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Archive for March, 2016

Memorandum of Understanding on the Social Determinants of Health


Dear Respected BC First Nation Chiefs and Leaders,

On behalf of the First Nations Health Council (FNHC), we are pleased to provide you with a copy of the Memorandum of Understanding (MOU) signed by the FNHC and the Minister for Aboriginal Relations and Reconciliation (MARR) on March 3rd, 2016.

Adding to the rich history and spirit of partnership with the Government of British Columbia (BC), this MOU sets out a pathway to partnership on the social determinants of health. This document embodies the shared commitment of the FNHC and the Government of BC to take the next step in our shared journey. We agreed to work jointly  with BC First Nations to develop approaches that will address the social determinants of health.

When BC First Nations completed the transfer of federal health programs and funding to First Nations control in October 2013, the FNHC fulfilled a key commitment. At the beginning of 2014, the FNHC started a dialogue with First Nation leaders to determine how we would fulfill other commitments in the FNHC mandate. Over the past two years, we shared perspectives and we listened and learned from one another.

During the last round of Regional Caucuses, Chiefs and Leaders considered priority areas for addressing the social determinants and supporting healthy child and family development. This MOU with the Government of BC is a direct reflection of those discussions. It is a starting point, not the destination. It is a shared commitment of the FNHC and the Government of BC to support an ongoing and regular process of engagement with BC First Nations that results in significant and culturally appropriate actions to address the social determinants of health.

As the FNHC take steps to implement this MOU with BC First Nations and the Government of BC, it is important to provide Chiefs with an overview of its contents. A copy of the MOU has been enclosed for your convenience.

The MOU with the Government of BC represents two significant steps forward. First, it reaffirms a shared commitment to work from a holistic perspective. It is an acknowledgement that coordinated and concerted action is required to address the related and underlying circumstances that determine individual and collective wellbeing. This encompasses the dimensions of physical and mental wellbeing, family income and food security, early learning and education, child safety, and connectedness to family, community, culture and language. Second, it serves as a shared commitment to support BC First Nations in building consensus, setting priorities and taking a staged approach to implementation. The social determinants of health are complex and require dialogue to set strategic direction for each area.

There will be many familiar elements to this MOU. At its core, this MOU represents a shared commitment of the FNHC and the Government of BC to support a process that is Community-Driven and Nation-Based. It serves as a shared commitment to use the Engagement and Approval Pathway endorsed by BC First Nations at Gathering Wisdom for a Shared Journey V as the process to engage BC First Nations at regional and provincial levels.

In the short-term, the MOU sets out a process of engagement, planning and priority setting. It means the FNHC will engage Chiefs at Regional Caucuses in spring and summer 2016 leading up to the Gathering Wisdom for a Shared Journey forum in fall 2016. Through this initial phase of engagement and planning, the FNHC envisions that First Nations will be able to set initial regional priorities related to the social determinants with a strong focus on supporting First Nation children, youth and families.

For its part, the Government of BC has made a commitment to review the initial regional priorities identified by BC First Nations with the FNHC. The BC Ministers and FNHC will develop a list of priority actions for discussion and feedback by Chiefs. At the Gathering Wisdom for a Shared Journey forum, Chiefs will review, discuss and give feedback on these priority action items. The feedback provided will inform the Ministers and Deputy Ministers as they prepare respective Ministry service plans for the 2017-18 Fiscal Year. This is an important first step and represents a fundamentally new way of working with the Government of BC on issues of collective importance.

While this work proceeds, the FNHC and Government of BC will redouble our efforts to bring the Government of Canada to the table. We acknowledge that the Government of BC is only one part of the picture and that the Government of Canada must be a full partner in this process. To this end, the MOU serves as a shared commitment to work jointly with BC First Nations and the Government of Canada in the design and development of a tripartite ten-year social determinants strategy that more fully describes actions to be taken to address the social determinants of health. We understand that the tripartite ten-year strategy will take time to develop and can only be developed once the FNHC engages Chiefs.

While these are important steps, the FNHC and Government of BC acknowledge that this is only a starting point. The constellations of lived realities that comprise the social determinants of health are complex and require many hands to do this work. In the coming weeks, the FNHC will sit down with Deputy Ministers for the Government of BC to discuss our approach over the next six months. In the months ahead, the FNHC will engage directly with Chiefs at Sub-Regional Caucuses, Nation Assemblies and Regional Caucuses. Through this dialogue, we will seek your guidance and leadership to design a strategic approach with clear milestones to guide the work.

