Presentation by NAN Health Transformation Lead, and Lead Negotiator

1. Health Transformation in
Nishnawbe Aski Nation
Mattagami First Nation
November 29, 2018
John Cutfeet, Health Transformation Internal Lead
Ovide Mercredi, Health Transformation Lead & Negotiator

2. What is Health Transformation?
A new direction:
• Co-creating with ALL the partners in health, not just Health Canada.
• Changing from a crisis-response system to an outcome-based, wellness system.
• Increasing and redistributing resources towards communities and making the
system directly accountable to community members.
Health Transformation is bringing back accountability, responsibility and resource
allocation to our communities. It will change the current colonial system to a new
system that is based on the needs and priorities of our communities.

3. Health Summit-November 2017
Directives for Moving Forward
 Guided by the Creator
 Legislative Framework Based on Recognition of Treaty and Aboriginal Rights
 Reconciliation Through a Nation-to-Nation Relationship
 Rooted in Cultures and Traditional Ways
 Community Driven and First Nations Controlled
 Recognize Diversity & Protect Existing Processes
 Nation-to-Nation Fiscal Framework
 Collaboration and Partnership
 Prevention, Health Promotion and Social Determinants of Health
 Community Capacity Building

4. NAN Health Transformation
Department
• NAN internal team under the direct portfolio of Grand Chief Alvin Fiddler.
• Ovide Mercredi, Lead & Negotiator
• John Cutfeet, Internal Lead
• Catherine Cheechoo, Manager
• Natalie Hansen, Senior Policy Analyst
• Paula Vangel, Policy Analyst & Negotiation Support
• Wendy McKay, Community Participation Coordinator
• Jenna Johns, Research Lead
• Leona Kakepetum, Project Assistant

5. Health Transformation Advisory
Council
• Teri Fiddler
• Helen Cromarty
• Dr. Doris Mitchell
• Mae Katt
• Dr. Mike Kirlew
• Ennis Fiddler
• Natasha Sugarhead, Youth
• NAN Health Advisory Group
• Janet Gordon/Chris McKay
• Francine Pellerin
• Jean Lemieux

6. Chiefs Council on Health
Transformation
• Chief Ignace Gull
• Chief Ellen Vontane-Keno
• Chief Alex Batisse
• Chief Titus Tait
• Chief Eno H. Anderson

7. Health Transformation Process
SYSTEMATIC REFORM
Policy & Legislative Reform
Long term - Governance & Operations
IMMEDIATE IMPROVEMENTS TO SERVICE DELIVERY
Policy Changes
Short term – Addressing Immediate Needs

8. SYSTEMATIC REFORM

10. NAN Territory First Nations Health and
Wellness System
The goal of NAN Health
Transformation is to build a First
Nations Health and Wellness
System which will include:
• An operations model,
• A fiscal model; and
• A governance model.
Fiscal Model
Governance Model
Operations Model

11. Five Health Transformation Pillars
1) Community Participation
o An ongoing process with many opportunities for community members to
participate and share insight, stories, input and perspectives.
o Health transformation will support and assist with the priorities identified
by the communities.
2) First Nations Law Development
o Communities will be supported in the exercise of their jurisdiction over
health and the development of their own laws. This will include building
upon traditional laws as well as developing contemporary laws and
exploring options for a legislative basis to establish a legally embedded
system in NAN territory.

12. Five Health Transformation Pillars
(continued)
3) Policy & Legislative Review
o Conduct a policy and legislative review to determine First Nation
entitlements to health services, including holding the government
accountable to providing legal obligations and Treaty health rights.
4) Fiscal Review & Funding Model
o A fiscal review will explore options to create a funding model for NAN First
Nations that is flexible, reflective of need and provides community control
over distribution of resources and that is founded upon Treaty and
Aboriginal Rights. All NAN First Nations should be receiving the same level
and quality of care at home that all other Ontarians are receiving.

13. Five Health Transformation Pillars
(continued)
5) Immediate Needs Process
o An ongoing process to address the immediate needs, including policy
changes to improve the current health delivery system.
o “This stuff saves lives now.”

