Primary Health Care Authority
Table of contents
- Appendix A: Terms and Conditions for Primary Health Care Authority
- 1. Summary
- 2. Objectives and results
- 3. Legal and policy authority
- 4. Eligible recipients and annual maximum amount payable
- 5. Eligible expenditures
- 6. Stacking provisions
- 7. Basis and timing of payment
- 8. Application requirements
- 9. Due diligence in managing and administering the transfer payment guidelines
- 10. Official languages
- 11. Other terms and conditions
- 12. Non-monetary contributions
- 13. Funding approaches
- Appendix H-1: Funding approaches
- Appendix H-2: Eligible activities
- Appendix H-3: Summary of requirements for due diligence
Appendix A: Terms and Conditions for Primary Health Care Authority
Effective date: March 5, 2026
1. Summary
1.1 Indigenous Services Canada general context
Indigenous Services Canada (ISC) aims to provide effective, sustainable and culturally appropriate health programs and services that contribute to the reduction of gaps in health status between First Nations and Inuit and other Canadians.
ISC's objectives are to support the health needs of First Nations and Inuit by ensuring availability of, and access to, quality health services, supporting greater control of the health system by First Nations and Inuit and supporting the improvement of First Nations health programs and services through improved integration, harmonization and alignment with provincial or territorial health systems.
In pursuing these objectives, ISC funds or provides a range of health programs and services to First Nations and Inuit, including:
- clinical and client care services in remote and isolated First Nations communities
- home and community care in First Nations and Inuit communities
- community oral health services in First Nations and Inuit communities
- community-based health programs, focusing on healthy child development, mental wellness and healthy living in First Nations and Inuit communities
- public health programs to all First Nations communities, including communicable disease control and environmental public health monitoring and inspections
- Non-Insured Health Benefits to individuals registered under the Indian Act and recognized Inuit, regardless of residence, in Canada
ISC also provides some prevention and promotion support to all Indigenous peoples. ISC can also facilitate the delivery of primary care services, for example, medical travel to Inuit and First Nations residents of Nunavut and Northwest Territories.
Improving the health of Indigenous peoples is a shared responsibility between federal, provincial or territorial and Indigenous partners. To improve health systems to better meet the needs of First Nations and Inuit, ISC works with its partners to develop sustainable, long-term, integrated solutions, through dedicated and collaborative efforts, including developing partnerships between provincial governments and First Nations to integrate federal and provincial health systems. ISC also supports the improved capacity of First Nations and Inuit communities to address their own unique health needs by increasing their control over health program design and delivery.
2. Objectives and results
2.1 Primary Health Care Authority
The Primary Health Care Activity funds a suite of programs, services and strategies provided primarily to First Nations and Inuit individuals, families and communities living on-reserve or in Inuit communities. It encompasses health promotion and disease prevention programs to improve health outcomes and reduce health risks, public health protection, including surveillance, to prevent or mitigate human health risks associated with communicable diseases and exposure to environmental hazards, and primary care where individuals are provided diagnostic, curative, rehabilitative, supportive, palliative or end-of-life care and referral services. All of these services will be provided by qualified health providers who have the necessary competencies and meet the regulatory and legislative requirements of the provinces and territories in which they practice.
Mandatory programs and services
Mandatory programs are those that have a direct impact on the health and safety of community members and the population. They have a strong public health or clinical component and require that health staff have certain credentials, certification or licensing and meet practice standards to ensure quality public health and client care services are provided.
Mandatory programs within the Primary Health Care Activity include:
- Communicable Disease Control and Management sub-sub activity
- Clinical and Client Care sub-sub activity
- Home and Community Care sub-sub activity
- Environmental Public Health within the Environmental Health sub-sub activity
2.1.1 Health Promotion and Disease Prevention Sub-Activity
The Health Promotion and Disease Prevention sub-activity funds and supports a suite of community-based programs, services, initiatives and strategies that collectively aim to reduce the disparities and improve the health outcomes of First Nations and Inuit individuals, families and communities. This is addressed through the provision of culturally relevant health promotion and disease prevention programs and services that focus on three targeted areas: Healthy Child Development, Mental Wellness and Healthy Living, which support the healthy development of children and families, improve mental wellness outcomes and reduce the impact of chronic disease. Activities and priorities are established by recipients and are funded through contribution agreements.
2.1.1.1 Healthy Child Development sub-sub activity
The Healthy Child Development sub-sub-activity funds and supports a suite of community-based programs, services, initiatives and strategies that address greater risks and poorer health outcomes associated with First Nations and Inuit maternal, infant, child, and family health, including nutrition, early literacy and early learning and child care, physical health, and the promotion of First Nations and Inuit culture. Programming aims to improve health outcomes for First Nations and Inuit infants, children, youth, families and communities.
The Aboriginal Head Start On Reserve Program, within the Healthy Child Development sub-sub activity, as it pertains to the implementation of the Indigenous Early Learning and Child Care Framework, will have the ability to serve all First Nations children 0 to 6 years of age and their families, living on and off reserve.
