Since the signing of the Tripartite First Nations Health Plan (2007) and the BC Tripartite Framework Agreement on First Nation Health Governance (2011), the Tripartite Partners (Health Canada, the BC Ministry of Health, and BC First Nations) have been working closely to develop a new First Nations health governance structure to improve health outcomes for BC First Nations communities.

In October, 2011, the First Nations Health Council and the First Nations Health Society (now the “First Nations Health Authority"), signed the British Columbia Tripartite Framework Agreement on First Nation Health Governance (“the Framework Agreement") with our Federal and Provincial government partners. The terms of the Framework Agreement allowed for a phased transfer of health service delivery programs and responsibilities to the First Nations Health Authority.

This new plan for phasing the transfer supports us to meet the following agreed upon success factors:

• Ensuring no disruption and minimal adjustment required by individual First Nations people and communities to the continuation of their health services or health benefits.
• Ensuring minimal disruption and minimal added work burden on First Nations program providers who deliver community programs.
• Respecting the 7 Directives from Gathering Wisdom.
• Respecting the Vision and Principles of the Framework Agreement and create a solid foundation for its continued implementation.

Transition, Transfer and Transformation

This phased process has been divided into three main stages: Transition, Transfer and Transformation.

The FNHA has reached the Transition stage. In this stage, the FNHA has built all of the infrastructure, systems and processes that need to be in place that has enabled us to take on service delivery responsibilities. It is important during this stage that the new FNHA “get to know" current FNIH programs and services and fully understands how programs are being administered to allow the FNHA to effectively take on service delivery upon Transfer and then Transform Programs and Services under guidance from BC First Nations later on.

Transfer is one of the activities that is part of Transition and refers to the Transfer of responsibility for Health Canada programs and services to the First Nations Health Authority. Transfer occurs at a couple of points in time and is not a long term process.

Transfer entails four key activities:

• Building solid Systems and Structures - systems and technology for Information Management, Finance, Human Resources, Health Benefits and other functions
• Assuming Assets – taking over assets such as vehicles, medical equipment, office furniture and equipment, computer hardware, office spaces, financial and human resources, and the accompanying development of sophisticated governance, controls, and systems.
• Taking over Programs and Services – seamless delivery through the transfer process
• Creating a New, Shared Organizational Culture - Creating a First Nations health organization, through merging with the current federal bureaucracy, that reflects the philosophy and culture of BC First Nations.

The Transfer of program and service responsibilities to the FNHA happens in a few phases.

Leading up to July 2, 2013

FNHA has Health Plan and Agreements Responsibilities

• Transformative Change Accord First Nations Health Plan
• Tripartite First Nations Health Plan
• BC Tripartite Framework Agreement on First Nation Health Governance
• Health Partnership Accord

July 2, 2013

FNHA has taken on Policy, Planning and Strategic Services

• Policy and Planning
• Leadership
• Strategic Services

FNHA has taken on Non-Insured Health Benefits Headquarters Functions

• Dental
• Pharmacy
• Medical supplies and Equipment

October 1, 2013

FNHA has taken on Regionally Delivered Programs:

• Non-Insured Health Benefits Program (Regionally managed functions- Patient Travel, etc.)
• Children and youth programs (ie. Fetal Alcohol Spectrum Disorder, Aboriginal Head Start on Reserve)
• Chronic Disease Programs and Injury Prevention
• Primary Care (ie. Community Primary Care and Nursing Services, First Nations Home and Community Care)
• Communicable disease control programs (ie. Vaccine, Immunization) Blood Borne Disease and Sexually Transmitted Infections (HIV/AIDS), Respiratory Infections (ie. Tuberculosis,)
• Mental Health and Addictions Programs (ie. NNADP)
• Environmental Health and Research Programs
• Health Governance/Infrastructure Support (ie.E-health solutions, Health Careers)
• Health facilities and capital maintenance
• Youth Solvent Abuse Program, National Aboriginal Youth Suicide Prevention Program

Now that the health transfer has occurred, the FNHA enters the Transformation stage.

The Transformation stage entails the exercise of analyzing, upgrading, and re-orienting current FNIH health programs and services to better meet the needs of BC First Nations. This process will also include identifying opportunities for stronger coordination with provincial programs and services. Community engagement on the transformation of programs and services will follow the engagement pathway workbook process with which communities are familiar. 

