Arctic Medical Research vol. 53: Suppl. 2,pp.130-132.1994 Health Administration: Reflections on Health Transfer in the Swampy Cree Tribal Council Area Patricia A. Stewart and Roger Procyk Cree National Tribal Health Center, Manitoba, Canada. The Swampy Cree Tribal Council, based in The Pas, the breaking of a promise made under Tre~ties be· northern Manitoba, has been faced with the chal­ tween the Federal Government and our Frrst Na· lenge of having to negotiate with two levels of gov­ tions. ernment - Federal and Provincial - for the transfer of When the Federal Government's Health Transfer administration of health care services dollars from Policy was developing in 1986, the Trib~ Co~cil these governments to our First Nations. Seven First immediately took steps to try to open d1scuss1ons Nations, in a territory of 150,000 square kilometers, with the Provincial Government to consider tranSfer· have cooperated to establish a regional Tribal Health ring the province's resources to First Nations. <_>v~ Center to deliver their own specialty health services the next two years there were some talks but with and to coordinate many of the training, health educa­ change in government and an election in 1988, ~ tion, research and on-going development activities. Tribal Council was put ,,on hold" by the new p~vi: The resources of health transfer have enabled us to cial government who stated they had no pos1non undertake a number of initiatives which we would policy on dealing with treaty people. like to share with you in this paper. Establishment of Health Boards History of The Tribal Council and Health In 1986, the Tribal Council entered into a pre-heal~ Development transfer agreement with the Federal Governmen. The Tribal Council, formed in 1975, is comprised of The agreement making process generated much com seven First Nations - Opaskwayak Cree Nation at munity-based health planning. By 1988, there we~ The Pas, Mathias Colomb at Pukatawagan - a fly-in local Health Boards established in the seven co': community, Grand Rapids, Chemawawin at Easter­ nities and training of these Boards comme . · ville, Shoal River, Indian Birch and Moose Lake. Policy Manuals were developed along with~~ The first Tribal Health service was established in ing. Health By-Laws were created under Sec: all 1976 when both the provincial and federal govern­ of the Indian Act, to regulate the boards road­ ments combined funding to help us provide our own health activities on the reserves. However, a be· visiting dental service to all the communities. In block remained - that of Provincial Govemme~al 1982, a Health and Social Development Manager ing unwilling to discuss the transfer o~ ~v position was created to facilitate local development, health resources in the affected comm?111ne~ ..-1 a workers were chosen for Alcohol and Drug Abuse In 1990, the first of our First Nanons ~f'{i;;v· Prevention counselling in the communities, and a Health Transfer Agreement with the Fed~ tion at Tribal Prevention Program Coordinator position cre­ emment. It was Mathias Colomb First~_ now ated. Community Health Representatives were al­ Pukatawagan - a community then of 1 p!U" ready working in four of the communities with Medi­ 1700. The Health Authority at Puka:tawagan unilY cal Services Branch funding. However, with the ex­ vides health services to the ~all fly-in ~o~atiOll· ception of Opaskwayak Cree Nation and Mathias of Granville Lake as well as its ~wn Frrs(JrallVille Colomb, the five other communities were receiving Both these places have nursing stanons ~th Board their professional health service delivery from the Lake has a representative on the loc3;1 He The pas Province. The history of this situation began with In 1991, Opaskwayak Cree Nauon at in 1991. Hydro Development in northern Manitoba, when in signed a Health Transfer Agreement. Alsot do\Vll al 1964 the Federal and Provincial Health Departments the Provincial and Federal governments s~ the t9t>l divided up the North so that only one government the table with our Chiefs and they all ~ date we level would be providing service in each commu­ Agreement had to come to an end. 1:0 .af (Joveflt nity. Our First Nations were not part of this decision are still trying to agree with the Provmct tiJDeS ()Ill' and regard it as a breach of a fiduciary responsibility; ment on a negotiation framework. Many Circumpolar Health 19'J3 Stewart & Procyk: Health Administration: Reflections on Health Transfer 131 leadership felt like giving up on negotiating with the Aboriginal nurses in their communities. The nurse is Provincial Government, because our treaty rights the key professional health care provider in the com­ (i.e.: health care) are with Canada at the Federal munity. Before the Health Transfer initiative was level. One option we have considered is suing the underway the Tribal Council had obtained funding Federal Government, however we are trying to re­ for a feasibility study to investigate the establish­ solve this through political means