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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

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Intergovernmental committee on manitoba first nation health addressing health jurisdictions

Intergovernmental Committee on Manitoba First Nation Health Addressing Health Jurisdictions

Presented to the

Canadian Public Health Association

Halifax, Nova Scotia

3 June2008

Establishing the icfnh
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.

Establishing the icfnh1
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.”

Establishing the icfnh2
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.

Who is the icfnh
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

Who is the icfnh1
Who is the ICFNH?

First Nations:

- Assembly of Manitoba Chiefs (AMC)

- Manitoba Keewatinook Ininew

Okimowin (MKIO)

- Southern Chiefs Organization (SCO)


- Health Canada

- Public Health Agency of Canada

- Indian & Northern Affairs Canada


- Health

- Aboriginal & Northern Affairs

- Family Services & Housing

The icfnh secretariat
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

Icfnh mandate
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.

Icfnh vision
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.

Icfnh guiding principles
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.

Our families to be served
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

Our challenges in manitoba
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

Our challenges in manitoba1
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)

Successes five key projects
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.

Successes five key projects cont d
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


Successes five key projects cont d1
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”

Successes five key projects cont d2
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”

Successes five key projects cont d3
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.

Existing projects
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


Manitoba first nations chronic disease diabetes action plan
Manitoba First NationsChronic Disease / Diabetes Action Plan


Relationship Building

Capacity Building

Disease Prevention & Health Promotion

Comprehensive Shared Care

Early Detection & Screening

Care & Treatment

Access to Medication & Equipment

Information Technology


Manitoba first nations disabilities
Manitoba First Nations Disabilities

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

Manitoba first nations disabilities1
Manitoba First Nations Disabilities

There are current discussions between Manitoba and

Canada to work towards addressing the issues identified.

First nation intergovernmental health council
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.


Medical relocation
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.


Medical relocation cont d
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.


Fn primary health care phc framework
FN - Primary Health Care (PHC) Framework


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


Retrospective evaluation
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

Swot analyses
SWOT Analyses


- Momentum

- 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

Some recommendations
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

What s next leading to action
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

Intergovernmental committee on manitoba first nation health addressing health jurisdictions

We have a Vision.

We see our Path.


Your presenters
Your Presenters

Peter Rogers

Senior Advisor, Policy & Strategic Planning

Health Canada, FNIH

Tel: (204) 983-4960

Fax: (204) 983-0079

Lorraine McLeod

ICMFNH Project Coordinator

Assembly of Manitoba Chiefs

Tel: (204) 987-4591

Fax: (204) 956-2109