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Evaluation of the First Nations Health Authority (FNHA)


First Nations Health Authority


Evaluation, Organizational Review, Strategy

Background and Challenge

In 2013, the First Nations Health Authority (FNHA) assumed responsibility for programs and services previously discharged by Health Canada's First Nations and Inuit Health Branch – Pacific Region and associated administrative functions, as part of a broader mandate to work with the Province of British Columbia to improve health services for First Nations in BC. The purpose of this evaluation, which covered fiscal years 2013/14 to the end of the fiscal year 2018/19, was to tell the story of change resulting from FNHA's creation and to give an account of the progress that FNHA has made against its mandate and strategic plan. More specifically, the project reviewed the progress made in transitioning the entire healthcare system and programs, enhancing health governance, championing the BC First Nations perspective on health and wellness, advancing excellence in programs and services, and operating as an efficient and effective First Nations health organization.

Approach and Methodology

Qatalyst was hired to develop an evaluation framework and tools and assess the progress made in establishing plans and providing health and emergency management services. The research program for this assignment was extensive. In order to properly evaluate the FNHA, we:

  • Conducted interviews with 50 key informants including representatives of the federal and provincial governments, senior members of the FNHA staff, members of the FNHA Board of Directors, and representatives of the FNHC and FNHDA.
  • Led focus groups with the FNHA and FNHDA Boards of Directors. A focus group discussion was conducted with both the FNHA Board of Directors and the First Nations Health Directors Association (FNHDA) Board of Directors. Focus group discussions covered key areas including the success of the FNHA in achieving its mandate, role and responsibilities, the effectiveness of its governance structure operations and programming, key challenges it faced, lessons learned and opportunities for improvement going forward.
  • Thoroughly reviewed documents and files related to the FNHA. Over 100 background documents were reviewed including agreements (e.g., Tripartite Framework Agreement, Canada Funding Agreement), annual reports, financial statements, strategic plans and multiyear health plans, policy frameworks, communication materials, evaluation reports, risk register, briefing notes and other relevant documents and files.
  • Undertook eleven case studies. The case studies provided an in-depth review of specific areas of FNHA operations, the evolution of these areas over time, impacts of the key changes introduced, challenges faced and mitigating strategies. Based on preliminary interviews with FNHA staff members, key areas of the FNHA operations and governance were selected to be further studied through case studies. The case studies explored a wide range of key areas of FNHA operations and programming, corporate capacity, and governance.
  • Results

    The evaluation enabled the organization to take a step back and evaluate the progress it had made in transforming the healthcare system for First Nations people in BC over the previous ten years. More importantly, it identified key priorities to improve the organization going forward including:

    • Strengthening its strategic focus on transforming the health care system.
    • Improving the operating model in order for the organization to function effectively at the provincial, regional and community levels.
    • Strengthening organizational capacity and effectiveness of its programs and services.

    The findings of the evaluation fed directly into the development of a strategic plan for the organization covering the next five years. The strategic pillars, tactics and actions directly reflected the key issues outlined in the evaluation. We worked with the FNHA in developing the strategic plan as well as in developing and performance measurement framework and evaluation strategy to track and report on the results. The project was completed on time and within budget.

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