Aboriginal health delivery systems slashed

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The British Columbia government's massive restructuring plan for the delivery of health services has predictably raised the ire of people who work for some of the agencies affected who will be out of a job April 1. In health, as in other sectors of the economy being mauled by the majority Liberal government's austerity measures, it is predictable that many are hostile to the changes.

The government says monies targeted to Aboriginal people's health that are now flowing through the Aboriginal Health Council of BC (AHCBC) and its six Regional Aboriginal Health Councils (RAHC) will not be cut. Effective April 1, five new regional health boards headed by senior corporate-style managers will administer the money.

It is not clear, however, whether the same Aboriginal-specific services will continue or whether Aboriginal leadership will have any say in how any of the total $9.5 billion health care pot is spent.

Cecilia Teneese, health administrator with the Kwakiutl District Council Health Office, expressed these concerns to Raven's Eye:

"The B.C. provincial cutbacks and layoffs will have a huge impact on our First Nations health organizations as we will no longer have representation on local health councils and health societies as they no longer exist. First Nations who relied on the provincial health services will now be turning to our First Nations' health organizations for services; and although we can continue developing working relationships with the local health organizations, the regionalization of health authorities will make it even more difficult to receive prompt responses and decisions."

Health Services Minister Colin Hansen, who was named as the person delivering the bad news to the First Nations Dec. 18, did not respond to our request for an interview. Health Planning Minister Sindi Hawkins did, prior to entering an early morning cabinet meeting Jan. 30.

The province's restructuring goals are threefold: eliminate administration duplication and costs; minimize inter-jurisdictional overlaps and ensure that health boards are accountable to the public.

Hawkins said the Liberals are standing behind a "government-wide commitment to improve the day-to-day lives of Aboriginal people. That is a key priority, and the premier has made that commitment.

"We are moving to a system of better management, and certainly accountability for money spent, and I know there are groups that would be concerned, but I can tell you right now that the funding remains at the same level in the coming fiscal year. It is protected; that means the funds can't be used for anything else. They have to be used for Aboriginal health services.

"We have some really good working tables. In fact, the premier, myself, the health services minister and the minister responsible for community Aboriginal women's services met with the First Nations Summit health committee just the day before yesterday (Jan. 28) and they are right on side with this. They feel if there's money going to be spent, we have to take a business-like approach and we have to make sure there's accountability, and the accountability has to show that there's been an improvement in health outcomes. And that's the system we're moving to in all areas of health services delivery. We are moving towards health authorities that will have accountability measures. They will be held to account to show that they are improving the lives of not only Aboriginal citizens, but all citizens in the communities that they're responsible for.

"The health authorities are in the process of developing Aboriginal health plans and they continue to work with our Aboriginal communities to ensure that those services are accessible and they meet the needs of residents."

She said the chiefs' health committee has been "doing some very good work" with what is known as the "senior officials' group," which includes members of both the chiefs' health committee and the health ministry.

"They (chief's health comittee) have had a very happy working relationship with the ministry; they want, they say, a business-like approach to health services delivery; they have made some significant progress in actual deliverables-in projects I think you'll see later this spring. There is a companion document to the B.C. health guide, which is a self-care guide for healthcare for our citizens. There is going to be a companion document for Aboriginal people-it is absolutely a first-class piece of work and they're very proud of it. I'm very proud of it."

In addition, Hawkins said the officials' group has invested work and time in informing the public what its aims are. It has held 10 information sessions across the province that included the health authorities and these were well attended. One of the educational tools that stemmed from that collaboration was a pamphlet on the rights and responsibilities of Aboriginal citizens regarding healthcare in B.C. They're also working on a tele-health project for rural and remote communities, the minister said.

"We're moving to more accountability, and we're going to flow those dollars through the regional health authorities that are going to be accountable to government and we're going to demand accountability." She added, "so there is more of a focus on outcome-based service delivery."

Hawkins said part of the responsibility put on the health authorities is to show in their service plans how they met the needs of all citizens. Whereas the previous NDP government thought it prudent to have representatives of various sectors-unions, physicians, Aboriginals-planning service delivery, "what we're looking for in our boards," said Hawkins, are very high-level, business-like people that manage multi-million budgets. That's the kind of expertise we were looking for."

The government has appointed board chairs. Criteria for board members is being handled through the government's resourcing office with input from the CEOs and the chairs, she said.

"If eople meet the criteria, they will be appointed. . . . We're not looking for specific groups, per se; we're looking for specific skills."

Hawkins said the chief's health committee "was quite happy and quite excited to work with us on this process."

First Nations Chiefs Health Committee executive director Shaunee Pointe could not be reached by press time.

"Government's going to get out of the business of micro-managing health care-out of the service delivery-that is the job of the health authorities," Hawkins concluded.

Mike Burns, director of AHABC, counters that setting up a new administrative system will not save money or benefit people.

"Our point of view is that they're taking away the path that we've been on towards self-determination."

He said it is well known that the more control one has over health resources and health spending, "the better health you have." He said both the current and previous medical health officers have publicly stated that.

"So through our Aboriginal health councils and through our Aboriginal health association, we've been making decisions in our communities about the types of programs that will benefit the community." Burns said the system has been working for them for 10 years.

When the five new boards take over, Burns said, although they've received assurances that money is targeted to Aboriginal people, "we still don't have a clue as to how that will be done."

He added that the Aboriginal councils have not directly been told their systems were not working or that anything is wrong administratively speaking.

"We've received nothing in writing as to why this is happening."

Burns said they've only had Minister Hansen's remarks passed along second-hand through the government's Aboriginal health director.

The minister apparently said at least two things that upsets them.

"The first thing, and we only learned this last week, is that the minister himself has decided that he does not want to see an Aboriginal health practicecontinue on. Now prior to that, we were led to believe that all we have to do really is align ourselves with new health authorities and we can continue on in our work, but that is not the deal." Indirectly, they have heard they are not operating cost-effectively. But Burns said especially the past couple of years they have worked to keep their administrative budget "within proper limits" of 10 to 15 per cent.

Adam North Peigan, whose position as governor of a health authority was eliminated through the restructuring, is director of health and social development for the Tsawwassen First Nation in the lower mainland. That position is federally funded. His job isn't threatened by the provincial cuts, but in his community, there are contracts that are affected.

"We're looking at laying off frontline staff. That's probably the only option that we as First Nations have. Unless we want to carry the deficit."

He recommends citizens should write to their MLAs to voice their concerns and explain how the changes are affecting their communities. In addition, he thinks people should write to the health authorities "strongly encouraging that they sit down and meet with the Aboriginal community in developing some kind of mechanism to ensure that these dollars continue to flow to the Aboriginal communities. There needs to be some kind of mechanism in place; there isn't one right now." He said about $10 million a year is at stake.

Chief Stewart Phillip, president of the Union of British Columbia Indian Chiefs, said on Jan. 29 that he and chief negotiator and task group member on the First Nations Summit Kathryn Teneese had met that morning. She told him the Summit had met with the premier "a day or so ago."

According to Phillip, "she was telling me that almost all of the questions that they had, they didn't get an answer. And the reason for that is this government's moving so quickly that in a sense they're making it up as they go along." He called the measures "an accounting