Health Sectoral Follow-Up Session: Facilitators' Report

Health Sectoral Follow-Up Session: Facilitators' Report

Background Information and Flip Chart Notes -
Métis Breakout Group

The following reflects a transcription of the comments posted on flipcharts in response to the questions indicated below in boldfaced text, during the breakout group discussions.

DAY 1 - NOVEMBER 4, 2004

ADDRESSING ISSUES OF JURISDICTION AND CONTROL

Working in breakout groups at four tables, the participants identified how a shared definition of success could look.

The launch question to focus discussion for this segment was:

How will we address the issues of jurisdiction and control that are impacting on the delivery of, and access to, health services?

Each table presented the results of their discussions.

Definition of Success

Table One:

Respecting Métis governance structures
Equitable access to health services for Métis
Equitable representation decision making bodies
Comparable and consistent Métis Health systems across nation
Programs s and services that reflect changing demographics
Clarified roles and responsibilities of all players (GOC, PTs, NAOs, Regions and Municipalities…)
Mechanisms to enable and facilitate partnership development between Aboriginal groups
Direct relationship with the federal government for federal funding

Table Two:

Needs to be an option when looking for health services-one that will serve Métis people
Need services that are sensitive to Métis culture and needs.
Key services must be status blind- success=status blind services
But pan-Aboriginal services don’t work for Métis people because doesn’t respect Métis culture
Success= Métis-specific services designed by Métis for Métis
Success= partnership with fed/prov. Govn’t to develop services
Issues: jurisdictional issues mean that Métis can’t use First Nation services, must go elsewhere
Measurable success where do Métis fit within provincial strategies? Only in Ontario, which has an Aboriginal Strategy not first nation strategy, this is a beginning issue of getting funding because people don’t know who Métis are and culture
Need database, but data issues although it seems there is lots of data available on Métis people, but not owned OCAP, still need to move forward at the same time.
Success programs and services for Métis respecting Métis culture and serving Métis people’s need.
Success- Métis people at table with fed/pt governments as full participants need people who represent Métis at the table
Success increased awareness of Métis needs
Success increased Métis capacity to participate at the table and dialogue on issues
OCAP, ownership, control, access partnership, DATA even if not resolved, still need Métis programming
Success outcome will be measurable moving from where we are now (nothing) to Métis specific strategy with the Blueprint for programs and services and facilities
Full participants in everything, all processes for all Métis people
Determining own priorities leading to all processes.

Table Three:

Outcomes

A) Immediate

F/P/T/A to agree to participate in a structured process, (transparent and open)
Resources for NAO’s to be involved
Aboriginal participation at F/P/T meetings
Urban aboriginal issues are a priority

B) Medium Term

increased capacity of local Métis organizations (women to address the health agenda
clearly describe jurisdictional issues
evaluate progress to solve jurisdictional issues

C) Long Term

Métis control (jurisdiction) of health care services
Canada to extend fiduciary responsibility to all Aboriginal groups, on and off reserve, re: Health care treatment and determinants

Table Four:

Métis specific primary care in rural and Urban Métis settlements
Governed by Métis/run by Métis staff currently a provincial responsibility
Health Surveillance and Population Health information, is necessary to Métis specific data (i.e. Canadian Prenatal Surveillance System can provide infant mortality rate for Métis population
These services respond to Métis specific population health and surveillance information
Métis lens to different programs- primary care
Bi-lateral relationship Métis
- a. Federal government
- b. P/T health programs
- c. Devolve responsibility, Métis would like similar involvement to FN and Inuit in F/P/T programming
Métis to access comparable services, Métis specific groups at a National level, Métis-specific how does it improve outcomes? Métis health centres staffed by Métis-National Information strategy
Need baseline Métis data, status based from Aboriginal People’s Survey, community-based planning, how to get equitable service from Non-Métis service provider? N.S. social inclusion and diversity policy.
Focus on specific populations
Move to a National Strategy National Métis Primary Health care strategy, safety, bi-cultural tension belonging
Métis specific health strategy addresses tense, racism
Jurisdictional issues fragment identity, Métis data process surveillance don’t ask Métis questions
Ask providers how they are addressing Métis community health issues
RHA’s accountable to Métis community local/PT
Service-based on need- needs bases service provision
FPT commitment to provide needs-based services
Start with the collection of Métis health info/data
Needs-based Métis specific
Métis specific health surveillance
National level mechanism, regional representation, nation to nation negotiation with Canada?

