Intergovernmental Committee on Manitoba First Nation Health Addressing Health Jurisdictions

1. Intergovernmental Committee on Manitoba First Nation Health Addressing Health Jurisdictions Presented to the Canadian Public Health Association Halifax, Nova Scotia 3 June2008

2. 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.

3. 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.”

4. 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.

5. Who is the ICFNH? 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

6. Who is the ICFNH? 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

7. ICFNH Organization Chart

8. The ICFNH Secretariat The Assembly of Manitoba Chiefs agreed to host the Secretariat which consists of: • 1 Full-Time Project Coordinator • 2 Policy Analysts / Researchers • 1 Administrative support person • Contractors: Independent and project specific

9. ICFNH Mandate Develop innovative strategies and solutions to ensure equity of health outcomes comparable to that 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.

10. 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.

11. ICFNH Guiding Principles • Guided by the seven teachings: love, respect, humility, truth, honesty, wisdom and courage. • Support First Nations self-determination and self-government initiatives. • Government policies must respect First Nations culture, values and language. • Initiatives must promote community capacity building and decision-making affecting their health.

12. Our Families to be Served 126,500 First Nations(2007)1 Projected 194,200(2029) +53% 64 FN communities 79,300 (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

13. Our Challenges in Manitoba 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

14. Our Challenges in Manitoba 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)

15. Successes: Five Key Projects • 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.

16. 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”

17. 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”

18. 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”

19. 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.

20. Existing Projects Chronic Disease / Diabetes Action Plan Manitoba First Nations Disabilities First Nation – Intergovernmental Health Council Medical Relocation – Phase II First Nation – Primary Health Care Framework Five Year Retrospective Evaluation 20

21. Manitoba First NationsChronic Disease / Diabetes Action Plan Priorities: Relationship Building Capacity Building Disease Prevention & Health Promotion Comprehensive Shared Care Early Detection & Screening Care & Treatment Access to Medication & Equipment Information Technology 21

22. 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

23. Manitoba First Nations Disabilities There are current discussions between Manitoba and Canada to work towards addressing the issues identified.

24. 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: To facilitate the necessary partnerships and support for a sustainable FN-IHC Model and Strategy. To achieve active participation among all the partners. To gain consensus on the FN-IHC Model and Strategy through partnership forums. 24

25. 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. 25

26. 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. 26

27. FN - Primary Health Care (PHC) Framework GOALS: Reduce inequities in health programs & services Improve access to comprehensive PHC services Ensure availability of quality comprehensive PHC services 4 First Nations lead the design, development, delivery and evaluation of PHC 27

28. 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

29. SWOT Analyses Strengths: - 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

30. 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

31. 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

32. We have a Vision. We see our Path. .

33. Questions ??

34. Your Presenters Peter Rogers Senior Advisor, Policy & Strategic Planning Health Canada, FNIH Tel: (204) 983-4960 Fax: (204) 983-0079 peter_rogers@hc-sc.gc.ca Lorraine McLeod ICMFNH Project Coordinator Assembly of Manitoba Chiefs Tel: (204) 987-4591 Fax: (204) 956-2109 lmcleod@manitobachiefs.com

35. http://www.manitobachiefs.com/issue/icfnh.html