Health Infrastructure Support Authority

Table of contents

  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. Audit framework
  11. Official languages
  12. Other terms and conditions
  13. Non-monetary contributions
  14. Funding approaches
  15. Terms and conditions effective date

1. Summary

1.1 General context

Indigenous Services Canada (ISC) through its First Nations and Inuit Health Branch (FNIHB) 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
  • 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 InuitFootnote 1, including:

  • clinical and client care services in approximately 138 remote-isolated and isolated First Nations communities
  • home and community care in 657 First Nations and Inuit communities
  • community-based health programs, focussing on healthy child development, mental wellness and healthy living, provided to approximately 600 First Nations and 50 Inuit communities
  • public health programs to all First Nation communities, including communicable disease control, and environmental public health monitoring and inspections
  • Non-Insured Health Benefits to status Indians and recognized Inuit, regardless of residence, in Canada

Improving the health of Indigenous people 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 Health Infrastructure Support Program

The Health Infrastructure Support Program underpins the long-term vision of an integrated health system with greater First Nations and Inuit control by enhancing their capacity to design, manage, deliver and evaluate quality health programs and services. It provides the foundation to support the delivery of programs and services in First Nations communities and for individuals and promotes innovation and partnerships and new health governance structures in health care delivery to better meet the unique health needs of First Nations and Inuit.

2.1.1 Health System Capacity sub-program

The Health System Capacity sub-program is the foundation for the overall management and implementation of First Nations and Inuit health programs and services. It enhances First Nations and Inuit capacity to design, manage, deliver and evaluate quality health programs and services through planning, management and infrastructure. This sub-program also supports the promotion of Indigenous participation in health careers and the development of and access to health research, information and knowledge to inform all aspects of health programs and services.

2.1.1.1 Health Planning and Quality Management sub-sub program

The Health Planning and Quality Management sub-sub program supports the enhancement of capacity for First Nations and Inuit in order to engage in and control the design of management and delivery of their health programs and services. It encourages the development and delivery of health programs and services through program planning and management. It also supports the ongoing health system improvement by embedding quality improvement activities into health programs and services through various methods such as accreditation and the evaluation of health programs

2.1.1.2 Health Human Resources sub-sub program

The Health Human Resources sub-sub program supports the promotion of Indigenous participation in health human resources management, health career promotion and career development best practices, to promote and support competent health services at the community level. This sub-sub program also supports health educational opportunities to:

  • achieve and maintain an adequate supply of qualified health care providers who are appropriately educated, distributed, deployed and supported to ensure culturally relevant, gender sensitive and safe health care
  • increase the number of Indigenous peoples working in health care delivery and as health care professionals to respond to client needs
  • improve the continuity of care for First Nations and Inuit leading to increased client and provider satisfaction and ultimately to improved client outcomes

This sub-sub program encourages work with Indigenous groups, communities and organizations, federal, provincial, territorial governments, health professional organizations and associations as well as post-secondary educational institutions and other stakeholders to develop and implement health human resources planning.

2.1.1.3 Health Facilities sub-sub program

The Health Facilities sub-sub program enhances the development and delivery of health programs and services through infrastructure by providing funding to eligible recipients for the design, construction, acquisition, leasing, expansion or renovation of health facilities, including residences for health professionals, for security services at such facilities. These activities provide First Nations, Inuit and ISC staff with the space required to safely and efficiently deliver health care services in First Nations and Inuit communities.

This sub-sub program funds projects that support the integration of health services with, or support the transfer of health services to, health authorities and health agencies. In addition, preventative and corrective measures will be carried out to enable First Nations to improve the working conditions for health facilities staff and to maintain or restore compliance with building codes, environmental legislation and occupational health and safety standards.

Eligible First Nations can apply to the health infrastructure loan support initiative (HILSI) to help meet their health infrastructure needs. For additional information regarding HILSI please refer to appendix E of this authority.

