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The Auditor General of Canada says the federal government cannot guarantee adequate health services for First Nations people living in remote areas in Ontario and Manitoba.
That’s a conclusion First Nations leaders agree with, but not for the same reasons outlined by Auditor General Michael Ferguson.
“I think the report miscued altogether,” said Ontario Regional Chief Stan Beardy, who holds the portfolio for health for the Assembly of First Nations. “(The audit) is correct what they reported, but it’s not where the real need is in terms of addressing access to quality health care for First Nations people.”
The focus needs to be on training nurses to deliver adequate primary care not on training nurses in advanced medical techniques, said Beardy. He adds that a lack of nurses nationally has forced the federal government to rely on agency nurses, whose experience comes in urban settings and not in isolated communities.
“What we need is advanced primary health care at the community level and what we’re looking for is community health specialists, nurses that can deal with mental health, addictions and acute care. People that have the ability to assess and manage. Right now, that is lacking,” said Beardy.
The Aboriginal Nurses Association of Canada and the Canadian Nurses Association agree with Beardy’s assessment. In a joint news release issued by the two organizations following the Auditor General’s report, they referenced a 2014 study they undertook that called for a concerted effort to recruit, train, and retain Aboriginal nurses.
“Aboriginal health inequities are deeply rooted in this country’s health system — from the lack of Aboriginal nurses in leadership and direct care positions to the disregard for Indigenous health practices,” said the Aboriginal nurses assocation president Lisa Bourque-Bearskin.
“The consequences of these inequities are clear in the evidence that access and health status for First Nations individuals in remote communities are not comparable to other residents in similar rural locations.”
Nishnawbe Aski Nation Deputy Chief Alvin Fiddler also had concerns with the nurses. The audit found that often times the nurses were required to perform duties that fell outside their legislated scope of practise.
Fiddler points to a 2010 Health Canada internal audit, which noted the same practise and the need for additional training for the nurses. Five years later, the Auditor General found that only one out of every 45 nurses had completed the mandatory training.
The Auditor General also found that Health Canada did not take into account the specific needs of the remote communities when allocating health support.
“The way the system is currently being delivered is putting lives at risk. It’s not designed to improving our health or saving lives, it’s designed to save money because each region gets a certain amount of money in an envelope and you’re directed to operate within that envelope that you’re given,” said Fiddler, whose organization represents 49 First Nations communities, 32 of which are considered remote fly-ins.
The Auditor General also found that not every resident was eligible for medical transportation benefits; and that many nursing stations had health and safety deficiencies. The audit encompassed 85 health facilities servicing approximately 95,000 First Nations people.
The Auditor General made 11 recommendations to improve training for nurses, nurses stations, medical transport benefits, and appropriate funding for health care. Federal Health Minister Rona Ambrose accepted the recommendations.
“Priority number one is ensuring that remote First Nations communities have access to healthcare providers,” said Ambrose in a statement. She also committed to implementing a nursing recruitment and retention strategy.
Fiddler is encouraged by Ambrose’s response and believes the Auditor General’s report will get the action the 2010 internal audit did not.
“The Auditor General of Canada, it’s more of a public process …and the pressure being put on Health Canada for them to do this is bigger this time around,” he said.
Fiddler adds that he is still awaiting a response from a letter sent to Ambrose asking her to meet with NAN and Manitoba Keewatinowi Okimakanak, which represents the northern Manitoba First Nations communities included in the report.
Beardy says Ambrose’s commitment to the Auditor General’s recommendations is in keeping with an earlier commitment she made to AFN to join in a review of the non-insured health benefits program. A committee was struck late last year with an equal number of representatives from AFN and Health Canada. However, Beardy says, they won’t be waiting until the review has been completed to take action. Ambrose has agreed to act on “quick win” health gaps that can be resolved with straightforward policy changes, he said.
“Both the joint policy review and the Auditor General report bring to the forefront that there are challenges for First Nations people in accessing quality health care. I think any report that comes forward that has credibility will feed into that process,” said Beardy.
“First Nations people are still struggling with basic human rights. Access to clean drinking water. We’re talking about access to a doctor, we’re talking about proper supports for health care. So we’re talking about very basic things, yet it’s a given for the rest of Canada. That’s what we’re still fighting for,” he said.
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