2.1.1.2 Mental Wellness sub-sub activity
The Mental Wellness sub-sub activity funds and supports a suite of community-based programs, services, initiatives and strategies that address greater risks and poorer health outcomes associated with the mental wellness of First Nations and Inuit, including members of landless bands. First Nations bands or Self-Governing First Nations registered in the Crown Indigenous Relations and Northern Affairs Canada (CIRNAC) Indian Registration System that do not have reserve land. Programming aims to contribute to the improved health status of First Nations and Inuit individuals, families, and communities through a range of culturally appropriate mental health and addictions programs and services, including prevention, early intervention, treatment and aftercare.
2.1.1.3 Healthy Living sub-sub activity
The Healthy Living sub-sub activity funds and supports a suite of culturally relevant community-based programs, services, initiatives and strategies that address greater risks and poorer health outcomes associated with chronic diseases and injuries among First Nations and Inuit individuals, families and communities. Programming aims to promote healthy behaviours through healthy eating, physical activity, food security, tobacco prevention, education, protection and cessation, chronic disease prevention, management and screening and injury prevention.
2.2.1 Public Health Protection sub-activity
Health Protection is a core function of public health and is underpinned by surveillance supporting a population health approach. Within the ISC context, the fundamental objective of the Public Health Protection sub-activity is to prevent or mitigate human health risks associated with communicable diseases and exposure to hazards within the natural and built environments. This is accomplished through a range of activities at the individual, community and population levels including: provision of health services to prevent, manage and control communicable diseases and help assure the safety of food, water and living environments, promotion and education efforts to encourage healthy behaviors, research to identify and reduce environmental health risks, strengthening community capacity to take greater control over public health protection and collaboration with partners to address the determinants of health, many of which are beyond the direct control of the public health system.
2.2.1.1 Communicable Disease Control and Management sub-sub activity
Communicable Disease Control and Management sub-sub activity is a core component of public health and is of particular concern in on-reserve First Nations communities and Inuit communities where the burden of communicable disease is higher than it is for other Canadians. This sub-sub activity supports a range of programs and initiatives to reduce the incidence, spread and human health effects of communicable diseases, in collaboration with other jurisdictions. Programming is delivered primarily through contribution agreements and focuses on:
- vaccine preventable diseases, for example, Varicella
- blood borne diseases and sexually transmitted infections, for example, HIV and AIDS
- respiratory infections, for example, tuberculosis
- communicable disease emergencies, for example, pandemic influenza, COVID-19
Specific activities include public health measures to:
- identify risks, for example, surveillance, reporting
- prevent, treat and control cases and outbreaks of communicable diseases, for example, immunization, screening, directly observed therapy
- promote public education and awareness to encourage healthy practices
- strengthen community capacity, for example, pandemic plans
A number of these activities are closely linked with those undertaken in the environmental health sub-sub activity, as they relate to waterborne, foodborne and zoonotic infectious diseases. Communicable disease control and management activities are targeted to on-reserve First Nations, with some support to address tuberculosis and other communicable diseases such as COVID-19 in First Nations and Inuit communities in Nunavut and Northwest Territories.
2.2.1.2 Environmental Health sub-sub activity
Environmental Health sub-sub activity is a core component of public health protection. The objective of this sub-sub activity is to identify, mitigate and prevent human health risks associated with exposure to hazards within the natural and built environments. This is accomplished through the provision of environmental public health services, community capacity building activities, surveillance and research and collaboration with partners to address the determinants of health. Programming is delivered directly by ISC and through contribution agreements. Environmental public health programming is directed to First Nations communities south of 60° and addresses areas such as climate change, drinking water, wastewater, solid waste disposal, food safety, housing, facilities and environmental aspects of emergency preparedness and response and communicable disease control. Specific activities include public education, sharing networks to support community-level decision making, training, and environmental public health assessments, for example, public health inspections, investigations, monitoring and surveillance, infrastructure plan reviews and the provision of advice and recommendations. North of 60°, responsibility for environmental public health programming has been transferred to territorial governments, ISC Northern Region or First Nations and Inuit control as part of land-claims settlements. Environmental health research programming is directed to First Nations communities south of 60° and in some cases to Inuit and First Nations north of 60°. It includes community-based and participatory research on trends and impacts of environmental factors, for example, contaminants, climate change, on the determinants of health, for example, biophysical, social, cultural, spiritual.
2.3.1 Primary Care sub-activity
The Primary Care sub-activity is a coordinated system of health services required to maintain health and treat illness and is the first point of individual contact by First Nations and Inuit with the health system at the reserve and community level. Primary care is delivered by a collaborative health care team, predominately nurse led, providing a set of integrated and accessible health care services that include assessment, diagnostic, curative, rehabilitative, supportive and palliative and end-of-life care. It is where health promotion and disease prevention actions are directed towards individuals or families in the course of provision of care. The identification of cases requiring complex care, the coordination or integration of care, and timely referral to appropriate provincial territorial secondary and tertiary levels of care outside the community are also essential elements of primary care. Primary care services are provided directly to First Nations and Inuit communities or through contribution agreements in locations where these services are not provided by provincial or territorial health systems and are necessary to ensure that First Nations and Inuit individuals and communities have access to the full range of health services as other provincial and territorial residents in similar geographic locations. Primary care services, including medical travel, are funded through contribution agreements with the Government of Northwest Territories and the Government of Nunavut until the end of 2025-2026, for the benefit of Inuit and First Nations residents of Northwest Territories and Nunavut, while a long term solution is being developed.
