1. Environmental Scan HEALTH HUMAN RESOURCES IN FIRST NATIONS HEALTH CENTERS IN BRITISH COLUMBIA

2. Background  A scan of health human resources of First Nations health centers throughout BC - Workforce Scan - Training, Recruitment and Retention of First Nation Staff  Using primary and secondary data collection methods; - Gathering Wisdom conference - face to face interviews - online survey - phone, fax, email options

3. Participation by Health Authority Regions Of the expected 78 individual health centers, 56 (72%) completed a survey Participation of the umbrella organizations are divided as follows: Umbrella health centers who completed surveys on behalf of ALL communities that they deliver health services = 11 out of 19 (58%) representing 74 communities participated; Umbrella health organizations for whom partial data was provided directly by member communities = 7 out of 19 (36%) representing 10 communities. The data from these umbrella health organizations excludes 13 communities who did not provide data.

4. Actual Participants of Health Centers by Health Authority region LOCATION OF ACTUAL RESPONDENTS BY HEALTH AUTHORITY REGION Individual health centers Umbrella health organizations (fully completed surveys) Umbrella health organizations (partially completed surveys) TOTAL ACTUAL PARTICIPANTS BY REGION # health centers # commun ities # health centers # commun ities # health centers # commun ities TOTAL HEALTH CENTERS TOTAL COMMUNITI ES Fraser 5511211718 Interior 15 627222344 Northern 18 217242239 Vancouver Coastal 10 12001112 Vancouver Island 88116231127 TOTALS 56 1174 710 74140

5. Provincial Highlights There were a total of 1,265 positions and1,076 people reported as working in the 74 (individual and umbrella) First Nations health centers across the province The majority of positions are in the home care field and corporate / administration area, followed by Registering Nurses and Community Health Workers The region with the highest number of positions in First Nations health centers is the northern region. This compares favorably with the number of health centers in the region Across the province, there are more full-time employees than part-time although in the Fraser region, there are more part-time than full-time workers Across the province, there are some 786 First Nations workers (73%) compared to 290 non-First Nations workers A total of 1,076 workers are employed by the First Nations health centers who responded to the survey (some 74 health centers representing 140 communities)

6. Provincial Highlights Of all workers, 50% are identified as full-time employees while 38% are noted as part- time employees, while 12% of the respondents did not report this information Overall, the majority of workers have been employed in the health centers for less than 5 years. Community Health representatives have the highest percentage (31.4%) of staff members who have spent between 11 - 20 years in service, while Elders have been identified as spending more than 21 years in the health centers (18.2%) Overall, the majority of all workers earn between $16 and $20 per hour in salaries / wages. The wage/salary ranges for some specific positions were extremely broad. For the Health Director positions for instance rates varied from an average of $30.50 per hour to an upper range of $48 per hour. The Region that appears to have salaries / wages in the upper limits is the Fraser region

7. Compiled Health Region Workforce Data from First Nations Health Centers Number of Positions Number of Full Time workers Number of Part Time workers Number of First Nation staff Number of Non-First Nation staff FRASER WORKFORCE 14530827045 INTERIOR WORKFORCE 3051709018875 NORTHERN WORKFORCE 40019814326969 VANCOUVER COASTAL WORKFORCE 24113410317162 VANCOUVER ISLAND WORKFORCE 17468 8839 TOTAL 1,265600486786290

8. Average Hourly Salaries/Wages for main positions in FN Health Centers POSITION (both FN and non-FN)FraserInteriorNorth Vancouver Coastal Vancouver Island AVERAGE WAGE ACROSS PROVINCE Health Directors$48$40$35$30.50$35$37.70 per hour Home Care Assistant$15$22.50$27.50$15$17.50$19.50 per hour Corporate / administration$20$22.50 $17.50$23$21.10 per hour Community Health Representatives / workers $30.50$25$17.50 $22.50$20.60 per hour Registered Nurses$40.50$48 $33$35.50$33.00 per hour NNADAP workers$27.50$25$20$23$25.50$24.20 per hour Head-Start Program$17.50$20.50$28$15$17.50$19.70 per hour Mental Health workers$65$45.50$28$22.50$28$32.20 per hour Child and Maternal health workers$12.50$30.50$20.50 $23$21.40 per hour Patient Transport workers$25$22.50$20$15 $19.50 per hour Registered Social Workers$28$35$25.50$30$20$27.70 per hour

