Accountability Framework

The Auditor General's annual reports have within the past few years clearly stressed the need for improved accountability mechanisms within First Nations and Inuit Health Branch (FNIHB) programs. Accountability, in a nutshell can simply be defined as the obligation to demonstrate and take responsibility for performance in light of agreed expectations. For more information on Health Canada's response to the Auditor General's reports, refer to the following:

• Government Response to the Standing Committee on Public Accounts Tenth Report on the October 2000 Report of the Auditor General of Canada: Health Canada - First Nations Health: Follow-Up
• Executive Summary: Response to the Public Accounts Committee Tenth Report on the Auditor General's Report, October 2000 (Health Canada - First Nations Health: Follow-Up
• Status Report of actions to be taken in accordance with the Response to the Auditor General's 2000 Report and the Standing Committee on Public Accounts' 2001 Report: First Nations Health

Why an Accountability Framework?

The delivery of health services is extremely complex and demanding with many different players involved. An Accountability Framework will serve to simplify this complexity by outlining roles and responsibilities. It will also ensure visibility and transparency in decision making throughout the health system. An Accountability Framework will improve information collection, resulting in better data being available to support evidence based decision making. This will ultimately improve the quality of service delivery to First Nations and Inuit communities across Canada.

Specifically, the accountability framework will operate at the following levels:

• First Nations and Inuit Leadership to Community Members;
• First Nations and Inuit Leadership to FNIHB;
• FNIHB to First Nations and Inuit; and
• FNIHB to Minister to Parliament.

Essentially, an accountability framework will enable FNIHB to:

• demonstrate value for dollars spent on programs and services and identify gaps;
• manage the risks to health status and programs;
• improve the capacity to deliver services; and
• improve overall management practices.

Creation of the Accountability Implementation Oversight Committee

In response to the recommendations from the Auditor General's Report on Accountability and the Gathering Strength Initiative at the Department of Indian Affairs and Northern Development (DIAND), FNIHB has embarked on a process to incorporate an Accountability Framework into its activities. The goal of this initiative is to facilitate and improve data collection as well as its exchange between Health Canada (FNIHB) and its stakeholders - mainly First Nations and Inuit leadership and communities.The Accountability Implementation Oversight Committee (AIOC) was formed with a mandate to oversee and facilitate initiatives aimed at implementing the recommendations put forward by the Auditor General and the Branch's Accountability Strategic Report. The committee which reports to the Branch Executive Committee (BEC), is chaired by the Director General, Community Programs (CP), FNIHB, also has stakeholder representation from the Assembly of First Nations (AFN) and Inuit Tapiriit Kanatami (ITK).

Objectives

The committee's objectives are:

• to develop and provide BEC with an implementation plan for a First Nations and Inuit health program Accountability Framework;
• to improve understanding of accountability for both communities and FNIHB staff;
• to facilitate and ensure an integrated approach toward program implementation processes; and
• to support evidence based decision making processes.

Mandates of Work Groups

To achieve its objectives and mandate 10 working groups were formed around the project themes identified below. It is envisaged that by early next year many of the Auditor General's recommendations will have been operationalised in the form of an accountability framework.

Group A Community Health Plan - The goal of this group is to come up with recommendations on what a community health plan should entail, as well as it's reporting requirements and capacity issues ( both FNIHB and communities) related to the development and implementation of a community health plan.

Group B - Work Planning, Information Transparency and Annual Reporting - The mandate of this group is to develop/improve and eventually automate existing FNIHB work planning processes with the aim of making them more transparent to First Nation and Inuit communities. Other issues of relevance to this group are annual reporting and FNIHB budget management processes.

Group C - Priorities, Decision Making and Transparency Processes - The focus of this group is to come up with recommendations that will improve transparency on how strategic management priorities and decision making is undertaken in the FNIHB.

Group D - Joint Management Processes - The task of this group is to document and provide insights on how joint management processes with First Nations and Inuit leadership could be used as model arrangements for regional, headquarters and national initiatives.

Group E - Describing the FNIHB "Tool Box"of Programs - The goal of this group is to compile a compendium of First Nations and Inuit programs that will form the basis for formulating community health plans. Program objectives, outcomes and reporting requirements are also to be identified. Also this group will review and provide recommendations on current "mandatory program requirements" if changes are deemed necessary.

Group F - Accountability Training/ Workshops - The aim of this group is to develop training programs and workshops that will help increase the profile and understanding of accountability mechanisms in FNIHB staff as well as First Nation and Inuit leadership, community health workers, tribal councils and other organizations involved in FNIHB - First Nations and Inuit health systems.

Group G - Agreement Management: How to Resolve Defaults in Agreements - The mandate of this group is to develop policies, guidelines and criteria that would guide FNIHB and First Nations in monitoring, assessing and redressing breaches/defaults in agreements in service delivery (financial and program management) issues.

Group I - Information and Knowledge Management - The goal of this group is to initiate and facilitate a process whereby an information and knowledge management framework is in place to effectively deal with health risk, surveillance, service delivery and program analysis functions.

Group J - Audit - The work of this group is centered around designing in consultation with other federal departments like Indian Affairs integrated audit programs that will allow for the development of a single auditing tool and process, thereby simplifying processes for communities.

Group L - Dealing with the North and Accountability - The mandate of this group is to identify unique service delivery agreements and program challenges that FNIHB faces in areas such as N.W.T., Nunavut , Yukon, Nunavik (Quebec) and Northern Labrador which require distinct accountability processes compared to other FNIHB regions.

Anticipated Outcome of Working Group Projects

It is envisaged that the outcome of FNIHB Tool Box Description process will yield a compendium of health programs that will serve as the main building block for communities in the preparations of a flexible Community Health Plan. This heath plan will identify and quantify an optimal number of health programs needed to address the priorities in a community depending on the needs and resources available. The foregone phase will assist in the determination of tombstone and health status data to be reported through the Health Information System or by communities in their annual reports in order to show results or outcomes and could assist in identifying health status or the degree of wellness in a community by providing measurable indicators.

Conclusions

The committee expects that clear accountability is needed to minimize and manage the risk to health and ensure access to adequate levels of health care and services for First Nations and Inuit community members. Accountability clearly lays out who is responsible for what, the standards that are expected, and the processes that will be used to ensure accountability at every level of the First Nations and Inuit - FNIHB health system.

The committee will work to keep you informed of its progress as it carries out its mandate.