14. Partnership Development
NAN Health Transformation Department is in the process of developing
partnership accords with:
• Health Quality Ontario
• Canadian Indigenous Nurses Association
• First Nations Health Managers Association
• Partners In Health, Canada

15. Meetings & Gatherings
• Matawa Chiefs – Thunder Bay - December 14, 2017
• Shibogama Health Directors – Thunder Bay - December 21, 2017
• Matawa Health Directors Meeting in Thunder Bay – January 9, 2018
• Oshkaatisak Council (NAN Youth Council) – January 29, 2018
• Health Directors Meeting January 29 & 30, 2018
• NAN Chiefs Assembly – January 31, 2018
• Sioux Lookout Chiefs Committee on Health - Sioux Lookout – February 6-7, 2018
• NAN Youth Gathering - Thunder Bay – February 9, 2018
• AFN Health Transformation Summit – Toronto – February 13-14, 2018
• Dennis Franklin Cromarty High School – Thunder Bay - February 27, 2018
• Northern Ontario School of Medicine – Thunder Bay – February 28, 2018
• NAN Chiefs Committee on Children, Youth and Families (CCCYF) – Toronto – February 26, 2018
• Sioux Lookout First Nations Health Authority (SLFNHA) Board - Thunder Bay – March 14, 2018
• Mushkegowuk Council Chiefs Meetings - Moose Factory – March 21, 2018
• NAN Education Community Engagement Session - Thunder Bay – March 22,2018

16. Meetings & Gatherings
(Continued)
• NAN Women’s Gathering - Thunder Bay – March 25, 2018
• British Columbia First Nations Health Authority - Vancouver – April 4-5, 2018
• SLFNHA and Meno Ya Win Health Centre - Sioux Lookout – April 17-18, 2018
• Windigo First Nations Council Frontline Workers - Sioux Lookout – April 18, 2018
• NAN Youth & Elders Gathering on Health Transformation – Thunder Bay – April 26-27, 2018
• Health Transformation & CCCYF Visioning Session – Thunder Bay – May 1-3, 2018
• NAN Chiefs Spring Assembly, May 8-10, Timmins, ON
• Shibogama Health Directors - Thunder Bay - May 17, 2018
• DetermiNATION Summit – Ottawa – May 22-24, 2018
• Standing Committee on Indigenous & Northern Affairs, Long-term Care on Reserve Study – Ottawa – June 7, 2018
• NAN CCCYF – Toronto – June 13, 2018
• Support for Garry Sugarhead, Walk for Diabetes – Thunder Bay – June 13, 2018
• Matawa Health Directors - Thunder Bay - June 14, 2018
• Health Advisory Group – Thunder Bay – June 19, 2018
• Mushkegowuk Council – Toronto – July 3, 2018

17. Meetings & Gatherings
(Continued)
• Tribal Council Executive, Social & Health Meeting – Toronto – July 4 & 5, 2018
• Health Quality Ontario –Toronto - July 5, 2018
• Chief of Ontario Health Transformation (Lily) – Toronto - July 5, 2018
• Community Visit– Kasabonika Lake First Nation – July 16 & 17, 2018
• Matawa Health Co-Op – Thunder Bay - July 18, 2018
• Wequedong Lodge Visit – Thunder Bay - July 18, 2018
• Wabun Tribal Council Chiefs – Timmins – July 31, 2018
• Ontario Medical Association (OMA) community visits – North Caribou & Keewaywin- August 1, 2018
• NAN Keewaywin Assembly – Chapleau Cree – August 14-16, 2018
• Canadian Indigenous Nurses Association – Ottawa – August 21, 2018
• St. Paul’s University – Ottawa – August 22, 2018
• Deputy Minister Gina Wilson – Ottawa – August 22, 2018
• First Nations Health Managers Association – Ottawa – August 22, 2018
• IFNA Family Physicians and Health Services Board – Winnipeg – August 31, 2018
• SLFNHA AGM – Lac Seul First Nation – September 12, 2018
• Matawa Health Co-Op – Thunder Bay – September 17, 2018

18. Meetings & Gatherings
(Continued)
• Joint Action Technical Table – Toronto – September 25, 2018
• Dennis Franklin Cromarty High School – Thunder Bay – October 1, 2018
• Minister Philpott – Ottawa – October 2, 2018
• Wabun AGM – Orillia – October 3, 2018
• Shibogama Health Directors – Thunder Bay – October 3, 2018
• SLFNHA Meeting Board – Thunder Bay – October 9, 2018
• Cree Board of Health and Social Services of James Bay – Chisasibi – October 23-24, 2018
• Community Visit - Marten Falls – October 25-26, 2018
• Community Visit – North Caribou – November 6-7, 2018
• NAN Chiefs Fall Assembly – Thunder Bay - November 13 – 14, 2018
• Windigo Health Directors Meeting – Sioux Lookout – November 15, 2018

