• Transition, Transfer and Transformation • Transition Updates • Frequently
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:
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:
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
July 2, 2013
FNHA has taken on Policy, Planning and Strategic Services
FNHA has taken on Non-Insured Health Benefits Headquarters Functions
October 1, 2013
FNHA has taken on Regionally Delivered Programs:
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.
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.
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:
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:
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.
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.
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.
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).
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.
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.
The transfer of health responsibility at this time is a big thing in First Nations history.
So those young people would be the living markers. They would have to say how old they are. They tell all the people. This is the age today. Then, we mark this event by their age. So, if they are 25, and when they turn 50, we will know we have had health transfer for 25 years.
So there is responsibility that comes with being corner posts and living markers. They continue to be the ambassadors, they continue to be the stewards of the work, they would have these responsibilities.
–Willie Charlie, Sts'ailes First Nation
Policy, Planning and QualityEmail: email@example.com