ONTARIO FIRST NATIONS PUBLIC HEALTH PROJECT The First Nations Public Health Advisory Committee (FNPHAC) Knowledge Management Advisory Committee (KMAG) Presentation for Alpha Education Day by Tracy Antone Chiefs of Ontario

What is the Ontario First Nation Public Health Project? The Ontario First Nation Public Health Project (OFNPHP) is a tripartite initiative intended to guide the development of a “made-in-Ontario” approach for Public Health Services for First Nations in Ontario.

Project Background In March and June 2005, tripartite meetings between COO, the Ministry of Health and Long-Term Care and FNIH Ontario Region were held to discuss the need to address First Nation public health concerns particularly in the wake of the SARS and Walkerton crises.

Subsequent Actions Based on these discussions, COO commissioned the completion of a First Nations Public Health Environmental Scan and Literature Review to document outstanding First Nations public health concerns in Ontario. Resulting recommendations called for further investigation into First Nations: pandemic planning information and surveillance jurisdiction and governance PH resourcing.

Subsequent Actions Continued In June 2006, the leadership of the 32nd AOCC passed Resolution 06/47 calling for the establishment of a First Nation Public Health Advisory Committee (FNPHAC) as well as a Knowledge Management Advisory Group (KMAG) to assist First Nations in the development of a First Nation Public Health Framework.

First Nations Public Health Relationship Framework Objectives Promote an integrated approach to public health on-reserve Ensure relationships are built/enhanced at all levels to address public health Consider how to incorporate and align with local and community efforts to address public health concerns

First Nations Public Health Relationship Framework Key Activities Scan current practices and relationships between Ontario First Nations and Public Health Units Review approaches in other jurisdictions Review public health policy direction at provincial, national and federal levels Develop framework based on best practices, current situation and existing legislation Test approach outlined in framework to ensure it will operate as intended

Public Health Project Committees: Three Distinct Pillars Project Management Committee Oversee project and maintain tripartite approach Knowledge Management Group (KMAG) Provide technical and policy direction for First Nations component of Public Health Surveillance Management System First Nations Public Health Relationship Framework (FNPHAC) Provide leadership in developing First Nations Public Health Relationship Framework

So what is the function of KMAG? As indicated in Resolution 06/27, KMAG is a First Nation driven (and Chaired) tripartite Advisory Group meant to inform First Nations in Ontario, via FNPHAC (the First Nation Public Health Advisory Group) on matters related to public health information systems and knowledge management . At present, its scope is limited to immunization.

Committee Mandate All Ontario Chiefs Committee (AOCC) resolution 06/47 directed the establishment of a Public Health Advisory Committee to follow up on the issues raised within the preliminary findings of the First Nation Public Health Environmental Scan

What is the function of FNPHAC? To deal with issues involving governance and jurisdiction, resourcing and the completion of a Public Health Framework for First Nations in Ontario. [Resolution 06/47] Improve the coordination of public health services on-reserve and to guide Canada, Ontario and First Nations in delivering public health services on-reserve, by designing and implementing a First Nations/Public Health Relationship Framework.

Suggested Functions To improve capacity within Chiefs of Ontario to support and lead the development of a relationship Framework. To engage Ontario PTOs and First Nations communities in developing a Relationship Framework, identifying best practices and relationship issues that require resolution. To establish linkages and ensure consistency with national and provincial approaches. To identify best practices in Ontario and other jurisdictions.

Suggested Functions (continued) To develop range of practical scenarios to test out design options. To continue the enhancement of pandemic planning processes and the development of Emergency Response Plans (ERP) To assess public health services within Ontario First Nations’ communities and advise on areas of improvement, where required.

Suggested Functions (continued) 8. To document options of service delivery within a collaborative framework whereby First Nations leadership through the Ontario First Nations communities, MOHLTC and FNIH-OB can ensure enhanced dialogue This process is not intended to interfere with positive relationships that have already been developed. It is intended to document the working models and augment processes for communities to collaborate more effectively with the provincial and federal governments for improved public health services. 9. Design a framework that will guide the collaborative process to facilitate governments capability for improved public health services

How is KMAG different from FNPHAC? KMAG focuses strictly on knowledge management requirements and is a technical, apolitical body Membership, however, is anticipated to change based on evolving knowledge management needs and challenges KMAG will provide recommendations and responses on how First Nation public health information and surveillance should be managed and governed In essence, it will act as a sub-committee of FNPHAC but due to the vast scope of IM/IT still requires a separate process.

KMAG Next Steps Based on discussions from the September 2007 KMAG meeting, work has begun to pursue two (2) First Nation Test Projects One - to conduct a First Nation Technical and Resource Capacity Survey which would be an extension of the work already conducted through the CSA (Current State Assessment)   Two - an Immunization Information/Data Matching Exercise which would involve the comparison of First Nation immunization data for 0 – 6 years (MMR) and HepB for youth aged 12 – 16 years.

KMAG Next Steps Continued… The data-matching exercise would involve a cross-comparison of immunization information from the First Nation communities as well as the adjacent Public Health Units Careful consideration and work will be undertaken with respect to OCAP; privacy and confidentiality; data sharing; and most certainly, client consent Outcomes anticipated will be that of informed models for data sharing agreements and information governance

FNPHAC Next Steps Inaugural Meeting set for February 11th and 12th Membership – 2 Reps from each PTO plus alternates (chair will be selected); 2 Reps from FNIH; 2 Reps from MOHLTC Review Tentative three year work plan.

Tentative Three-Year Workplan Fact Finding Year 2 Planning Year 3 Implementation Suggested Activities Review of PH Environmental Scan / Emerging Priorities May include research of: Review PH Service Capacity Gap Analysis Risk Assessment Promising Practices / Innovative Models for PH Service Delivery Initiate devt of the FN/PH Relationship Framework Identifying issues Defining roles and responsibilities Addressing jurisdictional and governance issues Consensus building Devt of diverse/ flexible PH Service Delivery models (Made in Ontario approach) Establishing linkages among FN, National and Provincial approaches Pilot/test models of PH Service Delivery Assign allocation of resources to meet identified needs Finalize FN PH Relationship Framework Suggested Outcomes Effective, ongoing and informed PTO and community input into the devt of the Relationship Framework Improved relationships, cooperation and collaboration amongst PHUs, First Nations, MOHLTC and Health Canada A FN/PH Relationship Framework agreed upon and committed to by all partners Consistent approach in addressing public health issues in all Ontario First Nations on day to day basis among the partners Mechanism for improved PH services in Ontario FN

Conclusion The First Nation Public Health Project is being launched at a time when there is unprecedented concern about the state of public health across the country. We must all work together to support this First Nations driven public health project so that models of excellence for First Nation Public Health delivery can be developed.