Indian Health Transfer Policy (Canada) - Process

Process

The process is designed to occur within the present funding base of federal health programs for First Nations, Inuit and Métis peoples communities are required to provide certain mandatory programs such as communicable disease control, environmental and occupational health and safety programs, and treatment services.

Initially, the enthusiasm for this process was varied. For some, it was seen as an important link to Self-Government where the community plans and controls health programs in their communities according to its own priorities. It was seen as a way to develop programs relevant to a community's own cultural and social needs. Others took a more hesitant approach. As the uptake of control of health services by First Nations increased, the Indian Health Transfer Policy began to be seen increasingly by First Nations people as a stepping stone towards the inherent right of Self-Government. Transfer became the cornerstone of Health Canada's relationship with First Nations and Inuit communities. Health Services Transfer Agreements between Health Canada and First Nation and Inuit provided the opportunity for communities or First Nations and Inuit organizations to manage their own health programs and services. At first, Transfer was the only option communities had for increasing their control over health programs and services beyond Contribution Agreements. Although many communities were interested in assuming increased control over health services and programs, not all communities were ready to move into this level of control so quickly. It became increasingly apparent that one design could not fit all the diversity of readiness. Some communities expressed interest in alternative strategies which would also give them increased control of resources.

Each year brought pressures for change and restructure in the transfer approach. First Nations and Inuit Health Branch searched for ways to respond to communities desiring to increase their control of community resources, either through the transfer process, or through other initiatives. This movement was further supported by a decision of the Departmental Executive Committee of Health Canada on March 15, 1994, which directed First Nations and Inuit Health Branch to commence planning all activities toward the following goals:

the devolution of all existing First Nations and Inuit Health Branch Indian health resources to First Nations and Inuit control within a time frame to be determined during consultations with First Nations and Inuit communities; moving First Nations and Inuit Health Branch out of the health care service delivery business; the transfer of knowledge and capacity to First Nation and Inuit communities so that they can manage and administer their health resources; a refocused role for First Nations and Inuit Health Branch; and a refocused role for Health Canada which will take into account First Nations and Inuit Health Branch's strategic direction.

In further support the search for alternative pathways to transfer, in late 1994, Treasury Board approved the Integrated Community-Based Health Services Approach as a second transfer option for communities to move into a limited level of control over health services.

1995 saw the distribution and implementation of Pathways to First Nations Control Report of Project 07 Strategic Planning Exercise. This cornerstone document set the essential differences between The Integrated Approach and Transfer. The Integrated Approach is an intermediate measure which provides more flexibility than Contribution Agreements, but less flexibility than the Transfer Agreement.

In 1995, the federal government announced the inherent Right to Self-Government Policy . This policy recognizes First Nations and Inuit have the constitutional right to shape their own forms of government to suit their particular historical, cultural, political and economic circumstances. The policy thus introduced a third option for communities to further increase their control of health services.

Self-governance gives Bands more flexibility to establish program priorities in response to tribal needs rather than following Federal program objectives. Bands are able to expand, consolidate and create new programs to improve services to their communities and to make certain laws governing their community with respect to health. Furthermore, the range of resources for health programs which can be included in a Self-Government arrangement is greater than those included in a Health Service Transfer arrangement and may eventually include fixed assets and services under the Non-Insured Health Benefits Program. The flexibility in terms of how resources are allocated is also greater and reporting requirements are fewer.

First Nations and Inuit peoples will determine the pace at which Self-Government arrangements proceed. Putting the arrangements in place will of course take time. The process will require intense local or regional negotiations between First Nations and Inuit peoples, the federal government and the provincial or territorial government concerned. Figure 3 depicts the status of First Nations and Inuit control activities at the close of the first decade of transfer, March 31, 1999. The uptake of transfer has steadily increased over the past decade the maps on figure 3 present a progressive overview of the rate of uptake of transfer by First Nation and Inuit communities starting in year one.