Table 1 The EPIC framework encapsulating a holistic approach to pandemic preparedness and response that centres Indigenous leadership
Concept | Strategies by phase | Examples from case study communities |
|---|---|---|
Equity: Promoting equity in health governance involves prioritizing Indigenous sovereignty and self-determination, ensuring fair access to health resources, and fostering a healthcare system that respects and addresses the unique needs and priorities of Indigenous peoples and communities | In Preparedness - Address inequities prior to pandemics to build resilience by strengthening the Indigenous public health workforce at all levels - Embed cultural governance models in health emergency management - Cultural safety of the health workforce | - Decolonisation of health services - Food security - Police and other government liaison partnerships - Housing (e.g., reducing crowded housing) - Maintaining on-the-land programs |
In Response - Prioritise Indigenous populations’ access to medical care, personal protective equipment (PPE), testing, vaccines - Allocate adequate risk-based funding to Indigenous controlled health services proportionate to the risk. - Develop and distribute culturally appropriate communications - Recording and reporting Indigenous status across all datasets through data-linkage - Mechanisms to support Indigenous staff | - Routine vaccination outreach with Indigenous communities - Hunter New England Local Health District (HNELHD) Aboriginal Cultural Support Team supporting confirmed COVID-19 cases and contacts o Establishment of an Indigenous public health team o Accountability framework embedded across all teams to ensure all cases and contacts were asked their Indigenous status. Replaced “not stated” response option with “not asked” and achieved 99.7% Indigenous status completeness. o Employed Indigenous wellbeing officer and prioritised support, networking, connection and debriefing. - FAFN community nurses led contact tracing - Community-led response in FAFN helped to establish trust amongst the community when measures were being implemented | |
Partnerships and Indigenous Leadership Strengthening partnerships in health systems to align rhetoric with effective action and resource allocation that prioritizes Indigenous leadership. | In Preparedness - Strengthen relationships and partnerships with key Indigenous health government services and Indigenous community-controlled health services and organisations - Embed Indigenous health leads in local health emergency management processes and committees | - Inclusion of senior Indigenous health leads (Indigenous Health Unit, Public Health Unit, Clinical Lead) on the local HNELHD Health Service Functional Area Committee - HNELHD Public Health Aboriginal Team actively involved in the development of Community Action Plans for discrete Indigenous communities - FAFN has annual meetings to review the pandemic plan - Coordination of response services with local health authorities (Weeneebayko Area Health Authority, Porcupine Health Unit, and Indigenous Services Canada) |
In Response Indigenous Public health leaders convene local Indigenous Governance Groups to oversee the response | - HNELHD Indigenous Governance Group on COVID-19 - HNELHD Indigenous Vaccination Steering Committee - Partnered with Indigenous Health Unit to provide on-ground community support and distribution of personal and household hygiene packs - FAFN had a pandemic committee and easing community restrictions group to help lead the response - Food and PPE deliveries were done with support from the Canadian rangers and local businesses | |
Intelligences (local and cultural): Respecting and incorporating community and cultural intelligence in health strategies and public health decision-making. | In Preparedness - Embed principles of data sovereignty and cultural intelligence in routine and emergency public health surveillance - Develop an Indigenous employment strategy and surge plan that includes Indigenous people at all levels and stages of the response | - Activated HNELHD Indigenous Data Governance Group - Representation on Local, Regional and State Emergency Management Committees - Surge plan included Indigenous focused positions for HNELHD COVID-19 response - FAFN used community-level data from local organizations to deliver services and advocate for more funding to mitigate community challenges (e.g., crowded housing, opioid addictions) |
In Response - Cultural oversight and insight applied to distribution and determinants of disease - Sharing and discussing data with Indigenous governance groups - Develop strengths-based Indigenous focussed surveillance reporting | - Accessing local contact and exposure networks and kinship networks to activate local support services - After-action reviews through Indigenous lens - Presented data at weekly Indigenous governance groups - FAFN committee was meeting a minimum of 3 times a week to review the situation within the community and discuss any new data | |
Change: Committing to informed systemic change that aligns actions with equity, partnerships, and intelligence (local and cultural). | In preparedness: - Embed cultural governance processes and practices in a health organisation - Cultural safety training | - Having HNELHD Population Health Joint Governance Group (health organisational governance) established since 2017 enabled cultural governance processes to be embedded within the public health emergency management - FAFN has had their pandemic plan since the H1N1 pandemic in 2009. This plan is reviewed every year to ensure staff are familiar with it. |
In response: - Public health ethics and minimum standards and Indigenous health | - Recruitment and training delivered to all surge staff - Meetings held regularly to ensure that all measures, clinics and services being delivered were running as efficiently as possible. |