Regional Summary of Governance Discussions. Summary of Feedback from Vancouver Coastal Regional Caucus and Health Partnership Workbook

Transcription

1 Reginal Summary f Gvernance Discussins 2011 Summary f Feedback frm Vancuver Castal Reginal Caucus and Health Partnership Wrkbk

2 Thank yu t all Vancuver Castal regin Chiefs, leaders, health prfessinals, and cmmunity members wh tk the time t attend reginal caucus sessins and prvide feedback thrugh the Health Partnership Wrkbk. Published May 2011

3 CONTENTS 1 INTRODUCTION p. 4 2 VANCOUVER COASTAL SNAPSHOT p A DETAILED FEEDBACK FROM VANCOUVER COASTAL REGION p Health Partnership Wrkbk Feedback 18 Additinal Feedback KEY THEMES & SUMMARY OF FEEDBACK p Cmmunity Principles 20 Reginal Principles and Reginal Caucuses 20 Prvincial Principles 20 First Natins Health Cuncil 20 First Natins Health Directrs Assciatin 21 First Natins Health Authrity 21 Reciprcal Accuntability 21 Other General Issues APPENDIX - METHODOLOGY p. 22

4 1 1. INTRODUCTION The First Natins Health Cuncil (FNHC) launched a Health Partnership Wrkbk in January 2011, and made the Wrkbk available nline and as the fcus f a series f First Natins reginal caucus sessins acrss the prvince. The Health Partnership Wrkbk summarized the discussins abut health gvernance held at mre than 100 First Natins reginal caucus meetings ver the past three years and asked First Natins Chiefs, leaders and senir health prfessinals in BC t cnfirm this summary f feedback gathered and share new thughts and perspectives. The results will infrm further discussins, negtiatins and relatinship-building tward the establishment f a new health gvernance arrangement fr First Natins health services in BC. The feedback prvided by First Natins thrugh the reginal caucus sessins and the Health Partnership Wrkbk has been rlled int 5 summary dcuments ne fr each regin in BC. The initial reginal reprts were prvided t each regin fr review, discussin and further amendment; this revised versin f the reprt was prvided again t each regin in May The five reginal summary dcuments will be merged int a prvince-wide Summary and Cnsensus dcument. This Cnsensus dcument will be put frward fr review and cnsideratin fr apprval at the 4th Annual Gathering Wisdm Frum t be held in May 2011 and will chart a path frward fr the establishment f a new health gvernance arrangement fr First Natins health services in BC. The summary reprt cllates all f the feedback frm the VANCOUVER COASTAL regin - as prvided at Vancuver Castal reginal caucus sessins and thrugh Vancuver Castal regin participatin in the Health Partnership Wrkbk. This reprt begins with a the snapsht prfile f the Vancuver Castal regin. It then prvides a detailed accunting f all feedback prvided by First Natins in the Vancuver Castal regin t this health gvernance prcess (thrugh reginal caucuses and wrkbks), fllwed by a summary f key themes based n feedback prvided by Vancuver Castal regin First Natins. The last sectin infrms an appendix which describes the Health Partnership Wrkbk prcess and methds. 4