first. ment of northern nursing education at the baccalau­ The Swampy Cree Tribal Council successfully reate level. This study was completed in 1986, with negotiated a Health Transfer with the Federal level funding from Health and Welfare Canada's new of government for the five remaining bands. This branch. The study promoted the concept of prepar­ enabled the Cree Nation Tribal Health Board to be ing Aboriginals for professional health careers. established by incorporating in April of 1992. The A contract with the University of Manitoba's Tribal Health Board is comprised of representatives School of Nursing was then developed by Swampy from each of the seven local Health Boards. Cree Tribal Council to enable university staff to ..1-!ealth Bylaws lay out the structure and responsi­ work with the Tribal Council staff in the develop­ b1hties of the local Health Authorities. Most local ment of a curriculum plan. This plan provided a two­ Health Board members are appointed by Chief and year degree level program for graduate nurses who Council; however one of the communities elects its had already completed a two or three year diploma Health Board member directly. program. The features of the curriculum were courses in native studies, primary care skills which are re­ Health Administrator Training quired in outpost nursing stations, and cross-cultural The Health Transfer Agreement between the Tribal learning experiences in community health centres Council and the Federal Government has enabled the and nursing stations. staffing of the First Nation communities with Health There are two diploma nursing programs in north­ Care Administrators. The people were selected by ern Manitoba. These are based on the campuses of the l?Cal l_fealth Boards and were local people. Their Keewatin Community College in the communities q~.catJo~s and experience were largely in the of The Pas and Thompson. The program in adm~strat10n or finance fields; they did not have Thompson is a three-year program which incorpo­ expenence or training in the health field. rates extra Moria!, personnel, financial, and upgrad­ . Therefore, in partnership with Keewatin Commu­ ing supports which lower the traditional barriers of ruty ~ollege, in The Pas, a program was initiated that education for Aboriginal students. The problem was provides twenty weeks of group education over a that there were not enough diploma nursing gradu­ =period.. The F~t Year consists of ten weeks ates to supply the baccalaureate program with Abo­ m learning which focuses on courses in per­ riginal candidates. In spite of this, about one-third of :e1. management, problem-solving, finance and the nursing candidates recruited were Aboriginal. m1stration in the health care system legal as- These students entered the Northern Bachelors Pro­ pects •. and an onentabon· · to computerization' of ac- gram on a full-time basis. Other Aboriginal students ~~- The courses were delivered in two week have taken courses on a part-time basis in all, a total 1 ~~ alnlterspersed with work experience. This ap- of sixteen Aboriginal students will have graduated . .owed the Health Administrator trainees to with their Bachelor of Nursing degree by 1994. =:~ the": families ~~ do val~ble develop­ An evaluation of the program has just been com­ lhe m theJT commuruties. The six shtdents in pleted (Salasan Associates: 1993) which included ~ogram have now achieved a Level One Certifi- the following recommendations: That Bachelor of Nursing programming be continued in the north, ~ !:ond Year courses will be offered in the either as a basic four-year or as a collaborative Di­ llgeme:t {8tudy f~at, but will focus on the man­ ploma/Degree program; that prerequisites and up­ Norsin S0 . commuruty based Health Centres or grading be included as part of the program; that a centres~ tati.ons and the programs delivered by these graduate level component be added to create a pool Rceenuy of northern Aboriginal nurses to staff the program; Vlncial Heai an arrangement was agreed to with Pro- and that a strategy for implementing the program in into the ~ ~at the ~dministrators would move more than one northern site be developed. hands 00'::vm~tal n~mg stations to start getting As part of a recent health-planning process which so the . penence with health programs and staff engaged our local health boards and staff, the y WJIJ be read he th · ' FCsoutces to be }'.' ~ n e Provmce transfers its Swampy Cree Tribal Council wants to shift towards admimstered by our First Nations. nursing education which occurs to a large extent in Nllrsiag Education the communities. The Council wants community N_11rses: The S . participation in planning and implementing all as­ llllecf the wampy Cree Tnbal Council recog- pects of the program. It also wants to develop mid­ need to provide a pool of well-qualified wifery programming, which will incorporate tradi- • Circu.mpolar Health J<)<)J 132 Chapter 2: Health Care Management tional Aboriginal midwives and their practices.