Grant: Travel Awards - Institute Community Support

The relationship between First Nations and the federal government is deeply rooted in the past with a series of shared events with often different meanings. This review examines the relationships between First Nations and the federal government in terms of the delivery of health services; an area of Canadian public policy that has also experienced a fairly high level of change over the last century. Delivery of health services to First Nations has evolved from direct services by federal employees, mostly nurses, to increased delivery of health services by First Nations. This evolution in service delivery is based on the 1979 Indian Health Policy, the 1989 Transfer Policy and more recently from partnerships endeavours such as the BC Tripartite Framework Agreement on First Nations Health Governance. Across the country, First Nations are looking at options for establishing and/or strengthening partnerships with federal and provincial governments as well as health authorities. Literature on concepts of collaboration sometimes refer to unequal relationships, but limited attention seems to have been given to the concept of working together in situations where there is a special relationship with the Crown. How can we, First Nations and governments, work together and succeed in improving access and quality of health services, and ultimately health outcomes? What would be the key ingredients for success? This review begins to examine a few options including trust, commitment, collaborative capacity and a changing role for public service managers.