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Intergovernmental Committee on Manitoba First Nation Health Addressing Health Jurisdictions. Presented to the Canadian Public Health Association Halifax, Nova Scotia 3 June 2008. Establishing the ICFNH. Romanow Report: Chapter 10
Presented to the
Canadian Public Health Association
Halifax, Nova Scotia
Romanow Report: Chapter 10
“A New Approach to Aboriginal Health” concluded with two recommendations proposing new funding and institutional arrangements.
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.
“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.”
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:
Committee on First
Nation Health (ICFNH)
Tripartite committee created
Represents all 64 Manitoba First
Nations and the governments of Canada
- Assembly of Manitoba Chiefs (AMC)
- Manitoba Keewatinook Ininew
- Southern Chiefs Organization (SCO)
- Health Canada
- Public Health Agency of Canada
- Indian & Northern Affairs Canada
- Aboriginal & Northern Affairs
- Family Services & Housing
The Assembly of Manitoba Chiefs agreed to
host the Secretariat which consists of:
Develop innovative strategies and solutions to
ensure equity of health outcomes comparable to
that of other Canadians.
Discussions / Negotiations:
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
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
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
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)
“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.
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
3. Primary Health Care
First Nations Primary
Health Care Conference
held in March 2005
Conference Synthesis Report
“Connecting With All Our
Relations - To Build Bridges
in Primary Health Care”
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”
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.
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
Disease Prevention & Health Promotion
Comprehensive Shared Care
Early Detection & Screening
Care & Treatment
Access to Medication & Equipment
A Position Paper on Manitoba First Nation Disabilities
was tabled in December 2007
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
There are current discussions between Manitoba and
Canada to work towards addressing the issues identified.
The FN-IHC project will enhance coordination and collaboration while improving the efficiency of federal, provincial, and First Nation health systems.
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.
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.
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.
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
- Culturally appropriate health model
- Poor communication at community & political levels
- Delays in work-plan approval
- Intergovernmental Support & Recognition
- Move work to next level (Health Council)
- Jurisdictional ambiguities
- Year-to-year funding
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
Engage Political Body