Health Governance





About Health Governance

(posted May 23, 2012)
The signed consensus paper and resolution from Gathering Wisdom V (May 15-17, 2012) is now publicly available for distribution.
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PDF Download | Consensus_Paper_-_Navigating_the_Currents_of_Change_.pdf
PDF Download | Signed Version of the FNHC_-_GW_V_Resolution_2012-01.pdf
PDF Download | FNHC_Resolution_-_Adoption_of_Consensus_Paper_May_2012_.pdf



New- Navigating the Currents of Change Video: Full Version

About Health Governance

Health Governance refers to the administration of health care, the administrative system and the overarching political decision-making related to health. Until recently health governance was the sole responsibility of the federal and provincial governments, depending on who the health care was being delivered to.

Both federal and provincial governments have agreed to negotiate a new relationship with First Nations in BC regarding health governance. This is partly a result of decades of relatively poor health outcomes for First Nations and partly a result of evolving relationships between First Nations and the Crown (federal and provincial governments).

First Nations, Canada and British Columbia have been working to reform health governance in British Columbia since 2005, signing a number of agreements and accords. Most recently the parties signed a Tripartite Framework Agreement on First Nations Health Governance in October of 2011.

This agreement is one of a series that is being implemented to transform health governance as it pertains to First Nations in BC.

“It’s a piece of paper (the Framework Agreement), it’s an important piece of paper, but it’s the people that will breath life into this paper and make a difference. The days when a First Nations child cannot expect to live, cannot expect to live as long as any other child must end. This (agreement) will help make that happen.” The Honourable Michael De Jong.

BC Tripartite Framework Agreement on First Nation Health Governance

News Release - BC Tripartite Framework Agreement on First Nation Health Governance | pdf download |
Backgrounder - BC Tripartite Framework Agreement on First Nation Health Governance | pdf download |
Tripartite Framework Agreement on First Nation Health Governance | pdf |
Ceremonial Document Framework Agreement | pdf |

FIRST NATIONS HEALTH COUNCIL PROCESS TO IMPLEMENT THE TRIPARTITE FRAMEWORK AGREEMENT ON FIRST NATION HEALTH GOVERNANCE
The purpose of this document is to describe the process for the First Nations Health Council (FNHC) to oversee the implementation of the Tripartite Framework Agreement on First Nation Health Governance (“Framework Agreement”), including the conclusion of sub-agreements.
FNHC Process to Implement the Framework Agreement | pdf download |

SUMMARY: FIRST NATIONS HEALTH COUNCIL PROCESS TO IMPLEMENT THE TRIPARTITE FRAMEWORK AGREEMENT ON FIRST NATION HEALTH GOVERNANCE
FNHC Framework Agreeement Implementation Process FAQ and Summary | pdf download |



Resolution 2011-01 Draft Workplan

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On May 26th 2011, BC First Nations leaders passed a historic resolution to approve the transfer of First Nations health programs and services from federal control to First Nations control. Through Resolution 2011-01 and the “Consensus Paper: British Columbia First Nations Perspectives on a New Health Governance Arrangement,” First Nations provided clear direction on the standards of this new arrangement, and tasked the First Nations Health Council with clear next steps in implementation.

One of the immediate next steps that First Nations directed the First Nations Health Council to undertake was the development of a Resolution 2011-01 Workplan. This workplan is being provided to Regional Caucuses for review and feedback between September 27, 2011 and December 31st, 2011. This Workplan includes specific key activities clearly set out in the Resolution, such as: signing of the Framework Agreement; supporting the development of Regional Caucuses and Tables; and, establishing a strategy and approach for the conclusion of sub-agreements.
Resolution 2011-01 DRAFT Workplan Package | pdf download |
Resolution 2011-01 Workplan PowerPoint Presentation | pdf download |

Tune in and hear the words expressed at the Tripartite Framework Agreement signing ceremony

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Federal Health Minister Leona Aglukkaq

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Provincial Minister of Health Services Michael deJong

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Grand Chief Doug Kelly, Chair, First Nations Health Council

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National Chief Shawn A-in-chut Atleo

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Chief Douglas White III, Snuneymuxw

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Chief Bill Cramner, Namgis

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Grand Chief Stewart Phillip

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Kukpi7 Wayne Christian

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Chief Wilf Adam, Lake Babine Nation

Please note that due to technical difficulties Chief Adam’s speech was not fully captured

First Nations Make Historic Decision in Health

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On May 26, 2011, First Nations in British Columbia passed a historic resolution to assume greater control and decision-making over their health and wellness.

146 of the 167 Chiefs and representatives in attendance (87%) voted in favour of the resolution which will make BC First Nations the first in Canada to take over health service delivery from the federal government. The resolution also provides the First Nations Health Council a strong mandate to work with the Province and the Health Authorities. Read the News Release | pdf download |

Consensus Paper : British Columbia First Nations Perspectives on a New Health Governance Arrangement
image May 26th, 2011 BC Chiefs and designates voted to adopt the Consensus Paper: British Columbia First Nations Perspectives on a New Health Governance Arrangement. The Consensus Paper was developed based on the feedback from five regional caucuses and Health Partnership Workbooks and articulates province-wide principles and advice for health governance. This paper brings together common elements from all five Regional Caucuses, and provides direction to the First Nations Health Council to move forward and work with BC and Canada to conclude a new First Nations Health governance structure. We are pleased to announce that the Consensus Paper and Resolution have been combined into one handy reference document.