Indigenous Services Canada has no control over any capital assets, health facilities funded through the Health Facilities and Capital Program. When Indigenous Services Canada staff is requested to work in First Nations health facilities for the purpose of delivering health programs at the request of the First Nations recipient, the recipient will be required, as a condition of funding, to allow Indigenous Services Canada to use these facilities free of charge or to enter into agreements to allow such free use by way of permit or designation under sections 28(2) and 38(2) of the Indian Act.

2.1.1.4 Health research and engagement component

In addition to the sub-sub programs under the Health System Capacity sub-program, the branch also engages in Indigenous health research and partner engagement activities which likewise support the overall objectives of the branch.

Indigenous health research activities support the improvement of:

  • quality and quantity of Indigenous health data, research and information
  • development, advancement, distribution and knowledge translation of Indigenous health information
  • capacity of First Nations and Inuit to generate and access Indigenous health information. Through various funding approaches, ISC engages in capacity-building, information dissemination, knowledge translation and research, data gathering and analysis with a variety of institutions and organizations

Health engagement, consultation and liaison activities support the establishment and maintenance of productive lines of communication and exchanges of policy, research, evaluation and program delivery information between various partners, such as government and Indigenous organizations and health care delivery agencies. These activities support substantive involvement of Indigenous leaders and community representatives in decisions and implementation relating to Indigenous health policy and program delivery and the development of Indigenous awareness and expertise in the field of health care.

2.2.1 Health System Transformation sub-program

The Health System Transformation sub-program supports the integration, coordination and innovation of the health systems serving First Nations and Inuit. Activities include the development of innovative approaches to primary health care, sustainable investment in appropriate technologies that enhance health service delivery and support for the development of new partnerships and initiatives to increase First Nations and Inuit participation in and control over the design and delivery of health programs and services in their communities.

Transformation will be achieved by engaging a diverse group of partners, stakeholders and clients including First Nations and Inuit communities, tribal councils, Indigenous organizations, provincial and regional health departments and authorities, post-secondary educational institutions and associations, health professionals and program administrators.

2.2.1.1 Systems integration sub-sub program

Systems integration supports partners in First Nations and Inuit health to integrate health programs and services funded by the federal government with those funded by provincial or territorial governments so they are more coordinated and better suited to the needs of First Nations and Inuit. Systems integration activities also promote and encourage emerging tripartite federal to provincial to First Nations and Inuit relationships. Activities include the development of multi-party structures to jointly identify integration priorities and plans for further integrating health services in a given province or territory and implementation of multi-year, larger-scale, for example, beyond 1 community, health service integration projects consistent with agreed-upon priorities, for example, a province-wide public health framework or integrated mental health services planning and delivery on a regional scale.

2.2.1.2 e-Health Infostructure sub-sub program

The e-Health Infostructure program supports the use of health technology to enable First Nations and Inuit community front line healthcare providers to improve people's health through innovative e-Health partnerships, technologies, tools and services. It focuses on the development and adoption of modern systems of information and communications technologies for the purpose of defining, collecting, communicating, managing, disseminating and using data to enable better access, quality and productivity in the health and health care of First Nations. The program evolved out of the need for ISC to align with First Nations' e-health strategies, health plans and policy directions as well as the movement by provinces and territories and the health industry towards increased use of information and communication technologies to support health service delivery and public health surveillance. Moreover, e-health infostructure, information plus systems plus technology plus people, has the benefit of modernizing, transforming and sustaining health care to provide:

  • optimal health services delivery, primary and community care included
  • optimal health surveillance
  • effective health reporting, planning and decision making
  • integration and compatibility with other health services delivery
2.2.1.3 Nursing innovation sub-sub program

Nursing innovation supports nursing recruitment and retention and ultimately impacts quality sustainable primary health care services in remote-isolated and isolated First Nations communities. This initiative is necessary because Indigenous Services Canada has a keen interest in improving and sustaining quality health care delivery in First Nations communities. Often the first and only point of contact in remote and isolated First Nations communities, nurses require adaptability to innovate their scope of practice and manage ever changing medical technologies and infrastructure. Multiple pilots are underway across Indigenous Services Canada regions to test new health care delivery models involving collaborative teams, linking technology and nurses and investigating new hours of operation in target nursing stations. The goal of the strategy is to improve primary care services in these First Nations communities through the implementation and evaluation of multiple innovative projects.

