Nishnawbe Aski Nation COVID-19 Task Team Terms of Reference

Version 6.1, July 2, 2020

1.    Background

NAN is a political territorial organization representing 49 First Nation communities within northern Ontario, with the total population of membership (on and off reserve) estimated around 45,000 people. Within NAN territory, many remote communities are only accessible by air for the majority of the year and have nursing stations that serve as their primary source of health care. These nursing stations are supported through the Government of Canada’s First Nations and Inuit Health Branch. Communities with road access will often access health care through services that are a part of the provincial health care system. There are also several First Nation-governed organizations in NAN territory that are involved in regional and local health service delivery.

This complex system results in jurisdictional ambiguity around health care delivery and public health, making NAN territory vulnerable to public health emergencies such as the COVID-19 pandemic. NAN community members lack comparable access to health care as non-First Nations people in Ontario, and a significant number of people in NAN have health conditions, such as diabetes, that put them at risk of serious complications from COVID-19. To decrease risks to NAN communities and to keep NAN First Nations and members safe and supported, a group of medical and field experts is needed to inform NAN’s response to the COVID-19 pandemic.

2.    Purpose

The purpose of the NAN COVID-19 Task Team (“Task Team”) is to gather and provide vital information to support NAN First Nation members during the COVID-19 pandemic. The Task Team will respond to the needs of Tribal Councils and health care providers throughout NAN territory, including two health authorities (SLFNHA and WAHA), as well as concerns identified by NAN leadership, area Chiefs, and community members.

Work by the Table will inform and support existing local plans and will align with both the provincial and federal response structures to COVID-19.

Overall goals of the table include:

• Decrease illness and death 
• Minimize community disruption
• Inform and support NAN leadership and community members

3.    Scope

There are two main areas within the scope of the Task Team:

1. Addressing specific questions from NAN communities, Tribal Councils, Chiefs and the NAN Executive.
   1. Many of these questions will be raised during the Chief’s Calls regarding COVID-19. The Office of the GC has regularly scheduled these calls throughout the pandemic; depending on the phase of the COVID-19 response, they have been scheduled every day, two times a week, and once a week.
2. Identifying immediate priorities and issues for NAN territory during the COVID-19 pandemic. This may include, but is not limited to, priorities and issues involving:
   1. Public health
   1. Acute care
   1. Primary care
   1. Critical care
   1. Community-level care
   1. Mental health and substance use
   1. Emergency management (example: critical infrastructure)
   1. Surge infrastructure
   1. EMS/community paramedicine
   1. Scaling community responses up and down
   1. Poor infrastructure, such as water and housing
   1. Inadequate health facilities and accommodation for health providers
   1. Effects of provincial reopening on NAN communities
   1. Risks of additional COVID-19 waves

The Task Team will consider the best interests and needs of all the people of Nishnawbe Aski Nation, including those living in urban, remote and road-access communities.

4.    Task Team Membership

1. The Task Team will consist of experts from the fields of public health, emergency management, critical care, nursing, acute care, and mental health and addictions, as well as Elders and Traditional Knowledge keepers.
2. The size of the Task Team and the composition of its membership is left undetermined; however, the group should try to maintain a balance between different areas of expertise, as well as the different areas of NAN (i.e. the West, East, and central/road access regions).  
3. Members are selected either through appointment by the NAN Grand Chief or through the recommendation of one existing Task Team member with the support of the majority of the Task Team.
4. The Task Team will have both a Chair and two Vice-Chairs; the Chair and Vice-Chairs will either be appointed by the Grand Chief or selected by the Task Team, through nomination by another Task Team member and with the support of the majority of the other Task Team members.
5. Of the two Vice-Chairs, one will represent the Northwestern region of NAN and one will represent the Northeastern region.
   1. This can either be through the organization they represent or as a member of a First Nation in one of these two regions.
6. Depending on the phase of NAN’s COVID-19 response, Task Team members may be further identified as either Core or Complete Members. These roles are described in greater detail in 8. Meetings and Other Activities.