FNHC Consensus Paper | pdf download |

Seven Directives

The Chiefs in Assembly at Gathering Wisdom for a Shared Journey IV approved the Consensus Paper, including the following directives for the new health governance arrangement:
Directive #1: Community-Driven, Nation-Based
Directive #2: Increase First Nations Decision-Making and Control
Directive #3: Improve Services (Consistent with the Principle of Comparability)
Directive #4: Foster Meaningful Collaboration and Partnership
Directive #5: Develop Human and Economic Capacity
Directive #6: Be Without Prejudice to First Nations Interests (including but not limited to Aboriginal Title and Rights, Treaty Rights, self-government agreements, court proceedings, the fiduciary duty of the Crown, and existing community health funding agreements)
Directive #7: Function at a High Operational Standard

Frequently Asked Questions- First Nations Health Council Process to Implement THE TRIPARTITE FRAMEWORK AGREEMENT ON FIRST NATION HEALTH GOVERNANCE

Who will sign the agreements?

The political agreement – the Health Partnership Accord – will be signed by the Government of Canada, Government of BC, and the First Nations Health Council.

The legal agreements (the sub-agreements flow from the legal Framework Agreement and describe legal commitments of the Government of Canada, Government of BC as applicable, and the First Nations Health Authority) will be signed by the First Nations Health Council’s legal and operational entity, the interim First Nations Health Authority (formerly the First Nations Health Society).

What is the process to conclude sub-agreements?

The Basis Agreement and the Framework Agreement, approved by First Nations establish the broad commitments of the Parties to the scope of the health transfer, the programs to be transferred, the funding to be transferred, and the timeframes and supporting processes for transfer.

Therefore, the future discussions are largely an implementation exercise – they are quite simply legal agreements that describe the mechanics of how to physically and legally transfer office space, assets, employees, funding, information, records, and programs from the First Nations and Inuit Health Branch to a First Nations Health Authority. Therefore, these discussions will be very technical and detailed in nature, and entirely within the scope of what First Nations have approved in the Framework Agreement and Consensus Paper. It is important to note that these discussions are in order to take over the federal programs and operations as they currently exist; they will not describe program redesign, which will take place in collaboration with First Nations only after the sub-agreements are completed.

Will the sub-agreements be shared with First Nations?

The political Health Partnership Accord will be shared with First Nations and be a public commitment document amongst the Parties.

The other sub-agreements will contain very detailed information, and at times confidential and personal information, that may not be appropriate for broad distribution. The signatories to these sub-agreements will be bound by privacy legislation intended to protect the confidential information of individual First Nations and federal employees. Legal advice will be sought on the disclosure of some or parts of these sub-agreements.

How are First Nations on the ground involved in the Process? Chiefs? Health Directors?

Although the sub-agreement discussions are largely technical and mechanical in nature, there may be the need for First Nations to provide their input and wisdom into specific negotiations subjects, such as health benefits. In these cases, the First Nations Health Council will strike subject-matter working groups to help identify First Nations interests in those specific subjects. The interim First Nations Health Authority will canvass all regions for volunteer First Nations leaders and health directors to participate on these working groups.

The real opportunity and need for First Nations leadership and health director involvement will be in program redesign – your direction and wisdom will be required to improve the current federal health programs and services to meet First Nations’ needs. This program redesign process will take place after the sub-agreements are finalized.

When do we redesign programs to meet our needs as First Nations?

First Nations have clearly stated that some, if not all, of the current federal health programs, services, and accountability processes do not meet their needs. The purpose of this health transfer process is to put greater control over these issues into the hands of First Nations.

The program redesign process must be driven by First Nations, who have the on-the-ground experience and wisdom on how to transform health programs and services to meet First Nations’ needs. The First Nations Health Council has circulated a draft “Engagement and Approvals Pathway” to First Nations that describes a process for First Nations to provide direction on the redesign of federal programs. Once finalized, this process would require a multi-staged way of gathering, summarizing, and confirming feedback from all First Nations in BC on how to better create and deliver programs to communities and citizens.

It is important to note the timing of this program redesign. This would not take place until after the sub-agreements are completed and the new First Nations Health Authority established. The sub-agreements will not describe this program redesign. However, we are anxious to start the work to collect your feedback on the priorities and concepts for the redesign of federal health programs and services, and anticipate engaging with First Nations on these issues following the approval of a new First Nations health governance structure at Gathering Wisdom for a Shared Journey V in May 2012.

Why is the term “Interim First Nations Health Authority” used in this document?

Through Resolution 2011-01 approved by First Nations at Gathering Wisdom IV, First Nations called upon the existing First Nations Health Society to take steps to become the interim First Nations Health Authority.

The First Nations Health Council, with participation from our Tripartite Partners recently completed a 30 minute documentary video on First Nations Health Governance called “Implementing the Vision: BC First Nations Health Governnace”

The Tripartite First Nations Health Plan was signed in 2007 amidst a growing body of research supporting the need for greater First Nations control over health. A first for BC First Nations and Canada, the Plan enables the development a new BC First Nations Health Governing Body.  This video documents the perspectives of BC First Nations leaders and senior government partners on the necessity of transformative change towards a new BC First Nations Health Authority.  A better way of managing health is discussed – a system which returns greater control over the design and delivery of health services to BC First Nations.

Copies of Implementing the Vision have been mailed out to all BC First Nations Chiefs and Health Directors.

Signed Basis for a Framework Agreement July 26, 2010 | pdf download |
March 2010 Final Legal Opinion on Draft Basis Agreement | pdf download |

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FNHC TIMELINE | image |