Next steps laid out for Nishnawbe Aski Nation’s health transformation during virtual chief’s assembly

Transforming and improving the First Nations healthcare system within the Nishnawbe Aski Nation (NAN) was top of mind during NAN’s virtual chiefs assembly this past week.

The two days were full of discussions about Indigenous health legislation and governance, the development of a community-based paramedics program within the 49 NAN First Nations and the signing of relationship accords with a number of healthcare organizations that provide services across the north.

Ovide Mercredi, the health transformation lead and negotiator for NAN, reminded those tuning into the assembly, “the change should not be limited to increasing services of the capacity of communities to deliver their own health plans, but it should also be done under their autonomy.”

Mercredi added, health transformation isn’t just about improving access to services, it’s about First Nations having jurisdiction over how healthcare is provided to their people, in their lands.

The process was kick-started in 2017, when Grand Chief Alvin Fiddler signed a charter of relationship principles alongside federal and provincial ministers of health that set out common objectives and set all three governments on the path to transform the delivery of health in Nishnawbe Aski Nation territory.

Ontario and feds share their updates

Both governments provided updates on their work to make the transformation happen.

Pam Damoff, the parliamentary secretary to the minister of Indigenous Services Canada, laid out the federal government’s plan to draft Indigenous health legislation that she said would aim “to improve Indigenous access to high quality, culturally safe health services.”

Damoff said the federal government has already begun engaging with Indigenous communities, leaders and other stakeholders, with plans to draft legislation toward the end of 2021. She also acknowledged the “core need” of mental health services.

She said this work would build on other conversations to address anti-Indigenous racism in all institutions, including healthcare.

Shortly afterwards, Ontario’s Minister of Health Christine Elliott spoke to the virtual gathering of chiefs, congratulating NAN on the success of Operation Remote Immunity to vaccinate remote, fly-in First Nations.

Elliott also announced that Charles Fox of Bearskin Lake First Nation, a former NAN Grand Chief and Ontario Regional Chief for the Chiefs of Ontario, would be the lead negotiator for the province on the health transformation file. The federal government had previously appointed Roger Jones as their lead.

But both elected officials faced questions from chiefs looking for immediate actions and investments that would address ongoing housing, water, addictions and other health crises.

NAN’s health transformation lead Ovide Mercredi also presented updates to chiefs on their Wechedowin document, a framework agreement they hope to present to the provincial and federal governments that would set out priorities and points of negotiation for the three governments moving forward. Wechedowin is a Cree word that roughly translates to “helping each other.”

Community-based paramedics program and ‘hospital-without-borders’ priorities for NAN

As the longer-term negotiations about health transformation continue, Mercredi said there were a number of priorities they wanted to expedite.

That includes a community-based paramedics program, which Mercredi says NAN hopes to bring to the 38 First Nations that are currently without paramedic services.

Surveys are currently underway to identify what infrastructure needs are required, a budget has been submitted to both levels of government for review, and Mercredi says work is ongoing to develop a paramedic education and training program that includes supports for interested applicants that may not have completed their high school diplomas.

Discussions and planning around funding, governance models and a possible headquarters for the proposed program are ongoing, Mercredi said.

He added there is a major gap in paramedic services in NAN First Nations, with the only service provider being the Weeneebayko Area Health Authority, which services six communities on the James Bay coast.

Chiefs were also provided an update on NAN’s “Hospital Without Borders” concept, which would look to bring primary healthcare services into communities.

“They’re receiving service in old nursing stations, old health centres and in smaller buildings,” said Mercredi.

The planning is still in its early stages, with the Sioux Lookout First Nations Health Authority being asked to develop the concept.

Relationship accords signed with healthcare organizations

A number of healthcare organizations were also virtually present at the chiefs assembly to acknowledge the signing of relationship accords with the Nishnawbe Aski Nation that aims to improve health outcomes for people throughout NAN territory.

The organizations included:

• Ornge.
• University Health Network – Peter Munk Cardiac Unit.
• Paramedics Association of Canada.
• Canadian Red Cross.
• Northern Ontario School of Medicine.
• Ontario College of Family Physicians.
• Registered Nurses’ Association.
• Association of Ontario Midwives.

According to a press release, the collaborative work will focus on developing practice guidelines, cultural-specific training and awareness, practice support and improving communications between the organizations.

In a statement, NAN Grand Chief Alvin Fiddler said, “these Accords are significant steps to achieving health equity and the removal of barriers to safe and effective healthcare.”

The next NAN chiefs assembly is scheduled for August, where health transformation conversations will continue.