Non-insured walk in clinic: addressing the needs of an under-serviced population

sikeeka NIWICSideeka Narayan (BScN, MPH) is a Registered Nurse with Access Alliance. She has played a pivotal role in coordinating the non-insured walk in clinic (NIWIC) since its opening in March 2012. Her research interests revolve around primary care, access to healthcare and refugee health. 


It is midway through a Friday morning when I step into the nurse’s room at Access Alliance on College, and there to meet me is Registered Nurse Sideeka Narayan. I had first heard of her work through an article on the midwifery services provided at the Non Insured Walk In Clinic (NIWIC) for pregnant patients in need of pre-natal care and delivery services. Sitting across from her in this sun-lit room expecting to hear more of the same, she cuts right away to emphasizing the clinic’s significance in its admittance of all undocumented, non-insured peoples in Toronto in dire need of health services.

Situated at AccessPoint on Jane, the clinic, which opened in March 2012, sees the majority of its patients coming from the West end of Yonge street, within the city of Toronto. However, nobody is turned away if they fit the eligibility criteria; namely, having no form of health insurance, without immigration status and lacking a primary care provider.

“At the NIWIC, many of our walk-in patients are refugee claimants who have been rejected by the Canadian immigration system and are flagged for deportation,” says Narayan.

“When it first opened, the clinic’s main objective was to provide primary care to the non-status and non-insured, a population marginalized in Toronto and greater Canada. They face barriers in accessing primary healthcare services. Community Health Centres (CHCs) are an essential point of service for this group. By partnering with them, we are better equipped to provide the right service at the right time and address access barriers, so these patients don’t end up in the Emergency department.”

Access Alliance MHCS along with the six other partnering CHCs (Unison, LAMP, Black Creek, Davenport-Perth, Stonegate and Rexdale) helps to coordinate and streamline the referral process by absorbing NIWIC patients with complex, chronic and/or unmanaged conditions. According to Narayan, the clients are from a highly vulnerable population group with backgrounds of complex medical and social situations, face language barriers, experience domestic abuse and live in fear of deportation. Since its conception, the demand for the NIWIC’s services have peaked. Recent-most figures from June 2013 to May 2014 revealed that 375 non-insured clients used its services, and is expected to only get busier.

“The success of working in this partnership model is that all stakeholders, from the nurses and volunteer midwives, to the partner CHCs, are advocating on behalf of the patients to address the needs of an under-serviced population,” states Narayan.

Success stories include an HIV-positive pre-natal patient whom the NIWIC connected to an interdisciplinary pre-natal care team specialized in HIV/AIDS who were able to provide appropriate resources and timely care to ensure a healthy delivery. In another case, an elderly, long term smoker was diagnosed with complex peripheral heart disease through the NIWIC, and was subsequently referred to a wound care specialist and vascular surgeon, and post-op offered ongoing primary care services at a partner CHC.

Narayan admits the trickiest part is connecting the medically complex patients to healthcare providers for ongoing care, due to their lack of healthcare insurance and precarious living circumstances. However, with the help of Access Alliance and similar organizations, hundreds within this extremely vulnerable population are provided access to essential healthcare services. The numbers of avoided ED visits speak for themselves.

Written by Yohani Mendis

NIWIC fact sheet for service providers can be found here.

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