19. Meetings & Gatherings
(Continued)
Upcoming:
• WAHA, with Health Policy & Advocacy, to be determined
• Initial Visit: Brunswick House FN – November 26, 2018 - Postponed
• Initial Visit: Chapleau Cree FN – November 28, 2018 - unconfirmed
• Initial Visit: Chapleau Ojibway FN – December 10, 2018
• Initial Community Visits: Eabametoong, Wapekeka, Missanabie Cree,
Ginoogaming and Neskantaga First Nations
– All to be finalized & completed before the end of December 2018
Invitations are welcomed for the NAN Health Transformation team to meet your
communities.

20. Meetings & Gatherings
(Continued)
Upcoming:
• NAN Gathering of First Nation & Northern Physicians, Nurses and
Community Health Representatives – March 6 & 7, 2019 – Winnipeg
• NAN Health Summit – January 22-24, 2019 – Thunder Bay
• NAN & Matawa Gathering of Traditional Knowledge Keepers

21. ACTION-BASED COMMUNITY
PARTICIPATION

22. Community Participation - Process
• 6 Tribal Councils have been funded to hire Community Outreach & Participation
Coordinators and 1 Tribal Council to hire a Community Outreach & Communications
Coordinator to work with communities to organize health transformation participation
sessions and provide information on health transformation.
o March 1, 2018 – May 1, 2018.
o Continued funding from May 1, 2018 – March 31, 2019
• Tribal Council Coordinators will be the main contacts at Tribal Council level for
transparency and to ensure timely communications take place.
• Two NAN Community Participation Coordinators will work with Independent
First Nations and be available to Tribal Councils.
• Chief & Council will select a community member to coordinate logistics for
community participation sessions, supported by Tribal Council Coordinators.

23. Community Participation – Process
(Continued)
• 5 teams of 5 Health Transformation Advocates will conduct the community
participation sessions, Community Outreach & Participation Coordinator can
provide support during the participation sessions (pending funding approval).
• Capacity Building: train the 25 individuals in health field professions to begin to
develop professionals to operate the new First Nations controlled health care
and wellness system, upon the completion of health transformation.
• Geographical location of each team still to be determined.

24. Community Participation – Process
(Continued)
• Initial Community Visit
o Information sharing with the community on the health transformation process & getting to
know the community and community members
• Second Community Visit
o Community participation session: three full days of talking with Chief & Council, health staff,
nurses, physicians & community members
o As many people as possible, in as many ways as possible
o Each community will define their own health priorities and what they would like to see in a
new health and wellness system
• Third Community Visit
o Validation of what was heard during the second community visit & assisting the community
with developing a community wellness plan
• Pending funding approval

25. Community Participation – Process
(Continued)
• Urban Community Participation Sessions
o Gatherings will be hosted in urban centers for NAN First Nations to be able to share their
stories and provide input into what they would like to see in a new health and wellness system
o Geographical locations and dates still to be determined

26. NAN Youth and Elders Gathering
Feedback from the Youth
• Traditional Practices: build sweat lodges, take youth out of the land, introduce ceremonies,
bring language into the school, drum making, skirt making, regalia-making, traditional
medicine, hunting, Turtle lodge, drumming and singing
• Treatment centres in our own communities
• Awareness workshops (bullying, suicide prevention, etc.)
• Getting to the root cause of problems (healing, breaking cycles, etc.)
• Community envisioning – gathering community members regularly and talking about pressing
issues, economic and community development
• Returning to traditional governance (matriarchy, clan systems, etc.)
• Building community capacity (training, education, job creation)
• Encouraging kids to go to school and come back and work for home community
• Harm reduction (training and educating people on drug and alcohol use)
• Teaching children about healthy sexuality, relationships and consent
• Individual change – lifestyle, getting involved and fighting for your rights “BE THE CHANGE YOU
WANT TO BE”
• Build exercise facilities and recreation centres

