First Nations and Inuit Home and Community Care Program - Biannual
Report 2000-2002
Challenges
Establishing the First Nations and Inuit Home and Community Care
Program continued to be a challenge during these two years, and
many of these challenges were in place prior to the announcement
of the program. Despite these challenges, significant progress continued
to be made in ensuring that the home and community care needs of
First Nations and Inuit were addressed.
Partnership/Collaboration
Historically, First Nations and Inuit have not been actively involved
in the early stages of accessing funding for new initiatives. For
the First Nations and Inuit Home and Community Care (FNIHCC) Program, First Nations and Inuit were involved in providing
input into the Treasury Board Submission. In addition, National
direction provided that this new initiative was to be planned and
implemented in partnership and collaboration with First Nations
and Inuit. For this reason, a National Steering Committee was established
with equal representation from both government and First Nations
and Inuit.
There was an expectation that the partnership and collaborative
activities would be carried out at the Regional/Territorial levels
as well. In many Regions/Territories, this created some challenges
as there had been working relationships that had been developed
and there were historical differences in how programs should be
delivered.
Developing linkages with other programs and departments was also
a challenge on a National, Regional, and Local level. While some
linkages have been relatively smooth, other programs were more challenging
to integrate due to conflicting mandates, priorities, or opportunities
for collaboration. That said, efforts continued in working with
these potential partners to identify opportunities for more effective
care and more efficient usage of human and financial resources.
Funding for Regional/Tribal Council Coordination
The development of the funding framework for the FNIHCC Program
was carried out to ensure that funds would be available to deliver
the essential elements of the program. In order to support First
Nations and Inuit in the planning process, funding was identified
for Regional coordination. In many instances, the funds provided
for coordination activities could not adequately cover the coordination
that was required. Many Regions used additional internal and program
resources to provide additional coordination services. It has been
made very clear by many Tribal Councils that they require coordination
funding as well as they are expected to provide advice and guidance
to their member communities. As the program gets further into program
delivery, there will also be a requirement for second and third
level services as well as nursing supervision. It is expected that
some of the components in the Needs Based Strategy will begin the
process of fully documenting the Regional and Tribal Coordination
services (third and second level services).
In many Regions, a significant number of communities are isolated
and many accessible only in summer months or via air. As such, travel
costs are extremely high.
Training and Capital Funding
While funding for both 2000/01 and 2001/02 included allocations
for training and capital spending, the need for such funding was
so acute in most Regions that significant gaps remained. This included
equipment, as well as permanent assets such as accommodations for
health workers and office and storage facilities. Future funding
for the program does not allocate money specifically for these two
areas and will require Regions to apportion money using total Regional
funding.
Staffing
As mentioned, staffing at the Regional level varied significantly
across the country. In some Regions, there was only one person dedicated
to coordinating the program efforts while other Regions provided
resources to employ people to coordinate at the district level and/or
additional personnel working either within Health Canada or through
partner First Nations/Inuit organizations. Not surprisingly, those
with more staff were typically able to work more closely with communities
and Tribal Councils to assist in planning, training, capital building,
and service delivery implementation efforts.
In some areas, turnover at the community level was a challenge
in terms of building capacity and in developing effective communications.
Many involved had other jobs and were coordinating planning efforts
on a volunteer basis. Those with more coordinating resources at
a Regional level were often better equipped to address some of these
issues.
Pace vs. Service Delivery
One conundrum facing all involved in the program is balancing
the "community pace" aspect of the program with ensuring clients requiring care in community receive services as soon as possible.
In an effort to address the latter concern, in 2000/01 the National
Steering Committee modified the funding process. In essence, funding
was provided to communities in concert with the phase in which they
were in for the program. The change in funding was admittedly controversial
and was perceived by some as a conflict with the "community paced"
aspect of the program. On the positive side, with this change in
funding communities did move through the process faster than prior
to this change, which enabled community members to begin receiving
services more quickly than what otherwise might have been the case.
