referral model
  • midwifery clinic within a CHC
  • conducting clinic visits at the CHC

A list of CHCs across Ontario can be found on the Ministry of Health and Long Term Care website.

How are CHCs funded?

CHC staff work in a salaried model. CHCs are funded to provide complete care for their patients. This includes care provided by physicians/practitioners at the CHC, any consultation fees to see specialists outside the CHC and any associated laboratory or diagnostic investigation.

When CHCs refer clients to midwives, they do not have to pay a consultation fee. Some CHCs have arrangements with hospitals to reduce hospital fees for uninsured clients.

Midwifery-CHC Partnerships


Midwives in Ontario are collaborating with CHCs to provide care. Here are some examples of these models.

  • Wellfort, Brampton
  • MATCH, South Riverdale Community Health Centre, Toronto  
  • Delhi Community Health Centre, Delhi (Between Hamilton and London)
  • Black Creek Community Health Centre, Toronto
  • NorWest Community Health Centre, Thunder Bay
  • Centre de sante Communautaire du Grand Sudbury (CSCGS), Sudbury
  • Outreach Community Midwifery Program, Grand River CHC, Brantford
  • Ancestral Hands, TAIBU, Toronto
  • Southeast Grey CHC, Ottawa
  • Southeast Ottawa CHC, Ottawa    


What is a reciprocal referral model?

All pregnant people who are patients of the CHC are referred to midwives. At six weeks postpartum, the midwife discharges the client and baby back to the CHC. This “reciprocal referral” model produces a seamless process of client care for both the CHC and midwifery practices.


What is cross referral model?

In this arrangement any uninsured clients of the CHC are taken into care by the midwifery practice, and vice versa. Planning caseload can be challenging as the number of referrals to MPGs can be sporadic. As well, some clients may not attend an intake appointment to register as a CHC patient.

What is an ad hoc CHC referral model?

Several Ontario CHCs refer clients to midwifery practices as needed, without an MOU.

There is no established flow of patient referrals, so caseload planning is challenging for MPGs. The MPG may not have spots for clients late into care.


Establishing a midwifery clinic within a CHC

In this model, a practice is established and funded in partnership with a CHC.

This practice is physically located in the CHC, and the practice partners are responsible for all administrative work, including booking of appointments and lab collection.

The practice's caseload encompasses CHC referrals of all low-risk pregnant clients and community referrals.

This arrangement may pose a challenge for growth depending on the physical space available at the CHC.


Conducting midwifery visits at a CHC

Midwives from a practice in the community may hold a regular clinic at a CHC where nurse practitioners and other providers are very knowledgeable and supportive of midwifery.

Clients receive midwifery care at the CHC, while all CHC services are available, including language interpreters, social work, and settlement services. After leaving midwifery care the CHC takes on clients if they do not have a primary care provider. Midwives working at the CHC take clients from the CHC. Any remaining caseload is filled from their MPG wait list. Some midwives may find it challenging to attend multiple clinic locations during their work week.