HESA Committee Report

ANALYSIS OF IMPLEMENTATION

ABORIGINAL HEALTH

Blueprint on Aboriginal Health

The First Ministers’ Meeting (FMM) on Aboriginal Issues, held in Kelowna B.C. on    November 24-25, 2005, fulfilled the F/P/T commitment to convene a meeting of First Ministers dedicated to Aboriginal issues.  The Blueprint on Aboriginal Health was tabled at FMM 2005 and fulfilled the F/P/T commitment to develop a Blueprint for concrete initiatives to improve the health status of Aboriginal peoples.  The Blueprint also fulfilled the commitment to explore practical ways to clarify roles and responsibilities and report back in one year.

Federal Investments of $700 million

The $700 million investment for the Aboriginal Health Human Resources Initiative (AHHRI), Aboriginal Health Transition Fund (AHTF) and upstream investments in health promotion and disease prevention was confirmed in Budget 2005.  Work with provincial/territorial governments and Aboriginal organizations on implementing the initiatives is ongoing.

Aboriginal Health Transition Fund (AHTF) – $200 million over five years

The Government of Canada is making steady progress in the development and implementation of plans and projects in the three funding envelopes of the AHTF.

Adaptation Envelope:

• Supports provincial and territorial governments in the adaptation of their existing health programs to the unique needs of all Aboriginal peoples, including those in urban areas and Métis settlements and communities.  Most provinces have submitted their request for planning dollars, and to date, six provincial adaptation plans have been approved with one more currently being reviewed. 

Integration Envelope:

• Supports First Nations and Inuit communities in activities to improve the coordination and integration between provincial/territorial health systems and federal health services provided in First Nations and Inuit communities.  All regional integration plans have been submitted and approved.  In addition, 81 integration projects have been approved (as of March 2008) and are proceeding in the implementation phase.

Pan‑Canadian Envelope:

• Supports cross jurisdictional integration and adaptation initiatives in three streams: First Nations, Inuit and Métis; capacity funding to National Aboriginal Organizations and Health Canada regions to facilitate the engagement of Aboriginal peoples in the AHTF; evaluation and knowledge transfer activities; as well as the overall administration of the AHTF. Pan-Canadian plans have been approved for AFN, ITK and MNC, and a total of 11 projects have been approved to date.

Aboriginal Health Human Resources Initiative (AHHRI) – $100 million over five years

The Government of Canada is meeting its program commitments related to the AHHRI.  The AHHRI has set out four targets in order to meet program goals: 

• Double the number of Aboriginal health career scholarships/bursaries in 5 years:
• The AHHRI has increased the amount of funding available to Aboriginal health career students from $500,000 in 2004 to its present level of $3 million per year, tripling the numbers of bursaries and scholarships that are awarded each year.
• Double the number of Aboriginal health professionals in 10 years:
• The increased numbers of bursaries and scholarships now being awarded is leading to increases in the numbers of Aboriginal health career students.  This will translate into increases in the number of health career professionals over the next several years.
• Increase the number of certified health directors/administrators on reserve by one third in five years:
• Work now underway in partnership with the Assembly of First Nations will see the development and validation of core competencies for health managers on reserve within the next year, and a process that will result in certification through accredited educational institutions for all First Nations health managers.
• A 50% increase in the number of post-secondary educational institutions with support programs for Aboriginal health care students in five years: 
• Work is underway in each Health Canada region to implement student support programs for Aboriginal health career students, and expect to meet this target in the next two to three years.

Upstream Investments in Health Promotion and Disease Prevention – $ 400 million over five years

Budget 2005 confirmed $400 million over five years for the Aboriginal Diabetes Initiative($190 million), National Aboriginal Youth Suicide Prevention Strategy ($65 million), Maternal and Child Health Program ($110 million), and Aboriginal Head-Start On Reserve ($17.5 million), Health Canada) and Aboriginal Head Start Urban and Northern Communities ($17.5 million, Public Health Agency of Canada).

The Government of Canada has met or is on schedule to meet policy and program commitments in relation to upstream investments.  Collaboration with P/Ts in upstream investments varies from region to region and is based on regional differences with regard to service delivery models, existing jurisdictional issues and priorities.  Overall, program collaboration with P/Ts has increased over time.

Aboriginal Diabetes Initiative (ADI):

• Expanded in 2006, the ADI is a community‑based primary prevention, screening and treatment program.  More than 600 First Nations and Inuit communities have access to health promotion and diabetes prevention activities funded through the ADI.
• ADI’s main objective is to reduce type 2 diabetes in Aboriginal people through a range of health promotion, prevention, screening and treatment services, delivered by an increased number of trained health service providers and diabetes workers. 
• The ADI also supports Métis, Aboriginal people living off‑reserve and urban Inuit by funding primary prevention projects through ongoing national Requests for Application and approximately 50 projects are being funded in 2007-08.
• In 2007-08, 86 community diabetes prevention workers were recruited into training, bringing the total number having received training to over 130.
• In 2006-07, funding was provided to two peer-reviewed First Nations diabetes surveillance projects.  By the end of  2007-08, a diabetes surveillance project will have been initiated in up to 20 First Nations communities across Canada and a partnership will have been established with the Canadian Institutes of Health Research to support intervention research.