5 2 2. VANCOUVER COASTAL REGION SNAPSHOT The territrial land base f the Vancuver Castal regin is 54,484 square kilmetres 5.9% f the prvincial ttal. The ttal ppulatin f the Vancuver Castal regin (2006) is 1,077,572 and the Abriginal ppulatin is 2.3% at 24,270. There are 14 First Natins Bands within the Vancuver Castal Regin (Samahquam, Skatin Natin, and Duglas First Natins may als be within the Fraser Health Authrity regin): 1. Duglas First Natin 2. Heiltsuk 3. Kitas 4. Munt Currie Band 5. Musqueam First Natin 6. N Quatqua First Natin 7. Nuxalk Natin 8. Samahquam Five Tribal Cuncils exist within this regin: 1. Naut sa Mawt Tribal Cuncil 2. Lwer St atl imx Tribal Cuncil 3. Oweeken-Kitas-Nuxalk Tribal Cuncil 4. Heiltsuk Tribal Cuncil 5. Lillet Tribal Cuncil 9. Sechelt Indian Gvernment District 10. Skatin Natin 11. Sliammn First Natin 12. Squamish Natin 13. Tsleil-Waututh Natin 14. Wuikinuxv Natin There is ne First Natins umbrella health rganizatin within Vancuver Castal the Suthern Stl atl imx Health Sciety % f First Natins in the Vancuver Castal regin participate in Cmmunity Engagement Hubs, as fllws: Tsleil-Watuth Natin ) Tsleil-Watuth Natin Squamish Natin Tla amin Cmmunity Health Bard Sliammn Klahse Lwer Stl Atl Imx Tribal Cuncil Duglas Lil wat N Quatqua Samagquam Skatin Heiltsuk Tribal Cuncil Heiltsuk Tribal Cuncil Nuxalk Wuikinuxw (Oweeken) Kitas Unrepresented cmmunities Musqueam 5

6 3. DETAILED FEEDBACK FROM VANCOUVER COASTAL REGION This sectin summarizes feedback frm the cmpletin f the Health Partnership Wrkbks by First Natins frm the Vancuver Castal regin and frm the minutes f meetings f Vancuver Castal reginal and sub-reginal caucus meetings. This sectin f the reprt summarizes feedback abut First Natins health gvernance at a cmmunity level, a reginal level and a prvincial level. Cmmunity Level Cmmunity level refers t the 203 First Natins in BC and the 130 First Natins cmmunity health centers in BC. At this level, First Natins and their health technicians deliver health prgrams and services t their lcal ppulatins. The wrkbk summarized the principles and requirements fr First Natins health gvernance at a cmmunity level, as stated by First Natins at reginal caucus sessins ver the past several years. Specifically First Natins have stated that a reginal health transfer prcess must: Increase and supprt First Natins decisin-making ver the health f their peples; Ensure the transfer results in pprtunities t leverage mre funding fr cmmunity-level prgrams and the reinvestment f current resurces t imprve health at the cmmunity level; and Enable cllabratin with ther First Natins and lcal and reginal health prgram and service prviders. First Natins in the Vancuver Castal Regin respnded t these principles as fllws: Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 2.8% 1 Disagree 0.0% 0 Agree 47.2% 17 Mderately Agree 11.1% 4 Strngly Agree 38.9% 14 answered questin 36 skipped questin 4 6

7 Thrugh participant feedback n the wrkbks, and thrugh the small grup sessins at the Reginal Caucus meeting, the fllwing principles and requirements were als identified as a pririty: Trained Prfessins need fr First Natins trained prfessinals t wrk in cmmunities at management / administratin level as well as health service level; Cmmunity-driven and Natin-based fcus n cmmunities (especially rural and remte cmmunities) and wrk n a Natin t Natin basis; fcus shuld be n Natin-building, nt cntinuing t wrk n a small scale in cmmunities as this ften prevents cmprehensive planning and health services being put int place; empwering grass-rts cmmunities t participate and create less dependence n the system and mre dependence n self-care and fstering wellness; Elders, children and yuth need t be a part f the cmmunity picture; strng cmmunicatin is needed at cmmunity and Natin level; and, Evaluatin develp evaluatin skills and t use the learning fr the cmmunity s benefit in the future. The wrkbk asked participants t indicate their level f supprt fr the fllwing statement: A Reginal Health Transfer prcess wuld supprt the greater lcal cntrl ver health services and the develpment f lcal health prgram and service delivery mdels The fllwing table indicates their respnse t this statement: Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 5.6% 2 Disagree 5.6% 2 Agree 25.0% 9 Mderately Agree 25.0% 9 Strngly Agree 38.9% 14 answered questin 36 skipped questin 4 7

