What Changes Would Manitoba First Nations Like to See in the Primary Healthcare They Receive? A Qualitative Investigation

Abstract

Background: First Nations (FN) have unique perspectives and experiences of health and healthcare services, which are critical to the provision of effective community-based primary healthcare (CBPHC). Objective: This paper shares FN perspectives on primary healthcare (PHC), taking geographical, cultural and historical realities into account, to elucidate opportunities to improve current healthcare services. Methods: Semi-structured in-depth qualitative interviews were completed with 183 residents of 8 Manitoba FN communities. Grounded theory-guided data analysis was conducted. Results: Improving PHC performance requires delivering timely and holistic healthcare that integrates traditional health knowledge, comprehensive CBPHC increasing services such as healthcare and medical transportation, healthy food as an important preventative measure and a culturally informed workforce backed by local leadership and promoting cultural respect. Conclusion: The relationship between self-determination and health is a critical factor in the implementation of CBPHC. FN must be respected to decide healthcare priorities that reflect the needs and visions of each community.

Collaborative and Systems Approach to Transforming Primary Health Care in Manitoba First Nations Communities

“…Additionally, First Nations promote an integrated and holistic approach to health and health care (Kyoon-Achan, Avery Kinew, et al, 2019;Kyoon-Achan, Lavoie, et al, 2019; as a more effective replacement for crossjurisdictional case management difficulties imposed by diverging funding mandates. Funding should be made to promote teamwork, case coordination, and holistic approaches in First Nations communities.…”

First Nations’ hospital readmission ending in death: a potential sentinel indicator of inequity?

“…It is well documented that FN’s socio-economic status (SES) is considerably lower than that of other Manitobans [ 4 ]. While we agree that improving FN’s SES will likely have an important impact on health status, FN in Manitoba has repeatedly reported receiving substandard care [ 22 , 23 ], at times culminating in premature death [ 24 ]. As an indicator, readmissions ending in death can provide invaluable insights.…”

“…The overall objective of this innovative, strength-based programme of research is to learn from FN and rural and remote communities that have developed effective community-based PHC. Numerous papers have already been published from this programme of research [23,26,27,[46][47][48][49], as well as presentations at many national and international conferences.…”

Our People, Our Health: Envisioning Better Primary Healthcare in Manitoba First Nation Communities

“…Additionally, First Nation communities find themselves entangled in jurisdictional quagmires that often leave the communities underserved when the federal and provincial jurisdictions are not able to clearly define and outline their responsibilities. This creates a paralyzing effect for First Nations that need to access services (Bourassa, 2018;Jordan's Principle Working Group, 2015;Kyoon-Achan et al, 2019). These factors taken together result in large health disparities (Benchimol et al, 2018;Frohlich et al, 2006).…”

“…It has also been argued that Canada needs a holistic First Nations healthcare strategy that considers and addresses historical and ongoing structures fueling gross health inequities (Auger et al, 2016;Katz et al, 2017). In previous articles, we argued that transforming community-based primary healthcare (CBPHC) should begin by understanding how that concept can take on an entirely different meaning for First Nation peoples and communities, and it should proceed by developing policies that align with priorities determined by affected communities (Kyoon-Achan et al, 2019;. In this article, we build further on this line of argument to assert that in order to secure long-term positive outcomes in First Nations health, it is imperative to support the implementation of the visions and highest ideals stated by First Nation peoples and communities.…”