KEY ISSUES & CHALLENGES

Over the last year, one key issue has been the preparation of the Manitoba First Nations Health & Wellness Strategy for input into the Federal and Provincial Aboriginal Health Blueprint Process. Manitoba First Nations leadership was successful in securing a First Nations specific blueprint process and AMC is currently working with national and regional working groups to establish a First Nations blueprint.

With regard to government policy and programming, AMC continues to challenge the limitations and barriers First Nations people face when accessing health care both on- and off-reserve. Formal recognition of the Treaty Right to Health remains as AMC’s primary objective when addressing health concerns and some progress has been made to ease the access to and delivery of health care services in Manitoba. While progress has been made, the challenge remains to ensure First Nations have a full seat at the government table when designing policy and programs for First Nations.

LINKAGE TO FIRST NATIONS COMMUNITIES

The AMC’s key health linkage to our First Nations communities remains to be our Manitoba First Nations Health Technicians Network (MFNHTN). The MFNHTN consists of Tribal Council Health Directors and Advisors and representatives from our North and South Independent communities. The MFNHTN meets every month and keeps AMC informed of community issues and continues to work collectively to advocate for First Nations health care access and delivery in Manitoba.

The AMC also works directly with individual First Nations on issues of common concern for all Manitoba First Nations. We continually receive calls from our Nations for support on addressing health issues and are happy provide information and advocacy when requested.

STATUS OF ACTIVITIES

Regional Activities:

a. Regional Health Authorities (RHAs)

The RPD unit has been involved in promoting and supporting First Nations involvement in regional health planning. The present provincial government has required through their funding agreements with the RHAs, a performance agreement to demonstrate that all eleven RHAs have an “Aboriginal Deliverable” as an integral part of their operations. The Burntwood RHA had already exceeded these expectations by working with First Nations leadership in the northern area served by Thompson health care facilities and has partnered with First Nations, KTC, MKIO and other non-Aboriginal people in establishing a joint health initiative, the Northern Aboriginal Peoples Health & Wellness Initiative (NAPHWI).

In February 2004, AMC cooperated with Manitoba Health, Aboriginal Health Branch to host a meeting with Manitoba First Nations and Manitoba RHA leaders and technicians on “The Role of First Nations People with Regional Health Authorities”. The two-day meeting clarified many issues such as citizenship/ membership of Aboriginal peoples, Treaty and aboriginal rights, and inter-jurisdictional gaps in health care service to First Nations people. First Nations stressed the importance of partnership, short and long term planning, and dealing with systemic and personal racism. A second forum will be held in July 2005 and will focus on finding solutions and implementing recommendations brought forward in the first forum.

b. Mental Health

In June 2003, the First Nations and Inuit Health Branch (FNIHB) released the Mental Health Program Review, which identified a number of recommendations to improve upon the way the program was being delivered both internally and within the communities. In July 2004, a meeting was held with FNIHB’s Regional Director and AMC to discuss next steps in FNIHB’s re-design process of mental health programs, and how they were planning on facilitating meaningful collaboration with First Nations for their implementation strategy.

FNIHB has assured AMC that there has been no movement to implement changes on the mental health programs without First Nations involvement, and that they would like to form a Working Group to move on this file. AMC has responded and they are fully prepared to organize a First Nations Working Group to move forward on discussing the proposed recommendations outlined in the review.

c. FNIHB Budget Review Exercise

AMC was invited to assist the First Nations and Inuit Health Branch (FNIHB), Manitoba Region with the budget/deficit review exercise. A Budget Management Review Working Group was established and included representatives from AMC, MKIO and SCO, including the Grand Chiefs, FNIHB Regional Director (RD) and FNIHB management.