8 Participants were asked t add ther cmments regarding lcal cntrl f health services r add general cmments. The fllwing is a summary f the cmments prvided by participants n this sectin: Cllabratin and Recgnitin reginal transfer prcesses needs t be inclusive t all Natins; Vancuver Castal Health needs t wrk with all Natins, regardless f ppulatin size; remteness must be factred in; the less we fcus n plitical issues amngst ne anther, the mre we can reach cnsensus t strngly supprt each ther ; Health Directrs need t be engaged as well as Chief and Cuncil; Capacity Capacity is very imprtant, especially with a fcus n cmmunity plans and individual health plans; imprtant t have prper qualified emplyees with sincere interest in their psitin f emplyment ; need t be pr-active and innvative in managing change and grwth fr these services, and an administratin well versed and trained in managing this prcess; Funding need fr increased funding fr administratin t be negtiated as part f the health transfer in additin t the funding ffered fr services; funding must be used fr what it is intended fr. Capital Develpment need fr funding t upgrade the infrastructure especially in mst small islated cmmunities; Cmmunity Engagement n health needs and perspectives ne said that mre cmmunity engagement is needed in the prcess; cmmunities shuld be facilitated t identify real needs nt just what peple think they are entitled t r wish lists; needs and wants are different; Self-Care First Natins have been negatively impacted t the pint f dependency and need t regain the unique ancestry & traditinal ways f wellness ; Service Gaps transprtatin t health facilities, clinics, hspitals and ambulances; health wrkfrce; prescriptins; and, Evaluatin and Learning - Being pen t making adjustments knwing trial and errr are valuable learning pprtunities; wning up t mistakes/miscalculatins and taking respnsibility t readjust by being flexible. 8

9 Reginal Level Reginal level refers t the five regins in BC Fraser, Interir, Nrth, Vancuver Island and Vancuver Castal. Within regins, First Natins cllabrate n shared health issues f relevance and develp reginal perspectives n First Natins health and wellness amngst themselves. They als cllabrate with the Reginal Health Authrity (RHA) n reginal First Natins health issues. Thrugh reginal caucus sessins ver the past several years, First Natins have frmed key principles and requirements fr health gvernance as it relates t the reginal level, as fllws: Maintenance f Reginal Caucuses t reflect cllective authrity and the high imprtance f partnerships and agreements with Health Authrities; Cntinuing t supprt cllabratins and relatinship building amng First Natins; Supprting the develpment f First Natin health prgrams, services and initiatives, which can be delivered by and serve the needs f the regin; Supprting the develpment f reginal perspectives n health and wellness; Increasing cllabratins with RHAs t leverage prvincial resurces; Enabling First Natins t have a greater influence ver services prvided by RHAs t First Natins; Supprting reginal and sub-reginal planning; and, Imprving cmmunicatin based n reginal expectatins, including accuntability and reprting. First Natins cmpleting the wrkbk were asked hw they felt abut these principles the results fr the Vancuver Castal regin participants prvided the fllwing respnses: Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 2.6% 1 Disagree 5.3% 2 Agree 39.5% 15 Mderately Agree 18.4% 7 Strngly Agree 34.2% 13 answered questin 38 skipped questin 2 9

10 Respndents als identified the fllwing principles and requirements: Abriginal Title and Rights - need t be recgnized thrughut all levels; the business f this new health authrity needs t respect the territries f Natins - we sit as family at the reginal tables; and, Gaps - Elder Care needs t be included as well as discussin f ur urban families at the Reginal level. The wrkbk als asked participants t indicate their level f supprt fr the fllwing statement: First Natins have stated that they wuld like t see the reginal caucus structure cntinue as part f the new reginal health transfer prcess with the purpse described abve The fllwing encapsulates their respnse t this statement: Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 0.0% 0 Disagree 5.6% 2 Agree 30.6% 11 Mderately Agree 27.8% 10 Strngly Agree 36.1% 13 answered questin 36 skipped questin 4 10