2.3.1.1 Clinical and Client Care sub-sub activity
The Clinical and Client Care sub-sub activity consists of essential health care services directed towards First Nations and Inuit individuals, living primarily in remote and isolated communities, that enable them to receive the clinical care they need in their home communities. It is provided either directly or through funding agreements with First Nations bands or tribal councils in locations where these services are not provided by provincial and territorial health systems. It is also provided until the end of 2025-2026 through funding agreements with the Governments of Northwest Territories and Nunavut to support increased health care costs, including medical travel costs, fixed and variable air ambulance services costs, and the cost of administrating medical travel, while a long term solution is being developed. Clinical and Client Care is the first point of individual contact with the health system and is delivered by a collaborative health care team, predominantly nurse led, providing integrated and accessible assessment, diagnostic and curative services for urgent and non-urgent care. The continuum of Clinical and Client Care is inclusive of health promotion and disease prevention at the client/family level in the course of treatment as well as the coordination and integration of care and referral to appropriate provincial and territorial secondary and tertiary levels of care outside the community. Physician visits, ambulatory and emergency services, and hospital in-patient care, are components of Clinical and Client Care services provided in some First Nations communities and supported through medical travel to ensure Inuit and First Nations residents in Nunavut and Northwest Territories have access to these services.
2.3.1.2 Home and Community Care sub-sub activity
The Home and Community Care sub-sub activity is a coordinated system of health care services that enable First Nations and Inuit people of all ages with disabilities, chronic or acute illnesses and the elderly to receive the care they need in their homes and communities. It is provided primarily through contribution agreements with First Nations and Inuit communities and territorial governments and strives to be equal to home and community care services offered to other Canadian residents in similar geographical areas. Home and Community Care is delivered primarily by home care registered nurses and trained and certified personal care workers. Service delivery is based on assessed need and follows a case management process. Essential service elements include client assessment, home care nursing, case management, home support, such as personal care and home management, in-home respite, linkages and referral, as needed, to other health and social services, provision of and access to specialized medical equipment and supplies for care and a system of record keeping and data collection. Additional supportive services may also be provided, depending on the needs of the communities and funding availability. Supportive services may include, but are not limited to: rehabilitation and other therapies, adult day care, meal programs, in-home mental health, in-home palliative care and specialized health promotion, wellness and fitness.
2.3.1.3. Community Oral Health Services sub-sub activity
The Community Oral Health Services (COHS) sub-sub activity includes primary and secondary preventive services, as well as tertiary restorative oral health services provided by ISC. These services support the overall improvement of oral health of First Nations and Inuit across the lifespan by building awareness, closing the oral health gap between Indigenous and non-Indigenous Canadians, and facilitating access to oral health care services in First Nations and Inuit communities. COHS focus on all populations living within these communities and support culturally appropriate community-based programs, services, initiatives and strategies related to oral health. The range of services includes prevention and health promotion, outreach and home visiting, treatment and referrals. COHS also collaborates with other professionals within the communities, such as nurses, school teachers and directors to promote the importance of healthy practices and to approach oral health as integral to holistic health. COHS is community led and supported by the regional and national offices.
3. Legal and policy authority
The following legal and policy authorities support the Primary Health Care Authority:
- COVID Emergency Response Act 2020
- Department of Indigenous Services Act, S.C. (2019)
- The Indian Health Policy (1979)
4. Eligible recipients and annual maximum amount payable
The following classes of recipients are eligible for funding under the Primary Health Care Authority categories of contribution. The following table lists the different classes of eligible recipients by sub-activity and the annual maximum amount payable for each sub-sub activity for this authority.
The annual amount for the Primary Health Care Authority for each recipient will not exceed the following dollar values listed in table 1 of this document. These levels were arrived at by conducting a review of historical funding levels and expenditures as well as input from program managers of headquarters and regional offices.
| Eligible recipients | Health promotion and disease prevention | Public health protection | Primary care | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Healthy child development | Mental wellness | Healthy living | Communicable disease control and management | Environmental health | Clinical and client care | Home and community care | Management and delivery of hospital services | Community oral health services | |
| First Nations in Canada Table note 1, such as communities, bands, district, tribal councils and associations | $6,000 | $6,000 | $6,000 | $2,000 | $2,000 | $8,000 | $8,000 | $20,000 | $4,000 |
| Inuit associations, councils and hamletsTable note 1 | $6,000 | $6,000 | $6,000 | $2,000 | $2,000 | $5,000 | $5,000 | Not applicable. Inuit associations, councils and hamlets are not eligible for the management and delivery of hospital services. | $4,000 |
| Canadian national Indigenous organizations | $5,000 | $5,000 | $5,000 | $8,000 | $2,000 | $2,000 | $2,000 | $2,000 | $4,000 |
| Non-governmental and voluntary associations and organizations, including non-profit corporations | $6,000Table note 3 | $20,000 | $6,000 | $4,000 | $4,000 | $6,000 | $6,000 | $4,000 | $4,000 |
| Educational institutions, hospitals and treatment centres | $8,000 | $8,000 | $8,000 | $4,000 | $4,000 | $6,000 | $6,000 | $20,000 | $4,000 |
| Municipal, provincial and territorial governments Table note 1Table note 2 | $8,000 | $8,000 | $8,000 | $4,000 | $4,000 | $8,000 | $8,000 | $20,000 | $4,000 |
| Health authorities and health agencies Table note 1 | $8,000 | $8,000 | $8,000 | $4,000 | $4,000 | $8,000 | $8,000 | $20,000 | $4,000 |
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| N/A: Inuit associations, councils and hamlets are not eligible for the management and delivery of hospital services. Crown corporations and federal departments and agencies are not eligible recipients. |
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5. Eligible expenditures
As a result of the unique and complex nature of ISC transfer payments, ISC will include a generic list of specific eligible key activities for each sub-sub activity which falls under the Primary Health Care Authority. See appendix H-2. Generally, eligible expenditures will include:
- administration of the programs
- staff salaries and benefits
- contracts related to program planning and delivery
- staff travel
- office supplies
- accommodation
- printing
- staff training
- operation and maintenance of health facilities,
- utilities such as broadband connectivity and telecommunications
- minor equipment
- furniture for eligible program activities
Other expenditures may be considered eligible based on program plans provided. These are subject to ISC review and approval. While these are the broad expenditure categories, considerations may be given to allow other expenditures related to cultural and traditional activities. However, each approved plan will describe the eligible activities to be undertaken and a clause which states that all expenditures must be related to the delivery of health programs and services as defined in the agreement.