DEFINITON OF SUCCESS - Summary

We know where we started: Services, Status and Data
Clear roles and responsibilities (Direct Métis / Federal relationship; Partnerships with others (governments, aboriginal organizations, etc.)
Métis Specific Health Strategies
Evaluation of Progress

RECOMMENDED ACTIONS

The participants were regrouped at three tables to develop action plans based on the definitions of success. Following are the results of that exercise:

Services, health status and data

Address gaps of knowledge

Métis identifiers
Financial resources and capacity building
Partnerships

Create gender equality framework that applied to both 1) processes (governance) and Protocols and mechanisms

Governance and protocols and mechanisms

Translate data to Métis specific policy

Métis capacity

Clear roles and responsibilities

Agreement to immediately establish Métis specific health table (equal Federal / Provincial / Métis partnership):

Support and implement a Métis specific health strategy

Relationship with leadership – MNC
Find ways to be inclusive
Recommend Federal / Provincial clarification of their responsibilities to Métis
Mechanism to demonstrate what Federal / Provincial does on Métis issues
Community driven consultation (political and non-political dimensions)
Community based approaches include gender and geography lenses

Métis specific Strategies

Short Term

Pilot projects primary care
Commitment to and recognition of Métis Nation
Involvement in all FPT health discussions and decision-making processes
Métis developed registry
Targeted funding for Métis specific programming based on a negotiated allocation formula
Program guidelines to access funding to be developed by Métis with community input

Medium Term (3 – 5 Years)

Community based planning processes that feed into programming and services
Increase # of Métis health care professionals
Implementation and extension of basic primary health care services and programs and implementation NIHB for Métis (aka Métis Health Benefits)

Note: Two additional measurements of success were discussed. These are:

Evaluation of Progress
Processes in place to achieve success

Métis Specific Health Strategies

Created collaboratively
Operating at National / Regional and Local Levels
Equitable Métis governance structures support Métis programs and services
Full and equitable participation in decision making
Culturally specific and sensitive programs and services
Leadership involvement at Federal / Provincial / Territorial meetings
Equitable allocation of health funding
Métis specific program guidelines

IMPROVING ACCESS (AND RECOGNITION)

The launch question to focus discussion for this segment was:

What are the key issues and adaptive approaches that would contribute to improved levels of access to, and integration of, health programming and services?

DEFINITION OF SUCCESS

Using a brainstorming session the whole group worked to define success statements as follows:

Consider impact of long term systemic racism as a critical determinant of health (27) (includes gendered racism - 1)
Community directed Métis focused promotional activities that build on knowledge and values of the community (24)
Adequate and effective prevention strategies (4)
Narrowing and eliminating of disparity between Métis and other Canadians (29)
Access to acceptable (confidential, culturally appropriate, gender sensitive) comprehensive high quality care (16)
Métis proportion of health care professionals that mirrors the Métis population (14)
Equitable and acceptable access to high quality care (culturally appropriate, confidential, gender specific) health care services
Ownership, control, access, possession over the system (20)
Equitable and knowledgeable access within the current system (14)
Focus on process, improved access and recognition not integration (13)
A Fair and equitable process can not occur where there is a deficit of power (12)
Availability of good quality medications and ability to choose (10): equity of access to health insurance?
Overall health is largely determined by socio-economic status (3)
Métis benefit from overall improvements to Canada’s Health system (2)
Reduction of waiting times (2)
Ensure that ‘integration’ does not close the doors to windows of opportunity for a direct relationship with the federal government (1)
Métis Health System (1)
Knowledge on how to navigate the system (1)
Healthy Métis People
Cautious about blaming the victim…oppression
It’s the system – make it accountable
Covert racism exists in the health care system