At the AMC Assembly held on June 14 &15, 2004 at the Opaskwayak Cree Nation, a position was presented and supported by way of resolution that Manitoba First Nations will not participate in a costsaving exercise that is to the detriment of First Nations health programs and services. Further, this position mandated the First Nations to participate only in long term planning that will establish a Regional Task Force to identify the actual health needs and to conduct a comprehensive program and financial analysis on all FNIHB programs, including the NIHB program, and in addition that a joint Treasury Board submission between AMC and FNIHB Manitoba Region be undertaken from the work developed by the Regional Task Force. Work is on-going.

d. Manitoba Tobacco Legislation and Reduction Strategy for First Nations

In March 2004, the Manitoba Government requested the formation of a First Nations Elders Advisory Council to define First Nation Ceremonial Use of Tobacco in the proposed legislation of Bill 21 (The Non-Smokers Health Protection Act). An Elders Forum was held on April 31-May 1, 2004, and approximately 50 traditional teachers, healers and Elders attended to provide input into definition of the Ceremonial Use of Tobacco. A second forum is being planned for Fall 2005 to discuss an Aboriginal education, communication and training strategy.

e. First Nations Dental Care

On June 15, 2004, the Chiefs-in-Assembly passed the “First Nations Dental Care at Risk” resolution (Jun-04.05) to address the dental crisis. The resolution directed AMC Grand Chief to meet with the FNIHB Regional Director to discuss allocation of resources for Pediatric dental surgery and discuss changes to streamline the Dental Pre-Determination Program (DPDP) approval process to facilitate better access and faster dental care turn-around time for First Nations in Manitoba.

First Nations have recommended to FNIHB that in order to address the long term goals of promoting good dental health, FNIHB must revise the DPDP to ensure efficiency and accountability in the provision of dental care by involving dental professionals and organizations, and First Nations health authorities, providers and technicians in its review and amendment to the program.

f. Status Verification System (SVS) Linkages

AMC has worked with the MFN Centre for Aboriginal Health Research to develop a master agreement and Memorandum of Understanding (MOU) on using FNIHB’s Status Verification System (SVS), the Indian Registry held by INAC and Manitoba Health databases. The agreement is on its third draft and is currently going through legal review by AMC legal counsel. The next step is to meet with all parties and begin negotiations. The time frame to complete the work and all negotiations has been set for April 2005.

The Manitoba First Nation Diabetes Committee (MFNDC) proceeded to develop a link to the SVS with the National Diabetes Surveillance System. The MFNDC was to develop a MOU agreement between First Nations, FNIHB and Manitoba Health and outline how the diabetes information would be utilized. However, developing the specific diabetes MOU has been a challenging process and concerns were raised regarding the time involved in developing an MOU and the cost of linking the SVS/Indian Registry to the Manitoba Health population registry data for each project. A decision was made to pursue a letter of understanding as opposed to a MOU.

g. Manitoba First Nations Centre for Aboriginal Health Research

The following research program illustrates the extent to which MFNCAHR is addressing health and health related issues in First Nations and indigenous communities regionally, nationally and internationally:

• Manitoba First Nations Regional Longitudinal Health Survey

In Manitoba, First Nations leaders, policy advisors, and community and tribal health service workers urgently require information on the health of the Manitoba First Nation population, as well as on factors associated with good and poor health. This information is required to secure immediate and longterm financial and human resources necessary for improving and developing policy and programs for healthy First Nation communities.

The Manitoba First Nations Regional Longitudinal Health Survey is a joint initiative of the Assembly of Manitoba Chiefs (AMC) and the Manitoba First Nations Centre for Aboriginal Health Research (MFNCAHR) at the University of Manitoba. The 2002 survey is part of a larger national study that is being conducting in First Nation communities across Canada. The First Nation Centre (FNC) of the National Aboriginal Health Organization (NAHO) is responsible for coordinating all national parts of the survey (from design to dissemination) on behalf of the First Nations' Health Information Governance Committee, of which an AMC Health Policy Advisor is a member. In Manitoba, the Assembly of Manitoba Chiefs and the MFNCAHR jointly manage this study (from design to dissemination) on behalf of Manitoba First Nations communities. The survey was completed prior to end of the 2004-2005 fiscal year and work will continue on analysis and dissemination.