6. Stacking provisions
The maximum level, stacking limits, of total Canadian government funding, federal, provincial, territorial and municipal assistance for any 1 activity, initiative or project, for recipients will not exceed 100% of eligible expenditures. The stacking limits must be respected when assistance is provided.
Recipients of contribution agreements are required to disclose any other government funding received for the same activity, initiative or project. Based on the provision of financial statements, financial reports and contribution audits, Indigenous Services Canada establishes whether stacking has occurred and if funds provided need to be recovered.
7. Basis and timing of payment
Payments are based on the achievement of predetermined performance expectations or milestones or a risk based approach. In ISC specific context and in order to provide cash flow to the recipient for delivering ongoing health programs and services, advance payments will be issued following a cash flow requirement forecast established in the contribution agreement. This may include, but is not limited to historical funding levels, per capita, population or geographic indices, and the cost to deliver programs.
The method to be used to determine the amount of a contribution is based on a review of the Program Plan, Multi-Year Work Plan or Health and Wellness Plan submitted, as well as historical funding levels and in some instances, historical actual expenditures incurred by the recipient for the same activity being funded. With the implementation of the Contribution Funding Framework, recipients can enter into a 2 year planning process to develop a plan, Multi Year Work Plan or Health and Wellness Plan.
For the purposes of putting in place contribution agreements with the Governments of Northwest Territories and Nunavut for Inuit and First Nations residents' medical travel and related costs until the end of 2025-2026, the department may, when it considers it appropriate, reimburse the Governments of Northwest Territories and Nunavut for eligible expenses that the recipient has incurred from the beginning of the fiscal year to the date of execution of the contribution agreement with the department within the same fiscal year. Eligible expenses may only be reimbursed following the submission of documentation to the satisfaction of the department. Canada's reimbursement of pre-agreement eligible expenses will be subject to the parameters specified in both the program terms and conditions and the contribution agreement.
8. Application requirements
ISC offers a variety of consolidated contribution agreements to First Nations and Inuit recipients that vary in the level of control, flexibility, authority, reporting requirements and accountability. At a minimum, recipients have a set funding agreement which offers no flexibility, recipients deliver the programs and services as set out or prescribed by the department. First Nations and Inuit communities interested in having more control of their health programs and services can decide among different approaches based on their eligibility, interests, needs and capacity. It is at this time that a recipient undergoes a recipient readiness assessment for a more flexible funding approach.
ISC has established relationships with First Nations and Inuit communities and other institutions through formal agreements to work together to develop, sustain and enhance their health, well-being and capacity to design, deliver and manage their health programs and services. By assuming control of their health programs and services, First Nations and Inuit are in a better position to meet their basic health needs. The long-term relationship established with eligible recipients impacts on the nature of the application requirements as well as on the level of flexibility of the financial arrangements chosen by both parties.
First Nations and Inuit interested in having more control of their health programs and services, have access to various types of funding approaches based on the demonstration of their eligibility, interests, needs and capacity. Based on need and capacity a recipient enters into the following funding approaches: set, fixed, flexible or block. Discussions between ISC and the eligible recipient are conducted to form a decision on the approach that is best for the recipient.