Chair and Vice-Chair Duties

Chair

• Facilitate the meetings.
• Approve recommendations and any other material that is sent to the GC’s office.
• Attend NAN Chief’s Calls regarding COVID-19 as a representative of the Task Team.
• Provide Task Team updates at NAN Chief’s Calls regarding COVID-19.
• Answer questions, when appropriate, from community leadership at NAN Chief’s Calls regarding COVID-19.
• Attend other conferences and meetings as requested by the Grand Chief’s office.

Vice-Chairs

• Attend NAN Chief’s Calls regarding COVID-19 to provide support to the Chair.
• Answer questions, when appropriate, from community leadership at NAN Chief’s Calls regarding COVID-19.
• Assume the duties of the Chair whenever the Chair is unable to do so.  

Terms of Office

• There is no set term of office for members of the Task Team. It is anticipated that membership will be determined by the duration of the COVID-19 Pandemic and the other duties and responsibilities of the Task Team members.
• If a member of the Task Team is unable to continue as a member, they must inform the Task Team by contacting the Chair, both of the Vice-Chairs, and Coordinator.
• The Task Team and/or the Office of the Grand Chief must make every attempt to identify a new Task Team member who would offer similar expertise to that of the departing Task Team member.

Members

Chair – Mae Katt, Nurse Practitioner

Dr. Mike Kirlew, Family Physician, Weeneebayko Area Health Authority

Lynne Innes, Nurse Practitioner, CEO and President, Weeneebayko Area Health Authority

Dr. Jane Philpott, NAN Special Advisor on Health

Dr. Claudette Chase, Family Physician, Sioux Lookout First Nations Health Authority

Michelle Gervais, Emergency Management Consultant

Michael McKay, Director of Housing and Infrastructure, Nishnawbe Aski Nation

Georgina Lentz, Director of Health Transformation, Nishnawbe Aski Nation

Barney Batise, Traditional Knowledge Keeper

Teri Fiddler, Traditional Knowledge Keeper

Helen Cromarty, Traditional Knowledge Keeper

Eric Goodwin, National Incident Management Team Chief, Team Rubicon

Janet Gordon, Chief Operating Officer, Sioux Lookout First Nations Health Authority

The Task Team will also seek to include:

Additional Emergency Management specialists

Members on Leave:

Dr. Natalie Bocking, Public Health Physician, Sioux Lookout First Nations Health Authority

5.    Outcomes

Resolutions

The expected outcomes of the Task Team are recommendations to the NAN Grand Chief that fall within the Task Team’s scope. Some examples include suggested public health guidelines during the COVID-19 pandemic; requesting advocacy from NAN regarding critical care equipment funding; or identifying the need for more clarity about the First Nations and Inuit Health Branch PPE ordering process.

These resolutions will be communicated in writing to the Office of the Grand Chief. The Office of the Grand Chief will then determine whether and how to act upon the Task Team’s recommendations.

Other Outcomes

Through working within its scope, the Task Team or one of its Working Groups may respond to a question, priority, or issue in such a way that a recommendation is not the appropriate outcome. Instead, another item (including, but not limited to, proposals, guidelines, guidance documents and/or protocols) is the more appropriate response.

When this occurs, the Task Team or Working Group should be guided by the primary principle of strengthening existing programs and services and not creating new systems.

The Task Team or Working Group should seek feedback and input on the item from Health Authorities, Tribal Councils, and communities. The length and scope of this process should be guided by what is appropriate and reasonable considering the urgency of what the item seeks to address. 

6.    Working Groups

From time to time, Task Team members may identify an issue in NAN territory during the COVID-19 pandemic that is of such complexity that the most efficient way of addressing it is through the formation of a Working Group.

This Working Group is to be time-limited and have clear objectives. Either the Chair or Co-chair of the Working Group will be a member of the Task Team. Working group members can be sought from outside of the Task Team, but membership in a Working Group does not constitute membership on the Task Team.

The Task Team member who is chairing or co-chairing the Working Group should establish this Working Group’s timeframe and the Group’s specific objectives prior to the Working Group’s second meeting and present these to the Task Team.

Once its objectives are met, the Working Group should be dissolved.

7.    Decision making

The Task Team will always work towards consensus, while respecting the autonomy of NAN communities, Tribal Councils, and organizations. The consensus of the Task Team only reflects the recommendations of its members; it is unlikely to speak to every need in a territory as diverse as NAN.

