ARCHIVED - Aboriginal Health Transition Fund: Outcomes and Lessons Learned

The Aboriginal Health Transition Fund (AHTF) has acted as a catalyst in supporting partnerships that seek new approaches to health care service planning and delivery, to improve access to care for Aboriginal Canadians.

Since 2005, the AHTF has funded 311 projects across every province and territory. Projects piloted different approaches to integrate and adapt health services in areas such as mental health, child and youth health, palliative care, e-health, chronic disease management, substance abuse, and health governance.

To date, partners have reported that AHTF has helped create:

More outcomes and results will become available in the final AHTF Meta-Evaluation, due in November 2011.

Working Together to Improve Aboriginal Access to Health Services

Health Canada is supporting collaborative work to address the unique challenges that Aboriginal people face in accessing quality health care. Through work on several initiatives over the past decade, federal, provincial and territorial governments have demonstrated a commitment to improving health care service delivery to Canadians.

Current Approach

The Health Services Integration Fund (HSIF) is a five-year $80 million Aboriginal health initiative that builds on past successes and lessons learned in the integration of federally funded services with those of the province and territory. It will support the collaborative efforts of the multiple partners in aboriginal health to improve the integration of health services for Aboriginal Canadians.

Since 2006, HSIF's predecessor, the Aboriginal Health Transition Fund (AHTF), funded a total of 311 projects across all the provinces and territories which piloted different approaches to better integrate and adapt existing health services in areas such as: mental health and addictions, chronic disease management, maternal and child health, public health, home and continuing care, health information management, human resource practices, and health governance. Outcomes and lessons learned from these projects have guided the development of HSIF.

Aboriginal Health Transition Fund projects have had the potential to reach approximately 78 per cent of First Nation communities and most Inuit communities. Approximately 480 of 615 First Nation communities were involved in AHTF projects. Inuit organizations participated in AHTF projects in all four Inuit regions--Inuvialuit (Northwest Territories), Nunavut, Nunavik (Northern Quebec) and Nunatsiavut (Labrador). In addition, there were Métis-led projects in British Columbia, Saskatchewan and Manitoba.

This brochure highlights some successes achieved under the Aboriginal Health Transition Fund.

Building on Aboriginal Health Transition Fund Successes

The Aboriginal Health Transition Fund demonstrated time and again that it is critical to create conditions that facilitate collaboration and an agreed upon plan by partners on how to improve Aboriginal health. Extensive discussions with partners that participated in AHTF projects and others shed some light on what works and what doesn't when parties with sometimes different perspectives come together to discover new ways of working cooperatively.

Ingredients for Success

  • Clear, shared understanding among participants of objectives, roles and direction
  • Trust between parties
  • Recognition of the values each party brings to the table
  • Readiness for change
  • Open minds, willingness to engage in dialogue and explore innovative options
  • Commitment to on-going collaboration- adequate human resources, time, senior level support
  • Political will at all levels
  • Community involvement
  • Flexibility in approach, given the different levels of readiness and priorities among parties
  • Realistic timelines
  • Achievable outcomes

Challenges on the Road Forward

  • Health system complexities - multiple parties, specialties and structures
  • Lack of understanding of partners in each system
  • Multiple organizational cultures and processes
  • Limited resources (human and financial)
  • Pace of progress - it takes significant time to build relationships, plan and realize change.

Early Outcomes Reported under the Aboriginal Health Transition Fund

The Aboriginal Health Transition Fund has acted as a catalyst in supporting partnerships that seek new approaches to health care service planning and delivery, to improve access to care for Aboriginal Canadians. To date, partners have reported that AHTF has helped create:

  • new ways of working together in Aboriginal health;
  • new ways of thinking in planning and delivering health care services;
  • new ways of doing business in Aboriginal health; and
  • new ways to access health care services.

1) New Ways of Working Together in Aboriginal Health

Aboriginal Health Transition Fund projects have brought together representatives from government (provincial/territorial/federal) and Aboriginal groups that have either never worked together before; or have done so predominately on an ad-hoc basis.

