The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.

Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.

Based on these observations, non-uptake of prenatal care is discussed using different types of explanatory typologies adopted for this study: non-knowledge, non-claiming by choice or constraints and non-reception of care. This theoretical approach reveals that failures in healthcare services as well as the dichotomy between social representations and medical standards of pregnancy and prenatal care contribute to exclude some women from the prenatal care system.

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This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

Les innovations en santé se produisent dans différents services, organisations et communautés.De plus, elles font face à de multiples logiques institutionnelles, qui sont souvent contradictoires. La logique du marché axée principalement sur la rentabilité et sur la création de la valeur économique à travers les innovations détient le monopole dans les systèmes d’innovation actuels. Cette orientation s’appuie sur une vision techno-économique de l’innovation, selon laquelle les technologies sont considérées comme une fin en soi. Par conséquent, la valeur économique de l’innovation est privilégiée par rapport à sa valeur sociale. Cette perspective dominante comporte différents défis et enjeux dans le domaine de la santé publique et communautaire, où maints acteurs concourent et ont des intérêts divergents. Cet article s’intéresse de près à la notion d’innovation dans le but de clarifier sa signification et de repenser ses différentes orientations paradigmatiques, notamment techno-économique et sociale. La discussion portera sur l’intérêt de l’innovation sociale comme paradigme à promouvoir dans le domaine de la santé publique.

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