• ​2013 Guidebook: Building Blocks for Transformation

Transition U​​pdates

• Transition Update: December 2013 Volume 1 Issue 5
• Transition Update: July 2013 Volume 1 Issue 4
• Transition Update: April 2013 Volume 1 Issue 3
• Quarterly Transition Update: December 2012
• Quarterly Transition Update: October 2012

Frequently Asked Que​stions

Transiti​on

When did the transition period start?

The Transition period started in October 2011 with the signing of the Framework Agreement and will extend to 2016.

What is the difference between "transfer" and "transition"?

Transfer is only one of the activities that is part of transition and refers to the transfer of responsibility for Health Canada programs and services to the First Nations Health Authority. Transfer is a point in time and not a long term process. Transfer is an operational

level discussion between the FNHA and Health Canada around the mechanics of moving something from point A to point B, and is really a problem solving exercise to ensure that the quality of service will be there on day 1. The target date for transfer is July 2, 2013. Transition will carry on after the transfer date.

What are we transferring?

Through transfer, the First Nations Health Authority will assume responsibility for all of the resources, people and facilities of the First Nations and Inuit Health (FNIH) BC Region. The FNHA will also have some additional responsibilities which are currently held by Health

Canada headquarters in Ottawa. It's helpful to think of the FNIH regional office as the arms and legs of Health Canada headquarters. The regional office acts on the directions of headquarters but it is not the 'head', it does not set direction. As part of transfer we will take over some of headquarters' responsibilities. This means that the First Nations Health Authority will be able to make changes that the regional office had no control over.

Additionally, the First Nations Health Authority will be taking on corporate services. Corporate services include the systems necessary to pay bills, maintain internet connections, and take care of facilities (etc). Corporate services for Health Canada in all regions are currently administered centrally from Ottawa.

The transfer of regional operations is only one piece of the puzzle, it is through the transfer of headquarters functions that we can really make the difference in how we can change programs and services for our citizens.

What is involved in the transition period?

The transition stream of work includes the transfer process mentioned above as well as ongoing work in evolution of our governance structure. The implementation committee will be in place for 5 years to complete the transition.

Where will the First Nations Health Authority get its funding?

The FNHA has entered into a 10 year funding agreement (called the Canada Funding Agreement) with Health Canada. It's helpful to think of this as a really big health transfer agreement. The FNHA will develop a Multi-Year Health Plan (MYHP). The MYHP is a strategic service plan and will include feedback from First Nations to describe how the FNHA will use its resources.

• Read more about the Canada Funding Agreement.

What is the Interim Management Committee?

The Interim Management Committee (IMC) is a venue for the FNHA CEO (Joe Gallagher) and FNIH Regional Director (Yousuf Ali) to jointly manage FNIH BC operations. An important function of the weekly IMC meeting is for the FNHA to get a sense of what the issues are today and the region's ability to address these issues. The Interim Management Committee is key to creating understanding around the challenges that FNIH has today operating within its current policy, mandate and structure. It also gives both partners an opportunity to see where improvements can be made moving ahead.

The IMC is also focused on making sure that the staff of both organizations understands what the transition means with in order to ensure continuity.

What are the FNHA priorities through the transition period?

Our priorities through transition are:

• No disruption to programs, service, and cash flow for First Nations communities and individuals
• Smooth and supported transitions for the staff being transferred, and existing staff of the FNHA
• Ongoing and robust partnership with Health Canada and BC to make the transfer a success
• Make administrative improvements where practical through transition.

What is the plan for the Transfer of current FNIHB Employees to the FNHA?

All eligible FNIHB employees will receive a Reasonable Job Offer (RJO) and the opportunity to become employees of the FNHA.

What are Sub-Agreements and how are they being finalized?

Sub-Agreements are legal agreements that describe the mechanics of how to physically and legally transfer office space, assets, employees, funding, information, records, and programs from the First Nations and Inuit Health Branch to a First Nations Health Authority.

The main Sub-Agreements (Framework Agreement, Schedule 5) are:

• Human Resources
  
• Health Benefits (NIHB)
• Records Transfer, Information Management and Information Sharing
• Assets and Software
• Accommodation
• Capital Planning/First Nations Health Facilities
• Assignment or Termination of Canada's Contribution Agreements

Sub-agreement finalization is being conducted jointly by the leadership of the FNHA and FNHC. Negotiations are largely an implementation exercise, and are focused on determining how to best facilitate the transfer of resources to the FNHA. It is important to note that these discussions will enable the FNHA to take over the federal programs and operations as they currently exist; they will not describe program redesign, which will take place in collaboration with First Nations only after the Sub- Agreements are completed.