• International Collaborative Indigenous Health Research Partnership Grants: Indigeneity, Resilience & Best Outcomes for Health: Celebrating Body, Land and Spirit

In a joint initiative, the AMC and MFNCAHR have applied for an international grant as one of three (3) research partners that will explore the capacity of indigenous peoples to overcome adversity, flourish and enjoy better health and well-being. This indigenous-led research is to examine policies, health disparities, service delivery, and indigenous aspirations that will have a particular focus on the link between resilience and good health.

Research partners from Australia and New Zealand plan to conduct the five (5) year study and if successful, Manitoba’s contribution to the study will consist of exploring First Nation Youth resilience as it relates to suicide. Information from the Manitoba First Nations Regional Longitudinal Health Survey will be used if the study is approved.

• Social Capital as a Determinant of Health in First Nations Communities

There is increasing evidence of social environmental factors affecting population health and there are a variety of possible ecological level descriptors of these factors. Social capital is one of these descriptors.

It is an elusive concept that, particularly in social epidemiological studies, appears to have been used with scarce theoretical examination. However, it is a promising concept for First Nations communities.

The two main contributions of the study were to articulate a conceptual framework for social capital in First Nations communities and to derive culturally-appropriate measures of the dimensions of social capital. The study took place in partnership between the Assembly of Manitoba Chiefs (AMC) via its Manitoba First Nations Health Information and Research Committee (HIRC), and the Centre for Aboriginal Health Research at the University of Manitoba. Three Manitoban First Nations communities took part in the study. The first phase of the study used ethnographic methodology with two aims, to contribute to the development of the conceptual framework, and to generate an initial list of instrument items.

NATIONAL ACTIVITIES:

a. Federal Aboriginal Health Blueprint Process

The process of developing a Federal Aboriginal Health Blueprint was mandated by Prime Minister Paul Martin at the First Minister’s Meeting (FMM) Special Session on Aboriginal Health on September 14, 2004. A deadline for completion of the Federal “Blueprint” was set for September 2005. At the same meeting, Prime Minister Martin directed the First Ministers and their respective Health and Aboriginal Affairs Ministers to work collaboratively within their regions to develop the Aboriginal “Blueprint”.

Prior to the FMM, the Canada-Aboriginal People’s Roundtable was held on April 19, 2004 and the federal government committed to hold meetings on key policy areas (sectoral sessions) with Aboriginal representatives to develop recommendations for change, which would then be shared at a Joint Policy Retreat of the Cabinet Committee and Aboriginal leaders for May 2005.

A Blueprint process was set in motion and six (6) Sectoral Sessions were organized and held from November 2004 – January 2005. These sessions were intended to provide an opportunity for First Nations to put forward their vision and priorities on critical sectoral/policy issues and to have a direct influence on policy-making at the federal level. After the first sectoral session on health held November 4-5, 2004, concerns were raised as to the intention of government and proposed outcome, as the session appeared to be more reflective of developing a pan-Aboriginal health policy rather than address a First Nation specific process.

As a result, Chiefs-in-Assembly at the Assembly of First Nations (AFN) Special Chiefs Assembly on December 5-7, 2004, passed resolution #31/2004 (AFN Opposes Government of Canada’s Pan- Aboriginal Approach), in response to the pan-Aboriginal approach. Furthermore, resolution #30/2004 speaks directly to the Blueprint process and the concerns expressed regarding the health sectoral session. Both resolutions clearly state that First Nations leadership are not in favour of a pan-Aboriginal approach and want government to act on establishing a First Nations specific process to address First Nation health issues.

In Manitoba, discussions have occurred between AMC and Minister Tim Sale (Minister of Health, Government of Manitoba) and Jim Wolfe (Regional Director, FNIHB, Health Canada), to begin development of an Aboriginal Health Blueprint process for Manitoba. AMC has put forth the position that Manitoba will require a First Nations specific process.

b. National Health Transfer Policy Evaluation Study

The National Health Transfer Policy Evaluation Study has been completed by the Manitoba First Nations Centre for Aboriginal Health Research (MFNCAHR), under contract from First Nations & Inuit Health Branch. The objectives in evaluating the health transfer policy were:

• To assess the results and impacts of the transfer policy considering the objectives originally set for the policy, maintaining/improving FN’s and Indian health status; enabling their capacity to design, manage and deliver health services; providing flexibility in the delivery of health services and strengthening communities accountability with regards to health programs and services; and

• To assess the effectiveness of the health transfer continuum of activities for transferring health services responsibilities to communities.