When the Task Team is unable to reach consensus, the Task Team will forward the recommendation supported by the majority of its members. The Task Team will also note that there are differing opinions on this recommendation and share the recommendation that is supported by the minority of the Task Team.

8.    Meetings and Other Activities

The activities of the Task Team will be dictated by circumstances of the COVID-19 pandemic. There are five phases of Task Team activity, with criteria for these following phases:

Task Team Response Phases

Task Team Activities

Core Team

Purpose and Description

As the risk of COVID-19 to NAN Territory is relatively low in Phases 3 and 4, it will be more efficient for the Task Team meetings to consist of only a Core Team during those phases. This allows for flexibility in scheduling and reduces the burden of participation on all Task Team members. Core Team Members may rotate in or out depending on their availability. During this time, the Core Team’s focus may shift to supporting communities as they recover and restart. Members of the Core Team can provide strategic-level support during this phase, including the review and analysis of a community’s pandemic response and facilitating relationships that would address gaps and inefficiencies in that response. The responsibility of the Core Team is not diminished from that of the Task Team in Phase 0; however, it will be a smaller and more agile team.   

It is not expected that the Core Team will be activated until there are no active cases in NAN communities and no active cases in urban hubs in NAN territory. At that point, the risk of COVID-19 to NAN will be low.

However, it is important to note that a low risk of COVID-19 does not mean no risk; both NAN staff and the core team should remain vigilant throughout phases 3 and 4 and closely monitor the COVID-19 situation, especially as the province reopens and seasonal factors change, increasing the risk of additional waves of the virus.

Composition

Along with a NAN Lead, the Core Team will be comprised of one representative for each of the following areas of expertise:

• Health Transformation
• Traditional Knowledge
• Public Health
• Mental Health and Substance Use
• Clinical Care
• Emergency Management

Membership

Task Team members can volunteer themselves for Core Team membership in their area of expertise. In the event that two or more members wish to participate as Core Team members in the same area of expertise, they may alternate participating as Core Team members at meetings.

The Chair and the Vice-Chairs will be selected from members of the Core Team.

Current Members

• NAN Lead: Michael McKay
• Health Transformation Lead: Georgina Lentz
• Traditional Knowledge Keeper: TBD
• Public Health Lead: TBD
• Mental Health and Substance Use Lead: TBD
• Clinical Care Lead: TBD
• Emergency Management Lead: TBD

Duties

When the Core Team is activated, it is expected that the following members will attend NAN Chief’s Calls regarding COVID-19 whenever possible:

• Chair
• Vice-Chairs
• Public Health Lead
• Mental Health and Substance Use Lead
• Emergency Management Lead

The following duties are expected of all Core Team members:

• Attend scheduled meetings of the Core Team whenever possible.
• Answer questions from NAN Executive, leadership, and community members to the best of their ability.
• Monitor the COVID-19 situation provincially, nationally, and internationally and assess for risk to NAN territory.

Complete Team

The complete team comprises all members of the Task Team (see p. 3) who are not part of the Core Team.

Duties

• Read and review any communication from the Core Team, including meeting reports.
• Be prepared to ramp up Task Team activities, as indicated by the circumstances of the COVID-19 pandemic.

9.    Support for the Task Team

Coordinator

1. The Task Team will be supported by a Coordinator.
2. This Coordinator will be a NAN staff member.
3. The Coordinator is not a member of the Task Team.

Coordinator Duties

• Drafting agendas for Task Team meetings
• Writing and/or reviewing briefing reports from Task Team meetings.
• Drafting recommendations and other documents for the Task Team.
• Organizing meetings.
• Maintaining records of the Task Team.
• Logging questions from the Chief’s Conferences.
• Logging emails directed towards the Task Team.
• Drafting responses on behalf of the Task Team.

10.          Records

The Task Team must keep accurate records of all matters that come before it. The Task Team Coordinator will maintain copies of its briefing reports for a period of at least 2 years from the end of the COVID-19 pandemic.

11.          Amendments

These terms of reference may be amended by consensus of all Task Team members at a Task Team meeting.

Approved:

Signature of Chair                                                                                                                                       Date

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NAN COVID-19 Task Team Terms of Reference