2.3.1 Tripartite Health Governance sub-program

ISC's longer-term policy approach aims to achieve closer integration of federal and provincial health programming provided to First Nations, as well as to improve access to health programming, reduce instances of service overlap and duplication and increase efficiency where possible. While the Health System Transformation sub-program focuses on targeted projects with time-limited funding, a Tripartite Health Governance process refers specifically to 3-party negotiation of a new province-wide First Nations health governance structure. Key components of a new structure would include a shift in responsibility for First Nations health programming away from the federal government to First Nations or provinces, an approach to integrating health programming on a province-wide scale, a First Nations organization with an explicit mandate to represent all bands in that province and an explicit political and financial commitment from the provincial government. Funding under this sub-program is initiated by a federal ministerial mandate for health governance negotiations and is limited to supporting the development and implementation of a tripartite health governance agreement.

2.3.1.1 BC Tripartite Initiative sub-sub program

The BC Tripartite Initiative consists of an arrangement among the Government of Canada, the Government of BC and BC First Nations. Since 2006, the parties have negotiated and implemented a series of tripartite agreements to facilitate the implementation of health projects as well as the development of a new First Nations health governance structure. In 2011, the federal and provincial Ministers of Health and BC First Nations signed the legally-binding BC Tripartite Framework Agreement on First Nation Health Governance. This BC Tripartite Framework Agreement commits to the creation of a new province-wide First Nations Health Authority (FNHA) to assume design, management and delivery and funding of First Nations health programming in BC. The FNHA will be controlled by First Nations and will work with the province to coordinate health programming. It may design or redesign health programs according to its health plans. Indigenous Services Canada will remain a funder and governance partner but will end its program design and delivery role. Funding under this sub-sub-program is limited to the implementation of the BC Tripartite Framework Agreement, with a single recipient, the FNHA.

3. Legal and policy authority

The following legal and policy authorities support the Health Infrastructure Support Authority and are grouped by their respective sub-sub program, where required:

Health System Capacity sub-program

Health human resources

  • First Ministers' Ten-Year Plan to Strengthen Health Care: Health Human Resources, Wait Times and Performance Reporting, approved-in-principle, December 2004
  • Health Human Resource Strategy, 2003 First Ministers' Accord on Health Care Renewal and 2003 federal budget announcement
  • Indian and Inuit Professional Health Careers Program, February 1984
  • Budget 2010
  • Health Human Resources Strategy, August 2004

Health facilities

  • Health Facilities and Capital Program
  • Budget 2009: Construction and minor renovation project investments
  • Health Canada's Long-Term Capital Plan, February 2002
  • Sustainability of First Nations and Inuit Health Systems, August 2003
  • Enhancing Early Learning and Child Care for First Nation Children Living on Reserve and Working towards the First Phase of a Single Window, October 2005

Health System Transformation sub-program

  • Strategy to Improve Health Information and Accountability, approved-in-principle, November 6, 2001
  • Department of Indigenous Services Act 2019

Systems integration

  • Extension of Policy Authority for the Aboriginal Health Transition Fund, May 12, 2009

e-Health Infostructure

  • Government On-Line Strategy, First Nations and Inuit Primary Care Electronic Health Record and Provincial-Federal First Nations Telehealth Project, July 2001 and September 2002
  • First Nations and Inuit Health Information System, 1997 and 2002

Tripartite Health Governance sub-program

  • Memorandum to Cabinet BC Tripartite Framework Agreement on First Nation Health Governance RD September 2011
  • BC Tripartite Framework Agreement in First Nations Health Governance, October 2011
  • Memorandum to Cabinet Implementation of the BC Tripartite Framework Agreement on First Nation Health Governance RD November 2012
  • Treasury Board Submission, Implementation of the BC Tripartite Framework Agreement on First Nation Health Governance: Transfer to the First Nations Health Authority February 2013

4. Eligible recipients and annual maximum amount payable

The following classes of recipients are eligible for funding under the Health Infrastructure Support Authority categories of contribution. The following table lists the different classes of eligible recipients by sub-program and the annual maximum amount payable for each sub-sub program for this authority.