Themes emerging from the above definitions of success

Ownership and control over the health system
Accessibility / Mobility
Human Resources
Ownership
Control
Access
Possession – delivering
Recognition
Access
Métis centered
Métis Control
Equity
Trust
Inclusion
Safety
Social determinants framework
Health Care System
Métis governed initiatives
Community knowledge and systems are respected and validated
Representative workforce
Métis Inclusion and leadership at all levels of decision making
Métis accredited cultural safety policies and programs
Métis control over equitable services

Each table then outlined and presented their recommended actions to achieve the “definitions of success” statements:

Recommended Actions

Table One:

Targeted funding for Métis specific programming based on a negotiated allocation formula (Intermediate)
Commitment and recognition and equal representation of Métis nation involvement in all FPT health discussions and decision making (Intermediate)
Develop & implement Métis specific cultural accreditation of health care facilities and providers who service Métis
Métis specific health strategy that respects communities and is protected by a federal-provincial-Métis accord (Medium)
Support and resource communities to develop and implement community based holistic health promotion programs that respect community knowledge, values and practices (1)
Implement Métis controlled primary health care services and programs (2)
Implement a Métis health insurance drug benefits program (3)
Métis health and human resources capacity building strategy (4)

Table Two:

Targeted, well-resourced. Develop a Métis Health Accord with the Métis governance structure that specifically represents the distinct needs of Métis people. *Provide Métis governance with the resources to develop policy in the area of health (capacity building)
Devolution of programs and services to Métis governance structure
Targeted funding for the development and delivery of equitable Métis specific programs (prevention, promotion, education, awareness, capacity enhancement, primary core, NIHB)
Identify existing gaps and barriers that deny Métis access to equitable shares to government programs
Develop a comprehensive Métis HR development strategy

Table Three:

Immediate

Resources made available for long-term (>5 yrs) capacity development for a Métis voice to develop a National Métis Health Action Plan that is inclusive of all Métis (provincially) and which includes marginalized Métis people i.e. women, people with disabilities, and remote Métis communities.
Research and address knowledge gaps if gender equality analysis.

Intermediate

Translation of research into policy
Continued capacity building and human resources
Implementation health policy framework
Increased cooperation F/P/M
Establish culturally appropriate, equitable, comprehensive, high quality health care system

Long Term

Métis health system is in place (specific)
Métis health profession representative of utilization / population
Health status of Métis is improved – demonstrated through evidence

Table Four:

Federal access point for Métis (1 yr)
Métis health policy centre (2 yr physical)
Métis recruitment and retention initiatives (2-3 yrs)

FPT governments to support and resource Métis developed, implemented and evaluated health strategies.

Day 2 – November 5, 2004

CAPACITY AND SUSTAINABILITY FLIP CHARTS

The launch question to focus discussion for this segment was:

What capacity supports are needed to ensure progress on shared health priorities and improved health status?

Definitions of Success

The participants brainstormed definitions of success using the following question:

What would capacity and sustainability look like and what would be different?

Métis Health and Human Resource Capacity Building Strategy
Provide Métis governance with resources to develop policy in the area of health (capacity building)
Targeted funding for the development and delivery of equitable Métis specific health programs….capacity enhancement
Develop a comprehensive Métis Human Resource Develop Strategy
Continued capacity building: Human Resources
Resources made available (>5 yrs) for capacity development…voice/health action plan
Métis health representative of utilization / population (>5yrs) – refer to point #6 in Access notes
Métis recruitment and retention initiatives (2 – 3 yrs)
Ensured long-term directed Métis specific funding for multi year programming and stable core funding, that is not proposal or competition based, as capacity to respond to competitions does not exist.
Planning process that engages all stakeholders and recognizes where the Métis Health and human resources development process is at
Imitative between Métis governments and post secondary initiatives for the delivery and development of Métis specific health professional programs
Comprehensive, adequately supported research through a Métis specific national research centre governed by Métis Nation.