For initial contribution agreements, the recipient must provide:
- For First Nations bands or Inuit organizations or a group formally mandated by Band Council Resolution or other formal mandate: Legal entity address and telephone number, band contract person and title, Legal quorum to sign an agreement and Number of councilors
- For corporations: Incorporating documents such as, Articles of Incorporation or Letters Patents, By-laws
- Disclosure of any involvement of former public servants who are subject to the Conflict of Interest and Post-Employment Code for Public Office Holders or the Conflict of Interest and Post-Employment Code for the Public Service
Regardless of the funding approach, the following requirements will apply to all community-based contribution agreements:
- A mandate, as evidenced by a Band Council Resolution or other formal mandate for initial agreements, upon renewal of agreements or for the addition of any new initiatives, as required by the program
- A plan: The Health and Wellness Plan, Multi-Year Work Plan, or multi-year Program Plan is the Recipient's primary document that identifies the community's health needs, defines its capacity to respond, and outlines its programs and services to address health priorities. The Health and Wellness Plan has the additional requirements of identifying all available resources, describing how various services will be integrated, and indicating how success will be measured. The plan becomes the focus for establishing priorities, building capacity, and enhancing accountability for program delivery. Additional details on the planning process are included in appendix H-1
- Evidence of demonstrated capacity in areas such as financial and administrative experience to deliver the programs and services. Successful experience in the management of programs and finances does not necessarily have to be in the area of health, it can also be in such areas as education, social services, and economic development
In the interest of promoting program coordination and avoiding reporting burden, ISC will support consolidation of the contribution agreement planning and reporting requirements among programs that are delivered under the same contribution agreement with different funding approaches. The consolidation of the contribution agreement planning and reporting requirements will be established based on the most flexible funding approach used by the recipient.
Renewal of contribution agreements
The decision to enter into subsequent contribution agreements will be based on:
- evidence that a plan has been implemented and updated
- discussions between ISC and the recipient to determine if the agreement will be renewed
- all required reports and audits
- risk assessment
ISC may sign agreements with eligible recipients in partnership with other sectors of Indigenous Services Canada or other federal departments for the provision of health services, specific programs or block-funded services. All other aspects of the terms and conditions will remain applicable under these agreements while trying to ensure seamless requirements between funders.
Redistribution of funding
This may include funding agreements where the recipient can redistribute funding to other entities. In these situations, the department and the recipient would agree that this method is the most effective delivery model and the recipient would be independent in the choice of those entities, with minimum guidance from the department while adhering to the terms and conditions of the funding agreement.
9. Due diligence in managing and administering the transfer payment guidelines
ISC ensures it has financial resources for the effective, management, administration and contribution audit activities related to programs under these terms and conditions.
9.1 Performance Measurement Strategy
The Performance Measurement Strategies developed for this authority demonstrates the department's intention and capacity to measure performance against key results commitments on an ongoing basis, ongoing performance measurement and periodically through program evaluation or specific research projects. The performance measurement strategies covers:
- main activities of the program and its client or target populations
- program logic models and expected results
- performance indicators
- data collection sources and methods
- responsibility and frequency for collection
- reporting commitments
| Immediate outcome | Indigenous peoples have access to community-based health services | Percentage of communities that have access to HIV testing on or near the reserve |
|---|---|---|
| Intermediate outcome | Indigenous peoples are engaged in healthy behaviors | Percentage of First Nations adults with diabetes who were currently attending a diabetes clinic |
| Ultimate outcome | Indigenous peoples have improved health outcomes | Percentage of Indigenous individuals who reported being in excellent or very good health |
Departmental systems, procedures and resources are in place to ensure due diligence in approving transfer payments, verifying eligibility and entitlement and managing and administering the contributions program. As the manager responsible for the Primary Health Care Authority, the Assistant Deputy Minister or designated representative will ensure:
- recipients are provided with appropriate assistance, advice or expertise
- progress of approved projects is monitored
- public funds are being managed appropriately
ISC has established a Transfer Payment Management Control Framework (MCF) that ensures due diligence in the establishment and administration of contribution agreements. In addition, ISC has policies, procedures, a contribution management system and training tools to support the management of all contribution agreements.
ISC uses standard agreements to serve as vehicles for the administration and management of First Nations and Inuit community health programs and resources. These agreements vary in terms of level of control, flexibility, authority and reporting requirements as described in the applicable Performance Measurement Strategy(ies). These agreements define the funding mechanisms in order to meet the needs of the recipient while taking capacity into account.
9.2 Intervention policy
As a result of the unique relationship developed with the recipients receiving funding to deliver health programs and services, an intervention policy has been developed to provide a framework for responding to the difficulties encountered by recipients with the management or delivery of programs. The intervention policy provides a list of potential triggers or indicators of the need for intervention, including default of the terms of the funding agreement, health emergencies, failure to deliver health programs and services and administrative or managerial difficulties. When intervention is required, the policy stipulates that the level of intervention must be appropriate to the situation, as determined through discussion with the recipient. Intervention may lead to third party management or other remedial management activities. ISC may sign agreements, either alone or jointly with other departments, in support of remedial management activities, including third party management agreements.
9.3 Reporting requirements
The contribution agreement contains provisions that outline the financial and non-financial reporting required from recipients. The level and frequency of reporting will vary depending on the mode of delivery. For targeted programs, reporting and accountability requirements specified in the contribution agreement will be at a level and frequency that is appropriate to determine whether program specific delivery requirements have been met and if expenditures were made by the recipient in accordance with the terms of the agreement.
Where special, time-limited funding is made available for programs or services aimed at specific health issues, the contribution agreement will stipulate any additional conditions associated with the funding. Unless otherwise specified, special, time-limited funding must be spent only for the purpose for which such funding is provided.
Existing mechanisms will be utilized to ensure that adequate reporting relationships, policy directions and administrative processes are in place to support the implementation, monitoring, and risk management of the transfer payments to meet the accountability of the recipient, the department and of the minister.
