First nations health networks: a collaborative system approach to health transfer

The Health Transfer Policy (HTP) of Health Canada's First Nations and Inuit Health Branch (FNIHB) offers First Nations the opportunity to assume a degree of administrative control over community-based health services. Although shortcomings of the policy have been documented, certain elements, particularly second- ("zone") and third- ("regional") level transfer (Health Canada 2001), have provided First Nations the flexibility to create novel organizations. These First Nations Health Networks (FNHNs), which have emerged through grassroots movements and interjurisdictional processes, have brought together a number of communities under a planning body, tribal council or health authority. The authors discuss the concept of First Nations Health Networks as variously implemented across Canada. In this study, the FNHNs may be defined as health authorities, fall under the auspices of a tribal council or be limited to a planning instrument. Yet, they all aspire to similar principles: cooperation, collaboration and sharing, under a consensus of optimizing health resources (Warry 1998). The authors explore these health management entities, look at their perceived strengths and challenges and identify key issues that may define the inherent risks and benefits or illuminate best practices for the benefit of other First Nation groups considering such a collaborative undertaking. The paper begins with a discussion of the emergence of the FNHN concept, followed by detailed case studies of six collaborative First Nation initiatives. The third section explores common themes, regional differences and jurisdictional challenges faced by these organizations. The authors conclude with an exploration of the FNHN as a health management concept and recommendations for further analysis.