The annual amount for the Health Infrastructure Support 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.

Table 1 - Eligible recipients and annual maximum amount payable (,000's)
Eligible recipients Health systems capacity Health system transformation Tripartite Health Governance - BC Tripartite Initiative
Health planning and quality management Health research and engagement Health human resources Health facilities Systems integration e-Health infostructure Nursing innovation
First Nations in CanadaTable note 1, for example, communities, bands, district, tribal councils and associations $3,000 $3,000 $3,000 $20,000 $4,000 $2,000 $500 $0
Inuit associations, councils and hamletsTable note 1 $3,000 $3,000 $3,000 $20,000 $2,000 $2,000 $500 $0
Canadian national Indigenous organizations $5,000 $25,000 $5,000 $4,000 $2,000 $5,000 $500 $0
Non-governmental and voluntary associations and organizations, including non-profit corporations $2,000 $6,000 $10,000 $16,000 $4,000 $5,000 $500 $0
Educational institutions, hospitals and treatment centres $2,000 $3,000 $3,000 $16,000 $2,000 $5,000 $1,000 $0
Municipal, provincial and territorial governments $3,000 $3,000 $3,000 $16,000Table note 2 $4,000 $5,000 $2,000 $0
Health Authorities and health agencies $3,000 $3,000 $3,000 $16,000Table note 3 $4,000 $5,000 $2,000 $700,000
Table note 1

These amounts are based on a single community. If the recipient is a multi-community First Nations or Inuit group or organization, this amount will be multiplied by the number of individual communities involved.

Return to table note 1 referrer

Table note 2

For 2024 to 2025 through to 2030 to 2031 and the Weeneebayko Area Health Authority Hospital Redevelopment project only, the maximum amount payable to the Ontario Ministry of Health will be $320 million and in alignment with agreed upon project schedule.

The maximum amount payable for all other municipal, provincial and territorial governments will remain at $16 million.

Return to table note 2 referrer

Table note 3

For 2024 to 2025 and the repair and maintenance work required at the existing Weeneebayko General Hospital only, the maximum amount payable to the Weeneebayko Area Health Authority will be $50 million. For 2025 to 2026 through to 2030 to 2031, the maximum amount payable to the Weeneebayko Area Health Authority will be $30 million. Starting in 2031 to 2032, maximum amount payable will revert to $16 million and ongoing.

The maximum amount payable for all other health authorities and health agencies will remain at $16 million.

Return to table note 3 referrer

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 program which falls under the Health Infrastructure Support Authority. See appendix C. Generally, eligible expenditures will include administration of the programs, staff salaries and benefits, contracts related to program planning, delivery and evaluation, staff travel, office supplies, accommodation, printing, staff training, operation and maintenance of health facilities, utilities such as broadband connectivity and telecommunications, minor equipment and 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. In accordance with the BC Tripartite Framework Agreement, this condition does not apply to the Canada Funding Agreement under the BC Tripartite Initiative and need not be applied to other BC Tripartite Initiative funding agreements where a rationale is documented by the department.

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 cashflow 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 Plan submitted, as well as historical funding levels. 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 Plan.

7.1 Exceptional authority

In light of the 2021 Canadian Human Rights Tribunal 41, under these terms and conditions, First Nations and First Nations authorized service providers can seek funding from ISC for the purchase or the recovery of costs incurred related to the construction of capital assets that is completed, underway or that the First Nations advise are ready to proceed to support the delivery of Jordan's Principle for eligible expenditures and activities incurred by eligible recipients starting from August 26, 2021.

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 branch. 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. Recently the branch has also implemented the Risk Tolerance Strategy and this is another layer of assessing the recipient.

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:

In addition to the above for capital construction contribution agreements, the recipient must provide:

The following requirements will apply to all community-based contribution agreements:

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 the 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 branches or 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 arrangements while trying to ensure seamless requirements between funders.

