Transition 2021 Minister Hajdu Indigenous Services Canada overview - Book 2

About the Program

• In Canada, Indigenous children account for only 7.7% of the country's child population, but represent 52.2% of children in foster care (according to Census 2016). At present, there are approximately 9,247 First Nations children in care.
• Indigenous Services Canada (ISC) provides funding, through the First Nations Child and Family Services Program, to First Nations child and family services agencies that are established, managed, and controlled by First Nations and delegated by provincial authorities to provide prevention and protection services to First Nations children ordinarily resident on-reserve.
• In areas where First Nation agencies do not exist, ISC funds provinces and Yukon to provide child and family services, based on their legislation and standards. Provincial and territorial governments also provide child and family services to Indigenous children off-reserve.
• Since 2016, ISC has used a prevention-based funding model to support early intervention and alternatives to traditional institutional care and foster care, such as the placement of children with family members in their community setting.
• The program provides four streams of funding:
  • Operations: core and operational funding for protection services (such as salaries and overhead).
  • Prevention: resources for enhanced prevention services.
  • Maintenance: direct costs of placing First Nations children into temporary or permanent care out of the parental home (such as foster care rates and group home rates).
  • Community well-being and jurisdiction initiative: funding for the ongoing provision of culturally appropriate prevention and well-being services to First Nations children and families on-reserve and in Yukon. First Nations may also use this funding to expand the availability of prevention and well-being initiatives that are responsive to community needs; complement prevention programming provided by First Nations Child and Family Services agencies or provincial and territorial agencies; increase capacity in the area of prevention programming; and explore and build capacity for Indigenous-led service delivery models, including the exercise of child and family servic es jurisdiction.
• In January 2018, ISC hosted an emergency meeting with Indigenous partners and provinces and territories to discuss the over-representation of Indigenous children in care and collaboratively chart a plan toward systemic reform. Six points of action were identified:
  1. continuing the work to implement the orders of the Canadian Human Rights Tribunal, and reforming the child and family services program to make it truly child centered and community-directed;
  2. shifting the programming focus to prevention and early intervention to support parents and keep families together;
  3. supporting communities to exercise jurisdiction and explore the potential for co-developed federal child and family services legislation;
  4. accelerating the work of trilateral and technical tables;
  5. supporting Inuit and Métis Nation leadership to advance culturally appropriate reform of child and family services; and
  6. developing a data and reporting strategy with provinces, territories and Indigenous partners.
• As part of these reform efforts, Bill C-92, An Act respecting First Nations, Inuit and Métis children, youth and families (the Act) was co-developed with Indigenous partners and introduced in Parliament on February 28, 2019. The Act received Royal Assent on June 21, 2019, and came into force on January 1, 2020.
• The Act affirms the rights of First Nations, Inuit and Métis to exercise jurisdiction over child and family services, contributes to the implementation of the United Nations Declaration on the Rights of Indigenous Peoples, and establishes national principles, such as best interests of the child, cultural continuity and substantive equality to help guide the provision of child and family services in relation to Indigenous children.
• The Act also aims to shifts the focus toward prevention and early intervention, to reduce the number of Indigenous children in care.
• Through the July 2020 Economic and Fiscal Snapshot, Canada has committed more than $542 million over five years to support the implementation of the Act in full partnership with Indigenous partners, including nearly $73 million over five years to support Coordination Agreement discussions; $35 million for internal services; and nearly $10 million over two years to support engagement activities.

Canadian Human Right Tribunal Orders for the First Nations Child and Family Services Program

• In February 2007, the Assembly of First Nations and the First Nation Child and Family Caring Society of Canada filed a complaint under the Canadian Human Rights Act. That complaint alleged that ISC provided inequitable and insufficient funding for child and family services on-reserve and in the Yukon (compared to provincial funding for off-reserve services). The Assembly of First Nations and the Caring Society alleged that ISC's conduct constituted systemic and ongoing discrimination on the basis of race and national or ethnic origin.
• On January 26, 2016, the Canadian Human Rights Tribunal found that ISC had discriminated against First Nations children and their families living on-reserve and in the Yukon by underfunding child and family welfare services under the First Nations Child and Family Services Program. The Canadian Human Rights Tribunal ordered ISC to cease its discriminatory practices and to reform the First Nations Child and Family Services Program (and the 1965 Agreement in Ontario). It also ordered ISC to cease applying its narrow definition of Jordan's Principle and to take measures to immediately implement the full meaning and scope of Jordan's Principle.
• The Canadian Human Rights Tribunal has released more than a dozen follow-up decisions on the First Nations Child and Family Services Program and Jordan's Principle since January 2016. Many of those decisions order Canada to take particular actions. The following orders are the most significant:
  • The February 1, 2018 Decision (2018 Canadian Human Rights Tribunal 4): Order to fund First Nations Child and Family Services agencies at the actual costs of, among other things, prevention activities (currently being implemented).
  • The September 6, 2019 Decision (2019 Canadian Human Rights Tribunal 39): Order to pay $40,000 to on-reserve children removed from their homes and to parents or grandparents of those children (currently under judicial review).
  • The March 17, 2021 Decision (2021 Canadian Human Rights Tribunal 12): Order with Canada's consent to provide prevention funds to First Nations not served by an First Nations Child and Family Services agency (currently being implemented).
  • The August 26, 2021 Decision: Order to fund First Nations Child and Family Services agencies and First Nations at the actual costs of building or buying office space, program space or other capital assets to support the delivery of child and family services.