11 Participants were asked t state what they believed Caucuses were ding well and what additinal things they thught the Caucuses culd imprve n. The results frm the Vancuver Castal regin are as fllws: What Caucuses are ding well What Caucuses need t imprve Representatin: Suthern St atl imx cmmunities are well represented but need t gather mre at cmmunity level; seem t have a gd mandate; I am sure they will be ding well because they will be wrking n ur cmmunities behalf; Caucuses need t include peple with wide range f skills s they represent a diversity f experience and backgrunds. Netwrking and Cmmunicatin: It is a gd place fr cmmunities t fcus n the needs f the entire regins; It is a gd frum t wrk with each Natin t wrk n Health & Wellness; lking t the cmmunities fr determining needs. Infrmatin Disseminatin: the infrmatin is very in depth and caucuses are ding well; they bring the grass rts issues and cncerns t management. Health Authrity relatinship: Engaging with the existing Health Authrities while at the same time representing the needs f individual First Natins cmmunities. Cmmunicatins: Cmmn reprting structure needs t be develped; agree cllectively f what needs t be reprted s the peple sign ff befre they take the infrmatin smewhere else; ensure we can see the needs f individual cmmunities r areas; cmmunicate mre with health technicians; use webcasts and make ntes available nline. Cst factr/benefit: des the caucus cst generate value r is there a better way? The analysis f achievements and benefits f their wrk shuld be prduced; meetings and caucuses carry a cst and are part f effective service delivery when they are fcused, effective, respnsive and accuntable. Reprting: Reprt regularly t individual cmmunities; make shrt, easy-t-read and understand mems that can be easily distributed t all cmmunity members & staff. 11

12 Participants were asked if they had any ther general cmments n reginal level pririties: Separating plitics and business - Be cnsistent and d nt fcus n plitical issues r let plitics take pririty; and, Caucus Member Knwledge - Educate reginal caucuses n the gegraphy f the First Natins in the regin such as gegraphy, remteness, ppulatins, needs, etc. and ensure they cntinually update themselves t represent the cmmunities accurately. One respndent recmmended a bi f each Caucus / FNHC member be prduced s regins knw what skills and backgrund each representative has t represent them. Prvincial Level Prvincial level refers t the full gegraphy f the Prvince f BC. At this level, health prgrams and services that serve all First Natins and First Natins individuals in BC are designed and delivered, and ther ppulatin health issues are addressed. First Natins engage at a senir level with federal and prvincial gvernments n strategic-level health issues. Principles f the Structure The wrkbk utlined a number f key principles and requirements fr the structure that needs t be in place t supprt the reginal health transfer prcess at the prvincial level. First Natins have stated that the reginal health transfer prcess must: Increase First Natins decisin-making, cntrl and flexibility in health prgram and service philsphy, design and delivery; Fster cllabratins and partnerships; Functin at a high peratinal standard; Nt impact n Abriginal title and rights r the Treaty rights f Natins; and, Nt impact n the Crwn s fiduciary duty including the ability f First Natins t transfer respnsibility back t the federal gvernment if the arrangement des nt wrk fr First Natins. 12

13 First Natins cmpleting the wrkbk were asked hw they felt abut these principles the results fr Vancuver Castal are as fllws: Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 2.9% 1 Disagree 5.7% 2 Agree 28.6% 10 Mderately Agree 22.9% 8 Strngly Agree 40% 14 answered questin 35 skipped questin 5 Respndents were asked if any principles were missing the fllwing summarizes the themes frm the respnses: First Natins and Inuit Health (FNIH) Plicy changes - Change the requirements fr the Hme and Cmmunity Care plicies and requirements t allw ther adult members in the hme a break and temprary respite care fr Elderly Clients wh cannt take care f themselves fully; Off-Reserve Inclusin - need t include ur families living in urban settings; and, Scial Determinants f Health Buy-in has t cme frm ther Ministries that are ging t play a rle in imprving First Natin health, nt just the Ministry f Health Services - Buy-in needs t cme frm Children and Families, Scial Develpment, Envirnment, etc. At ne f the Caucus sessins, queries were asked abut the rle f the First Natins prvincial rganizatins, the csts f maintaining these and wh was in charge. It was cnfirmed that cmmunities drive the mandate and fcus f the First Natins rganizatins. This discussin als cvered the need fr clarity f the Terms f Reference fr the FNHC and Caucuses and mre clearly defined rles f the First Natins Health Directrs Assciatin (FNHDA) and First Natins Health Authrity (FNHA). 13

