Evaluations and data – those were the two key themes of the Vancouver Coastal Region Health Assembly held Nov. 26 – 27 in Vancouver (health directors from the region met Nov. 28).
Delegates learned that a series of evaluations are underway or recently completed. At the highest level is the Tripartite Framework Evaluation – the assessment of the broader health system and the agreement between the federal, provincial and BC First Nation partners that led to the creation of the First Nations Health Authority (FNHA). This agreement calls for an evaluation very five years.
This process also includes evaluations of the Regional Partnership Accords. Complementary evaluations have been made – or are in the works – of the FNHA Board; the FNHA; and the First Nations Health Council (FNHC). In addition, the role of Indigenous Services Canada in supporting BC First Nations as a governance partner is under assessment.
The evaluations don't stop there. There are also sub-evaluations, technical reports and data reports. The FNHA-FNHC-FNHDA Agreement is being evaluated. An example of a technical report is the extensive evaluation conducted of Plan W (Wellness) – the pharmacy benefits program whose administration was transferred to the provincial PharmaNet system in October, 2017. Data reports include the regional health surveys; the population health and wellness indicators; a health systems matrix analysis; and one on patient-reported experience and outcome measures.
Then there are case studies on topics that include cultural safety; maternal and child health; data and information governance; and the response to the opioid overdose crisis.
All of the completed evaluations, case studies and technical reports are published on the audits and accountability page of the FNHA website.
Why so much focus on evaluation and data collection? At the high levels, the evaluations “look at the commitments made and whether they're being met" said the FNHA's Interim CEO Richard Jock. “It's to tell the story of change among the partners and within the broader system."
Regarding data collection, Richard said the FNHA is in a “unique position to look at health system utilization data and evaluate the system as to whether it's generating more access."
In her update on the National Data Governance Strategy, FNHC member Gwen Phillips said it's important for First Nations to take authority of data because “we're the only ones who can report on our health and wellness. Without context, data makes no sense. We are going to measure health and wellness in our own ways."
The PHO and FNHA have agreed to continue to jointly monitor the health and well-being of First Nations people in B.C. for the next 10 years with an expanded suite of 22 indicators of health and well-being, called the Indigenous Population Health and Wellness Agenda. The highlights of the baseline report for the Indigenous Population Health and Wellness Agenda were released at January's Gathering Wisdom forum. Interim reports will be released every 2.5 years until the final report in 2030.
What is the purpose of all the surveys, the data collection, and the evaluations? Knowledge Keeper Wayne Smith, Samu7, of the Samahquam summarized the review of the FNHA: “We turned the key, the engine started and we got some momentum. That was a good feeling." The journey to date, he said, was one of “re-claiming our wellness. Reclaiming our connections. What will the next 10 years bring? Reconciliation won't work if we don't look forward."
He described moving forward as an ongoing effort “to take over our own ways. To make our health and wellness something we can do on our own with the help of others."
Colleen Erickson, Chair of the FNHA Board, reported that the evaluation of the board was generally positive, with recommendations for improvement to engagement processes and planning for leadership succession that are already being acted on.
She reported that this assessment led to the decision that it was time for a leadership change – resulting in the departure of the organization's founding CEO, Joe Gallagher. Several comments from delegates revealed conflicting responses to that decision, as well as some frustration that confidentiality provisions prevent the board from providing more information about the basis for its decision. Delegates also asked about the inter-woven roles of the FNHC and the FNHA.
The FNHC provides political direction for the FNHA and appoints the FNHA board members. The FNHC is the First Nations partner in the Tripartite Framework Agreement that led to the formation of the FNHA. The FNHDA (First Nations Health Directors Association) provides technical advice to the FNHA. Read more about governance and accountability of the FNHA on our website.
Charlene Belleau, now the chair of the First Nations Health Council, said that once the evaluations are rolled out in 2021, the FNHC will look to chiefs [and councils] for a renewed mandate.
Meanwhile, Richard Jock, Interim CEO of the FNHA, said the evaluations and data collection will guide the FNHA with several major initiatives in particular. These include regionalization; primary health care; mental health and wellness; and health benefits.
Regionalization will continue a move that has seen regional teams grow to 20 to 60 people from pre-transfer numbers of two or three. It's a complex process that entails the details of office logistics to ensuring sustainable and equitable service delivery while accommodating the different needs and priorities of the five health regions.
Richard Jock said the question at the heart of regionalization is: “How do we go forward in a way that keeps us together and yet builds on diversity? That is our opportunity and our challenge."
Kim Brooks, Regional Executive Director for the FNHA's Vancouver Coastal Region (VCR), said regionalization “represent[s] a real shift how we're able to roll out the work and make decisions. For me it means honoring our regions and the unique cultures within; supporting decision-making closer to home; creating stability and better access to health and wellness services; and building capacity in community."
Kim noted that engagement with clients is key to the success of the work. For example, VCR employees have logged more than 100 points of engagement within community in the last eight months – integrating traditional knowledge keepers into this work.
Primary Care Networks
A provincial initiative will see 83 Primary Care Networks set up across province. While First Nations people will be served at all of these centres, three in each of the five health regions will be led by First Nations in order to improve access to culturally safe, integrated health services. The Lu'ma Project in the Vancouver Coastal region is the first of these networks to be launched.
Mental Health and Wellness
Mental health and wellness will continue to be a major focus of the work of the FNHA. One indication of the ongoing priority of this topic is the growth in funding allocated to it: from $57 million in 2015/16 transferred from the federal government when the FNHA was created to just over $97 million this fiscal year.
Some of these funds are allocated to support traditional healing methods, including land-based healing. Some ($20 million) are part of the FNHA's commitment to the $60 million Tripartite Mental Health and Wellness Agreement that will fund mental wellness projects that deliver a continuum of culture and strength-based services, including prevention and early intervention.
“This agreement is an example of a success that wouldn't have been possible under the previous health care model," noted Richard Jock.
Health Care Benefits
The evaluation of the Plan W pharmacy health benefits program led to the creation of a team of Health Benefits Community Relations Representatives and other actions to ensure more community outreach and engagement. Health Benefits staff members said the improved community engagement process was a large part of the success of transfer to Pacific Blue Cross of the administration of benefits for dental, vision care, and medical supplies and equipment. They vowed to continue the community outreach process as they embark on a review of the medical transportation benefit program, which will get underway in January with the goal of improving client satisfaction, experience and access by making the program more efficient. This will be accomplished through a combination of actions that will include technological enhancements as well as integration with primary care and e-health strategies.
Delegates were quick to emphasize the importance of this review, with one also pointing out that even people in the Lower Mainland can need travel assistance to get to health appointments and services.