What is the budget for Implementation? How is it being used?

The Framework Agreement approved by BC First Nations in May 2011 includes one-time funding of $17 million to support the implementation and transition costs required to establish the First Nations Health Authority and its operations, and to transition programs, services and functions to its management. These costs are significant particularly for new systems for information management.

Community Programs through Transition

What will happen to my contribution agreement?

Post-transfer community contribution agreements will be administered by the First Nations Health Authority. The FNHA is working closely with FNIH to ensure that there is no interruption in service to contribution agreement holders. It's important to note that until transfer occurs, FNIH remains responsible for program and service delivery including the administration of community contribution agreements. Contribution agreements will not substantially change for a number of years, this type of activity will occur in the transformation period.

The transfer of community contribution agreements between BC First Nations and Health Canada to the First Nations Health Authority is in progress and a large majority of First Nations organizations have already novated their agreements.

Health Canada will keep Contribution agreements holders informed of progress related to the transitioning of these agreements from Health Canada to the First Nations Health Authority.

How is the FNHA planning to address current contract/contribution agreements which expire or are up for renewal near the time of Transfer?

The FNHA does not intend the transfer to get in the way of community contribution agreements and ability to deliver programs and services. If your current contribution agreement is set to expire we suggest that you work with Health Canada staff to achieve a renewal. Post transfer, all contracts and contribution agreements will be held by the FNHA. The contracting processes associated with these agreements is not anticipated to change in the near future, and will only change through engagement with BC First Nations.

Will Health Canada nurses still come to the community?

Absolutely. Through the transfer process, FNIH nursing staff will become FNHA nursing staff. We do not anticipate any interruption in service through this time.

Transformation

What is Transformation?

Transformation refers to the exercise of analyzing, upgrading, and re-orienting current FNIH health programs and services to better meet the needs of BC First Nations. This process will also include identifying opportunities for stronger coordination with provincial programs and services.

When will Transformation take place? When will programs and services change?

Transformation won't begin until transition is complete. It is important that the new FNHA "get to know" current FNIH programs and services and fully understands how programs are being administered. The first round of community engagement on the transformation of programs and services will begin in the spring of 2013 and will follow the engagement pathway workbook process that communities are familiar with.

When and how will communities be engaged regarding transformation? What will be the approach to making changes?

Community will be engaged in the Transition (Transfer) and Transformation process through the FNHC Engagement Pathway. The 2013 Guidebook: Building Blocks for Transformation is intended to gain input and feedback into priorities for Transformation.

Our Structure

How are we ensuring the distinction between business/operations and politics/governance?

By approving the Framework Agreement, First Nation leaders clearly defined the roles of the First Nation components of the First Nations health governance structure by confirming the clear separation of functions of the First Nations Health Council (political), the First Nations Health Directors Association (professional association), and the First Nations Health Authority (service delivery).

Specifically:

• The First Nations Health Council and First Nations Health Directors Association can advise the First Nations Health Authority, according to their mandates, but cannot direct, or be seen as directing, the First Nations Health Authority
• First Nations Health Council members and First Nation Health Directors cannot serve as directors of the First Nations Health Authority
• Members of the First Nations Health Authority cannot participate in the day-to-day decision-making and operations of the First Nations Health Authority
• Within the First Nations Health Authority, no one person may simultaneously act as more than one of (i) member (ii) director and (iii) employee

To further protect against any perceived or real conflict of interest, the Framework Agreement stipulates that elected and political officials and First Nations Health Directors may not serve on the Board of Directors of the First Nations Health Authority.

As an Executive Director of an organization which holds a collective Contribution Agreement with FNIHB do I have a voice or role in the Transfer and Transformation process?

Yes. There will be ongoing opportunity to provide feedback and input into the Workbook process in accordance with the FNHC Engagement Pathway.

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Living Markers

Young Living Markers, representing the five health regions across BC, at Gathering Wisdom for a Shared Journey VI 

The Living Markers, because our elders here have said we don't usually put a name on something that is not alive, like a building. When there is something significant that has happened, we would choose young people to be a living marker for that.