B'C' Tripartite First Nations Health Plan

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B.C. Tripartite First Nations Health Plan

• Vancouver Island First Nations Health Governance
  Conference
• March 11, 2009

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THE BC TRIPARTITE HEALTH PLAN
On June 11, 2007, the First Nations Leadership
Council (FNLC), the Province of British
Columbia (BC) and the Government of Canada signed
the BC Tripartite First Nations Health Plan to
create fundamental change and close the gaps in
health status between First Nations and other
British Columbians.
It is a 10-year health plan with four key
elements

• Governance, Relationships and Accountability
• Health Promotion / Injury and Disease Prevention
• Health Services
• Performance Tracking

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HOW DID WE GET HERE?

• A New Relationship (March 17, 2005)
• The Province of British Columbia and First
  Nations Leaders agreed to enter into A New
  Relationship guided by the principles of trust,
  recognition and respect for Aboriginal rights and
  title.
• The New Relationship focuses on closing the gaps
  in quality of life between First Nations and
  other British Columbians.
• First Nations Health Blueprint for BC (July 15,
  2005)
• Improve delivery of, and access to, health
  services to meet the needs of all Aboriginal
  peoples through better integration and adaptation
  of all health systems.
• Measures to ensure that Aboriginal peoples
  benefit fully from improvements to Canadian
  health systems.
• A forward looking agenda of prevention, health
  promotion and other upstream investments for
  Aboriginal people.

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HOW DID WE GET HERE? (Contd)

• Transformative Change Accord (November 25, 2005)
• First Ministers and Aboriginal Leaders committed
  to strengthening relationships on a
  government-to-government basis and to focus
  efforts on closing the gaps in education,
  economic opportunities, housing and health.
• Establish mental health programs to address
  substance abuse and youth suicide.
• Integrate the ActNow Strategy with First Nations
  health programs to reduce the incidence of
  diabetes.
• Establish tripartite pilot programsto improve
  acute care and community health services
  utilizing an integrated approach to health and
  community programs as directed by the needs of
  First Nations.
• Increase number of trained First Nations health
  care professionals.
• As part of the TCA, the Parties agreed that by
  Dec. 2006, a detailed tripartite implementation
  plan would be developed laying out specific
  actions and building on a shared commitment to
  undertake as many initiatives as possible in year
  one of the 10-Year Plan (2006-2016).

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HOW DID WE GET HERE? (Contd)

• The bilateral First Nations Health Plan signed on
  Nov. 27, 2006 builds on the BC Provincial
  Health Officers Report (2001)
• Recognizes First Nations must be full partners in
  the design and delivery of health initiatives to
  benefit them and their people.
• Reciprocal accountability between governments and
  First Nations is fundamental to addressing
  socio-economic gaps.
• The Tripartite First Nations Health Plan MOU
  signed on Nov. 27, 2006 sets out an initial
  framework for a Tripartite First Nations Health
  Plan and identifies priority areas for
  collaborative action.
• The Tripartite First Nations Health Plan signed
  on June 11, 2007 reflects a shared vision of
• First Nations are fully involved in the
  decision-making regarding the health of
  their peoples.
• Health and well-being of First Nations is
  improved.
• Gaps in the health between First Nations people
  and other British Columbians closed.
• Equitable access to quality culturally competent
  services.

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SIMILAR ACTIONS IN OTHER SECTORS

• Tripartite Education First Nations Jurisdiction
  Framework Agreement (July 5, 2006)
• Power and authority to govern and control K-12
  education on reserve that is recognized by
  federal and provincial governments
• First Nations Education Authority to exercise
  jurisdiction in areas of teacher certification,
  school certification, and establishment of
  curriculum and examination standards
• Child and Family Services
• Delegation agreements to Aboriginal agencies to
  undertake administration of Child, Family and
  Community Service Act
• Levels of delegation include guardianship
  services for children in continuing care full
  child protection authority to investigate
  reports and remove children

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WHY WE NEED TO ACT

• Many decisions on programs are made outside of
  First Nations communities
• Division of federal and provincial roles and
  responsibilities leads to fragmented health
  services and programming
• Under-developed data, reporting, surveillance and
  management tools
• Services lacking in cultural competence
• Difficulty in collaborating between health and
  other sectors and lack of a plan to address
  health determinants

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FIRST NATIONS IN THE VANCOUVER ISLAND HEALTH
AUTHORITY REGION
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VANCOUVER ISLAND FIRST NATIONS

• Vancouver Island First Nations have been leaders
  and at the forefront of FNIHBs transfer policy
• 42 bands operating under a Health Plan (Transfer
  or Flexible Transfer Agreement)
• 2 bands operating under a Workplan (Integrated or
  Transitional Agreement)
• 6 bands operating under a Health Program (General
  or Set Agreement)
• There are 3 main First Nations entities on
  Vancouver Island
• Cowichan Indian Band
• Inter-Tribal Health Authority (Kwakutl District
  Council are members)
• Nuu-Chah-Nulth Tribal Council

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VANCOUVER ISLAND FIRST NATIONS