9. Regional Highlights Fraser: from 7 out of 12 health centers, some 70 (61%) identified as First Nations and 45 (39%) as non First Nations. Interior: from 23 out of 33 health centers, some 263 people working in health centers – some 188 (71%) people identified as First Nations and 75 (29%) people as non-First Nations. Over half the workforce is of First Nation descent, work full time and spend 5 years on average, but up to 21 years employed by the health center, earning between $10 and $70 per hour. Workforce is predominately made up of non clinical staff, and support staff, and there are few specialized clinical staff. Data shows there are many qualified staff with postgraduate qualifications Vancouver Island: from 127 workers from 11 out of 12 health centers who responded, there is an even split between full time and part time workers. Of the 127 people 88 (69%) are First Nations and 39 (31%) are non-First Nations, working predominantly in non-clinical positions, working full time and spending approximately 10 years at health centers, earning between $10 and $60 per hour. Ages vary from 16 to 70 years. A high number of staff are undergraduate and post graduate qualified and few are currently studying.

10. Northern: from 338 workers from 22 out of 31 health centers some 269 (80%) people identified as First Nations and 69 (20%) as non-First Nations. Many are full time working predominately in non-clinical positions or support positions, spend between 5-10 years employed by the health center, and earn mostly between $20 to $40 per hour. Workforce is well educated with many undergraduate and postgraduate qualified personnel, and many currently studying. Vancouver Coastal: 233 workers from 11 health centers in the region with some 171 (73%) people identified as First Nations and 62 (27%) as non-First Nations. Most work full time in non clinical and support positions, spending 5 years on average in Health centers, earning $10 - $30 per hour. Most have undergraduate qualifications, some with postgraduate and few are currently studying

11. Ethnicity Overall, there are more First Nation health workers (786 or 73%) in the health centers than non-First Nations workers (290 or 27%). Generally, health centers in the Northern region have more First Nations staff, and health centers in the Fraser region have the least number of First Nation staff

12. Overall number of First Nations and Non First Nation staff

13. Years of Employment Overall, the majority of workers have been employed in the health centers for less than 5 years. Few staff spent more than 10 years working at the respective centers Health Aids and Assistants have the highest overall percentage (66.6%) of staff members who have worked for less than 5 years. Head-start program workers have the highest overall percentage (54.1%) of staff members who have worked for periods between 6-10 years Community Health representatives have the highest percentage (31.4%) of staff members who have spent between 11 - 20 years in service, while Elders have been identified as spending more than 21 years in the health centers (18.2%).

14. Overall Summary of Workforce Findings The region with the highest number of positions in First nations health centers is the northern region. This compares favorably with the number of health centers in the region. Across the province, there are more full-time employees than part-time although in the Fraser region, there are more part-time than full-time workers Across the province, there are some 786 First Nations workers (73%) compared to 290 non-First Nations workers A total of 1,076 workers are employed by the First Nations health centers who responded to the survey (some 74 health centers representing 140 communities) The region with the highest number of First Nations workers is the northern region and the region with the lowest number is Fraser region

15. Recruitment, Retention and Development of First Nations Workforce in BC Overall, professional development is the most utilized retention strategy, with 74% of respondents selecting this option The least used is Internships, with only 8% having used this as a method for retaining staff. Other well used methods include creating positive environments and allowing time off for study Other methods identified from health centers include financial benefits such as fair wages and bonuses, strong leadership and support to study

16. Retention Strategies Used to retain First Nations staff Prof Develop ment Positive Environm ent Time off Employ Incentive Study Fees Mentor Living Incentive Intern Other (commen ts) FRASER553443411 INTERIOR1910 966132 NORTHERN161711885329 VANCOUVER COASTAL 1068430106 VANCOUVER ISLAND 121312747313 TOTAL 62514432252112721

17. Recommendation “ Agree to utilize the results of this report to work with First Nations communities; health centers and umbrella health organizations; post secondary institutions, Tripartite partners and health authorities – to develop a province-wide health human resource strategy to grow, develop and support the First Nations health workforce and current employers of this workforce in accordance with the Tripartite First Nations Health Plan” Presenters: Piri Robinson Kahui Tautoko Consulting probinson@fnhc.ca David Lindley First Nations Health Council dlindley@fnhc.ca