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Steps Taken Towards Indigenous Health in Indigenous Hands: Transfer of services from Guelph CHC to Southwest Aboriginal Health Access Centre shines light on the path to Indigenous self-determination in health care

[The shift of the Waterloo Wellington Indigenous Healing and Wellness Program (IHWP) to the governance and direction of Southwest Aboriginal Health Access Centre (SOAHAC) will enable a full provision of Indigenous health care services in Indigenous hands, guided by the Model of Wholistic Health and Wellbeing, pictured above.]

In November 2019, the Indigenous Primary Health Care Council (IPHCC) was founded with a mandate to support the advancement and evolution of Indigenous primary health care services provision and planning throughout Ontario. At the core of this work is the belief in Indigenous Health in Indigenous Hands. The organization promotes high quality care provision through the Model of Wholistic Health and Wellbeing, population needs based approach to health care planning, and Indigenous informed evaluation approaches and scaling leading practices for excellence in Indigenous health.

Indigenous Health in Indigenous Hands is also a core priority of the member organizations of the Alliance for Healthier Communities, who include many members of the IPHCC. At the Alliance’s annual general meeting in 2019, members unanimously passed a resolution that stated:

“The Alliance for Healthier Communities supports the position that Indigenous health care be planned, designed, developed, delivered and evaluated by Indigenous governed organizations, and urges member centres to work in a manner that honours and respects Indigenous voices, leadership and governance frameworks, and that exemplifies authentic allied relationships.”

But what does “Indigenous Health in Indigenous Hands” look like in practice? How can Indigenous and non-Indigenous organizations live up to this critical shift in how Indigenous health and well-being are supported in Ontario? What changes need to be made, and how can we begin to make them? What could the new relationships look like?

Last December, the Southwest Aboriginal Health Access Centre (SOAHAC) and Guelph Community Health Centre (Guelph CHC) announced that oversight and leadership for the Waterloo Wellington Indigenous Healing and Wellness Program (IHWP) is transitioning from Guelph CHC to SOAHAC. The voluntary transition was effective December 15, 2020, and “is informed by a comprehensive Indigenous-led consultant review completed by INDSight, which recommended that the program would be best served within an existing Aboriginal Health Access Centre,” Guelph CHC said in its open letter to the community to mark the milestone.

This transition resulted from years of relationship and trust-building, and careful steps to ensure that the needs of Indigenous people and communities are at the heart of the planning and actions to move towards Indigenous Health in Indigenous Hands.

We spoke to some of the people involved directly in the transition and its planning for more insights into how the work progressed, what it means for Indigenous health, and the path forward. Here are some of their comments.

We begin with Don McDermott, Chair of the Board, Guelph CHCtalking about some of the initial steps taken:

“I would go back to September 2019, when our full leadership staff and board met with the Indigenous Advisory Circle (for the existing IHWP at Guelph CHC). We had a really great conversation. It was all about what needs to be done, but as much how it needs to be done. It was very clear that the Advisory Circle needed and wanted to have significant input into any final decision and the choice of transfer. They wanted to be the major player in the decision and the consultant hiring. Our community-governed board thought that was perfect, and it has resulted in a pretty good working relationship between our board and the Advisory Circle, and a great decision for the transfer. The Southwest LHIN and the Waterloo-Wellington LHIN were really cooperative in helping us to move this through as expeditiously as possible without compromising on time needed for consultations. We used a consultant to help us identify where the program needed to go, and what steps needed to be taken to get there. The consultant was an Indigenous consulting firm called INDsite Consulting. I thought they did a super job.”

Brian Dokis, CEO, Southwest Aboriginal Health Access Centrerecalled some of the groundwork laid for this type of transition to happen:

“We are very happy and thankful that Guelph CHC realized that they shouldn’t be in the business of delivering Indigenous health care. The Alliance was instrumental in passing the motion in 2017 that Indigenous health should be in Indigenous hands. I think it wouldn’t have happened without the leadership of former Alliance CEO Adrianna Tetley. She recognized that the CHCs shouldn’t be delivering these services, and it should be done by Indigenous-led organizations or First Nations. Another strong and helpful voice in getting this done was the late Denise Brooks (Executive Director of Hamilton Urban Core CHC who passed away in August 2020). She recognized the racism, discrimination and oppression that was happening. For that, we’re grateful that it was recognized and that they were fully supportive of our sector and our need to deliver our own services by Indigenous people, for Indigenous people.

There has been a real lack of any type of culturally appropriate health care in the area for a large Indigenous population in the area – it’s estimated at 50,000 people. The AHAC model has been in existence in Ontario for over 20 years. It’s a successful model. Many of us are accredited. It’s high quality, culturally appropriate services. It’s delivered by Indigenous people that have lived the life, walked the walk, know the services, and who know what’s needed.”

Raechelle Devereaux, CEO, Guelph CHC talked about why the transition of leadership, governance and design is vital to Indigenous health and why the status quo was untenable:

“In the absence of an Indigenous-governed health organization in our region, Guelph CHC played an important role in the initial stewardship of the Indigenous Healing and Wellness Program (IHWP) since its inception in 2016. Since that time, we have been receiving increasing investments of Indigenous health funding, which we have used to hire Indigenous staff members to deliver Indigenous programming for the residents of Waterloo Wellington. Over this time, we have continually worked to build trust of with the Indigenous community, including approaches to infuse Indigenous guidance and direction to the program. Despite this, the program’s placement in our white-governed organization, with our inherent white worldviews, was inevitably experienced by our staff team, the IHWP Advisory Circle, and community as an extension of colonialism. Indigenous health services rightfully deserve Indigenous oversight and guidance -- Indigenous health services belong in Indigenous hands.”  