A supplementary discussion was led by two session participants on Métis Gender Equality. Following are the notes from that discussion:

Why/rationale – different realities between genders e.g. access to well women’s care (paps/breast screening)
Young male suicide rates
Violence against Métis women (e.g. physical, emotional, sexual assault rates)
Adult men ages 20 – 45 not getting screening for HTN, diabetes
Family violence, childhood sexual abuse

Definitions of Success on Métis Gender Equality

Service & Data – build in gender equality analysis frame i.e. family violence
Métis women’s’ seat/voice at governing table
Community has gender voice
Shift Métis specific research / strategy to Métis organizations (i.e. family violence)
Gender thinking happens throughout planning, development, implementation and evaluation by all actors
Population health officer for Métis in each region – guild in gender analysis, geographical, age stratification
Women’s seat on local program delivery boards
National accord has a gender analysis clause
Gender & cultural safety (these are intertwined)

WORKING WITH OTHER STAKEHOLDERS

Using a highly interactive World Café Exercise, the participants answered the following question:

In what areas of our recommended actions and definitions of success will we work with other “stakeholders” and how will we do that?

Areas to work together

Federal department (access point)
Métis Workforce development
Traditional Knowledge
Networks with Métis communities, leaderships, professionals (academics, MDs, Lawyers, Nurses, allied professionals) and traditional knowledge keepers, etc.
Métis specific prevention research
Work with other Aboriginal organizations in partnership to determine best practice models
P/T line departments – horizontal coordination among departments (similar to single point of access)
Shared resources to fund ‘ one of a kind’ positions, programs

How to work together

Leaders and government = point of access
Professional schools, curriculum, etc.
Gatherings, meetings with other TK holders
Include many voices: Elders, Youth, Women, FamiliesEstablish agreed upon principles of engagementTarget focus groups, approaches
-  Métis specific issues
-  Web-site, etc.
Develop an agreement with the Métis Settlements of Alberta –
only land based Métis in Canada
Partner/Development agreements
Get leaders to work together
Encourage/Highlight Métis specific services, programs, outreach
Link with Métis Communities
University/College Aboriginal student centres
Urban Aboriginal Health Access Centres
Aboriginal Health Professional organizations
Researchers, community people, universities
Be respectful of diverse educational, cultural, and life-experience backgrounds
M.O.U. with F/N, IN, Health Authorities

Summary Discussions:

Métis networking (starts by bringing Métis stakeholders together)
One Métis access point in the federal system
Métis workforce development
Métis specific health prevention research
Facilitate the “inclusiveness” of all Métis
Partnerships with other groups in Canada (e.g. indigenous / non-indigenous)

How will we know that progress is being made on our definitions of success and recommended actions? (be specific/measurable)

Internally

When there is a Métis Accord signed with the Métis Nation
When the Métis are delivering their own services and programs
When there is a federal agreement (health) signed with Métis Settlements
When we have Métis settlement specific health data/health care providers
Equivalent #s of Métis health professionals
When disparity in health concern as compared to general population has been significantly lowered
When MNC has a fully funded health department
When the MNC “health committee” can meet regularly to share successes and not so successful programs in a reasonable (not rushed) time frame: 2 X annually?
When there are community based health planning and promotion activities that respect community knowledge systems, values and are not stove-piped/externally determined
When we have Métis specific health programs and services developed by and delivered by Métis for Métis
When all Métis members enjoy safety, security (i.e. food, etc.) and good health
When the lives of Métis people are as long as mainstream Canadians or better
A process to include all Métis is in place
Process for Métis to access equitable health care is NO LONGER A STRUGGLE

