Aboriginal Diabetes Initiative
First Nations On-Reserve and Inuit in Inuit Communities Program
Program Framework
2000
ISBN: H35-4/1-2000E
0-662-29374-6
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Table of Contents
- Introduction
- Target Population
- Program Purpose
- Program Objectives
- Program Elements
- Program Delivery Model
- Program Funding
- Program Criteria and
Implementation
- Program Monitoring and Evaluation
1. Introduction
The Aboriginal Diabetes Initiative (ADI) program is one of four main
components of the Canadian Diabetes Strategy (CDS) announced by the Government
of Canada in 1999. The ADI has been allocated $58 million over five years
to assist in meeting the needs of Aboriginal people dealing with the
epidemic of type 2 diabetes in their communities.
The ADI program for First Nations living on-reserve and Inuit in Inuit
communities will provide a range of diabetes care and treatment, diabetes
prevention and health promotion, and lifestyle support services that
are community-based, culturally appropriate, holistic in nature, and
more accessible. The program will respond to the unique health and social
needs of First Nations people living on-reserve and Inuit in their communities,
and will take into account traditional practices and methods, wherever
possible.
First Nations and Inuit Health Branch (FNIHB) regions will be responsible
for establishing regional ADI work plans, in a collaborative process
with First Nations and Inuit partners. FNIHB is divided into the following
regions:
- Pacific (British Columbia)
- Alberta
- Saskatchewan
- Manitoba
- Ontario
- Quebec
- Atlantic (Newfoundland, New Brunswick, Nova Scotia, Prince Edward
Island)
- Northern Secretariat (Yukon Territory, Northwest Territories, Nunavut)
A second component of the ADI program will deliver diabetes primary
prevention and health promotion programs to Métis,
off-reserve Aboriginal people, and urban Inuit. It will be delivered
on a national basis, and is described in a separate framework document.
2. Target Population
The target populations for this program are:
- 2.1 First Nations (Innu are included in this definition)
and Inuit of any age; and
- 2.2 Those who live on a First Nations reserve, or in an Inuit community,
or in a First Nations community in the territories.
3. Program Purpose
The First Nations on-reserve and Inuit in Inuit communities program
of the ADI is intended to create diabetes care and treatment, prevention
and promotion, and lifestyle support services for First Nations living
on-reserve or in communities in the territories, and Inuit living in
their communities.
Type 2 diabetes is at epidemic levels among First Nations people, and
this program will begin to address the problem. The program intends to
create awareness of diabetes and its risk factors, look at viable community-based
care and treatment services, link to other health care programs running
in communities (such as First Nations and Inuit Home and Community Care)
and establish lifestyle support services.
The level of diabetes among the Inuit is not as severe as it is in First
Nations communities, making it an opportune time to create diabetes prevention
and awareness programs. The Inuit have indicated that their priority
will be on diabetes prevention and health promotion.
4. Program Objectives
The ADI program for First Nations on-reserve and Inuit in Inuit communities
will begin to address the high rates of diabetes and its complications,
and provide First Nations and Inuit communities with opportunities to
design, develop, and participate in projects to address diabetes within
their communities.
Specific program objectives are to:
- 4.1 Raise awareness of diabetes, its risk factors, and the value
of healthy lifestyle practices;
- 4.2 Support the development of a culturally appropriate approach
to care and treatment, diabetes prevention and health promotion programs,
and lifestyle support programs;
- 4.3 Build capacity, linkages and infrastructure for all components
of the ADI in First Nation and Inuit communities;
- 4.4 Promote self-management;
- 4.5 Coordinate with other community-based programming, specifically
the First Nations and Inuit Home and Community Care program.
5. Program Elements
There are three essential elements of the First Nations on-reserve and
Inuit in Inuit communities program:
- Care and Treatment
- Prevention and Promotion
- Lifestyle Supports
These elements will be based on the following principles and approaches:
- community-based to build/strengthen capacity within the community;
- establish self-management as a key goal of diabetes treatment;
- culturally specific and relevant;
- respect traditional wisdom, knowledge, healing methods and approaches;
- incorporate a systematic approach to the management of diabetes.
Care and Treatment services will begin to address the
needs of First Nations and Inuit people already diagnosed with diabetes
by providing them with direct services to help monitor their diabetes
status, screen for and prevent further complications from developing,
and provide diabetes education to clients to encourage self-management.
Creative ways to remove service barriers should be examined and linkages
with the First Nations and Inuit Home and Community Care program will
be established to help ensure that the fullest continuum of care services
may be realized.
Prevention and Health Promotion activities should target
the entire population, to increase awareness of diabetes and its complications,
promote healthy eating and active living, and encourage the integration
of traditional methods and practices with western-based approaches. Diabetes
prevention and health promotion activities that focus on the need to
educate youth will decrease the likelihood of the next generation suffering
from diabetes.
