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Intergovernmental Committee on Manitoba First Nation Health Addressing Health Jurisdictions Presented to the Canadian Public Health Association Halifax, Nova Scotia 3 June 2008
Intergovernmental Committee on
Manitoba First Nation Health
Addressing Health Jurisdictions
Presented to the Canadian Public Health Association
Halifax, Nova Scotia
3 June 2008
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Establishing the ICFNH
Romanow Report: Chapter 10
“A New Approach to Aboriginal Health” concluded with two recommendations proposing new funding and institutional arrangements.
Recommendation #42: Current funding for Aboriginal health services… be pooled into single consolidated budgets…to integrate health care services, improve access and provide adequate, stable and predictable funding.
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Establishing the ICFNH
Recommendation #43: “The consolidated budgets should be used to fund
new Aboriginal Health Partnerships that would be responsible for developing policies, providing services and improving the health of Aboriginal people. These partnerships can take many forms and should reflect the needs, characteristics and circumstances of the population served.”
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Establishing the ICFNH
First Nations disagreed with Romanow’s Pan- Aboriginal
approach as it was contrary to First Nation interests.
First Nations advocate for the 1996 Royal Commission
on Aboriginal People (RCAP) principles of:
1. Equity
2. Holism
3. Control
4. Diversity.
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The Intergovernmental
Committee on First
Nation Health (ICFNH)
Tripartite committee created
in 2003
Represents all 64 Manitoba First
Nations and the governments of Canada
and Manitoba
Who is the ICFNH?
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First Nations: - Assembly of Manitoba Chiefs (AMC) - Manitoba Keewatinook Ininew Okimowin (MKIO) - Southern Chiefs Organization (SCO)
Canada: - Health Canada - Public Health Agency of Canada - Indian & Northern Affairs Canada
Manitoba: - Health - Aboriginal & Northern Affairs - Family Services & Housing
Who is the ICFNH?
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ICFNH Organization Chart
Political BodyFederal Ministers (Health & INAC)
Provincial Ministers (Health, ANA, FS&H)Grand Chiefs (AMC, MKIO, SCO)
Senior Officials Steering Committee (SOSC)Federal Departments (RDGs & RDs – FNIH, INAC & PHAC)
Provincial Departments (DMs & ADMs)First Nations PTOs (Executive Directors)
Elder Advisor
Working Group (WG)Federal Representatives (Directors & Senior Policy Analysts)
Provincial Representatives (Directors & Senior Policy Analysts)First Nations (Directors & Senior Policy Analysts)
Elder Advisor
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The ICFNH Secretariat
The Assembly of Manitoba Chiefs agreed tohost the Secretariat which consists of:
• 1 Full-Time Project Coordinator• 2 Policy Analysts / Researchers • 1 Administrative support person• Contractors: Independent and project specific
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ICFNH Mandate
Develop innovative strategies and solutions toensure equity of health outcomes comparable tothat of other Canadians.
Discussions / Negotiations:• Will not derogate or abrogate Treaty or
Aboriginal Rights.• Will not impede or compromise any existing
and / or future First Nation initiatives relating to health.
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ICFNH Vision
Paramount to life is health. Thus, it is recognized and asserted that health is the total well-being and balance of our physical, emotional, mental and spiritual natures. It is our vision that total health is restored and maintained in the lives of First Nations citizens in Manitoba.
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ICFNH Guiding Principles
1. Guided by the seven teachings: love, respect, humility, truth, honesty, wisdom and courage.
2. Support First Nations self-determination and self-government initiatives.
3. Government policies must respect First Nations culture, values and language.
4. Initiatives must promote community capacity building and decision-making affecting their health.
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Our Families to be Served
126,500 First Nations (2007)1
Projected 194,200 (2029) +53%
64 FN communities79,300 (63%) on reserve Projected 129,800 (2029) +63% 47,250 (37%) off reserve Projected 64, 400 (2029) +36%
51% in 22 Remote & Isolated
Five linguistic groups: Cree, Dakota, Ojibway, Oji-Cree and Dene
1 INAC 2004 – 2029 Registered Indian Projected Growth
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High health care service utilization by First Nations
High morbidity rates ie: Diabetes
Young population – mean 24 yrs (MB = 40 yrs)
Separate administrative silos for service delivery
Remote & isolated communities – ready access to programs and services is problematic
Limited funding envelopes for on-reserve services
Jurisdictional ambiguities - Canada / Manitoba
Our Challenges in Manitoba
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If you are not a First Nations person living in Manitoba, imagine for a moment that you are. Your life expectancy just became eight years shorter than it is for other Manitobans. And the likelihood that you will die at a young age has more than doubled – tripled if you are female. The chances that you will have diabetes have more than quadrupled and the chances you will need amputation as a result of diabetes have increased sixteen times2
2The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study (Martens, 2002)
Our Challenges in Manitoba
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Successes: Five Key Projects
1. Environmental Scan completed May 2005, titled:
“Overview of Gaps in Service and Issues associated with Jurisdictions: Gaps & Duplication of Services”
This Report serves as a “map” of health care service delivery on and off reserve, including jurisdictional issues.