27. NAN Youth and Elders Gathering
Feedback from Elders
• Acknowledge the Creator when using land
• Teach young people about land, traditions and medicines
• Be open minded on diverse beliefs
• Traditional healing practices to be recognized
• Need to adopt policies and procedures to better service our communities
• Adequate support for people struggling with mental health after health
issues arise
• Don’t rush the elders when they speak, takes time for them to think and
don’t limit them when they want to speak
• Educate the communities on health transformation before community
engagement, will allow for them to prepare
• The use of Wawatay radio is critical
• We need action, not just talk about the problems

28. Negotiations

29. Negotiations
• It was determined at the Health Summit that negotiations and decision making
is to be elevated to the Ministerial level with each party appointing their lead
negotiator.
• The Joint Action Technical Table (comprised of Assistant Deputy Ministers, NAN
and Health Authorities/Co-Op) is to be responsible for implementation of
immediate issues and action items.
• The Terms of Reference for the JATT has been revised to reflect this structure.
o The Joint Health System Transformation Table Terms of Reference has been
approved by ISC & MOHLTC with minor revisions.
o Next meeting December 2018

30. Negotiations
(Continued)
• The negotiation agenda will be co-developed by NAN, Ontario and Canada.
• The negotiation agenda will address the needs of a NAN wide agenda as well as
community and regional priorities. In particular, communities will be supported
in bringing their own initiatives to the table. The level of negotiation support
will depend on the request of the community.
o Example – a community wishing to address their mental health and addictions will
bring their community-specific solution forward. Partners and service providers will
be brought into the process at the request of the community.
o Example – a community wishing to built a new health centre will be supported to
do so. The level of negotiation support will depend on the level of support needed.

31. IMMEDIATE IMPROVEMENTS TO
SERVICE DELIVERY

32. Improving Service Delivery – Addressing
Immediate Needs
• The Chiefs and delegates made it clear that it is imperative that both
governments commit to addressing the immediate needs and solutions as
we work through the transformation process.
• Feedback on the immediate needs have been provided through initial
engagement and will continue throughout the process.
– Example – Health Director’s Meeting – Top 5 immediate Issues
o Mental health and addictions (youth and family treatment and aftercare)
o Infrastructure (water, housing, space to provide services)
o Elder care and long-term care
o Addressing NIHB issues
o Funding mechanisms

33. Improving Service Delivery – Addressing
Immediate Needs
(Continued)
• Each community will identify their own priorities to be addressed
immediately and the NAN Health Transformation Team will support them
in addressing their needs and working with the appropriate partners to do
so.
• Creating a concrete process to addressing immediate needs & updating
JATT immediate needs workplan
o Case Specific Immediate Needs
o Community Specific Immediate Needs
o Regional (West, Central, East) Immediate Needs
o System Wide (NAN) Immediate Needs

34. Current Process for Addressing Immediate Issues
Policy
Solution
Chief and
Council
Health Directors
Tribal CouncilsNavigators
Health
Transformation
Team
NAN Health
Planning and
Advocacy
Medical
Immediate Issue

35. Improving Service Delivery – Regional Processes
• NAN will work with regional partners to improve service delivery at the
regional level and to use the negotiation process to advance regional priorities.
• Examples
– Continue to meet with Tribal Councils and support their initiatives (e.g.
Mushkegowuk Health Transformation Process)
– Continued process to meet with Heath Authorities
• E.g. SLFNHA/Meno Ya Win Meeting – Identified many areas requiring
support such as:
o Continued funding for Mamow Ahyamowen Data Partnership.
o Recognition and authority of SLFNHA Public Health Physician and role of SLFNHA as
a Health Information Custodian.
o Long term addiction and treatment programs.
o Dedicated prenatal programs.

36. Improving Service Delivery
SLFNHA/Meno Ya Win Areas of Support
• Address Nursing Model – enhanced system of care at community level,
including outpost training for nurses.
• Mustimuhw EMR – system and tools to support First Nations.
• Advocacy re: Capital Planning, including accommodation at community level.
• 4 Party – Federal Land.
• Advocacy to recognise challenges of northern recruitment.
• Community Health Worker (CHW) model to be applied in all program areas
(providing CHWs with supervision, mentorship and dedicated resources).
• Technicians in communities (pharmacy techs, X-Ray and Ultrasound techs).

37. Questions?
John Cutfeet
Health Transformation Internal Lead
807-738-0935
johncutfeet@nan.on.ca