Redistribution of funding

Where a recipient further distributes contribution funding to an agency or a third party, such as an authority, board, committee or other entity authorized to act on behalf of the recipient, the recipient will remain liable to the department for the performance of its obligations under the funding agreement. Neither the objectives of the programs and services nor the expectations of transparent, fair and equitable services will be compromised by any redistribution of contribution funding

Recipients have full independence in the selection of such third parties and will not be acting as an agent of the government in making distributions.

9. Due diligence in managing and administering the transfer payment guidelines

Indigenous Services Canada ensures that FNIHB has financial resources for the effective, management, administration, evaluation and contribution audit activities related to programs under these terms and conditions.

9.1 Performance Measurement Strategy

The Performance Measurement Strategy 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 strategy covers:

  • main activities of the program and its client or target populations
  • expected results
  • performance indicators
  • data collection sources and methods
  • responsibility and frequency for collection
  • reporting method

An evaluation strategy for the Health Infrastructure Support Authority has been developed as part of the Performance Measurement Strategy.

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 Health Infrastructure Support 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

Indigenous Services Canada has established a Transfer Payment Management Control Framework 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 Strategies. These agreements define the funding mechanisms in order to meet the needs of the recipient while taking capacity into account.

Expected results Performance indicators
Promote innovative integrated health governance relationships. Percentage of provinces and territories with multijurisdictional agreements to jointly plan, deliver or fund integrated health services for Indigenous Canadians.
Improved First Nations and Inuit capacity to influence and control, design, deliver and manage health programs and services. Number of communities involved in the planning process to influence and control, design, deliver and manage health programs and services.

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 and 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. Indigenous Services Canada 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 D.

10. Audit framework

10.1 Contribution audits

Risk-based contribution audits are conducted in accordance with the ISC Audit and Quality Assurance framework. This framework presents the kind of audit activities that the branch may conduct, the related roles and responsibilities and the approval process. Contribution audits are carried out in accordance with an annual audit risk-based audit plan that covers audits to be conducted based on an evaluation of risks.

The operational risks considered are the probability that:

  • First Nations and Inuit communities do not receive health programs and services for which they are entitled
  • program funds are not used for intended purposes or in non-conformance with the terms and conditions of the contribution agreement or that First Nations and Inuit internal control practices are inappropriate
  • program funds being used for personal profit

Indigenous Services Canada is responsible for determining whether recipients have complied with the terms and conditions applicable to the contributions. ISC can look at individual contribution agreements based on systematic risk assessment and intuitive risk assessment of program management when a problem is suspected, or when program internal controls have failed, for example, financial and operational monitoring.

10.2 Program audits

The internal audit function within the Audit and Assurance Services Branch is a professional, independent and objective assurance and consulting activity designed to add value and improve the department's operations through a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control and governance processes. Internal audits are selected using a risk-based audit planning process that spans multiple years, focuses primarily on departmental areas of high risk and significance and also considers departmental priorities.

A Risk Management Strategy to support the Health Infrastructure Support Authority was developed which details the risk profile for each main component of this authority. A risk assessment tool was also developed to standardize the risk. Audit plans include provision for the review of internal management policies, practices and controls over transfer payment programs and determination of the adequacy of the departmental processes to track whether recipients have complied with the requirements of applicable contribution agreements.

11. 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 VII 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.

12. Other terms and conditions

12.1 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.

For any funding agreement under the BC Tripartite Initiative the Minister may take:

  • no license
  • a license or licenses that match that used by ISC as aforesaid in this section for other ISC matters,
  • a license for:
    • any internal federal government administrative purpose relating to the initiative
    • for public communications or access to information requests about the initiative

This approach is consistent with the Directive on Transfer Payments.

12.2 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.

For the BC Tripartite Initiative, the Canada Funding Agreement will be terminable only if the BC Tripartite Framework Agreement is terminated or materially changed, on consent or if the corporation becomes inactive or inoperable due to corporate dissolution or similar changes or if it becomes insolvent.