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Successes: Five Key Projects (cont’d)
2. Health Human Resources:
Strategic Planning Meeting held February 2005. Document produced in May 2006, titled:
“Manitoba First Nations Health Human Resource Regional Strategic Framework: A Call for Action for Upstream Investments”
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Successes: Five Key Projects (cont’d)
3. Primary Health Care
First Nations Primary Health Care Conference held in March 2005
Conference Synthesis Report produced, titled: “Connecting With All Our Relations - To Build Bridges in Primary Health Care”
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Successes: Five Key Projects (cont’d)
4. Medical Relocation Phase I December 2005 – March 2006
Preliminary analysis of policies currently in place.
Medical Relocation is an occurrence when someone has to move from their home community to access medical treatment and services for a period of three months or more.
“The Impact of Medical Relocation on Manitoba First Nations - Possible Policy Responses”
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Successes: Five Key Projects (cont’d)
5. Fiscal Analysis Report titled:
“A Financial Analysis of Current and Prospective Health Care Expenditures for First Nations in Manitoba” The report examined total 2004 health expenditures by federal and provincial governments for First Nations and projected expenditures to the year 2029 based on the assumption that current policies would remain in place and no new funding would be invested.
2020
Existing Projects
1. Chronic Disease / Diabetes Action Plan
2. Manitoba First Nations Disabilities
3. First Nation – Intergovernmental Health Council
4. Medical Relocation – Phase II
5. First Nation – Primary Health Care Framework
6. Five Year Retrospective Evaluation
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Manitoba First NationsChronic Disease / Diabetes Action Plan
Priorities:1. Relationship Building
2. Capacity Building
3. Disease Prevention & Health Promotion
4. Comprehensive Shared Care
5. Early Detection & Screening
6. Care & Treatment
7. Access to Medication & Equipment
8. Information Technology
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Manitoba First Nations Disabilities
A Position Paper on Manitoba First Nation Disabilities
was tabled in December 2007
Issues
1. Significant gaps in access and availability of services on reserve compared to those received by other Manitobans
2. Payment of services delivered off reserve (for on reserve residents) is frequently in question and disputes arise from uncertain mandates or authority to deliver services
Manitoba First Nations Disabilities
There are current discussions between Manitoba and
Canada to work towards addressing the issues identified.
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First Nation – Intergovernmental Health Council
The FN-IHC project will enhance coordination and collaboration while improving the efficiency of federal, provincial, and First Nation health systems.
Proposal Objectives:
1. To facilitate the necessary partnerships and support for a sustainable FN-IHC Model and Strategy.
2. To achieve active participation among all the partners.
3. To gain consensus on the FN-IHC Model and Strategy through partnership forums.
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Medical Relocation
Medical Relocation Phase II
• Completed May 2008
• Technical review of administrative data to document service utilization (scope and severity of cases)
• Community Survey and eight interviews.
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Medical Relocation (cont’d)
Medical Relocation Phase III
• A more detailed analysis of the social, economic, health and cultural impacts of medical relocation on First Nations individuals and families.
• Additional interviews will be conducted
• CIHR funding-approved January 2008.
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FN - Primary Health Care (PHC) Framework
GOALS:
1 Reduce inequities in health programs & services
2 Improve access to comprehensive PHC services
3 Ensure availability of quality comprehensive PHC services
4 First Nations lead the design, development, delivery and evaluation of PHC
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Retrospective Evaluation
• Conducted January – March 2008• Five year retrospective: 2003 – 2008• Reviewed Terms of Reference• Document review – minutes, commissioned
reports• Assessed funding arrangements• SWOT analyses• Recommendations
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SWOT AnalysesStrengths:
- Momentum- Culturally appropriate health model
Weaknesses:- Poor communication at community & political levels- Delays in work-plan approval
Opportunities:- Intergovernmental Support & Recognition- Move work to next level (Health Council)
Threats:- Jurisdictional ambiguities- Year-to-year funding
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Some Recommendations
• Formation of Health Council• Develop new service models• Increase communication & awareness• Advocate for establishment of urban Transition
Centre• Ensure sustainability of funding• Ensure policy impact analysis• Incidence of activities vs intensity of activities
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What’s Next? Leading to Action
Strategic Planning Session (September 2008)
Identifying priorities (multi-year)
Increase the efficiency and effectiveness of programs and services
Maintaining and strengthening relationships
Increase communication & awareness
Sustainable funding
Engage Political Body
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.
We have a Vision. We see our Path.
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Questions ??
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Your Presenters
Peter Rogers
Senior Advisor, Policy & Strategic Planning
Health Canada, FNIH
Tel: (204) 983-4960
Fax: (204) 983-0079
Lorraine McLeod
ICMFNH Project Coordinator
Assembly of Manitoba Chiefs
Tel: (204) 987-4591
Fax: (204) 956-2109
http://www.manitobachiefs.com/issue/icfnh.html