Contribution agreements with municipal, provincial and territorial governments, health agencies and health authorities as well as international organizations, require adjustments to accountability requirements, in order to align with existing accountability structures and legal obligations of these organizations. These adjustments are intended to avoid duplication and facilitate integration. A summary table of the requirements for due diligence is presented in appendix H-3.
10. Official languages
Where a program supports activities that may be delivered to members of either official language community, access to services from the recipient shall be provided in both official languages where there is sufficient demand. In addition, ISC will ensure that the design and the delivery of programs respect the obligations of the Government of Canada as set out in Part roman numeral 7 of the Official Languages Act by ensuring that these projects provide benefits to all Indigenous Canadians, including French and English minority communities. ISC will ensure that it has the capacity to communicate with, and provide services to, members of the public in the official language of their choice. All communication with the public from ISC, for example, press releases, announcements, will be in accordance with the Official Languages Act.
11. Other terms and conditions
11.1 Intellectual property
Copyright in any material created by the funded recipient as the result of a contribution agreement related to the delivery of health programs and services in First Nations or Inuit communities will vest in the recipient. The minister shall be entitled to use, reproduce and translate any such copyright material for any government purpose and may share such materials with provincial or territorial governments for internal use only, subject to deletion of any personal or confidential information where required by law. The minister shall not otherwise distribute or disclose any material outside of the federal government unless authorized by law or the recipient.
Where a funded project or activity involves or additionally includes the creation of studies, research, reports, communications or other media relating to Indigenous health or the development of knowledge relating to Indigenous health, copyright will again vest in the recipient. The minister shall be entitled to use, reproduce and translate any such copyright material for any government purpose and may share such materials with provincial or territorial governments for internal use only, subject to deletion of any personal or confidential information where required by law. The minister shall also be entitled, by way of cost-free and royalty-free license, to distribute or disclose such materials outside of the federal government to any party if the materials are non-confidential information under the agreement and where the distribution is for non-commercial purposes only. For confidential studies or reports, external distribution should only be in accordance with the consent of those whose rights are affected or in accordance with law.
11.2 Termination
Either party may terminate a contribution agreement without cause by giving the other party notice in writing in accordance with processes defined in the contribution agreement. A termination clause is included in each agreement. The minister may terminate at any time within the course pursuant to the remedies on default section of the contribution agreement or for reasons of appropriation.
12. Non-monetary contributions
The minister may contribute goods, assets or services, rather than funding, to the recipient for health purposes. Non-monetary contributions may be employed in cases where the process would be of greater advantage to both parties and will not undermine long term objectives to increase First Nations and Inuit control of the delivery of health programs and services. Non-monetary contributions may consist of any good, asset or service that is required for, or can be used by, the recipient for health purposes, and may include for Primary Health Care: any medical equipment or assets and repairs thereto for use by a recipient or that supports other health programs funded or delivered by the minister goods or services required by the recipient to implement programs supporting Jordan's Principle.
The minister will use Vote 10 funds for all non-monetary contributions, including the contracting for and delivery of such contributions to the recipient's community or the location where the recipient delivers health programs and services. The minister will follow all federal contracting laws and policies for the purchase of non-monetary contributions. The minister will ensure that the recipient receives non-monetary contributions on the condition that they be used for health purposes and may require reporting and may audit for this purpose.
13. Funding approaches
The diversity of interests, needs and capacities of the recipients leads to the requirement for divergent methods of delivering health community programs and services. This requires adaptable vehicles for the administration and management of health programs and services, which vary in terms of level of control, flexibility, reporting requirements and accountability. ISC will be using the following types of funding approaches: set, fixed, flexible or block. The funding approach relevant to programs and services is defined in the program framework and is dependent on the capacity of the recipient to manage and deliver programs, the class of eligible recipient, and the nature of the program. The funding approaches are further described in appendix H-1.
Appendix H-1: Funding approaches
Contribution agreements can be established by combining programs and services from the different authorities, Primary Health Care, Supplementary Health Benefits and Health Infrastructure Support. The funding approaches within these authorities can be applied in a way that best suits the needs and capacity of the recipients provided that the approach used is within the approved program and policy framework established for the department.
Programs or services that are aimed at specific health issues may receive special time-limited funding, and this funding will have to be accounted for separately, no matter which funding approach is used. Time limited and additional programs services may also be considered to complement core programs.
Exceptions:
Project-based agreements
For contribution agreements which are not community-based, but support the improved capacity of First Nations and Inuit to take on the responsibility of program management and delivery of effective programs and services, recipients will need to meet the requirements as outlined in table 2, but their plan will take the form of a project proposal, budget, forecast or equivalent planning documents.
Indian Residential Schools Resolution Health Support
All contributions under the Indian Residential Schools Resolution Health Support will use the set or fixed funding approach. Under these approaches, the recipient must use the resources as they are set out in the contribution agreement. Funds may not be redirected from the Indian Residential Schools Resolution Health Support Program to any other programs, without the prior written approval of the minister. This will ensure that funds earmarked for the Indian Residential Schools Resolution Health Support Program are not used for activities outside the mandate of the program. The recipient will be required to track and account for funds received under the Indian Residential Schools Resolution Health Support separately from all other funds received from ISC, including those received under the Mental Wellness sub-sub activity of the Primary Health Care Authority, if applicable.
