The state of health in Quebec First Nations is alarming, despite some improvements observed in recent years. The communities have consequently seen that the current health and social services governance model does meet the needs of Quebec First Nations.

The process stems from the desire of the communities and organizations to increase the autonomy of First Nations and gain greater control over all decisions that affect them. This initiative aims to redefine the current governance structure so that First Nations can regain control over the responsibilities currently held by Indigenous Services Canada (ISC) in terms of health and social services. The work carried out as part of the process is therefore focused on developing a new governance model that will allow First Nations to take over the responsibilities for the health and wellness services that are intended for them. The structure and operation of this new model will provide First Nations with greater decision-making power and the autonomy and freedom needed to develop and deliver appropriate services that meet the genuine needs of those being served. 

By the end of the process, Quebec First Nations will have collectively built a health and social services governance model which is adapted to their needs and context and which fosters self-determination. The implementation of this model must ultimately improve First Nations’ wellness. 

In 1989, the Government of Canada began transferring responsibilities for health and social services to the First Nations, but without allowing them to determine the services to offer their populations. The existing governance model is based on the sharing of responsibilities and decision-making powers between different governmental entities, which limits the First Nations and leaves them little room for action at the local level. In the current model, the real decision-makers show little interest in the communities’ particular needs or the choices they would like to make. They do not take account of the fact that Quebec laws differ from those of the other provinces. They prefer to implement national programs defined by federal government departments for all the First Nations in Canada.

This is a process originating with the communities. In
accordance with a motion passed by the AFNQL chiefs, the FNQLHSSC is coordinating the process, with support from the AFNQL chiefs. The Board of Directors is closely following the progress being made. The FNQLHSSC is guided by various committees.

Its role includes ensuring the participation of all communities and organizations so that the governance model is adapted to the realities and needs of the First Nations in Quebec. The FNQLHSSC is also responsible for disseminating information on the process and promoting the adherence and mobilization of all local, regional and national stakeholders. As for the FNQLHSSC’s senior management, it is responsible for directing this process. To coordinate and support the work, a specific project team was established. 

Different local, regional, provincial and national stakeholders are involved in the governance process as active participants, collaborators or partners, both administratively and politically. Since the governance process is emanating from the First Nations in Quebec, they are the main stakeholders.  

*The Cree and Naskapi nations, as well as the Inuit, are kept informed and have access to the information. But because they adhere to the James Bay and Northern Quebec Agreement in 1975 (Cree and Inuit) and in 1978 (Naskapi), these nations are integrated into Quebec’s health system. 

The communities involved in comprehensive claims are also invited to participate in the meetings. They have essentially the same concerns regarding health and social services that the non-agreement communities have. The work being done collectively can be used by these communities to complement their reflections in various areas, e.g., transfer of responsibilities, taking of the communities’ needs into account, organization of services, mobilization of the population, expertise transfer, etc. The health and social services governance process is intended to foster local autonomy, at the same time organizing, where there is room to do so, the pooling of certain resources to ensure better support for the delivery of services in communities requesting such support. 

The model is being developed by representatives of the communities and organizations according to the principle of co-construction. Communities and organizations fuel the collective reflection and provide guidance to the FNQLHSSC for the development of the desired governance model. The FNQLHSSC relies on these directions in the context of the various work carried out.  

During phase I, the First Nations collectively decided to adopt an effective governance approach for the new health and wellness governance model. It is a concept that focuses on achieving collective goals through the involvement of all stakeholders in managing, sharing responsibilities, making decisions and delivering services. As for phase II, it enabled the communities and organizations to define 56 Guidelines for the Development of the Effective Governance Model regarding: 

• Planning in health and social services; 
• Accompaniment in health and social services; 
• Decision-making and accountability; 
• The Health and Social Services Directors Network. 

In November 2017, an important milestone was reached in the validation by community and organizational representatives of a general governance model developed based on the four components of effective governance: 

1. Authority;
2. Stakeholders involvement;
3. Regulation and intervention;
4. Guidelines. 

The process has therefore begun a new phase focused on the realization of this general model. The work associated with this phase aims to define the structure, responsibilities and functioning of each of the components of the model that will be presented to the Chiefs of the AFNQL in the spring of 2020.  

The health and social services governance model has two main components: local governance and regional governance. This model illustrates the structures and the major functions that they should assume. Band councils and First Nations organizations represent the local level bodies and a regional body supports them in achieving their goals. 

Governance at the local level is at the heart of this model. Community service planning is the cornerstone of effective governance, as this allows for setting the objectives related to improving health and wellness as well as the activities and interventions that will be undertaken to achieve them. The collective aspect thus supports the communities for the implementation of this planning. This governance, both locally and regionally, can only be achieved through the existence of a tripartite agreement bringing together the AFNQL and the federal and provincial governments. These three parties must be actively involved in supporting the First Nations health and social services governance process.  

Phase III work is dedicated to the realization of the governance model. More specifically, the work consists mainly of detailing each of the components as well as the different structures to be put in place, their roles and responsibilities, their composition and their rules of operation. This is a decisive phase, as it will lead to the adoption of the concrete effective governance model by the Chiefs of the AFNQL in the autumn of 2023.  

Various co-construction, validation and approval mechanisms will be implemented to ensure that all First Nations communities and organizations have all the information they need to make an informed decision. 

• Reappropriation and take-over of responsibilities in health and wellness. 
• Greater collective powers and greater autonomy at the local level for funding management and service delivery. 
• Improvement of the service offer and access to local and regional services. 
• Culturally relevant and adapted programs and services that meet the genuine and priority needs of those being served. 
• Since they are administered by First Nations at the local and regional levels, programs and services will better respond to the needs and realities of their populations, which can significantly improve individual and collective health and wellness. 
• The use of a comprehensive and integrated planning approach for health and wellness that includes the different social determinants of health.  

Yes. One of the principles adopted by the Chiefs addresses
respect for local authority. One of the roles of the First
Nations regional commissions and organizations, such as the
FNQLHSSC, is to support communities in their quest for
autonomy. The governance model provides for maximum autonomy for communities so that they can take on greater responsibility in terms of health and social services.

Any management requires accountability. In the case of a governance model, by and for First Nations, First Nations will assume more responsibility. The conditions associated with accountability will need to be negotiated between the federal government and the First Nations.

First Nations will decide on the governance model they want to implement to meet their needs. Depending on the model chosen, it will be necessary to review current governance and structures. The role of the FNQLHSSC is to coordinate the process and enable First Nations to define the desired governance model and the administrative structure required to support communities and organizations..