There are risks and benefits to the First Nations Health Authority.
I came to B.C. six years ago from the federal system, so I had an understanding of what they were trying to get away from. Everything that the regional office of first nations and inuit health had been doing—the funding, the building, the people, everything else—was part of the transfer agreement. We are just getting through what organizationally we are calling transition, sort of coming from that system to a transformative system where we have an opportunity to do things very differently.
At the same time, our funders have huge accountability requirements, so that's always a challenge, and because of that, you have to create a bureaucracy to be able to do that work of the planning, the response, the data, and the surveillance, those pieces. There's an element of bureaucracy you can't really avoid.
When the First Nations Health Authority was created, one of the strongest statements that came through from our communities was that everything we do should be community driven and nation based. We have a commitment to engage, and engagement is expensive. We have regional offices and we have regional caucuses. There is constant communication between regional leadership and regional health directors and the organization. But we also have to fit within this broader system and interact within the broader system, so my world is meeting with doctors in B.C., the B.C. coroners service, the provincial Ministry of Health, and some of our federal counterparts, and, and.... Even though we are working very hard to transform to be community responsive, to put as many resources in the region and community as available, it's inevitable that we're going to have some kind of administrative structure to support that.
It takes time to figure all that out. It takes time to unravel how things have been done in the past, how decisions have been made in the past, and how we might want to change the way those decisions are made.
My friends in Ontario would tell you that the chiefs in NAN, the chiefs of Ontario, and others don't necessarily agree on what those priorities are. We were really lucky that the 203 communities in B.C. came together with a single vision and continue to support that.