The following table provides an overview of the funding approaches that ISC will be using as well as the distinct differences and reporting requirements.
| Requirements | Set | Fixed | Flexible | Block |
|---|---|---|---|---|
| Planning | Recipient follows multi-year program plan. This plan will include: objectives, activities that will be delivered. | Recipient follows multi-year program plan. This plan will include: objectives, activities that will be delivered. | Recipient establishes Multi-Year Work Plan including a health management structure. This plan will include a budgetary plan, key priorities, objectives and activities that will be delivered. | Recipient establishes a Health and Wellness Plan including a health management structure. The Health and Wellness Plan will include key priorities, objectives, activities, mandatory health programs and other programs and services, annual reporting requirements, as well as information on the provisions of the professional or program advisory functions where applicable. Ability to redesign non-mandatory programs. Ability to foster integration initiatives with flexible approaches and intergovernmental arrangements. |
| Reallocation of funds | Recipients able to reallocate funds within the same Budget activity on written approval by the minister within the fiscal year reporting period. | Recipients able to reallocate funds within the same Budget activity. | Recipients able to reallocate funds in the same Program authority. | Recipients able to reallocate funds across authorities, with the exception of specifically identified programs. |
| Financial reporting | Final year-end financial reports. | Annual year-end audit report. | Annual year-end audit report. | Annual year-end audit report. |
| Annual program reporting | Annual report to the minister based on annual reporting guide. | Annual report to the minister based on annual reporting guide. | Annual report to the minister based on annual reporting guide. | Annual report to the minister based on annual reporting guide. |
| Unexpended funds | No retention of surplus and no carry over of funds into the next fiscal year. | Recipient are able to retain any unexpended funding remaining at the expiry of the agreement provided that the obligations and objectives set out in the funding agreement are met and the recipient agrees to use the unexpended funding for purposes consistent with the program objectives or any other purpose accepted by the minister. | Recipients are able to carry over program funding annually for the duration of their agreement. Upon termination the recipient must reimburse the government any unspent funds. | Recipients able to retain surpluses to reinvest in priorities. |
| Must ensure the provision of all mandatory programs. | ||||
Appendix H-2: Eligible activities
In addition to the eligible expenditures listed in Section 5, the following tables list additional examples of the eligible key activities that fall under the Primary Health Care Authority's sub-activities:
Health Promotion and Disease Prevention sub-activity
Healthy Child Development
Eligible key activities include: pre-conception and reproductive health care and promotion, pre-natal care, management of labour and delivery and post-partum and natal care in the case of midwifery services, nutrition, breastfeeding promotion, early literacy and early learning and child care, physical health, prevention and treatment, public awareness, outreach, public education, early identification and diagnosis of Fetal Alcohol Spectrum Disorder, services for children with special needs, capital in the case of Aboriginal Head Start On-Reserve and midwifery services, capacity building, continuing education, home visits and outreach, screening and assessment, case conferencing or case management, coordination of services, the promotion of First Nations and Inuit culture and language and program support activities such as early childhood development. Funding also supports knowledge development and dissemination, research, monitoring and evaluation, public education and outreach, capacity building, program coordination, consultation, and other health promotion and disease prevention activities related to Healthy Child Development.
Mental Wellness
Eligible activities include: mental health promotion, mental illness, addictions, solvent abuse, and suicide prevention, early intervention, residential and out-patient addictions treatment, mental health crisis management, professional and para-professional mental health counselling, resolution health support services, cultural and Elder supports, aftercare, capital for residential addictions treatment facilities, capacity building, continuing education and program coordination. Funding also supports knowledge development and dissemination, research, monitoring and evaluation, public education and outreach, capacity building, program coordination, consultation, communication, and other health promotion and disease prevention activities related to Mental Wellness.
Healthy Living
Eligible activities include: healthy eating and nutrition, physical activity, food security, tobacco prevention, education, protection and cessation, chronic disease prevention, management and screening, injury prevention, capacity building, continuing education, public education, outreach and promotion of healthy behaviours and supportive environments. Funding also supports knowledge development and dissemination, research, monitoring and evaluation, program coordination, consultation and other health promotion and disease prevention activities related to Healthy Living.
Public Health Protection sub-activity
Communicable Disease Control and Management
Provision of communicable disease control and management programming, including infection prevention and control, surveillance, assessment, screening, contact tracing, outbreak management, diagnosis, referral, treatment, preventive interventions, for example, immunization, counselling and follow-up. Culturally appropriate health promotion and disease prevention activities, including public education, social marketing and communications. Community development and capacity building initiatives associated with program management and administration, including emergency planning and response and professional and paraprofessional capacity building, including training, staff development and continuing professional education to obtain and maintain appropriate competencies. Purchase, maintenance, storage and distribution of equipment and supplies necessary to deliver services and programming, including biologics and therapeutics, for example, vaccines, medications, etc., cold chain management, for example, biologics refrigerators, personal protective equipment, associated infrastructure, for example, safe storage and other items necessary for infection prevention and control. Development and maintenance of surveillance systems, information management systems and data collection tools and systems. Funding also supports research, knowledge translation and dissemination, monitoring and evaluation and collaboration with provinces, health authorities and other organizations.