13. 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 Nation 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 the purposes of Health Infrastructure Support:

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.

14. 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 B.

15. Terms and conditions effective date

These terms and conditions came into effect on December 21, 2022.

Appendix B: Funding approaches

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 branch.

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 or 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.

The following table provides an overview of the funding approaches that ISC will be using as well as the distinct differences and reporting requirements.

Table 2: Funding approach comparison
Requirements Set Fixed Flexible Block
Planning Recipient follows multi-year program plan. This plan will include objectives and activities that will be delivered. Recipient follows multi-year program plan. This plan will include objectives and 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 plan including a health management structure. The health 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 and 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. Recipients are able to retain any unexpended funding remaining at the expiry of the agreement provided that the obligations and objectives set out in the 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 are able to retain surpluses to reinvest in health priorities.
Must ensure the provision of all mandatory programs

exception: funds provided to support the Health Facilities sub-sub program are only to be used for health capital projects.

Appendix C: 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 Health Infrastructure Support's sub-program:

Health System Capacity sub-program:
Name of sub-sub program Eligible key activities
Health planning and quality management Community health planning, management and administration, needs assessment, conferences and meetings. As well as community planning and self-assessment, including travel and hospitality, standards coordination and data input.
Health research and engagement Research, data collection, analysis or knowledge translation projects, international and national research coordination initiatives, research team travel, publications and conferences.

Supporting Indigenous consultation and liaison activities with various partners at the international, national, provincial and territorial, regional and community levels. This could include hospitality, participant and staff travel, telecommunications, administration and publications.
Health human resources Projects to promote Indigenous awareness of health careers, research, consultation, planning and pilot projects in Indigenous health human resources, educational support programs at post-secondary institutions for Indigenous health career students, health career student bursary and scholarship programs, summer student employment in health careers, projects to increase retention of community-based health care workers in First Nations and Inuit communities, training for community-based health care workers and First Nations health managers, support for capacity for Indigenous organizations to participate in Health Human Resources planning, national projects to increase the cultural competence of health care students and workers, development of Indigenous Health Human Resources planning frameworks, guidelines and criteria.
Health facilities

Funding may be used by recipients for expenses relating to the following matters for health facilities and associated residences or operational buildings:

  • planning, design, construction, replacement, acquisition, leasing, renovation, repairs or expansion of health facilities and associated residences or operational buildings
  • equipment for the support of health service delivery within the recipient community, including the repair and disposal of such equipment
  • remediation of environmental or Occupational Health and Safety issues associated with the facility. More specifically, this could include salaries, professional and legal fees and disbursements, feasibility studies, surveys, environmental assessments and remediation, architecture and engineering fees, security services, construction materials, supplies, construction equipment rentals, health and other support equipment, transport costs and security-related equipment necessary to complete the capital activity, to maintain the health infrastructure condition in order to support the delivery of health programming

Funding may also be used for the Health Infrastructure Loan Support Initiative, see appendix E.
Health System Transformation sub-program:
Name of sub-sub program Eligible key activities
Systems Integration Formation of multi-party structures to jointly identify priorities and create health systems integration plans, research, planning, development and implementation of projects, initiatives, policy frameworks and other activities that further the integration of health systems or promote and encourage emerging tripartite, federal-provincial-First Nations and Inuit relationships, production and dissemination of publications and other communication products that pertain to health systems integration, supporting the capacity of First Nations and Inuit organizations to engage in health systems integration policy development.
E-Health infostructure Planning development, implementation and monitoring of projects, strategies, policies and other activities furthering integration of health systems through improved use of and access to health information and communication technologies integrated with provincial systems. This includes, but is not limited to telehealth, electronic health records or electronic medical records, infostructure, public health surveillance, connectivity, administrative systems, other e-service development applications, continuing education of FNIH and community health staff to obtain and maintain e-Health Infratructure related skills and competencies, knowledge development and dissemination, research and monitoring and evaluation.
Nursing innovation Human resource planning, nursing education and competency assessment program, new models of care, collaborative teams, new hours of operations and integrated nursing and technology.
Tripartite Health Governance sub-program:
Name of sub-sub program Eligible key activities
BC Tripartite Initiative Consistent with the BC Tripartite Framework Agreement, the FNHA assumes the role of planning, design, management and funding and delivery of First Nations health programming in BC and all related administrative, policy and support functions. The FNHA's activities shall be in accordance with the BC Tripartite Framework Agreement, the Canada Funding Agreement and any other funding agreements and its Interim or Multi Year Health Plan.

