NEW! Health Human Resources Survey
As part of implementing the Tripartite First Nations Health Plan (TFNHP) and the AHHR Initiative, the FNHC wishes to complete a comprehensive health human resource survey in BC First Nations communities. We are looking for information about your health organization, employees (not names), professional development initiatives, and recruitment and retention strategies. The outcomes of this environmental scan will result in targeted strategies in closing the health human resource issues and gaps.
Who Should complete the survey?
We are mindful of time constraints and demands faced by Health Directors/Managers. If you are unable to complete the survey, we would appreciate it if you could designate appropriate staff within your organization.
We are hoping that our new on-line survey will make it easier for you to share this very important information. Please use the following link to complete the survey tool:
http://www.surveymonkey.com/s.aspx?sm=hRSuryiev2xHIasAK0SaVQ_3d_3d
Background
The need for more First Nations, Inuit and Métis working in health care fields has been identified as far back as 1996, when the report of the Royal Commission on Aboriginal Peoples[1] recommended that governments and educational institutions undertake to train 10,000 First Nations, Inuit and Métis workers in health and social services by 2006. The report suggested that workers would be required in all areas of health, including medicine, nursing, mental health, psychology, midwives, dentistry, nutrition, addictions, gerontology, public health, health administration, and other areas. The federal response to the RCAP report supported this recommendation as key to improving the health care delivery system for First Nations, Inuit and Métis.
Subsequent statistical reports have demonstrated that shortages of First Nations, Inuit and Métis health care professionals and para-professionals continue to be an issue. The Canadian Nurses Association estimated that of the 258,000 registered nurses working in Canada in 2003, approximately 1,200 were First Nations, Inuit and Métis nurses. This number falls short of the number required (3%) or (about 7,700) to ensure equitable representation of First Nations, Inuit and Métis nurses in the health workforce. Although exact figures are not yet available, early data demonstrates that there are only approximately 150 First Nations, Inuit and Métis physicians in Canada, again far short of the approximately 700 needed to ensure equitable representation of First Nations, Inuit and Métis physicians in the health care work force. These shortages are present in all areas of the health care work force.
The above paragraphs are excerpts from Health Canada’s AHHRI Framework [Draft], 2006 [unpublished].
HHR ENVIRONMENTAL SCAN (2007) AND GATHERING WISDOM (2007, 2008): SUMMARY OF FINDINGS
LABOUR MARKET
The majority of people employed in community health departments are First Nations. Half the positions such as the Community Health Nurses, Home Care Nurses and Mental health workers are First Nations.
We also know that health professionals serving BC First Nation communities (both aboriginal and non-aboriginal) face increased stress due wage parity, lack of support/mentorship, cultural leave, or bereavement leave. They are overworked and undervalued. Sometimes health care workers face an expanded scope of practice. In some of our remote areas, the first responder may be a Community Health Representative (CHR). They face high expectations from their community and are viewed as providers of medical treatment, especially when there is no nurse available. For example, one community in BC reports that it took 8 months to replace the nurse’s position. The lack of skill training and health human resource urban concentration and rural deficits compound today’s problems.
LIFE-LONG LEARNING AND EDUCATION
There is a cascade of cause and effect. For example, there is a lack of math and science focus in the K-12. This has a profound impact on the recruitment of First Nation students into science and health programs.
Also, First Nations are not fully aware of the range of health careers, or there is little interest in because industry jobs pay well, especially in the north. There is also a stigma attached to post-secondary education. Higher education is viewed as a waste of time because “you will end up with a minimum-wage job anyway.” And those who do continue their education face great financial challenges. For example, medical students have an average debt of $150K by the time they finish school (although they are able to quickly pay off this debt once they begin work).
On a high note, in 2007, there were (309) First Nations students enrolled in health care programs and forty-one (41) students will graduate in the Spring of 2008. This is most likely an underestimate (poor tracking systems and self-identification).
The PSI strategy is only one piece of a larger strategy that is needed. We need to explore the forces at play in the current HHR crisis. What First Nations are telling us is that:
We need a health career continuum and support services. This will provide students with an opportunity to find their career path, meet their educational goals, and promote lifelong learning as a professional.
