Health Systems Performance Measurement Systems in Canada: How Well do They Perform in First Nations, Inuit, and Métis Contexts?

OBJECTIVE To inventory and describe currently available health performance measurement systems for First Nations, Inuit, and Métis people in Canada to identify why current measurement systems are inadequate to inform community or regional level health planning. METHODS Inventory, classification, and synthesis of strengths and weaknesses among existing health system performance measures through systematic literature review and key informant interviews. RESULTS Indigenous-specific health indicators are available at national, provincial, regional, and community levels, but there is a paucity of data for non-registered First Nations, Métis, and Inuit people. Barriers to the effective use of these indicators include: indicator selection driven by accountability rather than public health requirements; poor data quality; inadequate infrastructure and human resources; minimal information returned to communities; tension between agencies collecting universal indicators and Indigenous-determined processes; and, mistrust by Indigenous communities of externally imposed processes. The focus on national systems results in greater attention to disease-based measures and less focus on regional cultural diversity and Indigenous-specific values and priorities. CONCLUSION Indigenous health system performance measurement infrastructure in Canada is underdeveloped, particularly at the local level, and hence deficient in its ability to support community or regional health planning.