gathering wisdom, now what? a tripartite presentation · • establishes a new governance structure...
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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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