1. BC Tripartite First Nations Health: Basis for a Framework Agreement on Health Governance UBC Learning Circle September 29, 2010 Presented by: Ian Potter Chief Federal Negotiator, Health Canada

2. 2 TRIPARTITE FIRST NATIONS HEALTH PLAN: BASIS AGREEMENT On July 26, 2010, lead negotiators from Health Canada, the British Columbia (BC) Ministry of Healthy Living and Sport and the First Nations Health Council initialled a Basis for a Framework Agreement on Health Governance. 2 This is a political agreement with no legal commitment, but a political statement of the intent of the three parties. This is part of a broader commitment made in the Tripartite First Nations Health Plan, to help close the gaps in health status between BC First Nations and other British Columbians.

3. 3 EVOLVING TO A NEW GOVERNANCE STRUCTURE The Basis Agreement is the result of many years of discussions among BC First Nations leadership and the federal and provincial governments. Builds on the Transfer Policy process. New administrative arrangement with a First Nations Health Authority (FNHA) taking over the policy, program and service delivery role now played by Health Canada for BC First Nations. The FNHA is part of a new governance structure for First Nations health. 3

4. 4 COMPARISON OF CURRENT & PROPOSED ELEMENTS 4 ElementsCurrentProposed Policies & Programs- Decisions are made in Ottawa by federal government - Decisions are made in BC by BC First Nations Regional Management- Accountable to Ottawa- Accountable to BC First Nations Health Services-Limited to federal policies - Little integration with regional health system -New partnership with Regional Health Authorities -Service designed to meet the needs of First Nations Funding- Year by year allocation uncertain -10 years certainty -Guaranteed annual growth

5. 5 BENEFITS OF THIS APPROACH Research has shown that health improves when individuals have greater control over the programs, processes and events that affect them. BC First Nations will have more control over the health programs and services that are intended to serve them. BC First Nations will have the ability to: –reshape health programs and policies to better meet their needs; and, –increase control and resources to design a health system that is consistent with their cultures and values, resulting in a more holistic and wellness-oriented system. Support for the health services work of individual First Nations communities. A more accessible, comprehensive, caring and compassionate system. 5

6. 6 KEY ELEMENTS OF THE BASIS AGREEMENT An administrative arrangement in health Transfer of community programs and services Transfer of the Non-Insured Health Benefits Program Includes all funding directly or indirectly attributed to First Nations health in BC New relationship based on reciprocal accountability New arrangements between First Nations and the Province and its health authorities Recognizes importance of the social determinants of health Does not end the federal fiduciary relationship with First Nations 6

7. 7 NEXT STEPS Currently working on the Framework Agreement (legal agreement) Transfer of regional office up to a maximum two years after signing Framework Agreement. Joint management of BC FNIH will occur after the Framework Agreement is signed and prior to transfer. Work will continue on capacity building and opportunities for shared learning. A jointly developed Implementation Plan will guide transfer and ensure a well managed and smooth transition. 7