Gathering Wisdom, Now What? A Tripartite Presentation

BC Tripartite First Nation Health Governance Framework Agreement

UBC Learning Circle September 29, 2011

Presented by: Grand Chief Doug Kelly, Ian Potter, and Arlene Paton

Gathering Wisdom IV

•  Unprecedented First Nations leadership support for: – New health governance structure – Transfer of Health Canada – B.C. FNIH

responsibilities to a new First Nations Health Authority

– Align to seven directives – Report back May 2012

Consensus: 7 Directives

•  Directives describe fundamental standards and instructions for new health governance arrangement

Consensus: 7 Directives

Directive #1:

Community-Driven, Nation-Based

Directive #2: Increase

First Nations

Decision-Making and

Control

Directive #3: Improve

Services

Directive #4: Foster

Meaningful Collaboration

and Partnership

Consensus: 7 Directives

Directive #5:

Develop Human and Economic Capacity

Directive #6: Be Without Prejudice to First Nations

Interests

Directive #7:

Function at a High

Operational Standard

Regional Caucuses in each Health Region will establish Regional Tables to: •  Engage with First Nations •  Develop and implement arrangements between Regional Tables and Regional Health Authorities •  Develop regional perspectives and approaches to health and wellness •  Effective, efficient and sustainable engagement and operations

Consensus: Role of Regional Caucuses/Tables

PRIORITIES Engagement with First Nations Effective delivery of services including

address service gaps and innovation Improve NIHB program Implement First Nations values Health literacy and self-care Health partnership with Province

including shared service opportunities Capital, infrastructure, equipment Health human resource development Cultural competency training First Nations Deputy PHO

Constituted with good governance, accountability, transparency and defined operating standards and governed by a Board of Directors with experience in First Nations health programs and services and successfully running a large

operation.

Consensus: Role of First Nations Health Authority

Work plan to deliver on Resolution

•  As directed by leadership at Gathering Wisdom IV, a work plan developed for review by regional caucuses.

•  Work plan details key deliverables set out in resolution 2011-01.

•  Work plan to be reviewed by regional caucuses this fall.

First Nations Health Governance Structure Workbook

•  Final FNHA form/structure to be developed via further research, analysis, and engagement with First Nations, as led by the FNHC (2012)

•  Permanent structure workbook process rolled out via regional caucuses (early 2012)

•  First Nations to vote on permanent structure at Gathering Wisdom V (May 2010)

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What does the Framework Agreement do?

•  Establishes a new governance structure for First Nations health – First Nations fully involved in planning,

programming and delivery – A First Nations Health Authority – First Nations take over Federal Regional

role – Federal and Provincial commitment to

funding

Federal Commitments in Framework Agreement

•  Transfer all resources to support programs to the FNHA

•  Ten year block funding agreement •  Implementation funding •  Participation by Canada in committees in

support of its role as governance partner •  BC First Nations invited to Federal “Health

Determinants” Tables

Why is the Framework Agreement Important?

•  First Nations involved in all aspects of their health services

•  Provides First Nations with governance and administrative tools for effective and efficient service

•  Creates long term stability

COMPARISON OF CURRENT & PROPOSED ELEMENTS

Elements Current Proposed

Policies & Programs

•  Decisions are made in Ottawa by federal government

•  Decisions are made in BC by BC First Nations

Regional Management (for day to day operations)

•  Accountable to Ottawa

•  Accountable to BC First Nations

COMPARISON OF CURRENT & PROPOSED ELEMENTS

Elements Current Proposed

Health Services

•  Limited to federal policies

• Little integration with Provincial health system

•  New partnership with Regional Health Authorities •  Service designed to meet the needs of First Nations

Funding •  Year by year allocation – uncertainty

• 10 years stable funding

• Guaranteed annual growth

•  No change to fundamental relationship •  No impact on First Nations rights, treaties or

self government •  Federal role changes to governance partner:

– Collaboration on: •  Social determinants of health •  Sharing research and promising practices •  Program design and policy

•  Federal Regional staff transferred to First Nations Health Authority

Evolving Relationship between First Nations and Federal Government

Transition

•  Transfer anticipated within two years of signing the FA

•  Mechanisms to support Transfer: – Canada Funding Agreement – Sub-agreement negotiations to effect the

transfer –  Implementation Structure – Health Partnership Accord

BC Undertakings

•  a commitment to explore various legislative options to establish legal authority of the FNHA and enable public health functions.

•  directing Health Authorities to collaborate with the FNHA at the regional level to facilitate coordination and integration of First Nations health programs and services.

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BC Undertakings Cont’d

•  Develop a Health Partnership Accord to describe the shared vision.

•  Discuss “innovative arrangements for

service delivery” where mutually agreed upon.

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Continued Role of Province and Health Authorities

• Ensure duplication will not occur and a parallel health service delivery structure will not be created.

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Ongoing Provincial Funding Commitment

•  $83.5 Million to the First Nations Health Society to implement the commitments in the Transformative Change Accord and the Tripartite First Nations Health Plan.

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