Typology of Indigenous health system governance in Canada

Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these differences, a typology is constructed based on three areas of decision-making space: governance rules, financing and accountability mechanisms. The nature of the relationship and in particular, the degree of control exercised by Indigenous communities over their respective health systems in relation to federal, provincial and territorial governments, is also assessed. The resulting five-level typology organizes Indigenous health systems into broad and strong control to moderate and narrow control. Although this typology is based on current governance arrangements, it nevertheless presents a baseline for the study of future innovations in Indigenous health systems as well as new types of provincial and territorial government engagement by Indigenous governments and organizations.