1. Conducted by Medicine Creek Solutions & Summit Innovations A Policy Issue Paper on Manitoba First Nation Foot Care Services Patient Wait Times Guarantee Project

2. Conducted by Medicine Creek Solutions & Summit Innovations Purpose The independent policy review is one component of the PWTG Project’s 3 rd phase of activities

3. Conducted by Medicine Creek Solutions & Summit Innovations Approach Document/Literature Review Documented Personal Knowledge Interviews Discussion of Impacts Suggested Policy Alternatives

4. Conducted by Medicine Creek Solutions & Summit Innovations Who is the Problem Affecting? MFN demographic information –8.9 % of Manitoban population –43.35% living off-reserve in 1999 –Population figures by tribal council for 1998 and 2008

5. Conducted by Medicine Creek Solutions & Summit Innovations Who is the Problem Affecting? Diabetes & Diabetes-Related Complications rates for Canadians 45/1000 vs MFNs 203/1000 91% of MFN amputations due to diabetes- related complications

6. Conducted by Medicine Creek Solutions & Summit Innovations What is the Problem? Amputation rates 18% higher for MFNs when prevalence of diabetes 4.2 x greater Inequitable, inconsistent provision of preventative foot care services in the Region

7. Conducted by Medicine Creek Solutions & Summit Innovations Who are the Players & Who Offers What? Manitoba Health Family Services and Housing Indian and Northern Affairs (INAC) First Nations & Inuit Health (FNIH) –Non-Insured Health Benefit Program (NIHB) –Foot Care Program

8. Conducted by Medicine Creek Solutions & Summit Innovations Who are the Players & Who Offers What? cont’d Manitoba Health –Foot care/podiatry is not an insured service in MB but is in other jurisdictions –The Act provides for prosthetic & orthotic devices but interpretation limits to post- amputation insoles –Unclear why preventative care not funded when downstream costs exponentially greater

9. Conducted by Medicine Creek Solutions & Summit Innovations Who are the Players & Who Offers What? cont’d Family Services & Housing –MFNs living off reserve and receiving provincial EIA are eligible for MD prescribed foot care services (9 visits per year @ $32 per visit) –PCH residents must first liquidate personal assets before approved –Prosthetic & orthotic devices not covered as considered an insured service

10. Conducted by Medicine Creek Solutions & Summit Innovations Who are the Players & Who Offers What? cont’d Indian and Northern Affairs (INAC) –foot care is considered a health related provision under NIHB –No provision for foot care services for MFNs living in PCHs –Discrepancy in entitlements for MFNs based on place of residency

11. Conducted by Medicine Creek Solutions & Summit Innovations Who are the Players & Who Offers What? cont’d First Nations & Inuit Health – NIHB –Allied Health Services (including podiatry) delisted in 1998 as offered through provincial insurance plans Resulted in service gaps and inequities –Cover custom made/modifed foot wear & orthotics but not therapeutic foot wear –Travel costs for fittings not covered –Travel for podiatry discontinued in 2005 –Travel for traditional healers covered

12. Conducted by Medicine Creek Solutions & Summit Innovations NIHB vs Other Federal Plans –Veteran’s Affairs –RCMP Benefits –Inmate Benefits NIHB covers considerably less

13. Conducted by Medicine Creek Solutions & Summit Innovations Who are the Players & Who Offers What? cont’d FNIH – Foot Care Program: a 3 tiered system –Where funding exits the levels are disproportionate to the population

14. Conducted by Medicine Creek Solutions & Summit Innovations What Were the Policy & Practice Shifts? Chronology of Foot Care Related Events

15. Conducted by Medicine Creek Solutions & Summit Innovations How Concerned Should We Be? Diabetes-related amputations projected by Blanchard, Wadja, and Green

16. Conducted by Medicine Creek Solutions & Summit Innovations How Concerned Should We Be? Immeasurable Costs to MFNs and considerable costs to the healthcare system

17. Conducted by Medicine Creek Solutions & Summit Innovations Estimated Regional Foot Care Program Costs NMU Proposal 2003 –$914,000 Internal FNIH Proposal 2005 –$1.027 Million

18. Conducted by Medicine Creek Solutions & Summit Innovations What Needs to Change? Policy Alternatives First Nations and Inuit Health 1.Recognize program provisions, accept mandate for foot care programming, develop policies, secure program funding from TB 2.Equity—all communities have access to basic foot care— implement original plan. 3.Consistency—develop a funding formula to ensure programs are adequately resourced to decrease wait times 4.Funding Envelopes 5.NIHB Travel—provide travel for urgent podiatry visits and shoe fittings 6.Therapeutic Shoes—reimburse clients for therapeutic shoes

19. Conducted by Medicine Creek Solutions & Summit Innovations What Needs to Change? Policy Alternatives Indian and Northern Affairs 1.Increase PCH institutional funding to include foot care programming 2.Cover the foot care costs for clients in off- reserve PCH

20. Conducted by Medicine Creek Solutions & Summit Innovations What Needs to Change? Policy Alternatives Manitoba Health 1.Cover Podiatry as an insured health service