This collaboration has:

  • created new relationships and strengthened existing partnerships in Aboriginal health;
  • generated a new appreciation and commitment to the value of collaborative work;
  • improved trust in partnership approaches;
  • facilitated the creation of formal partnership arrangements with specific goals;
  • expanded Aboriginal representation in provincial and territorial health systems;
  • generated explicit commitments among key groups involved in health service delivery to work collaboratively to address challenges impacting access to, and quality of, health services for Aboriginal people; and
  • led to the emergence of champions committed to improving the integration and adaptation of health services for Aboriginal people.

Aboriginal Health Transition Fund-inspired relationships and projects have enhanced awareness of the unique challenges Aboriginal people face when seeking health care. AHTF projects facilitated proactive changes between provinces/territories and Aboriginal communities to address these challenges.

Following the involvement in AHTF projects, the
Government of New Brunswick
now includes First Nations in their health planning and engagement processes. These engagement processes positively influenced the work the Department of Health and the Regional Health Authorities have undertaken with communities in a number of areas. For instance, government representatives note that the relationships established under AHTF positively influenced the roll out of the H1N1 vaccine in 2009.

2) New Ways of Thinking in Planning and Delivering Health Care Services

Changes in attitudes, beliefs and values facilitate successful integration and adaptation of health services. Formalized committees and working groups have enabled partners to openly discuss challenges and barriers to integrating and adapting health services and find solutions. These approaches have facilitated:

  • improved understanding of the roles, responsibilities and limitations of provincially and federally funded health care services;
  • improved understanding of health care access issues, health disparities and social and cultural considerations of First Nations, Inuit, and Métis; and
  • innovative approaches to integrate and adapt health care services to better meet Aboriginal patient needs.
British Columbia's Provincial Health Services Authority
is providing cultural competency training for health professionals to improve the suitability and quality of services. Increasing employee awareness of Aboriginal cultures and their concept of wellness--holistic, involving physical, mental spiritual and emotional elements--helps ensure Aboriginal client needs are understood and effectively addressed.

3) New Ways of Doing Business in Aboriginal Health

Several Aboriginal Health Transition Fund project proponents have reported innovative ways of planning and delivering health services to Aboriginal Canadians, resulting in:

  • enhanced Aboriginal participation in provincial and territorial health care planning and delivery processes;
  • more culturally-relevant programs and services (adapted programs and models of care); and
  • improved coordination of care for Aboriginal patients accessing services funded by different agencies (protocols and frameworks governing patient referrals).

The Nunavik Regional Board of Health and Social Services worked with 14 communities and the local health committees on a mental health project focussed on the design and implementation of a culturally appropriate mental health services model targeted towards Inuit youth.

The Manitoba Métis Federation worked to raise awareness of the range of challenges Métis encounter when seeking health care services. Manitoba will now be better positioned to identify priorities to improve Métis access to health programs and services.

On October 1, 2010, the federal Weeneebayko Health Ahtuskaywin and the provincial James Bay General hospitals were fully amalgamated into a single hospital operating under the Ontario Public Hospitals Act, governed by a First Nations Regional Health Authority. The integration of the two hospitals into the Weeneebayko Area Health Authority (WAHA) is aimed at improving the quality, accessibility, delivery, effectiveness, efficiency and cultural appropriateness of health services in communities along the Hudson and James Bay Coast. Services that were previously fragmented are now integrated under the WAHA to better meet the needs and priorities of James Bay Coastal First Nations.

4) New Ways to Access Health Care Services

Improving access to quality health care is the ultimate goal of the Aboriginal Health Transition Fund. Through partnerships, discussions and problem solving, improved access to health services has been achieved by:

  • improved awareness of existing health services;
  • offering existing provincial and territorial health services closer to Aboriginal communities;
  • more suitable health services for Aboriginal clients; and
  • improved coordination of health services and referrals.

The Alberta Health Services has extended its mobile cancer screening to communities in the Western Cree Tribal Council.This is the result of the establishment of an inter-jurisdictional process for deliberations regarding the health care needs of First Nations in Alberta.

The Pauktuutit Inuit Women of Canada adapted existing prenatal resources to be more culturally relevant and increase awareness of available prenatal programs, which increased participation in prenatal classes in Happy Valley Goose Bay.