Top Key Current Files or Projects

• ISC is working with Indigenous partners with a shared vision of an Indigenous child and family services system that focuses on prevention within communities.
• ISC will continue research with First Nations partners and other experts to further inform and support the development of options for a funding methodology for a reformed First Nations Child and Family Services Program.
• ISC is committed to seeking input from a diverse range experiences and perspectives to help guide implementation of the Act, including seeking information from Indigenous partners, provinces, and territories.
• To achieve this goal, nearly $10 million will be available over the next two years to support Indigenous-led engagements to advance the Act's implementation, including the establishment of distinctions-based governance engagement mechanisms. Through these mechanisms, other established protocols and working groups, ISC will work directly with Indigenous partners at the community, regional and national levels to learn best practices, strengthen partnerships, discuss data sharing, and receive guidance on the overall implementation of the Act from a culturally relevant lens.

Key Milestones

• ISC will continue to implement the Canadian Human Rights Tribunal orders and seek to resolve any outstanding issues through collaborative partnerships with the Consultation Committee on Child Welfare and the National Advisory Committee (NAC) on First Nations Child and Family Services. The Consultation Committee on Child Welfare's mandate is to oversee the implementation of the Canadian Human Rights Tribunal orders. It includes the parties to the Canadian Human Rights Tribunal complaint (ISC, Assembly of First Nations, Caring Society, Nishnawbe Aski Nation, Canadian Human Rights Commission, and Chiefs of Ontario) and their legal representation. The National Advisory Committee provides advice on the design of First Nations Child and Family Services policies and programs on-reserve and is comprised of the ISC, the Assembly of First Nations, the Caring Society as well as agency and community representatives from each province.
• ISC will continue working in collaboration with the parties on long-term reform of the First Nations Child and Family Services Program, including moving forward with the third phase of the work with the Institute of Fiscal Studies and Democracy involving piloting and testing funding methodologies with selected agencies and First Nations.
• ISC will continue to support communities in their exercise of jurisdiction over child and family services and engage with Indigenous, provincial, and territorial partners on the co-development of governance engagement mechanisms to support the implementation of the Act.
• ISC will continue to lead distinctions-based working groups with Indigenous, provincial, and territorial partners to co-develop data and reporting strategies. The new strategies and approaches are designed to increase inter-jurisdictional data collection to deliver insights that will contribute to a better understanding of ways to reduce the over-representation of Indigenous children and youth in care, all the while respecting Indigenous data protocols and practices.