14 Future Mandate fr the First Natins Health Cuncil (FNHC) The wrkbk summarized that, based n feedback frm Reginal Caucus sessins, the mandate fr the First Natins Health Cuncil frm 2012 and beynd shuld include: Cntinued leadership fr implementatin f the Transfrmative Change Accrd: First Natins Health Plan and Tripartite First Natins Health Plan; Prviding supprt t First Natins in achieving their health pririties and building relatinships at lcal and reginal levels; Health advcacy with gvernment partners and thers at the highest levels; Overseeing and advcating fr service imprvements fr First Natins; and, verseeing the transitin f First Natins and Inuit Health (FNIH) t a new First Natins Health Authrity (FNHA). Participants were asked if any key principles fr this mandate were missing. The Vancuver Castal regin participants respnded as fllws: Relatinships between the First Natins health gvernance partners - Principles need t emphasize the relatinship between FNHC & First Natins Health Directrs Assciatin (FNHDA); desn t state relatinship between FNHC, FNHDA & FNHA; and, First Natins Decisin-Making - Ensure decisins are made with First Natin practices, medicines, traditinal teachings as part f the cnsideratins; add a rle fr internatinal advcacy fr indigenus health rights. Future Structure and Cmpsitin f the First Natins Health Cuncil Sme participants recmmended that since the reginal health transfer prcess will strive t devlve services t the lcal and reginal levels as much as pssible, and include representatin f First Natins in reginal caucuses and the new First Natins Health Authrity, the future FNHC shuld be a smaller grup, with perhaps 1-2 representatives appinted per regin. Participants were asked if they had any cmments abut the future structure and cmpsitin f the FNHC and the respnses were as fllws: Diversity f FNHC Structure Representatin shuld include peple wh represent a diversity f cmmunities - elder reps, yuth reps, and cmmunity and scial wrk peple; Need fr Cntinuity - Representatin shuld nt be changed cnsidering all the wrk dne n implementatin and the length f time it takes t get up t speed n health. Further alng int prcess it may be an ptin if everyne agrees it shuld be; Advcacy Ensure representatives are held accuntable fr having a vice n behalf f cmmunities and nt just shwing up saying nthing; be sure they are speaking at the meetings. If they are nt vcal enugh; nt advcating enugh fr us then they shuld nt be present; and, Transparency Even when the FNHC and Caucuses are selected, their Terms f Reference, appintment prcesses and accuntabilities must be made transparent t everyne. 14

15 One respndent questined what wuld happen t the FNHC nce the FNHA cmes int effect, asking Will the FNHC remain the same? Will their staff transfer ver t the FNHA? Will the FNHA wrk at the senir level discussins with Gvernment with the FNHC r alne? Anther asked if the FNHC wuld cntinue t serve just British Clumbia, r whether it wuld ne day becme a natinal-level rganizatin. First Natins Health Directrs Assciatin (FNHDA) Based n the feedback prvided in the wrkbks, there was general cnsensus that the FNHDA shuld play a key rle in prviding technical advice and guidance t the FNHC and the First Natins Health Authrity. Participants respnded as fllws: Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 2.8% 1 Disagree 2.8% 1 Agree 27.8% 10 Mderately Agree 19.4% 7 Strngly Agree 47.2% 17 answered questin 36 skipped questin 4 15

