Missing Pathways to Self-Governance: Aboriginal Health Policy in British Columbia

Lavoie, Josée G.; Browne, Annette J.; Varcoe, Colleen; Wong, Sabrina T.; Fridkin, Alycia; Littlejohn, Doreen; Tu, David

doi:10.18584/iipj.2015.6.1.2

Cited by 18 publications

(23 citation statements)

References 13 publications

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“…These arrangements are only available to discrete First Nations and Quebec/Labrador Inuit communities, while services for Métis and Aboriginal people living in urban areas are provided by mainstream organizations, with few urban Aboriginal health clinics available. Some of these services are resourced through relational contracts, while others depend on a collection of classical contracts (Lavoie et al 2013). More research is needed to map funding and accountability pathways off-reserve.…”

Section: Integrated Contracting With Exclusionsmentioning

confidence: 99%

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Dwyer

Boulton

Lavoie

et al. 2013

Public Management Review

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This article analyses reforms to contracting and accountability for indigenous primary health care organizations in Canada, New Zealand, and Australia. The reforms are presented as comparative case studies, the common reform features identified and their implications analysed. The reforms share important characteristics. Each proceeds from implicit recognition that indigenous organizations are 'co-principals' rather than simply agents in their relationship with government funders and regulators. There is a common tendency towards more relational forms of contracting; and tentative attempts to reconceptualize accountability. These 'frontier' cases have broad implications for social service contracting.

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Section: Integrated Contracting With Exclusionsmentioning

confidence: 99%

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Dwyer

Boulton

Lavoie

et al. 2013

Public Management Review

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“…While we agree that CHCs could possibly be government agencies, the CHCs with which we worked emerged as a result of government services’ failure to meet the needs of vulnerable populations [ 3 – 5 ]. A key component of the success of CHCs in meeting needs has been attributed to their community-grounded governance structure, which ensures pathways for community feedback on the performance of the CHCs and their programs to meet community needs [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The push for smaller government and interest in harnessing competition among providers to stimulate innovation can act as an added incentive for governments to transfer healthcare responsibilities onto the NGO sector [ 19 ]. In other cases, however, CHCs surface primarily in urban areas where surplus capacity (underemployed community-engaged professionals) exists and where unmet needs persist [ 5 ], to complement services provided by for-profit providers (providers in private practice) and governmental not-for-profit providers. Although histories vary, in either case, these CHCs generally emerge as a result of social activism, to meet the unique, and unmet or poorly met, healthcare needs of marginalized populations.…”

Section: Introductionmentioning

confidence: 99%

Sentinels of inequity: examining policy requirements for equity-oriented primary healthcare

Lavoie

Varcoe

Wathen

et al. 2018

BMC Health Serv Res

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BackgroundNon-government, not-for-profit community health centres (CHCs) play a crucial role within healthcare systems in fostering equity, acting both as direct providers of services and as sentinels of health and social inequity. In a study of an intervention to promote equity-oriented health care, we enlisted four diverse primary healthcare clinics with mandates to serve highly marginalized populations. All of these CHCs operate as not-for-profit, non-government organizations (NGOs), and have a marginal relationship financially and socially to other parts of the system. The purpose of this paper is to provide an analysis of the factors that shape how CHCs are able to carry out an equity mandate and, from this, to identify what is required at the level of policy to enhance capacity to provide equity-oriented health care.MethodsWe systematically examined the clinics’ policy and funding contexts, and identified influences on the clinics’ capacities to promote equity-oriented health care.ResultsWe identified three key mechanisms of influence, each playing out against the backdrop of a contested and marginal position of CHCs within the health care system: a) accountability and performance frameworks; b) patterns of funding and allocation of resources, and c) pathways for emergent priorities. We examine these mechanisms, considering how each influenced the pursuit of equity, and propose policy directions to optimize the primary health care sectors’ capacity to support equity-oriented health care.ConclusionsAlthough this analysis is based on a study within a high-income country, we argue that because the dynamics between community health centres and broader healthcare systems are similar across national boundaries, the implications have applicability to low and middle-income countries.

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“…First Nations' perspectives on health were absent from the design and delivery of First Nations' health services, which were guided by the Indian Act and controlled by distant federal government offices with little or no insight into the health needs of the communities they served (Abele and Prince, 2006;Lavoie et al, 2010). Over the last decade, a transformation process has been underway to reincorporate First Nations perspectives and decision making into the design and delivery of health services (Lavoie et al, 2015). A hallmark of this journey of transformation, and the focus of this paper, is the creation of partnerships for change within the broader health system.…”

Section: Introductionmentioning

confidence: 99%

Transforming First Nations’ health governance in British Columbia

O’Neil

Gallagher²,

Wylie

et al. 2016

IJHG

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Purpose The purpose of this paper is to present a study of the transformation of First Nations’ health governance, describing the development of partnerships between First Nations and provincial and federal governments for co-creating solutions to address First Nations’ health inequities in British Columbia (BC). The paper frames this transformation in the context of a Canada-wide reconciliation initiative stimulated by the Truth and Reconciliation Commission. Design/methodology/approach This qualitative case study was a joint initiative between Simon Fraser University and the BC First Nations Health Authority (FNHA), involving interviews with senior leaders within the BC health system, FNHA and First Nations communities. In addition, a policy roundtable was held in February 2015 which gathered 60 participants for further dialogue on the process. Findings Key themes included: partnership and relationships, governance and reciprocal accountability, First Nations perspectives on health and wellness, and quality and cultural safety. Findings indicate that significant transformational changes have happened in the relationship between First Nations and the mainstream health system. The creation of the FNHA has led to more representation for First Nations people at all levels of governance and health service planning, which will ultimately lead to more culturally safe health services that incorporate a First Nations perspective of wellness. Social implications The transformation of First Nations health governance in BC can serve as an example in other indigenous health settings both within Canada and internationally. Originality/value This paper describes a transformative health governance process in First Nations communities that is an historical first in Canada.

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Missing Pathways to Self-Governance: Aboriginal Health Policy in British Columbia

Cited by 18 publications

References 13 publications

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Sentinels of inequity: examining policy requirements for equity-oriented primary healthcare

Transforming First Nations’ health governance in British Columbia

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