The evaluation has produced a three (3) volume final report on the results and developed 12 recommendations based on their consultation with transferred First Nation communities. First Nations have voiced their concerns about the long term direction, sustainability and funding of the transferred programs, impact on First Nations health status, and capacity building, especially for those First Nations who have chosen not to pursue health transfer.

First Nation Health representatives have explicitly stated that if FNIHB intends to use their feedback to make health transfer policy amendments, First Nations need to be involved and no changes should be made without expressed involvement from Manitoba First Nation leadership, as they will direct how the process will proceed (e.g. Political and/or Technical processes).

c. National Medical Transportation Reporting Requirements

The National First Nations Health Technicians Network (NFNHTN) has been actively involved with FNIHB to resolve concerns over the new medical transportation reporting requirements planned for implementation in this fiscal year’s contribution agreements. First Nation concerns lie with the 21 different data elements (requirements) and reporting requirements.

Also, individual “privacy protections” are at risk with the new elements, especially for clients from small communities as data collected could possibly identify an individual in the community. A legal analysis has been done of the policy and found there is potential for privacy breaches and individual identification.

Work is on-going and negotiations are proceeding under the guidance of the AFN Chiefs Committee on Health.

d. Non-Insured Health Benefits (NIHB) Pilot Projects Evaluation

According to AFN, Hollander Analytical has completed Phase 1-3 of the Evaluation Reports. The First Phase was completed in June 2004. The 2nd and 3rd Phase of the evaluation reports were recently submitted in draft form.

The purpose of the current evaluation is to provide input regarding the future transferability of the NIHB Program to First Nations and Inuit control. The primary focus of Phase 1 was to develop a broad understanding of the NIHB Program and the previous evaluations on the various pilots. Phase 2 was to focus on the development of an in-depth understanding of issues and challenges regarding the transferability of the NIHB Program, and Phase 3 to focus on First Nations who applied for NIHB pilot project funding, and those who were successful in obtaining the funding, and have continued to function as a pilot site. Review of the consultant’s draft report #2 and 3 is underway, with review of draft report #1 already completed by the National First Nations Health Technicians Network.

e. Additional Committee Work

Currently, the committees listed below have been attended by various Manitoba First Nations Health technicians and the AMC has responded to requests for support and input when required.

• National Native Addictions Partnership Foundation Inc.
• FNIHB Fetal Alcohol Syndrome Advisory Committee
• FNIHB Tobacco Control Strategy
• Injury Reduction
• AFN Continuing Care Focus Group (Ad Hoc)
• AFN Prenatal & Nutrition Sub-Committee
• Canada Prenatal Nutrition Program Steering Committee
• Home & Community Care Steering Committee

The following groups have since been dissolved:

• Institute for Aboriginal Peoples Health - Expert Panel on Research Ethics: no update has been provided since early 2003.
• First Nations & Inuit Health Information Systems (FNIHIS) – FNIHB is currently focusing efforts on building an e-Health System to replace it.
• NIHB National Joint Technical Working Group – Currently exists to discuss the Medical Transportation file only.

ACCOMPLISHMENTS

Manitoba First Nations Health & Well-Being Strategy - A 10 year Action Plan

At the First Ministers Meeting Special Session on Aboriginal Health held on September 13, 2004, there was an announcement to proceed in the development of an Aboriginal Health Blueprint; a blueprint intended to bring together Federal, Provincial and First Nation leadership in addressing First Nation health care needs and solutions.