16 First Natins Health Authrity (FNHA) The fllwing prvides a summary f the principles that First Natins believe are fundamental t the activities and peratins f the First Natins Health Authrity: Recgnize the authrity f individual BC Natins in their gvernance f health services in their cmmunities; Prtect, incrprate and prmte First Natins knwledge, beliefs, values, practices, medicines and mdels f health and healing int the health prgrams and services in BC First Natins; Enhance cllabratins and relatinships that impact n First Natins health; Uphld reciprcal accuntability particularly in their relatinship with First Natins; Uphld prfessinal standards and ethics; uphld the highest standards in rder t avid cnflict f interest; Have a transparent and manageable appintment prcess; and, Have a Bard f Directrs with relevant experience and expertise with respect t First Natins health prgrams and services and successfully running a large rganizatin. Answer Optins Respnse Percent Respnse Cunt Strngly Disagree 2.9% 1 Disagree 2.9% 1 Agree 40% 14 Mderately Agree 25.7% 9 Strngly Agree 28.6% 10 answered questin 35 skipped questin 5 Participants were asked if they supprted these principles the results are as fllws: Respndents were asked if any key principles fr the FNHA were missing. Many f the cmments fcused n accuntable and the need fr assurance that the principles they develp wuld say fr reciprcal accuntability between the FNHA, FNHC, and FNHDA fr timely cmpletin. 16

17 Reciprcal Accuntability Reciprcal accuntability is a key part f the reginal health transfer prcess. Reciprcal accuntability means shared respnsibility amngst the Federal Gvernment, Prvincial Gvernment, the Health Authrities, the First Natins Health Cuncil, the First Natins Health Directrs Assciatin and in future the First Natins Health Authrity. It als includes First Natins themselves wh have primary respnsibility t lk after themselves first and fremst and t wrk with partners t imprve health utcmes fr First Natins ppulatins. Principles fr Reciprcal Accuntability The wrkbk set ut the fllwing principles based n First Natins input and dialgue ver the past several years: Clear rles and respnsibilities; Clear perfrmance expectatins; Balanced expectatins and capacities; Credible reprting; and, Reasnable review and adjustment. Vancuver Castal First Natins wh respnded t the wrkbk added the fllwing principles: Evaluatins and cst effectiveness: annual perfrmance reviews f the First Natin gverning entities; and, Ethics: based n cultural teachings with Elders verseeing ethics guidelines r establishing an Elder s Ethics Cmmittee. Prcesses fr Reciprcal Accuntability The wrkbk utlined a number f suggestins frm First Natins t achieve a high level f reciprcal accuntability: Reginal Caucus sessins including all BC First Natins and their health rganizatins; Regular meetings f the Prvincial [nw Tripartite] Cmmittee n First Natins Health; Regular reciprcal accuntability and health partnership meetings between the partners t measure prgress and discuss ptential changes t rles, pwers r funding that may be required; and, Regular senir plitical and technical meetings with key decisin-makers at natinal and prvincial levels t fcus n BC First Natins health pririties and plans. 17

18 Additinal Feedback Questins and Cncerns Several ther issues were raised: Gvernment readiness whether the gvernment (prvincial particularly) is ready t engage with First Natins as First Natins develp their wn traditinal health and wellness plans and whether they wuld prvide r supprt these plans with sustainable resurces; Traditinal Healers and Practices - spiritual healers in the frnt-line wrk need t be included in any mdels f health and there shuld be standards set; Off-Reserve Peple must be included in these prcesses but d nt appear t be reached by the FNHC prcesses; Cntinuity cmmunities wh have visiting dctrs r n call dctrs d nt have cntinuity f care; Funding tracking cncerns abut whether funding will be clawed back by the FNHA; and, Infrastructure fr n-reserve health centers, r reginally-based clinics that serve abriginal clientele. One cmment seemed t highlight a theme frm the engagement in this regin related t cst-benefit and cmmunity-driven fcus f the First Natin gverning bdies: After reading the wrkbk and watching the vide, I ntice that the FNHC has dne a lt f gd wrk. There is, hwever, A LOT f mentin abut cmmittees, caucuses, bards, etc. I am curius t knw what we are ging t see happening n the grund as a result f the wrk yu are ding, and hw sn will we see thse changes implemented? 18

