Quebec First Nations Health and Social Services Governance Process:
A renewed approach to governance fostering self-determination

First Nations in Quebec have noted for many years that the current health and social services system does not adequately meet their realities and needs. Initiated in 2013, the Quebec First Nations health and social services governance process stems from this observation made by First Nations regarding the need to renew the current governance structure.

Thus, the health and social services governance process aims to develop and support the autonomy of First Nations communities and organizations in a perspective of self-determination and improvement of their wellness. At the end of this process, the First Nations will have collectively built a new model of effective governance by and for First Nations that relies on a co-construction approach that is supported by environmental analysis and they will have worked towards its implementation.

Objectives and expected results

Build the local and regional decision-making capacity of First Nations communities and organizations with respect to the governance of health and social services in terms of existing programs, sectors and initiatives.

Renew the partnerships between First Nations and government institutions, in accordance with a model of governance adapted to the needs and realities of First Nations in order to improve the service offer and access to services at the local and regional levels.

The status quo is no longer acceptable…the time has come to start making, together and collaboratively, the changes that will allow us to turn the table and make sure that the health and quality of life of First Nations changes radically.

– Ghislain Picard, regional chief of the AFNQL

Vision, values and principles

In February 2014, the Chiefs of the Assembly of First Nations Quebec-Labrador, reunited for an extraordinary assembly, adopted a vision statement as well as values and principles to guide the entire health and social services governance process:

VISION

« Through our self-determination, a global and concerted approach, individual and collective commitment, we will be healthy people connected to Mother Earth and our physical, mental, emotional and spiritual well-being will be balanced. »

VALUES

Honesty

Respect

Autonomy

Community

Solidarity

Assistance

PRINCIPLES

1

We affirm that our ceremonies, values, languages, teachings and traditional medicines, are an integral part of our way of living healthy life.

2

We affirm that the First Nations healing journey will be strengthened when considering the person and the environment as a whole.

3

We affirm that the social determinants of health to First Nations are unavoidable to address health issues.

4

We affirm our right to self-determination and our inherent right to have and to freely pursue our own health, economic, social and cultural development.

5

We affirm that the ten Nations are responsible for First Nations health.

6

We affirm that responsibilities of the local and regional institutions are to manage, protect and enhance health and social services programs according to the mandates they received from Nations and First Nations communities.

7

We affirm that our regional institution supports First Nations in their autonomy quest in supporting strategic alliance building between First Nations with governments in their organisation of health care and services, development of expertise as well as knowledge transfer.

8

We affirm that the federal government has a legal and fiduciary duty and constitutional responsibility to provide adequate, sufficient and sustainable financial resources for the development, implementation, management and delivery of quality health programs and services that respond to our needs and taking into account the determinants of health.

Coordination

Since the resolution that was adopted by the Chiefs of the AFNQL on March 26, 2025, work on governance in health and social services has been carried out under the authority of an Ad Hoc Committee established by the Chiefs Advisory Committee.

The FNQLHSSC governance team coordinates the work of resources to: 

  • Continue the governance model work that will contribute to the negotiation and transition mandates.
  • Support the work of the Ad Hoc Committee and its members.
  • Support the negotiation team established by the Ad Hoc Committee.
  • Support the FNQLHSSC’s mandate in preparing for the transition.
  • Maintain consistency with the model desired by the First Nations. 
Ad Hoc Committee

The Ad Hoc Committee is entrusted with the mandate to guide the preparatory work for negotiations as well as the negotiation process with the governments of Canada and Quebec. 

This mandate is part of the implementation of the health and wellness governance model that was adopted by the Chiefs of the AFNQL at their meeting on March 26, 2025. 

In order to support and fuel the reflection of First Nations, several committees have been created to bring different sets of expertise to the table and help collect the necessary information and knowledge to develop the relevant governance model.

Monitoring Committee

This committee monitors the operational and logistical aspects of the project. Its role is to monitor the content and quality of documents that are produced and to ensure respect of deadlines and costs.

Chiefs’ Advisory Committee

The objective of this committee is to look at the political concerns. Seeing that the Chiefs’ Assembly is a key regional authority, It is necessary to maintain an important link with it to ensure that account is taken of the Chiefs’ concerns.

Committee of Partners

It is imperative to mobilize the stakeholders to ensure productive collaboration. Thus, this committee helps to inform partners and ensure their engagement throughout the process.

Committee of Experts

This committee provides professional and technical advice on the project and on how to carry out the activities.

Phases

Phase 1
Portrait of the situation (2014-2016)

Identification and analysis of the processes of change in governance in health and social services carried out in the world in recent years.

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Phase 2
Re-appropriation (2016-2018)

Re-appropriation of the federal government’s health and social services responsibilities: development of guidelines.
Development of an effective governance model.

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Phase 3
Options (2018-2022)

Finalization of the governance model based on the responsibilities repatriated from FNIHB and INAC.

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Phase 4
The choice (... -2023)

Summary of transformations.
Decision-support at the community and chiefs level.

Depending on the governance model that will have been chosen and in accordance with the wishes of the First Nations, other actions may be pursued, such as the completion of a feasibility study, negotiations with the federal and provincial governments and the drafting of a transition plan.

decision-making process

The Health Directors Network, at the caucus meeting on January 24, 2018, recommended setting up a representative working group composed of the different nations in Quebec to guide the decision-making process between the Health and Social Services Directors and Indigenous Services Canada (ISC). This representative working group will enable each nation to be involved in the implementation of the decision-making process.

Mandate

Supporting the Health and Social Services Directors in the reflection leading to the development of a decision-making process: a reciprocal and joint planning cycle between First Nations and ISC.

Composition

  • Nicole Ratt (representative for the algonquin nation)
  • Jean Vollant (representative for the abenaki nation)
  • Valerie Diabo (representative for the mohawk nation)
  • Marceline Tshernish (representative for the innu nation)
  • Sophie Picard (representative for the huron-wendat nation)
  • Amanda Larocque (representative for the mi’gmaq nation)
  • Serge Awashish (representative for the Atikamekw nation)

Click here to read our publications regarding the decision-making process.