We need a multi-media campaign that would entice youth and others to consider careers in health. The AHHRI and Aboriginal Health Career programs need to commit to this, and it will require the commitment and dedication of First Nation communities and organizations to make aboriginal health careers a priority in community capacity building. We need to develop collaborative and complimentary services to support the AHHRI such as First Nation organizations, educational systems and governments to look at the many opportunities for new health training programs.
We also need the commitment from elected leaders and service agencies alike.
The government will need to ensure resources are available for communities to address health human resources recruitment and retention strategies. The public post-secondary institutions need to provide an environment that is conducive for First Nations students (e.g. admissions, curriculum, support and programming). There is a disturbing trend that health programs are becoming graduate level programming, rather than undergraduate programming. Funds are needed for fellowships, scholarships and bursaries to ease the financial burden. Students also need affordable housing.
Community-based training is also needed for education, and professional development. This will reduce the costs of travel and accommodation and they could remain close to their family and community. It should recognize that not all people are able and willing to commit to the rigor and demands of academic study but they want the training in specific health issues on a paraprofessional basis. This would allow them to work in their communities. We need to consider ways that courses can receive academic credits leading to certification over a period of time.
First Nations are also asking for their care takers to have cultural competencies with backgrounds, languages, and social attributes which make them accessible and able to reach diverse First Nations populations. They also say that we need to identify duplication of funding and services. This is because the duplication of services and competition for funds makes it difficult to strengthen relationships and linkages, especially because duplication takes away from fulfilling gaps.
AHHRI Program Goals
To advance a health care system that would improve health services and population health status for all aboriginal people, the federal, provincial and territorial governments agreed to work collaboratively with aboriginal people and created the First Ministers Meeting Health Accord of 2003. This was followed by an agreement reached at the Special Meeting of the First Ministers and First Nations, Inuit and Métis Leaders in September 2004. The 2005 federal budget secured funding of $100 million spanning five years for the Aboriginal Health Human Resources Initiative (AHHRI).
Through the AHHRI, Health Human Resource (HHR) strategies responding to the unique needs and diversity among BC’s First Nations, strategies will respond to the current, new and emerging health service issues and priorities, and also increase the level of cultural safety for First Nations clients/patients while under the care of all health care providers. Through strategically targeted activities some of which may be First Nations, Inuit or Métis specific and others which are pan-Aboriginal in nature, the objectives for the 5 year AHHRI are (2005 – 2010):
1. To increase awareness of First Nations, Inuit and Métis youth about health careers and increase the number of students entering into, and succeeding in health career studies;
2. To increase the number of post-secondary educational institutions that are supportive of Aboriginal students pursuing health career studies;
3. To identify the conditions conducive to the retention of First Nations, Inuit and Métis health care workers, and non-Aboriginal health care workers working in First Nations and Inuit communities;
4. To establish standards of practice and certification for community-based para-professional health care workers.
The AHHRI is intended to complement and wherever possible, integrate with the work already underway in the provinces and territories (e.g. BC’s Tripartite First Nations Health Plan) and the existing Pan-Canadian Health Human Resources Strategy.
Tripartite First Nations Health Plan
Health Human Resources is one of the key drivers to address health, and hence, a performance indicator of the Tripartite First Nations Health Plan (TFNHP). The following priorities have been identified
1. Priority #18. The province will dedicate post-secondary seats to First Nations in order to increase the number of trained First Nations health care professionals. This will be accomplished by working with public post secondary institutions and First Nations communities in order to improve access, participation and success of First Nations learners.
2. Priority #19. First Nations and the Province will develop a curriculum for cultural safety in 2007/2008, and require health authorities to begin this training in 2008/2009. Training will be mandatory for Ministry of Health and health authority staff, including executive and senior management.
3. Priority #24. Access to primary health care services in Aboriginal Health and Healing Center’s will be improved by further developing the role of the nurse practitioner and enhancing physician participation in these center’s through a number of contractual options and incentives.
4. Priority #25. Each regional health authority will increase the number of professional and skilled trades First Nations in health professions. Health Authorities will identify emerging employment opportunities in health authorities, share that information, and then link Aboriginal learners with appropriate training institutions.