The File Hills Qu'Appelle Tribal Council worked with First Nations partners and the Province of Saskatchewan to expand access to prenatal and women's health services at the All Nations Healing Hospital. Expectant mothers can now access provincially funded midwifery, ultrasound and nurse practitioner services closer to home.

For more information on the AHTF, please visit www.healthcanada.gc.ca/ahtf
Pour plus d'informations, veuillez visitez le site web du FTSA : www.santecanada.gc.ca/ftsa

Aboriginal Health Transition Fund across Canada

Here are just a few examples of the good work that Aboriginal Health Transition Fund (AHTF) projects have accomplished across the country. From patient navigator initiatives in British Columbia, to cross-border partnerships between Quebec and New Brunswick, and community specific wellness plans in the North, these projects illustrate the richness, variety, level of engagement, reach, and impact that the Aboriginal Health Transition Fund is having on communities, systems and working relationships.

British Columbia

Partners in British Columbia have adapted health programs and services to guide Aboriginal people through an often complex health care system.

Aboriginal people in British Columbia can better access the health services they need under the AHTF. Through the fund, the province recruited more Aboriginal patient navigators, doulas and nurses to help Aboriginal people find their way through the health care system. Aboriginal patient navigator projects across the province have led to improvements in access. For instance, the Vancouver Coastal Health Authority reports an increase in referrals from the community--as opposed to hospital referrals--from 24 per cent prior to the introduction of Aboriginal patient navigators to 40 per cent.

Aboriginal patient navigator initiatives are the result of extensive consultation with Aboriginal people. Consultations helped to identify gaps and opportunities in the health system. They also highlighted the importance of engaging Aboriginal people in policymaking.

Alberta

In Alberta, partners are signing formalized agreements and protocols to support collaborative health service delivery.

First Nations in the Athabasca Tribal Council area can now access more clinical health services and have better resource capacity for tele-health and videoconferencing. As a result of project leadership from the Athabasca Tribal Council, the Wood Buffalo Primary Care Network and Alberta Health Services now deliver some programs directly to First Nations communities, whether in person or via videoconference. Partners signed a memorandum of intent and accompanying service agreements clarifying roles and responsibilities in health service delivery to First Nations. This project has contributed to broad system change in a variety of health areas, including primary health care, public health and chronic disease management.

Children and mothers at risk for Fetal Alcohol Spectrum Disorder (FASD) are receiving better intervention and follow-up care in Enoch Cree Nation. The First Nation and its partners have signed service agreements aimed at reducing gaps in FASD programming. These service agreements have resulted in improved access to culturally sensitive FASD intervention, education, diagnosis and support services for First Nations.

Saskatchewan

The AHTF is contributing to "historic change" in Saskatchewan, including regional and province-wide integration initiatives and tripartite discussions.

Pursuant to the Saskatchewan Memorandum of Understanding (MOU) on First Nations Health and Well-being, the Federation of Saskatchewan Indian Nations (FSIN), the Saskatchewan Ministry of Health, and Health Canada established a formal tripartite relationship and structure, and are drafting a 10-year First Nation Health and Wellness Plan. This project has increased First Nations participation in health planning--FSIN has engaged and consulted Saskatchewan First Nations throughout the implementation of the MOU. Additionally, by working together toward system change in Saskatchewan, partners have a greater awareness and understanding of health issues facing First Nations in Saskatchewan, of each others' roles and responsibilities, and of the complexities of the health system.

The Prince Albert Grand Council led the creation of a Chronic Disease Network and Access Program in partnership with the Prince Albert Parkland Health Region and the Northern Health Strategy Northern Chronic Care Coalition. Partners are developing coordination and communication protocols to improve chronic disease case management, patient information sharing, referrals, and provider education. The program is introducing a holistic approach to chronic disease management. It also aims to increase patient access to specialist health services.

Manitoba

AHTF partners in Manitoba are improving the quality of and access to health care services for First Nations by creating new, integrated health governance structures and ensuring services are culturally relevant.