In response, the Assembly of Manitoba Chiefs have worked with other First Nations partners to develop a Manitoba First Nations Health & Wellness Strategy and 10 year Action Plan to present to Federal & Provincial partners in the process of developing a Manitoba blueprint in the spirit of full cooperation and full engagement. As a result of this announcement, Manitoba First Nation leadership expressed the need to hold a Special Chiefs Assembly on Health.

The RPD unit worked diligently to secure funds to host a Special Chiefs Assembly on Health, January 24-25, 2005, to present the draft health strategy to AMC Chiefs-in-Assembly. A unanimous resolution was passed supporting this draft plan of action, which included the development of a FN Health Blueprint Workplan and the establishment of an interim AMC Chiefs Task Force on Health (CTFH). It is the expectation that the CTFH will be evolve into a FN Health Council once the 10 year Health Strategy document has been ratified by leadership.

A Manitoba First Nation Blueprint Workplan and proposal was created and submitted for funding. The completion date for submission of a FN-specific blueprint is June 27, 2005. It must be noted that the MFNHWS has received national and provincial recognition.

Intergovernmental Committee on First Nations Health (ICFNH)

The Inter-governmental Committee on First Nation Health (ICFNH), formerly called the Romanow Joint Working Group (RJWG), is entering its third fiscal year of working on dissipating the interjurisdictional issues affecting program responsibilities to create solutions for a more seamless health care delivery model. The committee’s intent is to develop recommendations to improve the health status of First Nations’ people by means of analyzing the current health services available to First Nations. The ICFNH understands that the development of this framework and recommendations would include participation from key First Nation health and social organizations and communities.

The ICFNH has identified four key projects to be completed in the 2004-05 fiscal year and has been successful in securing funding to achieve the project deliverables in the following areas; First Nation Health Human Resource Initiative, Primary Health Care Conference, Two Health Research projects: An Overview on the Gaps in First Nation Health Services, and Fiscal Analysis and Projections on Health Expenditures for Manitoba First Nations.

A Multi-Sectoral meeting on First Nation Health Human Resources (HHR) was hosted by the ICFNH February 24-25, 2005. This meeting was the initial step in a Strategic Planning process to bring together a cross-section of personnel in the Education, Health and Human Resource fields in Manitoba.

The information contributed by the participants assisted in achieving the initial project objectives, which included:

1. Exploring First Nation HHR needs;

2. Designing education strategies across the academic continuum;

3. Sharing HHR recruitment & retention strategies;

4. Laying the groundwork for multi-sectoral partnerships;

5. Identifying policy changes required to meet these objectives.

The participants informed us that a comprehensive HHR strategy for First Nations must be reflective of a journey from early learners to adult students to meet the attainment of professional qualifications and employment within the work force. The ICFNH intends to host two more HHR Strategic Planning sessions in the 2005-06 fiscal year to build upon the ideas generated at this meeting. These recommendations will also be incorporated into the First Nation Health Blueprint.

To meet their second project deliverable, the ICFNH hosted a successful conference on First Nation Primary Health March 22-24, 2005 and met their goals to transfer knowledge, promote best practices and build bridges between First Nation health organizations and the relevant provincial and federal government departments that hold responsibilities in delivering health services.

The strengthening of networks between First Nations, Regional Health Authorities, the provincial government, the federal government, non-governmental organizations, and the private sector, at the conference was apparent and many great ideas were forwarded to the committee for consideration.

Recommendations generated from the primary health care conference will be included in the First Nation Health Blueprint to assist the Chiefs and First Nations, provincial and federal governments to consider, plan and pursue strategically effective options and cooperative team approaches specific to primary health care.

In order for the ICFNH to formulate strategies on a better coordinated health care system for First Nations, two pivotal research projects were designed to present evidenced based policy directions. The ICFNH recently completed the first research project: the “First Nations Health and Wellness in Manitoba – Overview of gaps in service and issues associated with jurisdictions”. Approximately 50 recommendations were forwarded to the committee for consideration and it is expected that several of these recommendations will be worked on in the 2005-06 fiscal year.

The second research project, Fiscal Analysis of Health Care Expenditures on First Nation Health” has been deferred into the 2005-06 work plan, completion is expected by September 2005.