Why transform health and social services governance?

First Nations health is a source of concern, and self-government is a social determinant of the population’s health status. Better governance in health and social services, whether at the regional or local level, has the potential of expanding self-government within the current legislative framework.
The current processes in place to deliver health and social services to Quebec First Nations have several shortcomings that stem from a system that cannot make optimal use of its resources or provide programs and services at the desired level of effectiveness. The results obtained for health and well-being, using the data available, show that First Nations are at a significant disadvantage with respect to the rest of the Quebec population.

As recommended by the First Nations, the solution to this problem lies in the fundamental transformation of the health and social services governance structure. Better governance, which would require a transfer of powers to First Nations leaders, would result in more effective programs and services for First Nations.

It has been recognized that policies and programs are better structured when based on an in-depth knowledge of its targeted clientele; indeed, in such cases, better information is available throughout the planning process and service providers can be accountable directly to the beneficiaries of these services.

It is crucial that new agreements be signed to return control to First Nations over all the health and social services to which they are entitled and require access, to thus ensure better governance and to help improve the well-being of Quebec First Nations populations.

The First Nations of Quebec have a choice to make. They must decide the road to borrow and the shape their new governance model must take to achieve better results for their population.

 

Article 23 of the United Nations Declaration on the Rights of Indigenous Peoples (ONU, 2007)1

 

Indigenous peoples have the right to determine and develop priorities and strategies for exercising their right to development. In particular, indigenous peoples have the right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own infrastructure.



Origin of the process

In 2006, the First Nations of Quebec collectively launched a reflection process and made the decision to introduce a blueprint for health and social services. A large-scale, far-ranging consultation took place across Quebec, which led to the development of the Quebec First Nations Health and Social Services Blueprint, 2007-2017: Closing the gaps... Accelerating change.

In 2007, this blueprint was presented to the AFNQL Chiefs, who adopted it by means of resolution.  

The health and social services governance process emanates from the conclusion reached by the First Nations that it is necessary to renew the current structure in order to move forward with their plans for self-determination.

In 2014, the Chiefs once again reiterated their support to revise the current governance structure. This new motion, adopted in February 2014, reaffirmed the interest of First Nations to put in place a consultation and reflection process to develop a new governance model to meet their needs and special requirements. 
 

Issues associated with the current governance structure 

First Nations must contend with a complex political and legal context that has several repercussions on the administration of health and social services in the communities—repercussions that are reflected in the health status of the populations. The issues presented below have been reported by community representatives and will be taken into account when developing the new governance model.

Decision making

Although several communities have taken over their health and social services, the fact remains that they have little freedom to develop and manage their own services to meet the needs of their population. Communities are therefore restricted to offering services that are subjected to external laws, which involves legal conflicts, grey areas and heavy administrative burdens. Communities are held to managing the programs imposed, which oftentimes have not been culturally adapted, have been designed without consulting the First Nations and furthermore involve complex reporting requirements.

Funding

First Nations do not have independent financial resources to adequately meet their specific needs. Services must be offered in keeping with the allocated funding and based on pre-established criteria. The sources of funding are far-ranging and uncertain, and many funds are nonrecurrent. In addition, all funding is tied to exaggerated reporting requirements that meet the needs of the financial backers and not those of the First Nations. There are also inconsistencies in the allocation of resources, such as decreases in the allocated funding despite rising needs, or funding that ignores the social determinants of health.

Access to human and material resources

Few professional resources operate in First Nations communities, which hinders the cultural adaptation of services. There are also problems with personnel retention in the communities as a result of the non-competitive work conditions, which creates its own set of problems in terms of human and professional resources, such as a high turnover rate and an ad hoc physician presence in several communities. Material and operational resources are also limited, as there is insufficient funding to invest in infrastructure and develop new services such as residential care facilities for seniors.

Access to services

First Nations living in remote communities have to travel significant distances to access the services offered by the Quebec health and social services system in urban centres. Even though First Nations have access to specialized provincial care, the continuum of services between community care and the Quebec system is often lacking and varies from one community to the next, according to organization-specific agreements. Language is yet another barrier to service access.

Communication and information management

There is a mutual lack of understanding between First Nations and the Quebec system workers. Among other things, this misunderstanding or ignorance leads to confusion in the roles and responsibilities each must play. It also results in poor information and data sharing and insufficient consultation of First Nations. There is also little available funding for First Nations-led research that meets First Nations priorities.

Integration of culture

It is often mentioned that First Nations have difficulty adopting a holistic and culturally appropriate approach given the way the programs and services are presently conceived. First Nations postulate that by factoring in culture and integrating it into the health system, the services will be more effective and more widely used as they will better reflect the communities’ values and principles. In terms of the services offered outside of the communities, First Nations want to reinforce ties with Quebec health and social services system workers to foster the development of more culturally sensitive services.

 
 

1. The United Nations Declaration on the Rights of Indigenous Peoples can be found on the United Nations website at: www.un.org.