Canada
A delegation of Queensland Aboriginal and Islander Health Council (QAIHC) staff, some members of Queensland Health and the Chief Executive Officers from Apunipima and Gurriny Yealamucka travelled to Canada in 2007 to meet with Health Canada and First Nations organisations. The focus of the trip was to examine the health transfer program in this country to see what, if any, lessons could be learnt from the First Nations experience to inform future directions for the primary health care transition process in Queensland.
Through this experience it was easy to see that one of the key success factors for the health transfer program in Canada was the leadership provided within the First Nations organisations. All the services visited had specifically sought people with the right levels of skills and expertise for the roles including First Nation people from other communities. One of the problems faced was that the funding for management and capacity building had been insufficient for them to develop a coherent succession plan, with the potential for problems in the future.
The First Nations experience of health transfer showed that the directions that QAIHC and members are taking in regard to this are right on track. In particular the Canadian experience showed the value of:
- First Nations (communities) joining together to form regional health service bodies that can take on advocacy and lobbying, provision of health services, support functions such as HR and financial management
- Strong linkages between health service organisations and other First Nations groups working on education, housing, economic development and other related services.
- An integrated approach to primary health care that brings all the related services together and reduces the number of funding sources and reporting requirements.
- Demonstration of Federal Government commitment to improving the health of First Nation peoples.
The Canadian experience highlighted the need to do more work around the following negotiating principles for transfer.
- Establishing levels of funding with a growth factor that includes cost/wage indexation, population increases and demographic change, and the increased burden of diseases facing Aboriginal and Torres Strait Islander communities.
- A funds pooling model that reduces the number of targeted programs and maximises the number of services/programs that are included in the transfer agreement. This will increase flexibility and make it easier to meet community priorities.
- Ensure there is adequate funding and support to build capacity, both in the community and amongst health staff, particularly the health service managers and the “hidden” costs associated with health reforms (i.e. Organisational growth) which was highlighted by the services as still under-funded due to inaccurate cost reporting.
- The need to have an evaluation strategy that produces some evidence on health benefits of transition. This requires agreement on some baseline data and a set of indicators that are comparable across the communities that are having a transition process.
- The ability to collect statistical information (over a given period) that the community controlled sector is able to use to justify benefits of health reform and transfer of PHC services. This is justification for the state-wide project of health performance indicators.
QAIHC Delegation Canada Report 2007 - Full Text