If done properly and not politicized, a deal between the federal government, the Manitoba government and First Nations in southern Manitoba could really improve health care for Indigenous communities in the province.
The Southern Chiefs’ Organization – which represents 34 First Nations and more than 81,500 people in southern Manitoba – signed an agreement-in-principle in late June with the other levels of government. No specific timelines have been mentioned for implementing the deal.
The agreement envisions transferring decision-making authority to the First Nations involved in the agreement and the eventual vacating of FNIB (First Nations and Inuit Health Branch) offices in the region.
At present, health care for most Indigenous communities in Canada is delivered by the federal government through various agencies. However, this longstanding arrangement has often been criticized because it results in top-down services that are often out of touch with the communities it serves. However, an arrangement to decentralize services is an example of subsidiarity. Subsidiarity is the organizing principle that important community matters ought to be handled by the lowest level of government, so the authority closest to the people affected.
This agreement could work if it focuses on the bottom line of improving health outcomes for Indigenous people. However, if it becomes politicized in the communities it serves, the agreement would not be better than under the federal government. This means the authority should be focused on outcomes and should have to regularly report back to the government on its progress.
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The whole issue is critical because Manitoba First Nations have some of the lower health outcomes in the country. The transfer must be done right. The arrangement finds inspiration from the B.C. First Nation Health Authority which has seen some measurable success.
There are other models of success of subsidiarity for First Nations, such as the Atlantic First Nation Water Authority, which transferred control over water services to those communities. First Nations in that agreement were able to take advantage of economies of scale and shared services.
In the case of southern Manitoba First Nations, there is an emphasis on a cultural-based approach, but this is not well defined. Respecting culture is important, but this must be connected to improving health outcomes. Sometimes when First Nations decentralize services, the focus gets disproportionately put on intangibles like culture, with the overarching goal getting lost. This can’t happen here, given that people’s health is at stake.
The First Nations involved must also avoid the temptation to allow old-school First Nation politics into the system. Once the agreement is implemented, the health authority must still work to keep elected politics out by creating firewall policies that separate administration and service delivery from elected politics. For some reason, the problems inherent in band politics tend to filter into Indigenous organizations. Look at the Assembly of First Nations right now or the First Nations University of Canada.
Transferring health authority to First Nations in southern Manitoba is a new chance to transform the lives of First Nations without all the politics that come with top-down control from Ottawa. They must now resist the urge to just replace that with Indigenous politics.
Joseph Quesnel is a senior research associate with the Frontier Centre for Public Policy.
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