Misipawistik Cree Nation and the town of Grand Rapids, Manitoba have agreed to create a single integrated health authority, with shared governance between the First Nation and the town, to deliver primary health care services. In addition to integrating services and creating new health governance structures, this project has increased Aboriginal participation in the design of health services by involving members of the Cree Nation in planning activities for the health-care model.

Fisher River Cree Nation and the Manitoba First Nations Personal Care Home Networking Group developed culturally appropriate licensing standards for six personal care homes in First Nations communities in Manitoba, to ensure First Nation seniors receive the care they need.

CancerCare Manitoba is working with Norway House Cree Nation and other partners to adapt its services to the needs of the First Nation. CancerCare Manitoba sought input from community members on ways of making its services more culturally appropriate. Based on feedback, it intends to incorporate traditional knowledge and spirituality into its approach. Partners are also developing a cancer prevention and wellness strategy for the community.

Ontario

In Ontario, partners are working to improve the quality of, and coordination of, care for Aboriginal populations. This is being done by incorporating current evidence on traditional First Nations and western approaches to health, and aligning services offered on reserve with provincial efforts to address health concerns.

Under the Ontario First Nation Tripartite Public Health Initiative, the Chiefs of Ontario (COO) engaged political and territorial organizations and First Nation communities across the province in the development of an Ontario First Nation Tripartite Public Health Relationship Framework. The framework outlines an integrated approach to public health on reserve, guides ongoing and everyday relationships between Health Canada, public health units and Ontario First Nations, and includes a First Nation health information management system supported by provincial government systems. This project has increased First Nation participation and capacity in integrated First Nation public health planning. It has also resulted in the establishment of two key tripartite advisory committees, environmental scans of current practices and relationships, establishment of links to ensure consistency with national and provincial approaches, and the development of a range of design options.

The Centre for Addiction and Mental Health (CAMH) in Toronto was successful in adapting its men's residential treatment program to establish an ongoing Aboriginal-specific and culturally appropriate cycle for addictions/mental health. As a result of the successful adaptation, CAMH senior management has changed policy and redirected core funds to support continuation of the program after the AHTF ends. In addition, due to the success of the program, an Aboriginal women's cycle will begin in 2011. Moreover, this model may be extended to other health centres in the province. For example, Sioux Lookout Meno Ya Win Health Centre has expressed interest in learning more about the model.

Couchiching First Nation is working with other Fort Frances-area First Nations, and local, provincial and federal health and social service delivery agents to assess substance abuse and addictions service delivery needs in the Fort Frances region. The project aims to strengthen relationships between existing services and regional health authorities, and develop a service delivery model that is better suited to the needs of communities. Partners collaborated on strategies to improve the coordination of services based on evidence and recommendations identified in focus groups and treatment and support service reports.

Quebec

Quebec First Nation communities are collaborating with regional and provincial health and social service providers to provide a continuum of care adapted to Aboriginal populations.

For the first time under AHTF, eight Innu communities represented by the Uashat mak Mani-Utenam Health and Social Services, and four local branches of the Agence de la santé et des services sociaux de la Côte-Nord Region are working together to improve Innu health by better coordinating and adapting health services. Partners are developing health-service agreements to provide a continuum of health services adapted to Innu populations, which will be supported by coordination mechanisms between the Innu and provincial health service organizations. Reported project outcomes to date include the establishment of working tables on various health subject areas, the creation of Aboriginal patient navigators, improved awareness of Innu health issues among provincial staff, and improved trust and communication between service providers. The Agence de la santé et des services sociaux in the Côte-Nord Region solidified its commitment to improving Innu health in its five-year strategic plan to better coordinate services for First Nation communities, revealed in September.

Gesgapegiag Health and Community Services worked with Listuguj First Nation and provincial and regional health and social service organizations in Quebec and New Brunswick to improve access to culturally relevant detoxification services for Gesgapegiag and Listuguj community members. Partners formed a working group and developed procedures and protocols to better integrate addiction services offered by the provincial health care systems of Quebec and New Brunswick and the health centres in Gesgapegiag and Listuguj. Partners have reported increased awareness of the need for detoxication services for First Nations--the Centre de santé et services sociaux mandated two bilingual social workers to work with First Nations clients. What's more, First Nation and regional addictions workers are meeting regularly and are working together on a referral toolkit. They've also offered joint training in the communities and cultural awareness workshops to health care personnel.

