Historically, Indigenous communities in Canada have had to rely on a primary healthcare system developed and controlled by the Canadian government. Community action and research has shown the importance and benefit of community designed primary healthcare. These models of primary healthcare do not fit into conventional definitions. Within the context of a the larger Innovation Supporting Transformation in Community Based Primary Healthcare in First Nation and Rural and Remote Communities in Manitoba (iPHIT) study, two Manitoban case studies in an Anishanabee and Dakota community examined the Indigenous development of primary healthcare. Specifically, the case studies sought to describe current primary healthcare issues in each community and determine how communities innovate towards self determined community health goals. Data was gathered through a combination of focus groups, interviews, and phone conversations with the communities. Data was analyzed through grounded theory. Each community described a context of a health resource deplete environment and continuing effects of colonialism. However, both communities demonstrated a strong community identity which was critical to both defining and taking action on their primary healthcare goals within this context. The respectful research relationship that iPHIT has fostered was key for allowing Indigenous self determination in this project.