Environmental Health
Provision of environmental public health services in the areas of drinking water, wastewater, food safety, housing, solid waste disposal and facilities inspections, and in the context of environmental communicable disease control such as foodborne, waterborne, vectorborne and emergency preparedness and response, and other emerging issues in the areas of environmental public health. This includes inspections and investigations, sampling, testing, monitoring and reporting, reviews, from a public health perspective, of infrastructure project plans, risk assessments, advice and recommendations and consultations. Environmental health research activities, for example, in the areas of environmental contaminants, food safety, climate change, determinants of health, including scientific, community-based, participatory research projects, development and implementation of surveillance and performance data collection tools and reporting mechanisms and evaluation, surveillance, monitoring, laboratory and data analysis and reporting. Development and dissemination of research, public education and awareness materials, best practices, procedures, manuals and guidance documents. Community capacity building initiatives such as collaborative events, consultations and knowledge sharing activities, as well as hiring and training of community-based water monitors and recruitment, training and skills development and retention initiatives for environmental public health staff and management.
Primary Care sub-activity
Clinical and Client Care
The provision of urgent and non-urgent assessment, diagnostic, treatment, collaborations with provinces and territories and health authorities and other organizations, quality improvement initiatives, operation and maintenance of the health facility from which services are provided; administrative support services for clinical and client care; continuing education of staff to obtain and maintain competencies; pharmaceuticals, medical supplies and equipment to support service delivery; record keeping, data collection and management. Purchase, maintenance, storage and distribution of equipment, pharmaceutical and supplies necessary to deliver services and programming. Funding also supports knowledge development and dissemination, research, monitoring and evaluation. Until the end of 2025-2026, to address increased health care costs related to medical travel for Inuit and First Nations residents of Northwest Territories and Nunavut and to enable ISC to provide medical travel funding to the Governments of Northwest Territories and Nunavut for these residents while a long term solution is being developed beyond 2025-2026, eligible activities also include activities and patient access to activities that normally fall within the domain of the territorial governments' health units, including medical transportation, air ambulance and administration of medical travel for Inuit and First Nations residents of Northwest Territories and Nunavut.
Management and Delivery of Hospital services
Management and continued operations and physicians services, staff salaries, staff and board training, physical plant and utilities, staff housing, diagnostic and laboratory services, medical supplies and drugs, rehabilitation services, surgical services, medical services, patient support services, family medicine clinic, corporate services, patient record services, continuing education of staff to obtain and maintain competencies, administration and governance.
Home and Community Care
Needs assessment and developmental projects while in planning, home and community care assessment, treatment, rehabilitative, supportive and palliative and end-of-life services including structured client assessment process, managed case process, home care nursing services, home support personal care services, provision of access to in-home respite care and access to medical equipment and supplies, administrative support services for home and community care, continuing education of staff to obtain and maintain competencies, supplies and equipment to support service delivery, record keeping, data collection and management. Purchase, maintenance, storage and distribution of equipment and supplies necessary to deliver services and programming. Funding also supports knowledge development and dissemination, research, monitoring and evaluation.
Community Oral Health Services
Primary and secondary prevention which focuses on the prevention of oral diseases through treatments such as cleanings, fluoride applications and the placement of sealants. Procedures include cleanings such as scaling and prophylaxis, fluoride applications such as varnish and Silver Diamine Fluoride, dental sealant placement, temporary fillings, for example, Alternative Restorative Treatment or Interim Stabilisation Therapy and preventive resins.
Diagnostic services which includes the assessment and diagnosis of conditions related to oral health, such as dental caries and gum diseases. Procedures include examinations including recall and specific emergency, oral screenings, radiographs and treatment planning.
Operative restorative and endodontic services which include basic restorative procedures including the filling of cavities. Procedures include primary and permanent 1 to 5 surface fillings such as amalgam or composite, stainless steel crowns and primary pulpotomies, nerve treatments.
Operative emergency services which include the provision of emergency care for issues such as dental abscesses and trauma affecting the teeth and oral cavity. Procedures include palliative treatment of dental pain and infection.
Operative oral surgery services which include simple extractions and other minor surgical interventions that do not require complex surgical settings. Procedures include primary and permanent extractions, post-surgical care such as treatment of dry socket and suture removal.
Appendix H-3: Summary of requirements for due diligence
Planning requirements at the beginning of each year of agreement
| Set | Fixed | Flexible | Block | |
|---|---|---|---|---|
| Program planTable note 1 | Yes | Yes | No | No |
| Multi-year work plan | No | No | Yes | No |
| Health and wellness plan | No | No | No | Yes |
|
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Reporting requirements
| Set | Fixed | Flexible | Block | |
|---|---|---|---|---|
| Auditor's report | No | Yes, annual | Yes, annual | Yes, annual |
| Balance sheet | No | Yes, annual | Yes, annual | Yes, annual |
| Combined statement of revenue, expenditures and accumulated surplus | No | Yes, annual | Yes, annual | Yes, annual |
| Financial report on health program expenditures | Yes, year end only | No | No | No |
| Report on the provision of mandatory programs | Yes, as required by authorities | Yes, as required by authorities | Yes, as required by authorities | Yes, as required by authorities |
| Annual report to the minister | No | No | No | Yes |
| Report on program activities, other than mandatory | Yes | Yes | Yes | No |