19 Framewrk Agreement fr the prpsed Transfer f First Natins Inuit Health The FNHC presented the draft Tripartite Framewrk Agreement n First Natin Health Gvernance t sme f the Reginal Caucus sessins and several queries were raised relating t: Legal Review currently underway and t be disseminated t cmmunities Supprt fr cmmunities in regard t the transitin t be addressed with supprt f the FNHDA fr technical advice, training and accreditatin Cverage fr n and ff reserve members Nn-Insured Health Benefits (NIHB) funding issues Generating revenue as the new FNHA - s there isn t a lng term reliance n Gvernment funding Assurance that Health Transfer agreements wuld nt be affected It was nted at ne Caucus sessin that BC was the frnt-runner in terms f frming a FNHA t assume management f a FNIH reginal peratin, and s there were few precedents t fllw in terms f frming a FNHA in Canada. 19

20 4 4. KEY THEMES & SUMMARY OF FEEDBACK Cmmunity Principles Of the respnses received, ver 97% f participants agreed with the cmmunity level principles that were expressed in the Health Partnership Wrkbk. Almst 89% f the participants agreed that a Reginal Health Transfer prcess wuld supprt greater lcal cntrl ver health services and the develpment f lcal health prgram and service delivery mdels. Sme further cnsideratins put frward included the need t develp trained prfessinals fr cmmunities; ensure a cmmunity-driven natin-based apprach; cnduct an evaluatin and address prblems with Nn-Insured Health Benefits (NIHB). Participants als nted the need fr greater cllabratin and recgnitin; capacity building fr health planning; ensuring plitics frm business; addressing capacity develpment needs; and supprting peple t maintain wellness and reduce dependency n services. Reginal Principles and Reginal Caucuses Frm the wrkbk feedback, 94.5% agreed with the reginal level principles that were expressed in the Health Partnership Wrkbk. Further, 91.5% f respnses agreed that they wuld like t see the reginal caucus structure cntinue as part f the new reginal health transfer prcess. Additinal cmments were made abut the need t separate plitics frm business and t ensure Caucus members develped and made themselves aware f their regin in all respects s that they culd advcate effectively. Participants were asked t identity what the Reginal Caucuses were ding well many believe that the caucuses play an imprtant rle and carry ut their respnsibilities effectively; netwrking and cmmunicatin; infrmatin disseminatin and building a health authrity relatinship. Areas that felt the Caucuses need t imprve upn are cmmunicatins, cst/benefit cnsideratin f their wn value t cmmunities and reprting t cmmunities. Prvincial Principles In ttal 93.5% f the respndents agreed r strngly agreed with the Prvincial level principles expressed in the Health Partnership Wrkbk. Other principles that respndents felt shuld be cnsidered are the need t fcus n changing FNIH plicies t benefit cmmunities; ensuring ff-reserve inclusin and addressing the scial determinants f health. First Natins Health Cuncil (FNHC) In terms f the mandate f the Cuncil, respndents agreed with the principles prpsed including the need fr enhanced relatinships between the First Natin health gvernance partners and ensuring First Natins decisin-making was dne in a traditinal way. Respndents als cmmented n the FNHC structure and cmpsitin and nted the need fr diversity with respect t membership (t include elders, yuth etc.); and the need fr cntinuity f existing members; advcacy and transparency. First Natins Health Directrs Assciatin (FNHDA) Nearly 94.4% f respndents agreed that the FNHDA shuld play a key rle in prviding technical advice and guidance t the FNHC and the First Natins Health Authrity. 20