Caroline Lidstone-Jones, CEO, Indigenous Primary Health Care Council explained why relationships are the key to success and ensuring that Indigenous people and communities have access to culturally safe services, programs, and spaces for health and well-being, no matter where they live:

“I think it is vital to have relationships at the local level to support these shifts. This is a true recognition of the importance of Indigenous Health in Indigenous Hands and allows us to have our say in what that looks like. The openness provided by community governance is important to enabling this kind of relationship building. It is also about establishing and creating a space where this work is done respectfully and doing that jointly between organizations.

“The central part of what we do is ensuring Indigenous people have a say over their services and how the funds for their services are allocated. That is a huge piece and something that all of us have advocated for years to make sure that it is our voice leading how these services and programs are structured and rolled out to our people.

“When you look at it from the provincial level, our critical role is to continue to educate, and to share those wiser practices, success stories, and what authentic relationships mean.

“On the other side, community health providers need to realize that they can still be strong fundamental partners, but you don’t necessarily need to lead that service. You can follow and still be a good leader in following what that service might look like and shaping what that might be. It does not mean that an organization segregates itself from that relationship; it just becomes a different role in supporting that relationship.

“We’ve been learning through our Indigenous Cultural Safety (ICS) Program the importance of co-designing the curriculum rollout. It is about realizing that both parties must come to the table to make it work, that both parties need to be respectful. I think fundamentally that everyone has to come together and support what you’re doing – from a community perspective, but also from a wellness perspective.”

We also asked what the future looks like for Indigenous health in Waterloo-Wellington, and what this milestone and work means for the movement towards Indigenous Health in Indigenous Hands more broadly.

Brian Dokis, CEO, SOAHAC:

“We will use our holistic model of care. Right now, we’re not offering primary care directly in Guelph, but primary care is the foundation for accessing health care in Ontario, without a doubt. Until we get those services up and running, we will continue to offer the existing Indigenous Health and Wellness Program (IHWP) at Guelph CHC.

“This will be our fifth main site. We have an interdisciplinary model of team-based care that we use. It involves primary care, traditional healing, mental health services, other allied health professionals. That is the model that we are going to promote and push for in the area. It’s a much-needed service. There have been many reports – evaluation reports and assessments – that indicate the need for Indigenous-led primary care and mental health supports. We’re more of a regional provider; we already provide health services from Lake Erie to Georgian Bay. Waterloo-Wellington is new for us, but if you come into our services in the Waterloo or Guelph region, our goal is that it will be the same services that we offer in Windsor. People will be able to come in and expect the same quality, the same type of services as at other SOAHAC locations.”

Caroline Lidstone-Jones, CEO, IPHCC:

“It is fundamentally the belief of our organizations that it truly is only us as Indigenous people who can create a fully safe space for Indigenous people. That means a space that encapsulates holistic care and ensuring that there is a rightful place for people to have patient-centered choice and the integration of traditional healing methods.

“A lot of the things we do are not just isolated to looking at primary care, but primary health care, and looking at that from a holistic perspective: so that’s your physical, spiritual, mental, emotional aspects of healing. We are aiming to make sure that when services are in place, people can access all aspects of primary health care in a way that address the entire wellness of that person. That is one of the primary things that our organization was founded upon, to make sure holistic health and well-being is at the center of everything that we do.”

“The supportive role that other organizations can play in this process is equally as important. Being able to improve outcomes depends on the quality of care, and the relationships that we have locally to be able to meet needs. Indigenous providers do not deliver everything independently on our own, so we have needed to create good relationships. That needs to be celebrated, and people need to know that is why this is a true success story. We look forward to showing more stories like this, so people can begin to see how it is done, the steps involved, and why it matters.

“The nice part of this shift in Guelph, is that it does not have to be adversarial, it does not have to be a have and have-not, and then at the end of the day, hopefully we’re supporting the best outcomes for the patients and clients who we jointly serve. It’s an “and and” not an “and or” outcome.”

Don McDermott, Chair of the Board, Guelph CHC:

“We will be working with SOAHAC to ensure that anything they need, we will try to accommodate. We know there will be growth. We know there will be new programs. We’re ready to do our part in this new and evolving relationship.”

Raechelle Devereaux, CEO, Guelph CHC:

“We wholeheartedly believe that the transfer of the IHWP to the Southwest Ontario Aboriginal Health Access Centre (SOAHAC) will enable improved health and well-being for the Indigenous community. We could not be more excited for the future of this vibrant program under SOAHAC’s highly-reputed leadership.”

Sarah Hobbs, CEO, Alliance for Healthier Communities:

“As the Alliance moves forward in its relationship with the Indigenous Primary Health Care Council and Indigenous-led health organizations in the province, we know that the core principles of Indigenous Health in Indigenous Hands and moving towards culturally safe and appropriate spaces and services for all Indigenous people and communities are what will guide us. It’s why Indigenous Health in Indigenous Hands and the self-determination in health that is entailed in that principle is prominent in the Alliance’s newly revised and updated Health Equity Charter. And it’s why the leadership shown by the Indigenous Advisory Circle at Guelph CHC, SOAHAC and IPHCC, as well as by Guelph CHC’s community-governed board are not only a milestone to celebrate, but a shining example of success to build on in the months and years ahead. We look forward to continuing to work with Indigenous health leaders and their allies to continue this vital work.”