Considerations for the elaboration of the proposed health and social services governance model 

The process’s focus has thus far been on the necessary points of consideration for the development of a governance model: culture, regulations, accountability, participation, transparency, effectiveness and fairness.

The discussions with community representatives have shed light on how each of these different elements should be treated during the development of the new Quebec First Nations health and social services governance model.

Culture

  • First Nations want to institute a governance model that integrates their culture and understanding of health.
  • First Nations lay claim to the right to offer their population health and social services that are culturally adapted.

Regulations

  • Predetermined regulations and statements in the agreements concluded with the governments during a partial or full transfer of authority to the First Nations. 
  • Regulations determined by the First Nations to ensure local authority for each community.

Accountability

  • The roles and responsibilities of all signatories, understood and accepted by all parties.  
  • Expectations respecting reporting requirements that are explicit, understood, agreed upon and determined based on each party’s capacities.
  • Reasonable reporting requirements. 

Participation
  • The inclusion of mechanisms to mobilize stakeholders and the population to take part in the decision-making process.
  • Stakeholder commitment, bolstered by relevant, targeted goals. 

Transparency

  • A detailed and accessible description of each party’s powers and responsibilities. 
  • The implementation of a process to ensure the free flow of information.

Effectiveness

  • Capacity reinforcement for the development and delivery of programs and services. 
  • Strengthening of First Nations institutions.

Fairness

  • The implementation of management processes to guide the application of regulations, signatory autonomy and conflict resolution.

Other aspects of the potential model must also be considered by the First Nations. 

 

The unique characteristics of each community

The Quebec First Nations communities have varying degrees of organizational capacity, which could condition the transfer of new responsibilities. In addition, communities have a wide diversity of needs and priorities. As such, the new governance model must take the unique characteristics of each community into account.

Economies of scale

One of the greatest benefits of uniting the First Nations communities under a shared governance structure is the opportunity to achieve economies of scale. At the present time, it would be impossible for each community to have the necessary human resources to fill every position, whether medical or administrative in nature, to improve the health and well-being of its population. So long as it is warranted by the situation, equipment and human resources should be shared to optimize potential services and reduce associated costs.