First Nations health transformation

Moving towards health models where First Nations design and deliver their own programs and services.

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About First Nations health transformation

To make significant improvements in overall health outcomes for First Nations, the federal role in health is changing. Instead of designing and delivering health programs and services for First Nations, Canada is moving towards models that support First Nations to design and deliver their own health programs and services.

Through health transformation, the Government of Canada is supporting First Nations-led institutions and organizations to increase their control over the design and delivery of First Nations health services and to advance cultural safety and self-determination in health care.

First Nations health transformation is a collaborative process between Canada, First Nations and provinces, where we establish new partnerships based on reciprocal accountability, so that decisions over health for First Nations can be made by First Nations.

Health transformation projects support the development of new First Nations-led health organizations that will assume responsibility for the:

The goals of First Nations health transformation are to:

Another part of the change process is Co-developing distinctions-based Indigenous health legislation. Legislation may provide the framework that describes the vision, roles and responsibilities for Indigenous health. Health transformation efforts will help build the capacity in First Nations communities to implement the vision.

This process of change may take a long time, but the Government of Canada is committed to the process and its partners.

Models of health transformation

In British Columbia, a new era in First Nations health was forged in 2011 with the signing of the British Columbia Tripartite Framework Agreement in First Nation Health Governance. This tripartite agreement created a new province-wide First Nations Health Authority in 2013 with a direct leadership role for the design, delivery and management of health programs and services for First Nation communities in British Columbia. The tripartite partners work closely together to improve health outcomes for British Columbia First Nations communities through a First Nations health governance structure that addresses health and other inequities experienced by First Nations and works to identify opportunities for stronger coordination with provincial programs and services.

In 2023, Canada renewed its 10-year funding agreement to continue to support the FNHA in its work to improve health outcomes for First Nations in British Columbia.

In other parts of Canada, including Manitoba, Nova Scotia, Ontario and Quebec, the Government of Canada is supporting First Nations-led institutions and organizations to increase their control over the design and delivery of First Nations health services and to advance Indigenous cultural safety and self-determination in health care. These health transformation projects aim to improve health outcomes and access to services for First Nations. Each project is unfolding in a unique way depending on the priorities of First Nations communities. With federal funding support and guidance, efforts are underway to create organizational capacity, engage community members to identify health priorities, create provincial and federal partnerships, explore and develop governance and service models, and work towards service delivery improvements on the path to a full transfer of control. This work has resulted in some promising developments:

  • In 2018, Manitoba Keewatinowi Okimakanak (MKO) signed a Memorandum of Understanding with Canada committing to First Nation-led health care transformation in MKO territory. In 2020, MKO established the Keewatinohk Inniniw Minoayawin (KIM), a northern First Nations led-health organization that is exploring innovative primary care services models tailored specifically for northern Manitoba First Nations communities and preparing to assume the responsibility for service delivery.
  • In 2019, the First Nations of Quebec and Labrador Health and Social Services Commission signed a tripartite Memorandum of Understanding with Canada and the province of Quebec, which committed the partners to work towards a new health and social services governance model.
  • In 2020, the Southern Chiefs' Organization (SCO) signed a Memorandum of Understanding with Canada to establish a new health governance model focused on equitable and culturally appropriate health care for First Nations in southern Manitoba.
  • In 2021, the Nishnawbe Aski Nation (NAN) signed a trilateral statement with Canada and the province of Ontario, committing to work together in partnership to support the establishment of a First Nations health services delivery system in NAN Territory. NAN has actively worked with their communities to identify key health priorities requiring immediate action in conjunction with exploring new models of health service delivery that will bring services closer to home and build capacity in northern communities to access and deliver more culturally responsive services.
  • In 2022, Canada committed support to a partnership with Tajikeimɨk, a newly formed health and wellness organization working on behalf of Mi'kmaw communities in Nova Scotia.
  • In November 2022, Canada committed $23 million of Budget 2021 funding over 2 years to support MKO and KIM in their progress towards transforming the design and delivery of health services for northern Manitoba First Nations, which includes engaging First Nations communities to identify priorities for health and its design and structure as a new health organization.
  • In 2023, Tajikeimɨk signed a trilateral memorandum of understanding with Canada and the province of Nova Scotia declaring ongoing partnership and mutual support toward transforming the design and delivery of health services serving the Mi'kmaq in Nova Scotia.
  • In 2023, health transformation funding was provided to the Battleford Agency Tribal Council (BATC) to advance their health services model agreement including second-level health services. FNIHB is currently in early stages of health transformation discussions with BATC.
  • In June 2024, the SCO signed an Agreement-in-Principle on Health Governance with Canada, which outlines how health programs and services will be transferred from Indigenous Services Canada to the soon-to-be-established Southern First Nations Health Authority, serving the 34 Anishinaabe and Dakota Nations in Manitoba.

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