The federal government is handing off responsibility for first nations health care in British Columbia to a new aboriginal authority, reducing its obligation to an annual cheque.
The B.C. First Nations Health Society signed a pact Thursday with federal and provincial health ministers that will see Ottawa's authority – and hundreds of millions of dollars each year – transferred to the new agency over the next two years.
Under the agreement signed Thursday, most acute health-care services will continue to be provided by six health authorities that already exist in B.C. But the province has agreed to work with the new authority to incorporate first nations' cultural knowledge, beliefs, values and models of healing.
The agency will be responsible for a host of on-reserve programs including primary care, mental-health and addiction services, and maternal and child health initiatives.
"The difference I want to see is that every first nations citizen in British Columbia 20 years from now accepts responsibility for their own health and their own wellbeing," said Grand Chief Doug Kelly, chair of the First Nations Health Council, an architect of the deal.
Once the new authority is up and running, Ottawa will transfer what it typically spends on first nations health care in B.C. – $380-million a year to start, rising over time to reflect population growth and cost increases.
The new authority will take on the struggle now facing provincial and federal governments to manage escalating health-care costs. By agreeing to a set amount of cash, first nations at least have certainty, Mr. Kelly said.
It will put the aboriginal authority on roughly equal footing with the province in the provision of health services to first nations in B.C. The province spends an estimated $280-million a year on physician services and Pharmacare for aboriginal citizens, but that figure does not include costs of complex care such as cancer treatment.
Perry Kendall, the provincial health officer, said the change should help first nations overcome mistrust of health-care providers that often lead them to delay treatment until problems are acute. During the H1N1 pandemic in 2009, he recalled, one first nations community on Vancouver Island couldn't get a doctor to come to their reserve to administer anti-virals. "There are things you can do better once you have some money in your pocket," Dr. Kendall said in an interview.
The agreement is the first of its kind in Canada, but the devolution of power to first nations in education and child protection in B.C. has produced mixed results.
In education, some first nations schools have made dramatic gains, while others lag far behind in provincial exam scores.
And just last month, the province's watchdog for children and families urged the B.C. government to claw back some of the authority it has delegated to native agencies for aboriginal children, finding a lack of accountability and gaps in care.
B.C. Health Minister Mike de Jong said the new authority is the product of a more collaborative process, so he's hopeful it will prove more effective than the province's handoff of child protection services.
First nations in B.C. experience poorer health by just about any measure – life expectancy, infant mortality, teen pregnancy, diabetes. Mr. de Jong is optimistic that the province's health system will be able to work more closely with the new aboriginal authority to close those gaps.
"This is a big shift, in terms of how health programming will be delivered in first nations communities," he said. And the results of the new system will be followed closely. "It also represents a significant devolution of operational authority from the federal government to local first nations, and I have no doubt that first nations leaders across the country are looking at this and watching."