Appendix D: Summary of requirements for due diligence

Set Fixed Flexible Block
Planning requirements at the beginning of each year of agreement
Program planTable note 1 Yes Yes No No
Multi-year work plan No No Yes No
Health plan No No No Yes
Reporting requirements
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
Not applicable to the BC Tripartate Initiative
Annual report to the minister No No No Yes
Report on Program Activities other than mandatory Yes Yes Yes No
Table note 1

Program plan: The nature of the program plan varies from 1 program to another. It could be presented as a project chart, a budgetary plan or a costed list by activity.

Return to table note 1 referrer

Appendix E: Health Facilities sub-sub program: Health infrastructure loan support initiative

1. Context

This appendix outlines supplemental terms and conditions that will apply to the health infrastructure loan support initiative, under the Health Facilities sub-sub program, to create sustainable capital to meet Indigenous health infrastructure needs. Unless otherwise stated below, the overall terms and conditions for the Health Infrastructure Support Authority apply to this initiative.

2. Objectives and results

Under the health infrastructure loan support initiative, qualifying First Nations may apply to ISC for contribution funding to support infrastructure loans they would like to take out from the First Nations Finance Authority or other financial institutions in order to construct health infrastructure in their communities.

Supporting increased access to financial tools presents an opportunity for First Nations and their health services organizations to exercise more control over decisions around planning and timing of investments in the health infrastructure that better serves them.

Under the health infrastructure loan support initiative, First Nations will be able to address their communities' healthcare infrastructure gaps sooner than what would be possible under current funding regimes.

They will be able to use a lifecycle approach to manage and plan for their healthcare infrastructure needs over the long-term rather than being able to merely provide short-term solutions.

3. Eligible recipients

To qualify for the health infrastructure loan support initiative, eligible recipients need to demonstrate the ability to meet a series of governance, capacity and regional representation pre-requisites, which may include, but will not be limited to:

  • being scheduled under the First Nations Fiscal Management Act
  • being a participant in the First Nations Land Management Act (FNLMA) and having a land use plan or Financial Management Systems certification
  • working with the First Nations Financial Management Board (FNFMB) to complete the standards set out under legislation or regulation

4. Application requirements

The health infrastructure loan support initiative will function on a proposal basis for construction projects, for example, building replacements, new health facilities. Proposals will need to include relevant pre-capital planning and detailed design documentation, which may include a class A estimate, an asset management plan including an amount for lifecycle costs, such as operations and maintenance costs and a specific project plan.

5. Due diligence and reporting

The health infrastructure loan support initiative will use a specific project charter and include additional provisions within the funding agreement, which will, in combination with the lending institution's standard borrowing agreement, mirror the due diligence and reporting elements of the Management Control Framework and FNIHB protocols for funded infrastructure.

The project charter will be signed by the Senior Assistant Deputy Minister of FNIHB and the recipient. In addition to the regular capital planning elements, supported loan documentation will confirm the recipient's consent to participate in the health infrastructure loan support initiative. Funding for the health infrastructure loan support initiative will be approved by senior level officials in the department, as outlined in the Management Control Framework. The contribution agreement will be between the department and the recipient. The lending institution will not be a party the funding agreement. The borrowing agreement will be between the recipient and the lending institution. The department will not be a party to the loan agreement.

5.1. Special reporting requirements

In addition to recipient reporting requirements contained in the contribution agreement, it is expected that the recipient will be required to report to the lending institution. Where duplication of reporting may exist between reporting to the lending institution and contribution agreement reporting requirements, the department may be able to accept reports submitted to the lending institution in lieu of ISC reporting requirements.

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