Issues for First Nations communities
The vision of the TFNHP is that all First Nations individuals in all regions of British Columbia have access to quality health services comparable to those available to other Canadians living in similar geographic locations.
First Nations aim to continue increasing their capacity to directly deliver health services to their people and communities. Since 2001, the Province has invested in targeted funding for programs and services to improve Aboriginal health. Positions for Aboriginal Health Leads have been created in health authorities and are responsible for developing and implementing health plans to address the needs of their Aboriginal populations. The Province works with post secondary institutions to encourage and support Aboriginal learners in the health disciplines. Seats are also dedicated to First Nations students studying in health disciplines in various universities and colleges, as well as strategy development to increase recruitment and retention. However, not all post secondary institutions have adopted this model and gaps remain in the Aboriginal workforce in health services.
In a recent study done of the Aboriginal Health Human Resource in British Columbia, the data shows that for a number of reasons, many Aboriginal people want to work in health but are faced with challenges – both during study at PSIs and also when entering the workforce. The Province currently works with post secondary institutions to encourage and support Aboriginal learners in the health disciplines. Universities and colleges take a number of approaches including dedicated seats in health sciences programs, academic support and laddering programs. Some post secondary institutions offer introductory workshops for Aboriginal students entering medicine. The Aboriginal Nursing Strategy has been developed with the aim of increasing recruitment and retention of Aboriginal nurses practicing in BC and to increase the number of aboriginal communities in BC with quality nursing services. However, regardless of these efforts, health services are not always available, accessible or culturally appropriate.
The allocation formulae for transfer agreements should ensure that funding for the First Nations health infrastructure enables the capacity to offer competitive salaries and wage levels, and offer competitive and equal employment opportunities.
Post secondary institutions that offer training in health must focus on increasing opportunities for First Nation people to enter the health profession at various levels receiving recognition of prior learning. In a recent study done of the Aboriginal Health Human Resource in British Columbia, the results show that there is generally a lack of resources, lack of use of role models and lack of support for professional development. Incentives for the retention of First Nations staff include pay rates, job security and study support.
Health services are not always available, accessible or culturally appropriate, and ongoing federal/provincial jurisdictional and funding issues create wider gaps. The TFNHP reaffirms that the development of health services must reflect First Nations cultural values and extend the opportunities for health services to practice First Nations ways of health and healing. All jurisdictions must commit to the basic requirement of cultural competent service providers to facilitate a holistic approach to First Nations health that links with the key determinants of health. First Nations developed and delivered education and training programs will be the most appropriate vehicle for the ongoing support of this requirement at all levels.
The FN submission on the Health Blueprint identified that the lack of cultural competence of many care providers in provincial and regional health services, private practice, labs, pharmacies, outpatient services is a significant barrier for First Nations people in their attempts to access health services.
Some of the key Health Human Resource issues raised by First Nations throughout the province inlcude:
Education & Awareness
- Wage and workload issues in First Nations health systems are a primary issue in BC;
- The lack of cultural competence of many care providers in provincial and regional health services, private practice (physicians), labs, pharmacies, and outpatient services is a significant barrier for First Nations people in their attempts to access health services in British Columbia;
- Fee-for-service does not meet relationship building and patient-centered care requirements; and
- HHR Planning in Isolation: costly; unintended impacts; mismatch between supply and demand; duplication or gaps in services.
Building a capable and competent First Nations health work force is fundamental for providing care that is sustainable, holistic, and culturally appropriate. The paper presents the following recommendations:
This information was obtained from a variety of sources including the First Nations Health Blue Print for British Columbia 2005; BC Aboriginal Health Human Resources Initiative Environmental Scans (2007-2009); Gathering Wisdom for a Shared Journey (2007, 2008 & 2009); Health Director’s Forum (2008); and BC First Nations Health Regional Caucuses (2008 to 2010).
Specific Health Actions from the TCA: FNHP and TFNHP
# 18 – Dedicate post-secondary for Aboriginal health professions
# 20 – Designate senior staff in health authorities responsible for Aboriginal health
# 24 – Develop the role of Nurse Practitioners and Physician participation in Aboriginal health and healing centres
# 25 – Increase the number of professional and skilled trades First Nations in health professions
# 26 – Increase the number of Aboriginal hospital liaison staff employed by Health Authorities
# 19 – To develop a cultural competency curriculum for health authorities