National Aboriginal Youth Suicide Prevention Strategy (NAYSPS):

• The goal of NAYSPS is to increase protective factors such as resiliency and reduce risk factors associated with suicide.  The strategy has four key elements:

1. Primary prevention activities focus on mental health promotion and public education;
2. Secondary prevention activities focus on supporting community‑based approaches to suicide prevention in First Nations and Inuit communities;
3. Tertiary prevention activities focus on improving crisis response in First Nation and Inuit communities; and
4. Knowledge development aims to improve what we know about suicide and its prevention in Aboriginal communities.

• Currently, approximately 140 projects are being funded across Canada, which are community-based in order to respond to specific needs and circumstances in youth suicide prevention.
• To engage youth and strengthen the evidence base regarding safe and effective suicide prevention practices, NAYSPS is funding the implementation of five Mental Health Promotion Demonstration Projects. 

Maternal and Child Health Program (MCH):

• On reserve, the Maternal Child Health Program builds on the foundation provided by nursing services, the Canada Prenatal Nutrition Program and the Fetal Alcohol Spectrum Disorder Program to improve health outcomes for pregnant women and families with infants and young children.  Program elements include home visitation, screening and assessment, case management and culturally appropriate care.
• In the North, funding is provided to enhance the health promotion programs that Health Canada already supports for pregnant women and families with young children to complement services from the province or territory in which they live.
• By the end of  2007-08, the Program will be providing home visiting by nurses and home visitors for pregnant women and families with young children in approximately 70 First Nations communities.
• This target of approximately 70  communities does not include the Ontario region, whose situation is unique. In Ontario, there is a high level of collaboration around planning between the federal government and the provincial government.  In the case of Ontario, the federal funds, which began  to flow to communities in the Fall of 2007, will fund up to 50 projects as well as enhance services in other communities.
• The Quebec Region began implementation of five projects in early 2008 following successful discussions with First Nations organizations to identify options to implement the program in Quebec.

Aboriginal Head-Start On Reserve (AHSOR)

• AHSOR prepares First Nations children from birth to six years of age for school by meeting their emotional, social, health, nutritional, cultural and psychological needs.
• The program focuses on First Nations languages, educational activities to prepare children for school and activities promoting nutrition, healthy lifestyle choices and physical activity.                        
• The AHSOR program has expanded to reach over 9000 children.  In 2006-07, existing AHSOR capital infrastructure was enhanced, with $7 million transferred to the regions to support capital projects.

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Further Investment in Health Services Historically Provided to First Nations and Inuit

The Government of Canada has continued to invest in health services historically provided to First Nations and Inuit in the 2006, 2007 and 2008 budgets.

• Budget 2006 investments of $234 million were made in the areas of health promotion and disease prevention, early childhood development, and the adaptation of the health systems in order to more better meet the needs of First Nations and Inuit peoples.
• Budget 2007 increased funding for First Nations and Inuit health by $126 million dollars to approximately $2.1 billion in total spending.  This increase includes $60 million dollars to sustain existing health services for First Nations and Inuit and $15 million dollars to support new innovations in health service delivery, including tripartite agreements with the provinces and territories, and First Nations and Inuit.
• Budget 2008 commits $147 million over the next two years to stabilize current programs and put in place concrete improvements aimed at better health outcomes for First Nations and Inuit.  Funds will support improvements in health care delivery through greater integration with provincial and territorial health.  Budget 2008 also invests over $330 million over the next two years to extend the Plan of Action for Drinking Water in First Nations Communities.  Of the $330 million, Health Canada will receive approximately $55 million.                     

Explore Métis Health Issues

The Government of Canada continues to work to explore Métis health issues in collaboration with other orders of government and Métis leadership, including a $10 million agreement signed in February 2007 through the AHHRI to support Métis health human resources, and a $714,000 agreement signed in January 2007 through the AHTF to support the Métis in planning the improved adaptation and integration of health services to better meet the needs of the Métis peoples.  An additional $625,000 in capacity funding through the AHTF has been provided through agreements signed in 2005-06 and 2006-07 to support Métis work in the AHTF.

Reporting

The Special Meeting of First Ministers and Aboriginal Leaders saw the commitment to “explore practical ways to clarify roles and responsibilities of the various parities and [to] report back to First Ministers and Aboriginal Leaders within one year.”  This reporting commitment was part of the development of a blueprint to improve the health status of Aboriginal peoples.

The Blueprint on Aboriginal Health was tabled at First Ministers’ Meeting on Aboriginal Issues, held in Kelowna B.C. on November 24-25, 2005.  The Blueprint fulfilled the commitment to explore practical ways to clarify roles and responsibilities and report back in one year.  Through the Blueprint, new arrangements were to be explored and developed to improve seamless health care delivery in a manner that addressed mandate and jurisdictional issues to the satisfaction of First Ministers and National Aboriginal Leaders.

COMMENTS BY THE HEALTH COUNCIL OF CANADA

The Health Council of Canada’s 2006 Annual Report was critical of the federal government on a number of key issues, including:

• perceived inaction on the Blueprint on Aboriginal Health;
• questions around the adequacy of investments in building Aboriginal health human resources capacity and increasing the number of Aboriginal health professionals;
• funding for the Aboriginal Health Transition Fund; and
• the federal government’s overall plan and direction for funding Aboriginal health programs.

The 2006 report recommend that “the federal government should provide clear direction with respect to the Blueprint on Aboriginal Health and the Kelowna accord and outline its overall plan and direction in support of Aboriginal health.”  The report did not focus on other federal governments commitments such as the AHHRI or upstream investments in health promotion and disease prevention.