Primary health care transition fund - update

Aboriginal Nurse, The, Summer 2003 by Dodds, Jeff

On September 11, 2000, First Ministers agreed that "improvements to primary health care are crucial to the renewal of health services. Governments are committed to ensuring that Canadians receive the most appropriate care, by the most appropriate providers, in the most appropriate settings." In response to this commitment, the Government of Canada announced the Primary Health Care Transition Fund (PHCTF), which is an investment of $800 million, ending in March 2006.

While most of the available funds were dedicated to provincial and territorial governments, who are responsible for most of Canada's health services, other Envelopes of funding were made available to address the needs of specific populations. The purpose of the Aboriginal Envelope is to respond to the needs of Aboriginal populations for access to integrated primary health care services by promoting large-scale, sustainable changes to the First Nations and lnuit primary health care system and provincial/territorial primary health care systems which support Aboriginal health. Large-scale refers to a broad geographic area that is affected by renewal, but it can also refer to the depth of renewal (e.g. a very radical renewal to a smaller system). Integration refers to coordinated or seamless service delivery, where the patient/client is the central focus (rather than the delivery system).

In late 2002, the Aboriginal Envelope of the PHCTF released a request for interested applicants to submit "letters of intent" to the Fund. These brief letters were intended to provide the Fund with explanations of the kinds of activities that were being proposed, the numbers and kinds of partnerships that would contribute, and the amount of time and money their initiative would cost, all without requiring the applicant to invest large amounts of time developing full proposals.

In all, 129 letters of intent were submitted to the Aboriginal Envelope of the PHCTF by the December 2002 deadline. The key criteria for reviewing the letters of intent was based on whether the submission was transitional (i.e. not ongoing) and whether the initiative was focussed on primary health care. An attempt was also made to ensure that successful letters represented all regions of the country, and that each Aboriginal culture was included. For the most part, letters were determined to be ineligible because they were proposing to augment or enhance existing programs. As an example, an applicant who sought funding to hire additional Diabetes educators would be declined funding because their proposed activity is one that augments existing programs rather than reforming the primary health care system. In addition many of these enhanced or augmented services are not sustainable and therefore, again, don't qualify.

The Aboriginal Envelope has two components: one that looks at activities that would enhance existing primary health care systems, and a second component that would reform a system. After reviewing the letters of intent, Health Canada has invited 15 organizations, communities and governments to submit full proposals to the Envelope. The review process of the Envelope has not concluded so no funding decisions have yet been made. However, a major theme has emerged based on the selected applicants: creating integrated primary health care services. Integrated service delivery proposes to create tripartite agreements between levels of government who have a responsibility for health service delivery. Through these agreements, communities find ways to share resources, identify common areas of where gaps may exist, and create economies of scale across the existing primary health care systems.

The largest challenge with instituting tripartite agreements is that negotiation across a range of governments and stakeholders can be quite time consuming and not always as productive as one might hope. The PHCTF has been providing some support to applicants to assist in travel costs associated with bringing partners together as they work toward agreements that would result in proposals to the Fund. It is expected that all funding decisions under the Aboriginal Envelope will be concluded by the end of the year.