21 4 First Natins Health Authrity Nearly 94.3% f the respnses were agreeable t the principles relating t the FNHA expressed in the Health Partnership Wrkbk. Respndents als stated that it is imprtant that there is a prcess t ensure these principles are upheld; t ensure there is reciprcal accuntability between the FNHC, FNHDA and FNHA and that the three gverning bdies remain tied tgether. Reciprcal Accuntability N participants disagreed with the principles utlined fr reciprcal accuntability; Hwever, sme added ther ideas such as evaluating fr cst-effectiveness f the First Natin gverning structures and addressing ethics (with ne idea f frming an Elders Ethics Cmmittee). Other General Issues A number f ther issues were imprtant t the participants at the Vancuver Castal reginal caucus sessins and thrugh the wrkbks. These related t: Gvernment readiness (t supprt First Natins with implementing their Health and Wellness Plans); The draft Framewrk Agreement fr the transfer f FNIH; Including Traditinal Healers and Practices; Cncerns abut service cntinuity; The need fr infrastructure funding; and, Including ff-reserve peple in all f the FNHC prcesses. 21

22 A 5. Methdlgy The Health Partnership Wrkbk was develped by the FNHC in late 2010, and rlled ut t First Natins acrss BC in January The Wrkbk summarized the feedback frm mre than 90 reginal caucus sessins held ver the past three years, and psed key questins t cnfirm this summary, and slicit further wisdm and advice. There were tw main methds f cllecting feedback frm First Natins cmmunities, Chiefs, leaders and health prfessinals, int the Health Partnership Wrkbk: 1) Cnducting Reginal Caucus meetings in each f the five regins in BC and inviting all Chiefs, leaders and health wrkers t attend Reginal Caucus meetings and during these meetings: a. asking participants t cmplete wrkbks at the sessins (r t send them in after the sessin) s that the FNHC had cmpleted hard cpy wrkbks t cntribute t these reginal summary reprts; and b. taking ntes at reginal and Vancuver Castal Reginal Caucus f discussins and questins which culd als add additinal value t the infrmatin cntained in the wrkbks r cmplement the wrkbk infrmatin; and 2) Making the wrkbk dcument available n-line thrugh surveymnkey.cm which is an n-line survey tl, and encuraging cmmunity representatives t respnd using this methd if they culd nt attend the engagement sessins. 22

23 A The reginal sessins were rganized in accrdance with the needs and pririties f each regin. Therefre, the reginal sessins included a variety f appraches, such as: cnvening sub-reginal sessins in sme f the larger areas; cnducting ne t ne sessins with sme Natins wh wanted their Tribal Cuncil t hear the infrmatin at a Cuncil meeting; cnducting presentatins at ther gatherings and hlding sessins ver tw days instead f ne where there were a larger reginal attendance requiring significant travel time. This reprt includes Health Partnership Wrkbk feedback and input frm Vancuver Castal First Natins received in the perid frm January 2011 thrugh t May 2011, and frm a number f reginal and sub-reginal caucus sessins and cmmunity meetings, including (but nt limited t): January 7: Vancuver Castal Reginal Caucus January 17: Mt. Currie January 28: Vancuver Castal Nrth Sub-Reginal Caucus February 10: Lilwat Natin March 8: Tsleil-Waututh Natin March 10: Lwer Sta alt imc March 21-22: Vancuver Castal Reginal Caucus March 25: Sliammn Natin March 28: Musqueam April 17: Nuxalk Natin May 2: Vancuver Castal Reginal Caucus May 3-4: Heiltsuk Natin Facilitatrs, presenters and nte-takers attended every meeting t present prepared infrmatin such as PwerPints and hand-uts; hear questins and issues; and recrd the prceedings. Hard cpy wrkbks were handed ut at the sessins and sme participants cmpleted these at the meetings while thers agreed t cmplete them later and send them in. On sme ccasins, smaller wrk grups cnvened at the sessins and ntes n flipcharts were als incrprated int the ntes f the sessin t be included in the reginal summary reprts. Infrmatin gathered frm these sessins and methds (ntes, cmpleted wrkbks, flipcharts, n-line wrkbks) has been incrprated int this reprt. 23

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