Externally

When P/T are implementing the Métis Accord signed between the Prov/Fed/Métis Nation
When there is a significant improvement in Métis Health (comparable to the rest of Canadians)
Development of culturally appropriate evaluation plan
When governments accept equitable distribution of resources
When governments in partnership with Métis governments develop a culturally appropriate accountability system
When there is Métis specific data
When there is a dedicated ‘Métis’ door to access Federal Health System
When jurisdiction is no longer an issues (e.g. clearly defined roles and responsibilities of all players)
When providers and health services for Métis have passed a Métis run cultural accreditation
When we have public health data and this data shows Métis health status is equal to that of the rest of Canadians
When all Métis coast to coast have equal or better health status compared to the mainstream
When OECD countries recognize Métis health care in Canada as being preeminent
When F/P/T government departments recognize and acknowledge (by way of funding, capacity development/enhancement, etc) that Métis deserve the same health benefits as other healthier communities
When we aren’t competing for funds to help our communities

Summary Report:

Self-determined and self-governed design and delivery of health services and programs
Sufficient resources, infrastructure and capacity are in place to support Métis health initiatives
An inclusive Métis health accord has been signed with Canada
Measured improvement in Métis health status
Representative Métis health workforce

BROAD DETERMINANTS OF HEALTH

Focusing on the following question, the participants summarized how this can be addressed in the Métis community:

How could a “Broad Determinants of Health Approach” be applied within a Métis context?

Collaboration between government ministries and Métis government structure to produce a joint community based planning and promotion and prevention initiatives

Holistically addressing socio-economic marginalization, classism, and recognize racism as a determinant

Mental Health and AddictionsInclude a ‘health lens” to all Sectoral Sessions

Ensure an internal mechanism that would ensure that health concerns are always on every agenda

Recognize racism (including gendered racism) with the concept of health

Collaboration between Métis policy people: health, housing, etc.

Summary Report:

Partnerships between government ministries and Métis government structures to support and resource joint holistic community based health planning, promotion, prevention initiatives that empower community to improve determinants of health.
Holistically address socio economic marginalization, classism, violence and racism at all stages of planning, implementation and evaluation
Recognize racism (including gender racism) as a determinant of health and take this into account at all stages
Health is always considered on all agendas including other Sectoral Sessions in the process
Collaboration between Métis policy people (health, housing, education)

EVALUATION OF THE SESSION

The participants were asked for their observations, comments and suggestions on the two day session.

What Worked

Superb facilitators
Flexibility to change process
Breaks when we ‘stalled’
Accomplished something by Lunch
Opening up the room space
Sincere desire to work together
Good to have both politicians and professionals at the session (should be so at all sessions)

What Didn’t Work or Could Change at Future Sessions

Explain time allocations for exercises
Plenary room – congested space
More explanation of Métis authority structures…assumes we all know that
Yellow tags vs. having everyone talk
Minister committing to something at the end of the session – something from the discussions
Clarification on this overall process (information, changes, participation)(Leading to this point – planning committee)
Room temperature

PLENARY PRESENTATION DAY 1

Métis Session

Issues of Jurisdiction and Control

Definitions of Success

We know where we started: Services, Status and Data
Clear roles and responsibilities
Métis Specific Health Strategies
Evaluation of Progress

1. WE KNOW WHERE WE STARTED

Services and Health Status and Data
Improved Data (Ownership, Control, Access, Possession

Services, Health Status and Data Recommended Actions

Address gaps of knowledge
Métis identifiers
Financial resources and capacity building
Partnerships
Create gender equality framework that applied to both processes
Governance and protocols and mechanisms
Translate data to Métis specific policy
Métis capacity

2. Clear roles and responsibilities

Direct Métis / Federal relationship
Partnerships with others (governments, aboriginal organizations, etc.)

