Contracting Care: Evaluating the effects of the "Second Generation Health System Strategy' on the contracting environment for community organizations in the Downtown Eastside of Vancouver

This paper examines the impacts of the Downtown Eastside ‘Second Generation Health System Strategy’ (2GHSS) on the contracting environment for community organizations and programs receiving funding from the regional health authority, Vancouver Coastal Health (VCH). The 2GHSS was designed by VCH and implemented in 2015 with the aim of removing siloed services and providing a more integrated and responsive health system in the Downtown Eastside (DTES). The 2GHSS represents a significant reorientation of government priorities in the community and the accompanying funding shuffles and cuts – primarily directed at non-clinical programs and organizations – have shifted the landscape of the DTES third sector. Informed by the theoretical framework of feminist political economy, and through the use of thematic analysis, this paper identifies trends in the DTES contracting environment between 2015 and 2019 that reflect the intensification of medical dominance and indirect neoliberal governance, including: funding cuts to organizations without links to the formal health system; use of market-based competitive tendering; valuing health services for their clinical rather than their social components; and contributing to an environment of fiscal precarity. It is concluded the 2GHSS is an extension of the neoliberal ideological orientation that has long directed the priorities of the BC health sector.