Lifestyle Support Services should provide support to
people living with diabetes and their families/care providers in coping
with the consequences of having a chronic, potentially debilitating and
life threatening disease. Lifestyle supports may enhance community capacity
to provide holistic approaches to the realities of living with diabetes.
Activities may include peer support groups, sharing circles, drop-in
programs for people with diabetes and their family members, or youth
programs. These activities may provide an opportunity to share feelings,
and discuss issues, problems and solutions.
The distribution of projects between the three elements will be related
to the identified needs in each region, but all three elements must be
addressed, either in separate projects or as integrated parts of an overall
project. Examples of projects or activities that may be established could
include, but are not limited to those that:
- increase awareness of diabetes as a serious health risk;
- increase awareness of the signs and symptoms of diabetes and its
complications;
- increase awareness of the importance of healthy lifestyles (such
as healthy eating, weight management, physical activity);
- reduce the complications of diabetes;
- include the family and community as part of the program.
6. Program Delivery Model
In response to the consultation feedback, information sharing and planning
sessions with First Nations and Inuit in regions, the program
delivery model chosen for this component of the ADI is that of Targeted
Strategic Investments. Within the context of this ADI program,
Targeted Strategic Investments will refer to regional 'blueprints' that
include a variety of activities supporting the identified priorities
within each region. This approach has been selected based on the feedback
received from First Nations and Inuit in regional discussions which recognized
that the ADI funding is insufficient to support universal programming
to all communities. Therefore, regions will be collaborating with First
Nations and Inuit to ensure that projects and activities are shared between
communities wherever possible, and that every community has access to
at least one of the three elements of this ADI program.
To promote innovation and allow for program flexibility, each region
will, in collaboration with its First Nation and Inuit partners, determine
the most appropriate approach for establishing the program in that region.
This includes targeted investments (such as shared diabetes workers among
several communities, or a joint project with the province to set up a
diabetes centre of excellence) and may include solicited proposals based
on regionally defined priorities.
Communities are encouraged to think of ways to partner to share resources,
develop the most cost effective program possible, and take advantage
of linkages to the First Nations and Inuit Home and Community Care program
for care and treatments activities.
In all cases, projects must be culturally appropriate, holistic in nature,
and designed and delivered either by, or in partnership with, First Nations
and/or Inuit. The program will recognize and address the unique health
and social needs of First Nations people living on-reserve and Inuit
in their communities, and will take into account traditional practices
and methods, wherever possible.
Care and treatment programs should be delivered by
trained diabetes care workers and integrated with the First Nations and
Inuit Home and Community Care program wherever possible. The creation
of linkages and partnering in programming ( i.e. shared diabetes workers)
is encouraged to make the most effective use of resources. Programs must
be based on needs identified by the community or in combination with
other communities/Tribal Councils/Inuit regions.
Diabetes prevention and health promotion programs may
take a number of formats, depending on the needs of the communities.
Programs that focus on education and primary prevention for youth in
communities may be a priority; a theme highlighted often during the consultation
process.
Issues of sustainability and capacity building must be addressed at
the outset of the program. Rigorous evaluation plans will be required
for all projects to ensure accountability of the program.
Diabetes programs may include separate activities for care and treatment,
diabetes prevention and health promotion or lifestyle support, or be
integrated, depending on the needs of the communities. For example, a
diabetes educator usually delivers diabetes prevention and health promotion
information along with care and treatment, and often offers support to
the family as well. Examples of diabetes programs that could be delivered
through this initiative may include but are not limited to:
- community, Tribal Council or regional level trained/certified diabetes
workers/educators;
- Centres of Excellence that partner with provincial programs to deliver
a full continuum of diabetes care services;
- school-based education programs;
- nutritional counseling programs;
- diabetes awareness programs;
- development of active living health promotion programs;
- screening programs;
- diabetes care clinics;
- diabetes support services.
7. Program Funding
Program funding for First Nations on-reserve and Inuit in Inuit communities
care and treatment, diabetes prevention and health promotion, and lifestyle
support services will flow through the First Nations and Inuit Health
Branch agreements as outlined in the: Contribution for National Indian
and Inuit Time Limited Special Initiatives.
Given the amount of funding available to the ADI over the five years
of the strategy, and the breakdown per year ($2 M, $11 M, $15 M, $15
M, $15 M), it is clear that the program does not permit each
First Nation or Inuit community in a region to receive a base amount
of funding.
7.1 Funding formula
Based on feedback from the consultations and regional implementation
planning sessions, the factors considered in the funding formula to allocate
resources out to regions were:
- First Nations on-reserve and Inuit population;
- remoteness of communities; and
- capacity within the community/region to deliver services.
The number of people with diabetes in a community/region was also considered
as a factor in funding, but due to the current lack of accurate data,
it was not possible to factor in this element during these first few
years of ADI programming.
