Contribution Agreements
Through contribution agreements, the Government of Canada provides
funding that must be spent according to agreed upon conditions.
Spending is monitored and reviewed to ensure that these conditions
are met.
For many years Health Canada has provided direct health care services
to First Nations and Inuit people of Canada. Beginning in the 1970s,
government policies advocated more direct control by First Nations
and Inuit communities of their own health services delivery. As
a result, new health programs called for mechanisms to enable First
Nations and Inuit communities to manage and control the delivery
of health services to their members. First Nations and Inuit health
programs, approved by Treasury Board, began to include contribution
agreement authorities for First Nations and Inuit communities to
administer the health programs themselves. Over the years, Treasury
Board has approved various types of contribution arrangements based
on the nature of the programs and the administrative capacity of
the First Nations organizations to deliver the service.
The following are three broad categories that programs and services
supported by Health Canada grants and contributions fall into:
- In lieu of services the Department would deliver
itself (First Nations and Inuit Control);
- Inter-departmental partnerships; and
- Research projects.
1. In lieu of services the Department would
deliver itself.
The First Nations and Inuit Health Branch (FNIHB) has a variety
of contribution agreements which serve as vehicles for the administration
and management of First Nations and Inuit community health programs
and services. This is part of FNIHB's strategic direction to transfer
autonomy and control of programs to First Nations and Inuit within
a time-frame to be determined in consultation with them.
These agreements vary in terms of level of control, flexibility,
authority, reporting requirements and accountability. First Nations
and Inuit communities interested in having more control of their
health programs and services can decide among different approaches
based on their eligibility, interests, needs and capacity. A preliminary
discussion with FNIHB provides information to assist communities
to decide on the approach that is best for their community.
These types of contribution agreements templates
include the following:
- Consolidated Contribution Agreement - General (previously
known as a contribution agreement) do not allow communities to
re-prioritize or redirect health resources. Resources are released
from the First Nations and Inuit Health Branch (FNIHB) through
advances and monthly payments and the submission of quarterly
financial reports.
- Consolidated Contribution Agreement - Transfer/Targeted (previously
known as the Health Services Transfer Agreements) offers more
authority and control of health resources and thus requires a
different set of accountability measures. First Nations and Inuit
communities situated south of the 60th parallel are eligible
to enter into the health services transfer process. Following
the completion of a planning period, and the development of a
community health plan, communities may sign multi-year transfer
agreements. Under these agreements, communities may design new
programs and redirect resources to areas of high priority, as
long as mandatory programs are provided.
- Consolidated Contribution Agreement - Integrated/Targeted (previously
known as the Integrated Community-Based Health Services Approach
offers integrated community-based health care services. A community
operating with the integrated approach sets up its own health
management structure but shares responsibility for delivering
services with FNIHB. As well communities are able to make some
program adjustments, to reallocate resources, and to set up health
management structures which receive funding.
For some communities, operating under the integrated approach
may be a starting point for assuming greater control through
transfer or self-government. For other communities, this approach
may be the most appropriate way to deliver health services to
their community members.
Multi-Departmental Funding Arrangements
- Canada First Nations Funding Agreement -
Health Canada (First Nations and Inuit Health Branch) and Indian
and Northern Affairs Canada collaborate on an ongoing basis to
explore what actions could be taken to streamline funding mechanisms
and instruments. As a result a multi-departmental funding agreement
was jointly developed by Health Canada (First Nations and Inuit
Health Branch), Indian and Northern Affairs Canada and the Department
of Justice for implementation during fiscal year 1999/2000. The
Canada/First Nations Funding Agreement (CFNFA) is a new funding
mechanism which may be used by First Nations who wish to have
one agreement that includes several federal departments' programs,
resulting in a reduced number of agreements and less administrative
burden for both bands and federal departments.
For a complete list of the types
of health programs and services available, and to learn about
the current projects receiving funding, see Funded
Health Programs and Services.
2. Inter-departmental Partnerships
To enable partners to address major national health priorities
or health problems and for which there is no one departmental infrastructure,
expertise or resources (for example: the National AIDS Strategy,
the National Breast Cancer Strategy and, the Alcohol and Drug Treatment
Strategy).
3. Research Projects
Research projects that stimulate the development of knowledge
(for example: contribution programs that help the Canadian Institute
for Health Information coordinate the development and maintenance
of a comprehensive and integrated health information system). See Health
Policy Research Contribution Audits for information on audited
First Nations and Inuit research projects.
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