Background: Why Akwesasne? Akwesasne's management and recent restructuring of our own health system is a demonstration of our inclination to innovate and pursue better ways to provide health care. We are presently serving as the pilot test centre for the Ministry of the Ontario Region Health Information System. Akwesasne is unique among First Nations in taking over management of non-insured dental and pharmacy services from the Federal Government. Benefits The major benefit of the Institute is that it serves to facilitate the development, design, and implementation of management capacity of First Nations. The Institute will continue to supply long term management and planning input and assistance to promote sustainability. Specific benefits include: Networking to build productive relationships between individuals and communities. Increased technical competence and experience of health professionals. Improved education and understanding of health needs. The development of standards of quality and excellence of care.