We look forward to meeting with you soon.

In wellness,

Grand Chief Doug Kelly


Warner Adam

Deputy Chair

Read this letter in PDF format here

Read the Memorandum Of Understanding in PDF format here

Read the FAQ for the Memorandum of Understanding here

FNHC Speaks to Auditor General Report


Dear Respected BC First Nations Chiefs and Leaders,

As duly appointed representatives to the First Nations Health Council (FNHC), we write to share information in response to recent questions and concerns. First, we wish to thank the Chiefs and Leaders that shared words of encouragement and appreciation for the work of the First Nations Health Authority (FNHA). The Office of the Auditor General (OAG) report and the subsequent media storm caused the FNHA Board, Senior Staff, and Caregivers significant stress. Your words of support meant so much. Thank you.

On February 2nd, the Office of the Auditor General of Canada (OAG) published a study on the FNHA. On that same day, an anonymous and redacted document was published online. This document contained serious allegations about the FNHA and the First Nations men and women leading the FNHA. It is important to be clear that the study conducted by the OAG and the anonymous document released by the media are separate and the contents of these should not be confused with each other.

As health and wellness leaders, the FNHC seeks to end all forms of lateral violence. We are committed to act with lateral kindness. We acknowledge that the anonymous document and the subsequent media coverage have clouded the OAG report and its conclusions. We acknowledge that this type of media coverage can be unsettling and that Chiefs and Leaders have questions. We urge Chiefs and Leaders to read the OAG report itself and to not confuse the recommendations of the OAG with the extreme and negative narrative painted by the media.

To assist you, the FNHA Board has attached a summary of the OAG report for your convenience. As we prepare for our Regional Caucus meetings this year, we ask you to review the report, consider its contents, and ask us questions.

The study completed by the OAG study was composed of two parts. The first part of the study looked at how BC First Nations worked together to establish the first-of-its-kind FNHA. The second part of the study looked at the corporate policies of the FNHA. The anonymous document was not the primary subject of the OAG’s study. While the OAG reviewed FNHA policy in light of the anonymous document, the OAG did not investigate these allegations.

We would like to highlight the following from the report:

  • The OAG did not audit the merit of the allegations contained in the anonymous document. The OAG reviewed FNHA policies and the application of those policies in relation to these allegations.
  • The OAG concluded that the FNHA was taking steps to strengthen accountability and governance by revising key policies and procedures and providing added guidance to staff to ensure consistent application of corporate policy.
  • The OAG concluded that the decision of the FNHA to pursue accreditation will serve to strengthen corporate policy as this process requires voluntary third party verification.
    Health Canada confirmed that the FNHA has fulfilled all of its obligations as set out in the Framework Agreement (2011) and the Canada Funding Agreement (2013).

Health Canada’s official response to the report confirms that “the FNHA has been diligent in providing Health Canada with quality and timely deliverables against all its obligations and meeting the accountability and governance requirements set out in the framework agreement.” In addition to providing Regional Caucuses with our annual reports and audit statements, the members are confident the FNHA is meeting its accountability obligations to our governance partner and funder.

When we started this journey ten years ago, we agreed to complete health transfer only if we did a better job. Along the way, we faced challenges and tough conversations. We agreed that we are stronger together and worked to resolve those challenges. BC First Nations established governance standards and structures to ensure oversight, high operational performance and the separation of operations and politics. Our shared vision, values and standards for good governance have been key to our collective success and will continue to be the center of this work.

As leaders we witnessed the FNHA overcome many challenges as it navigated through transfer and built a new First Nations organization from the ground up. The FNHA has publicly committed to the highest standards of excellence in serving our communities. The FNHA has acknowledged that there are areas for improvement and, as a learning organization, has committed to listen, learn and act. As members we will do what we have always done, and look to our First Nations leadership for wisdom and guidance in finding ways to strengthen our health governance structure. In closing, we recruited the FNHA Board of Directors based upon their competencies, skills, and expertise. The FNHA Board of Directors, the CEO, and the Senior Management Team continue to have our full confidence and support as we make the necessary changes and improve upon our processes to deliver the highest quality services for First Nations peoples in BC.

In wellness,

Members of the First Nations Health Council


Click here to read and download the full summary document