The original Treasury Board submission outlined that communities
were to be in service delivery by the end of 2001/02. While some
communities were able to meet this objective, other communities,
notably those with lower levels of capacity and/or smaller communities,
were more challenged in getting through the phases of the program.
It was taking communities longer than anticipated to work through
all of the planning process activities and capacity was more limited
overall than what had been projected. Other changes during this
period included modifications to the contribution agreement template.
Incorporating change management theory during this time of transition
may have reduced the impact of change on communities and other stakeholders.
Communications
As with most programs of this scope, communications is an ongoing
challenge. The challenges include:
Number of Stakeholders
The scope of this program is a complex mix of stakeholders that
represent National, Regional and Local interests of First Nations
and Inuit health care. Developing communications processes that
are both effective and workable is an ongoing challenge when there
is such a vast amount of information to share at all levels.
Amount of Communications
With the program requiring input and ongoing communications among
National, Regional and community representatives, First Nations
and Inuit organizations, other departments and organizations, and
health care professionals among others, the communications requirements
are vast.
Staffing Issues
Some communities and Regions were better staffed than others were.
Those in areas with less support or with high turnover were more
challenged in maintaining effective communications with all stakeholders.
Varied Perspectives among Stakeholders toward Communications
There was no consensus on the amount, format, or channels of communications
among all stakeholders. All parties were working through a new program
that had a condensed time period.
Addressing Communications Challenges
To address these challenges, stakeholders at all levels looked
at opportunities. For example, Regional coordinators and Regional
partners formalized meetings across regions during 2001/02. Semi-annual
meetings were scheduled as well as monthly teleconferences to share
successes and challenges.
Regions developed processes to maximize the human and financial
resources they had to coordinate activities and communicate with
communities and First Nations and Inuit partners. These included
community visits when possible, as well as ongoing telephone calls,
email, mail and fax communications.
The National Team worked to develop and implement tools to assist
communities and Regions in meeting the reporting requirements for
the program. These included the development of the tracking tool,
reporting templates, evaluation framework and associated training.
Not surprisingly, the reporting requirements were not universally
embraced. Workshops and training sessions were organized in all
Regions to assist workers in understanding and meeting these requirements.
Training Standards
Training standards for personal care workers vary from Region
to Region and, in cases such as the Atlantic Region, they vary considerably
within the Region.
Because some areas have significantly higher standards, the challenge
was for communities to meet these requirements using the finite
funding earmarked for training during the two years.
Inuit Challenges
While challenges exist to varying degrees for all communities
involved, it is worth noting the characteristics common to Inuit
Regions that affect the planning and implementation of the FNIHCC
Program. In the four Inuit Regions of Nunavik, Nunavut, Inuvialuit,
and Labrador, there are political, geographical and cultural factors
that influence the delivery of health and social services unique
to the North.
These challenges include but are not limited to the following:
- Remoteness and isolation
- Cost of service delivery
- Availability and access to appropriate health care services
- Access to health care providers
- Socio-cultural considerations (e.g. many Inuit areçunilingual
Inuktitut speakers).
While these challenges are certainly not limited to Inuit communities,
they help exemplify that culture, geography, size, resources, and
access to existing services heavily influence the home and community
care capacity of communities.
About The Inuit Regions
The Canadian Arctic has four Inuit Regions, each with its own
Inuit Association.
Inuvialuit
- Inuvialuit Regional Corporation was established in 1984 and
represents the 5,000 Inuit of the western Arctic.
Labrador
- The Labrador Inuit Association was established in 1975 and
represents the 5,000 Inuit of Labrador.
Nunavik
- Makivik Corporation was established in 1978 and represents
the 9,000 Inuit of Nunavik Region in northern Quebec.
Nunavut
- Nunavut Tunngavik Incorporated was established in 1992 and
represents the 21,500 Inuit of Nunavut.
Source: http://www.itk.ca
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