Although most of the funding will be regionally allocated for programs,
a small portion of funding will be retained at the national level for
projects such as a national Aboriginal diabetes resource centre.
7.2 Elements that will not be funded
The ADI will not:
- provide any major capital or construction funding;
- fund research projects;
- provide services that fall under provincial/territorial jurisdiction,
such as dialysis;
- fund operational activities not directly related to the ADI projects;
- duplicate services provided through the First Nations and Inuit Home
and Community Care program.
8. Program Criteria
and Implementation
8.1 Program Criteria
As there are limited resources for the ADI program, each community in
a region will not be able to run a full complement of care and treatment,
prevention and promotion and lifestyle support services.
Partnerships with other communities, or partnerships at a regional
or Tribal Council level will be necessary to maximize program effectiveness.
Each ADI program activity will be required to submit a plan to an established
regional review process for approval. The plan must meet the following
criteria:
- 8.1.1 Identification of what diabetes services will be provided as
a result of the program, the target population, and how the activities
tie into the goals and objectives of the ADI;
- 8.1.2 Identification of how the program will be established, including
any support services that will be required from the region;
- 8.1.3 Identification of how this program will help to build capacity
within the community;
- 8.1.4 Identification of existing diabetes or home care programs operating
in the community, and how the proposed program will link to those existing
programs;
- 8.1.5 Identification of all linkages relevant to the ADI between
and within communities, with Tribal Councils, other Inuit regions,
provincial/territorial organizations, non-governmental organizations,
and provinces/territories;
- 8.1.6 Identification of all the activities and related costs associated
with the program;
- 8.1.7 Description of how the community is involved in the design,
planning, operation and evaluation of the program;
- 8.1.8 Identification of how information on the program activities
will be disseminated back to communities;
- 8.1.9 Identification of the ongoing training and human resource development
activities;
- 8.1.10 Identification of how the program will be evaluated and reported
on, in accordance with the ADI evaluation framework (Fall 2000).
Each FNIHB region will determine, in collaboration with First Nations
and Inuit, the exact approach to accessing funding. However, for the
First Nations and Inuit component of the ADI, funding is limited to:
- First Nations on-reserve or Inuit Communities' health authorities
or Band Councils, Tribal Councils, Provincial/Territorial Organizations,
First Nation or Inuit Associations;
- Other First Nation or Inuit organizations deemed eligible under the
terms and conditions of the above-mentioned agreements (see section
7);
- Governments of the Territories, provided that funding is targeted
to First Nations and Inuit in these Territories, and that First Nations
and Inuit have demonstrated involvement, partnership and support in
the development of diabetes programs in their communities;
- Other organizations provided that they have the demonstrated support
of First Nations or Inuit to deliver the ADI program.
8.2 Program Implementation
The ADI First Nations on-reserve and Inuit in Inuit communities program
will be composed of projects designed by communities, or organizations
on behalf of communities. Each First Nation or Inuit organization wishing
to develop and implement a diabetes program is required to submit a program
plan. The plan must:
- describe how they will deliver one or all of the essential elements
of the ADI (see section 5);
- describe how program criteria (see section 8.1) will be met.
All plans will be reviewed by a collaborative regional review process
(some regions may already have established processes in place; others
will need to establish processes) to ensure that program plans are complete,
eligible, and adhere to the program criteria as outlined in section 4.
This regional review process will also ensure that available ADI resources
are distributed equitably, and that all communities have access to some
ADI activities.
Once the regional review is completed, the Regional Director will approve
the plan or ask for revisions prior to approval.
Regions will be required to demonstrate how they are working with First
Nations and Inuit and what collaborative processes they are using (i.e.
either existing or new groups established for this program). Regions
must submit a plan to FNIHB headquarters, demonstrating clearly how they
will implement the program in their region.
9. Program Monitoring and Evaluation
The accountability framework for the Canadian Diabetes Strategy will
form the basis of the evaluation framework for the ADI programs. Interim
reports will be prepared and presented by the Minister of Health to Cabinet
in 2003. Formal evaluation will take place during the fifth year of the
ADI (2004), which will permit the department to return to Cabinet with
a report on the successes, gaps and future needs with respect to diabetes.
As a requirement for funding under the ADI, any program or project must
contain an evaluation component and will clearly outline:
- 9.1 the principles and objectives of the evaluation in relation to
the program goals, objectives and key results;
- 9.2 the roles and responsibilities for program evaluation at the
community/program, regional and national levels;
- 9.3 the evaluation methodology that will be used;
- 9.4 the detailed questions and indicators to be used in annual local
and regional evaluations and in the final evaluation of the ADI;
- 9.5 reporting and approval mechanisms for evaluation reports.
A final detailed report will be submitted to Treasury Board at the conclusion
of the ADI (2004), reporting on whether and how the overall program met
its identified objectives, and accounting for all ADI funding.
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