Atlantic Region

AHTF has solidified and supported efforts towards improved health planning in Newfoundland and Labrador. First Nations are working with the province to address jointly identified health priorities and jurisdictional challenges.

The Labrador-Grenfell Regional Integrated Health Authority worked with First Nation, provincial and federal partners to examine current mandates, programs and services, and develop a plan that identifies areas requiring collaborative efforts. As a result, partners created an Aboriginal health-planning forum that will continue to meet beyond the AHTF and work on jointly identified priorities, such as mental health and addictions. In addition, the forum has spearheaded a mobile health and wellness team.

Health and social service providers in Miawpukek First Nation now have better access to health information. Miawpukek First Nation worked with partners to develop and implement a community health information electronic plan. The First Nation also worked with the regional health authority to identify community health priorities and ways to address jurisdictional challenges.

Nova Scotia is committed to new ways of working together in Aboriginal health through improved coordination in health service delivery and continuing care.

Two First Nations in Nova Scotia and the Guysborough Antigonish Strait Health Authority developed an MOU to clarify roles and responsibilities for health-service delivery, establish specific targets and improve coordination of health services. Partners mapped out existing services and resources and developed a joint planning framework.

With AHTF funding, the Nova Scotia Department of Health set out to integrate its home care program with the federally funded home care services offered on First Nations reserves. The province is currently considering a change in policy, which would increase access for First Nations living on reserve to the full range of home care services offered through provincial policy.

In New Brunswick, the AHTF has helped to establish and strengthen relationships between First Nation communities, regional health authorities, and the department of health. Together, partners have worked to better coordinate efforts and improve access to health services for First Nations.

Five Maliseet Nations in New Brunswick worked with representatives from the provincial department of health and the regional health authority to develop a culturally appropriate model for mental health and addictions treatment programs and services for Aboriginal youth. Partners have accessed alternative funding to support the implementation of the model beyond the AHTF.

Prince Edward Island is working with First Nations and Health Canada to develop collaborative approaches to address jointly identified health priorities.

Under the AHTF, the Mi'kmaq Confederacy of Prince Edward Island, the Prince Edward Island Department of Health and Health Canada formed a trilateral Health Services Integration Steering Committee to develop collaborative approaches to jointly identified priorities. The committee meets regularly to identify and monitor progress toward priorities. Partners expect the committee to form the basis for the Health Policy and Planning Forum under the new Canada / Prince Edward Island / Mi'kmaq Partnership Agreement.

Northern Region

In the North, the AHTF has enabled First Nations and Inuit to engage in health planning and develop strategies and programs that reflect their culture and local priorities.

Nunavut Tunngavik Incorporated's Community Wellness Strategy enabled six communities in Nunavut to identify their health needs and work with the Government of Nunavut to develop integrated health plans reflecting local priorities. The project has increased Aboriginal participation in the design, delivery and evaluation of health services by empowering communities to engage in health planning and provide feedback on health priorities.

The Inuvialuit Regional Corporation (IRC) developed and distributed oral health memory books to children in the Beaufort-Delta region. The books allow parents and health practitioners to track a child's oral health from birth to age six. The initiative--undertaken in partnership with the Beaufort Delta Health and Social Services, the Gwich'in Tribal Council, the Canada Prenatal Nutrition Program and the Government of the Northwest Territories--is intended to raise awareness about the importance of oral health among parents, educators and health and social service providers. The IRC promoted the oral health memory books through public service announcements and oral health education sessions in community health centres and early childhood education programs.

The Council of Yukon First Nations engaged staff and community members from all 14 Yukon First Nation communities in community health scans. The scans identify the strengths and gaps in existing health and social services. The Council translated the results from the scans in two "easy to use" documents for health and social planning: "Community Specific Information," and "Community Health Scan Report." The report highlights several themes, including access, capacity and administration, communication and relationships, incorporation of culture, and barriers and gaps.

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