The First Nations Health Authority wants to change the philosophy behind how health care is delivered to its citizens in B.C.
Set to take over some areas of health care delivery for Aboriginals from the federal government next summer, the agency is looking to move away from a system based on illness to one centered around health.
"What our chiefs and our citizens want is a wellness system so that we can get support to become well as opposed to be going there when we're sick," Grand Chief Doug Kelly of the First Nations Health Council said.
The health council is the political wing of the First Nations Health Authority (FNHA) and by this time next year, it's expected that the (FNHA) will have taken over all service planning and delivery from the federal government.
Once everything is in place, the FNHA will be able to start evaluating the effectiveness of programs using a First Nations method rather than what the federal government is currently doing.
"The way that [federal government departments] measure success is very different from the way that we would measure success," Kelly said. "When they look at how the program is doing, they're actually talking to service providers. When we talk about how a program is doing, we talk to clients or patients."
It's been 13 months since B.C. First Nations signed an agreement with the federal and provincial governments which set out a framework of how health care for Aboriginals could be managed by Aboriginals. The past year has been spent going through the details, trying to make it happen within the 24-month window set out in the original plan.
Among the agreements the FNHA has signed is a deal with Northern Health to set up a committee to look at how services will be delivered in the region. The regional group met once in September and has another meeting set for January.
"They're going to work together on improving health services delivery to Northern First Nations," Kelly said. "It's pretty exciting. They're organizing and getting themselves ready to develop a plan and an approach and we're doing similar work in other regions."
Northern Health chief medical health officer Dr. Ronald Chapman is eager to help sort through those details and is excited to be working with a new partner in the FNHA.
"We've had our fair share of challenges [with the federal government], although I think we worked successfully together," Chapman said. "We welcome the establishment of the First Nations Health Authority that will take over those functions and what we like about is the local people we'll be working with, instead of federal officials."
The FHNA has a few more hurdles to overcome before it can start administering services, the largest one being a funding agreement with the federal government. The two sides have already agreed on the structure - a 10-year deal beginning with $380 million in Year 1 and increasing in future years - but still need to sign the final document.
If all goes according to plan, the federal government will sign off on the financial package in February or March.
"We're hopeful cabinet will see fit to approve the work that we've been doing, both in terms of a long-term partnership accord and the funding agreement," Kelly said. "We're not anticipating any troubles, but it's a process."
Assuming there are no hiccups, the FNHA will begin its transition to a service provider in July, starting with big picture items like health policy and moving towards more hands-on areas. The complete transition is on track to be finished by October.
One of the goals the FNHA has set out is to improve how primary care is delivered to remote communities. Kelly pointed to the cost of transporting residents from fly-in, boat-in or winter-road access committees to urban centres for treatment, when it might be easier to bring the doctor to them.
"It would be a whole lot more efficient and cheaper if we were to find a way to bring the physician to the community instead of bringing the community to the physician," Kelly said.
All that's been accomplished in the past year hasn't come without its challenges. For instance, Kelly said the FNHA had a "steep learning curve" in dealing will all the existing health authorities in the province because they all operate slightly differently.
Another hurdle the FNHA could face is meeting the expectations which have been created.
"Expectations are high, the need is high but often the resources aren't there to support that," Chapman said. "That's the reality all of us face - and them being a new health authority, that's one of the issues they'll face fairly soon."
The amount of resources available and how they will be deployed are some of the details that will be worked out in the coming months. Kelly is confident they'll find the right balance to make the FNHA a quick success.
"I think it's a matter of learning what our communities have available in terms of resources and what the province and the regional health authorities have available for resources," he said. "In many respects it's really about getting to know one another and beginning to explore the opportunities for doing things better."