• Cowichan Indian Band
• One of the largest bands in BC
• Expected to move to a Flexible Transfer Agreement
  in 2010
• Inter-Tribal Health Authority
• Largest First Nations multi-disciplinary health
  service organization in British Columbia
• Nuu-Chah-Nulth Tribal Council
• Signed the first 10 year Flexible Transfer
  Agreement in Canada effective April 1, 2008.
  Previously, NTC managed a health service transfer
  agreement for 20 years

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COLLABORATIVE ACTION HEALTH PROMOTION, DISEASE
PREVENTION AND SERVICES

• Aboriginal Physician Advisor (Dr. Evan Adams)
• Early Childhood Screening Programs (vision,
  dental, hearing)
• Mental Health and Substance Use (Aboriginal
  Reference Group)
• Tele-health (Centre of Excellence, E-health,
  Tele-wound care MOU)
• Patient Navigator Program (supported by AHTF)
• Gathering Wisdom 2008
• ActNow BC

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COLLABORATIVE ACTION GOVERNANCE

• There is a commitment to create a new structure
  for the governance of First Nations health
  services in BC that will be responsible for
• Regional health planning and administration
• Health design, delivery and accountability
• Reflect the service delivery needs of First
  Nations and,
• Define the status of results to be achieved.
• The new governance structure for First Nations
  health services in BC will have four essential
  components.

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COMPONENTS OF A NEW FIRST NATIONS HEALTH
GOVERNANCE STRUCTURE
FIRST NATIONS HEALTH GOVERNANCE, RELATIONSHIPS,
AND ACCOUNTABILITY
First NationsHealth Council
Provincial Advisory Committee On First Nations
Health
First Nations Health Governing Body
Association Of Health Directors

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FIRST NATIONS INTERIM HEALTH GOVERNANCE COMMITTEE
(FNIHGC)

• FNHC has created the FNIHGC to lead this work for
  First Nations in the discussions with BC and
  Canada around the new structure to govern First
  Nations health services in BC.
• FNIHGC has three Co-Chairs Grand Chief Ed John
  Grand Chief Doug Kelly and Chief Wayne
  Christian.
• 5 First Nations regional caucuses are being
  formed to provide a mechanism for First Nations
  to participate and drive the process.
• Each Caucus will identify members to sit on the
  FNIHGC.

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FIRST NATIONS HEALTH GOVERNANCE

• First Nations central to design and delivery of
  all health services at community level
• Control of First Nations health services by
  First Nations.
• Health Canada to become funder and governance
  partner.
• Governing Body Effective participation of First
  Nations in
• Enacting policies
• Identifying results
• Allocating resources
• Establishing service standards and,
• Implementing reciprocal accountability.

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HEALTH CANADA FUNDER AND GOVERNANCE PARTNER

• A New Funding Relationship
• A fair share of HCs First Nations dedicated
  resources
• Multi-year agreement with built in escalator
• A share of new program funding and,
• A flexible transfer like financial agreement.
• Reciprocal Accountability
• Maintenance of the historical First
  Nations/Federal legal relationship
• Accountable to meet its commitments and,
• Holding other partners accountable for their
  commitments in the Tripartite Health Plan
• A partner in health planning and evaluation.
• A new governance structure for FNIHB that gives
  BC First Nations a role in shaping federal First
  Nations health policies and programs.
• A non-political professional relationship as
  well as a separate political one.

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OPPORTUNITIES AND CHALLENGES

• What would happen if First Nations in BC were
  free to design their own programs, create their
  own priorities, allocate funding as they see fit?
• Would the health programs and financial support
  to First Nations be better or worse if First
  Nations where to take over the functions of FNIH
  regional office?
• What would a health care system based on BC First
  Nations community values look like?
• What would happen if the provincial government
  and First Nations in BC became close partners,
  working together to provide health services to
  First Nations people and other BC residents?
• Can we manage a smooth transition so that First
  Nations people receive ever improving health
  services?

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POTENTIAL BENEFITS

• Decisions made by First Nations in BC for First
  Nations in BC.
• Services organized by needs of patient and skills
  of organization not jurisdiction
• Opportunity to pool/ re-allocate resources and
  leverage funds to increase access and obtain
  better care.
• More effective and efficient programs and
  services.
• Community-based approach where the services are
  reflective of regional particularities and also
  provided closer to home.
• Service delivery that makes sense within
  catchments that could extend to urban
  populations.
• Increased collaboration across sectors and
  effective action on health determinants.
• Improved accountability.

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NEXT STEPS

• Communicating
• Continue talking, engaging and listening -
  explaining what we are doing and why we are doing
  it
• Building
• Preparatory work to transition control of FNIH
  programs, services and resources to a new FNHGB.
• Strengthening the relationship between First
  Nations and provincial health authorities.
• Adapting and enhancing programs and services to
  better serve First Nations.
• Collaborating
• Developing the capacities, mechanisms, tools and
  procedures to work more effectively together.
• Performance Tracking
• Putting in place evaluation tools to measure
  progress against that goals we have set for
  ourselves.

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ANNEX A BC REGION EXPENDITURES

• Total Expenditures approximately 288,000,000
• Staff approximately 225

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ANNEX B BC REGION NON-INSURED BENEFITS
2007-2008 ( Millions)
Total 119.6M

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ANNEX C BC REGION COMMUNITY REGIONAL PROGRAMS
2007-2008 ( Millions)
Total 156.6M

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