Results at a Glance – Evaluation of Health Canada’s Role in Supporting BC First Nations Health Authority as a Governance Partner (Health Canada)

British Columbia Tripartite Framework Agreement on First Nation Health Governance

• In 2011, the Federal and British Columbia Ministers of Health and the First Nations Health Authority (FNHA) signed the legally binding BC Tripartite Framework Agreement on First Nation Health Governance, including nine supporting Sub-Agreements.
• Health Canada committed up to $4.7 billion to the FNHA over 10 years for this initiative.
• Since 2013, the Agreement has empowered the FNHA to assume the responsibility for the design, management, delivery, and funding of First Nations health programming in BC.
• The FNHA is managed and controlled by First Nations, and coordinates with the BC Health Authorities to deliver services to approximately 150,000 First Nations people in over 200 communities across BC.
• The BC Tripartite Relations Unit within the First Nations and Inuit Health Branch (FNIHB) administers Health Canada’s responsibilities under the Tripartite Agreement.

What the evaluation found

• Health Canada supports the governance of the Agreement by actively participating in governance forums, and by facilitating new relationships between the tripartite partners and other federal departments and stakeholders. This occurs increasingly through informal channels as relationships have matured.
• Partners to the Agreement report a high level of satisfaction with Health Canada in supporting the FNHA, and suggested that they would like to see collaborative experiences further expanded and built upon, particularly with regards to policy and program development, and the sharing of information and best practices at senior levels.
• Health Canada has effectively followed through on commitments through adherence to reciprocal accountability and the creation of appropriate processes and tools. Health Canada’s responsiveness has contributed to a smooth transition to the new service delivery model, as defined in the Tripartite Framework Agreement.
• The Framework Agreement is the first of its kind in Canada. While one of the keys to successful transfer of responsibilities was to document and follow formal processes, partners now recognize that a certain level of flexibility is necessary to ensure that the FNHA is able to continue delivering quality services to member communities.

Best Practices

Based on the findings and conclusions outlined in this evaluation report, there are some best practices that will be valuable to consider in the future for similar initiatives. These include:

• Creating and honouring a working relationship based on reciprocal accountability;
• Working in partnership to create processes and tools that meet the unique needs and unanticipated situations of a new initiative;
• Formally documenting all processes in order to facilitate relationship building, demonstrate the strength of the service delivery model over time, and provide opportunities for interested parties from other jurisdictions to access tools, instruments and best practices; and
• Creating processes with enough flexibility to allow for innovation and evolution over time, despite the need for formal processes at the outset in order to build trust among partners.

About the evaluation

The purpose of this evaluation is to satisfy a commitment made to the Treasury Board Secretariat to evaluate Health Canada’s role in supporting the FNHA in BC as a governance partner and funder.

Due to the potential for overlap with an ongoing tripartite evaluation (led by the FNHA), the scope of this internal evaluation was reduced so as to not duplicate work or overburden the stakeholders involved.

The objective of this evaluation was to assess Health Canada’s governance role related to the Agreement for the period from 2013-14 to 2015-16, and to highlight best practices. It does not assess what has already been covered by the 2016 internal audit of Health Canada’s management of the administration of the Agreement. The evaluation included a document review, and key informant interviews.