Roles and Responsibilities Recommended Actions

Agreement to immediately establish Métis specific health table (equal Federal / Provincial / Métis partnership)
Support and implement a Métis specific health strategy
Relationship with leadership – MNC
Find ways to be inclusive
Recommend Federal / Provincial clarification of their responsibilities to Métis
Mechanism to demonstrate what Federal / Provincial does on Métis issues
Community driven consultation (political and non-political dimensions)
Community based approaches include gender and geography lenses

3. Métis Specific Health Strategies

Short Term

Pilot projects primary care and recognition of
Commitment to Métis Nation involvement in all FPT health discussions and decision-making processes
Métis developed registry
Targeted funding for Métis specific programming based on a negotiated allocation formula
Program guidelines to access funding to be developed by Métis with community input

Medium Term (3 – 5 Years)

Community based planning processes that feed into programming and services
Increase # of Métis health care professionals
Implementation and extension of basic primary health care services and programs and implementation NIHB for Métis (aka Métis Health Benefits)

4. DEFINITIONS OF SUCCESS

Evaluation of Progress
Processes in place to achieve success

Improving Access and Integration

Definitions of Success

Consider impact of long term systemic racism as a critical determinant of health
Community directed Métis focused promotional activities that build on knowledge and values of the community
Narrowing and eliminating of disparity between Métis and other CanadiansImproving Access and Integration Definitions of Success
Métis proportion of health care professionals that mirrors the Métis population
Equitable and acceptable access to high quality care (culturally appropriate, confidential, gender specific)
Ownership, control, access, possession over the systemImproving Access and Integration Definitions of Success
Equitable and knowledgeable access within the current system
Focus on process, improved access and recognition not integration

PLENARY PRESENTATION DAY 2

Capacity and Sustainability and Broad Determinants

Definitions of Success

Métis ownership and control over a Métis centered health system
System that accommodates issues of accessibility and mobility
Health care workforce that is representative of Métis needs and the Métis population
Respect and validation of community knowledge systems
Access and Integration
Métis inclusion and leadership at all levels of decision making
Métis accredited cultural safety policies and programs

Equity Trust Inclusion

Access and Integration - Recommended Actions

Develop a Métis Health and Human Resource Capacity Building Strategy
Develop a comprehensive Métis Human Resource Develop Strategy
Provide Métis governance with resources to develop policy in the area of health (capacity building)
Targeted funding for the development and delivery of equitable Métis specific health programs
Ensured long-term funding for multi-year programming that is Métis directed and Métis specific
Métis health workers that are representative in numbers of the utilization and the Métis population
Métis recruitment and retention initiatives
Inclusive planning process that engages all stakeholders
Joint Métis governments and post secondary initiatives for the delivery and development of specific health professional programs
Comprehensive, adequately supported research through a Métis specific national research centre governed by Métis Nation.

Access and Integration: Lens - Métis Women

Different realities between genders e.g. access to well women’s care (PAP/breast screening)
Violence against Métis women (e.g. physical, emotional, sexual assault rates)
Service & Data – build in gender equality analysis frame
Métis womens’ seat/voice at governing table
National accord has a gender analysis clause

How will we know that progress is being made on our definitions of success?

Self-determined and self-governed design and delivery of health services and programs
Sufficient resources, infrastructure and capacity are in place to support Métis health initiatives
An inclusive Métis health accord has been signed with Canada
Measured improvement in Métis health status
Representative Métis health workforce

How could a “broad determinants of health” approach be applied within a Métis context?

Partnerships between government ministries and Métis government structures to support and resource joint holistic community based health planning, promotion, prevention initiatives that empower community to improve determinants of health.
Holistically address socio economic marginalization, classism, violence and racism at all stages of planning, implementation and evaluation
Recognize racism (including gender racism) as a determinant of health and take this into account at all stages
Health is always considered on all agendas including other Sectoral Sessions in the process
Collaboration between Métis policy people (health, housing, education)
In what areas of our recommended actions will we work with other “stakeholders” and how will we do that?
Métis networking
One Métis access point in the federal system
Métis workforce development
Métis specific health prevention research
Facilitate the “inclusiveness” of all Métis
Partnerships with other groups in Canada (e.g. indigenous / non-indigenous)

Table of Contents

The documentation contained on this website does not necessarily represent the views of any government or National Aboriginal Organization. The purpose of this website is to share information related to the Canada-Aboriginal Peoples Roundtable: background papers, Facilitator's sectoral and final reports, agendas and media announcements.

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