Okay.
Our organization works on behalf of CHRs, community health representatives. CHRs are the front-line, paraprofessional health care providers who have been serving in first nation and Inuit communities for close to 50 years. Many of these communities are remote or isolated. The CHR's tasks encompass health education, health promotion, and disease prevention based on a concept of wellness where the body, mind, spirit, and soul are interconnected. The view of the aboriginal health continuum is about wellness, not illness.
As an organization, we do our utmost to provide an annual national training session promoting holistic health and to build capacity on various issues ranging from diabetes, to prescription drug abuse, to tobacco cessation, to developing resources on sudden infant death syndrome, to HIV/AIDs, to keeping older aboriginal elders active.
The health needs and human resource requirements are about justice and the right to have basic health needs met and the right to fundamental health protections. It is for this reason that I am here to present the health human resource needs and challenges facing CHRs. I will touch on the related issues, such as community and nursing needs.
As far back as 1943, when the then Department of Health and Welfare assumed the responsibility for the health services of Indians, emphasis was put into providing health institutions and into providing professionals to work in these institutions in the remote areas. In 1958 a different approach was taken that led to a primary health care program being initiated in 1962 with 11 CHR pilot sites. The basic element of the program was the training of Indian and Inuit as primary health care workers to enable them to fulfill a role that expanded the health care system. By the time National Indian and Inuit Community Health Representatives Organization was incorporated in 1992, there were an estimated 717 first nation and Inuit CHRs.
In relation to health needs and human resources, it is unreasonable and unjust that first nations are expected to provide an increased and increasing quality and level of community-based health care with funding that does not recognize population growth and current costs over the past 20 years. In addition, the number of CHR positions or associated funding has remained static since 1990, which was the same time as the introduction of the First Nations and Inuit Health Branch's health transfer policy. There was a nursing transformation strategy implemented around the year 2004 that provided one additional nursing position to remote nursing locations only. Everywhere else the number of nursing positions has remained static since the mid-1990s.
When thinking of health human resources from a first nation and Inuit perspective, our list—and I would have to say considering NIICHRO and many of the communities—is doctors when available, nurses when possible, but more importantly, we think of the stable workforce, workers who come from and live in these communities. We think of the community health representatives, a paraprofessional, and how that role has facilitated community development through the introduction of various health programs, such as the national native alcohol drug addiction program, the Canadian prenatal nutrition program, and the aboriginal diabetes initiative.
The CHR scope of duties is very broad. They work with all community members within all stages of life, from promoting good pre-conception health, right up to providing comfort to those in the last stages of their life. They are key in delivering services from a local context, a lifeline in community health. Yet supports for many CHRs are lacking. CHRs and nurses are absolutely necessary in the delivery of core community-based health services, which at the very bare minimum must provide for immunization, TB, and communicable disease control activities.
In preparation for this presentation, I reviewed the 1983-84 CHR program evaluation study. The recommendations from the study are still issues that need to be addressed: financing of CHR training, taking a systematic approach to training, having CHRs as trainers, a method for allocating CHR resources, having advanced training, and having CHR coordinators.
While this evaluation study is dated over 25 years ago, the situation is still the same. The needs of CHRs remain access to training, competitive wages, and defining their scope of practice, as there is such a diversity in that role across the country.
The Royal Commission on Aboriginal Peoples stated that the CHR program is one of the “most successful programs involving Aboriginal people in promoting the health of Aboriginal people”. It further states that, in particular, CHRs “can help Aboriginal individuals and communities learn to exercise personal and collective responsibility with regard to health matters”. One would believe that such statements would set the stage for greater support and capacity development of CHRs.
Sadly, instead of greater support for the program and these important, stable, and trusted front-line paraprofessionals in first nation and Inuit communities, we have in fact seen the CHR program removed from the compendium of programs at the federal level. Other cuts that support the program were made to the CHR national organization, which had operational funding cut in 2000.
Through our initiative called “Road to Competency”, we have developed a list of seven CHR core competencies and 22 sub-competencies. These competencies are to facilitate development of training programs for CHRs. With support from the Assembly of First Nations, we hope to bring this to the regions for consultation that will lead to development of CHR training programs in each region of Canada.
A well-trained community health provider knows their community and has the trust of the population to work together on the modifiable factors to extend life expectancy, that is, lifestyle, diet, exercise, driving safely, reducing misuse and abuse of tobacco, and facilitating access to care. All of these are within the scope of the CHR duties. Thus, they can generate a positive impact, but they need training, ongoing continuing education opportunities, sufficient culturally appropriate resources, and wage parity.
There are some who have stated that the role of CHRs has diminished or that communities are not hiring CHRs. What NIICHRO has noted is that the CHRs are just being retitled; instead of building capacity and increasing the number of these paraprofessional health providers, a variety of new program positions are being created. These new program workers are doing what CHRs have done for almost 50 years.
Working to increase the number of CHRs and their skills capacity is needed now more than ever as we consider the lack of health professionals in this country. For isolated and remote first nation and Inuit communities, this is especially important, as they suffer from periods when there is no nurse, and they only have access to fly-in doctors. The amount of time these health professionals spend in communities is limited and does not provide continuity and opportunity to build trust relationships, both of which would enable better health outcomes.
The major issue is that there needs to be a policy or formula to address how to correct the base funding of health transfer agreements. That funding was based on populations at the time of the health services transfer in the early 1990s.
Support the first nation and Inuit communities with adequate funding to meet their growing population and needs. Support CHR training so that they can evolve to respond to community needs now and in the future.