Results and outcomes

• The Government of Canada has substantially increased funding for the First Nations Child and Family Services Program from $676.8 million in 2015-2016 to $1.47 billion in 2019-2020, to meet the immediate service delivery needs for First Nations children and families, including for prevention. However, long-term reform of the program is still being discussed with the parties to the mediation for compensation of individuals.
• On January 1, 2020, An Act respecting First Nations, Inuit and Métis children, youth and families came into force. The Act was co-developed with First Nations, Inuit, and Métis partners, and is the culmination of extensive engagement in the summer and fall of 2018, which included more than 65 engagement sessions with nearly 2,000 participants. ISC also engaged with Indigenous partners and provincial and territorial representatives on the draft content of the proposed legislation in January 2019.
• The Act has received strong interest and support from Indigenous communities in moving towards the exercise of jurisdiction under the Act. Notably:
  • ISC currently has 16 ongoing Coordination Agreement discussion tables and has received 52 notices of interest to exercise jurisdiction, representing more than 100 Indigenous groups and communities.
  • The first two Indigenous laws have come into force, namely the Wabaseemoong Independent Nations' Customary Care Code in Ontario, and the Cowessess First Nation's Miyo Pimatisowin Act in Saskatchewan.
  • The first tripartite Coordination Agreement has been concluded with the Cowessess First Nation and the Government of Saskatchewan. Discussions with the Wabaseemoong Independent Nations in Ontario and potentially Splatsin in British Columbia are expected to conclude in the coming weeks, which will trigger requests for rapid approval of Coordination Agreements.
  • ISC has invested heavily in our relationships with provinces and territories, both bilaterally and through multilateral meetings, recognizing that their full engagement is critical to the success of the implementation of the Act.
  • The courts are recognizing the Act and its minimum standards when making important decision matters in relation to Indigenous children in care. There are 49 court cases that have referenced, interpreted and/or enforced the Act since it came into force, as well as two Federal Court cases and three Canadian Human Rights Tribunal cases.
• In November 2020, the Prime Minister announced over $542 million in funding to advance First Nations, Inuit, and Métis engagement to co-develop the implementation of the Act, and to support Indigenous communities and groups in building the capacity to establish their own child and family services systems. A total of 116 capacity-building proposals have been received, and 73 of these proposals have been approved. The total funding requested for fiscal year 2021-2022 is currently $80,465,422 and the total funding approved to date is $30,278,846. Based on the review of the 43 outstanding proposals received, it is expected that up to $47 million in additional funds for capacity-building could be approved in fiscal year 2021-2021.
• This funding supports the $3 billion already invested to improve the government's funding support for First Nations child and family services.
• Through Budget 2021, the government invested an additional $1 billion over five years, with $118.7 million ongoing, to increase funding to support First Nations child and family services.
• The first Ministerial Federal, Provincial, Territorial, and Indigenous Meeting on the Act was held in May 2021, and meetings with Indigenous, provincial, and territorial technicians are planned in the coming months.
• While time and sustained commitment will be needed to see the full benefits of current investments, improved outcomes for children and families are becoming evident. Taking into account population growth, the number of First Nations children in care on-reserve is plateauing in most provinces and a downward trend in numbers of children in care has emerged in British Columbia, Newfoundland and Labrador.
• Further, investments in prevention since 2018 are yielding successes in communities across Canada. As an example, the Tahltan, Kaska, and Tlingit First Nations in British Columbia, through the Stikine Wholistic Working Group, are trailblazing best practices in their work to build healthy communities by using local expertise to restore traditional practices and networks of support and have reduced the number of children in care in the Stikine Region by 50%. In Manitoba, the Assembly of Manitoba Chief's Grandmothers Council has been playing an important role in revitalizing traditional parenting ways, providing traditional knowledge as community customary care models are planned, and taking the lead role in preventing newborn apprehensions.

Lead Departmental Official
Isa Gros-Louis
Director General
Child and Family Services Reform

Snapshot

The underlying goal of the Lands and Economic Development Sector at Indigenous Services Canada (ISC) is to transfer economic development programming and service delivery to Indigenous-led Institutions. As the sector moves in this direction, the sector strives for the creation of wealth and the full economic participation of Indigenous communities and entrepreneurs in the Canadian economy, according to community vision and needs. Through its programming, ISC partners with communities, Indigenous economic development organizations (such as the National Aboriginal Capital Corporations Association and the Canadian Council for Aboriginal Business) and other internal and external partners to improve access to capital; foster a climate of economic development within communities; and leverage public and private sector partnerships and funds. Services are provided directly to communities through core and targeted funding, as well as indirectly to entrepreneurs through the National Aboriginal Capital Corporations Association and the network of Aboriginal Financial Institutions and Métis Capital Corporations. ISC's economic development programming, services, and policy areas are outlined as follow:

• Entrepreneurial support: The Government of Canada provides indirect funding to Indigenous entrepreneurs through the Aboriginal Entrepreneurship Program. The program has been devolved to Indigenous partners and is shifting towards distinctions-based delivery. It offers support to qualifying First Nations, Inuit and Métis entrepreneurs so that they can access the capital needed to start and grow their businesses. ISC, along with Public Services and Procurement Canada and the Treasury Board of Canada Secretariat, is implementing revisions to the Procurement Strategy for Aboriginal Business (now called the Procurement Strategy for Indigenous Business) and a mandatory requirement for federal organizations to ensure a minimum of five percent of the total value (approximately $1 billion annually) of federal contracts are awarded to Indigenous firms.
• Community-based capacity support: ISC's Community-Based Economic Programming provides funding and capacity development support directly to communities so that they can take advantage of economic development and business opportunities. Reserve Land and Environmental Management, First Nations Land Management, Land Use Planning, First Nations Solid Waste Management Initiative, Contaminated Sites On Reserve Program, and Community-Based Economic programming provide direct funding and capacity development support to communities to preserve and sustainably manage their lands and resources, and take advantage of economic development and business opportunities. Additionally, ISC provides secretariat assistance to the recently co-developed Indigenous Centre for Cumulative Effects, which supports the technical and scientific capacity of Indigenous communities to address cumulative effects, based on the values of First Nation, Inuit and Métis communities.
• Legislative and policy support: This component includes the development and implementation of legislation, regulations and policies, which support sectoral self-government in lands and environmental management and federal processes and reforms related to lands and environmental activities, such as Additions to Reserves and Reserve Creation; addressing the environmental regulatory gap on reserve; and meeting ISC's legislative requirements under the Impact Assessment Act.
• The sector also provides secretarial support services to the National Indigenous Economic Development Board, a Ministerial appointed board that is mandated to provide the government with strategic policy advice on matters pertaining to Indigenous economic development. ISC also implements the First Nations Commercial and Industrial Development Act (2006), which supports First Nations in their pursuit of complex commercial and industrial projects on-reserve.
• Partnerships support: Partnerships with Indigenous organizations are key to delivering the lands and environmental management programming. The Strategic Partnerships Initiative works across 21 federal departments and agencies using a collaborative approach to promote partnerships between federal and non-federal partners, bridge gaps in existing federal funding, as well as leverage other sources of funds to support economic reconciliation through complex economic development opportunities, such as the Community Well-being Pilot Project (Ring of Fire in northern Ontario); the British Columbia Indigenous Clean Energy Initiative; and the Arctic Gateway Initiative in northern Manitoba. See number 14 Strategic Partnerships Initiative for additional details on these initiatives.

Context

The most recent data indicate that:

• In 2017, there were nearly 19,000 businesses located in Indigenous communities (approximately 17,000 in First Nation communities and 2,000 in Inuit communities). Combined, these businesses generated just over $10 billion in total revenue and $0.4 billion in profits in the reference year of this study (A Profile of Businesses in Indigenous Communities in Canada (statcan.gc.ca)) (PDF 349 KB, 43 pages).
• The population of self-employed Indigenous Peoples continues to grow at a greater pace than that of self-employed non-Indigenous Peoples overall, increasing 44% between 2011 and 2016 (Canadian Council for Aboriginal Business - New study gives first impression on the impact of intellectual property on Indigenous businesses).
• There is enormous diversity across location, size and sector of Indigenous businesses. However, access to capital is a major barrier for most Indigenous entrepreneurs, over half of whom relied on personal savings to start their business (ccab-businessurvey-f2-singles.pdf (nadf.org)) (PDF 1.47 MB, 52 pages).
• In 2015, the median income of Indigenous Peoples was $25,526, which is $9,078 lower than that of the non-Indigenous population. The median income of First Nation peoples who are registered and living on-reserve was less than half of the non-Indigenous population (from Annual Report to Parliament 2020 (sac-isc.gc.ca)). It should also be noted that 7.4% of Indigenous workers are self-employed, compared to 11.7% of non-Indigenous Peoples. Within the Indigenous population, self-employment is highest for Métis.
• Businesses that are incorporated and have employees are more likely to report revenue growth. However, Section 87 of the Indian Act serves as a deterrent to incorporation. Section 89 of the Indian Act restricts the use of collateral for those on-reserve, which has a negative impact on their ability to finance a business.
• There are over 9 million acres of reserve lands, representing 3.7% of Canada's total land mass, with an additional 3 to 4 million acres of land owed to First Nations through existing Treaty Land Entitlement and Specific Claims settlement agreements. Currently, ISC provides some level of funding to support the administration and management of reserve lands, natural resources and the environment to 46.5% of First Nations.
• There are 102 First Nations who have enacted community ratified land codes, opting out of 44 lands related sections of the Indian Act and reasserting jurisdiction over their lands under the Framework Agreement on First Nation Land Management and the First Nations Land Management Act.
• Twenty-five percent of First Nations have developed and implemented community land use plans.
• On average, the number of projects completed annually is more than 1000 projects, which help communities to manage and dispose of their waste.
• There are currently 2,024 contaminated sites on-reserves across Canada, with a known liability of $268.6 million (2020–2021). The Contaminated Sites On-Reserve Program has closed 2,409 sites since 2005.

Results and Outcomes

• It is anticipated that about 2,000 additional Indigenous businesses will register in the Indigenous Business Directory.
• Federal departments and agencies will increase the percentage (minimum of five percent) of value of contracts awarded to businesses managed and led by Indigenous Peoples.
• Federal bodies would report annually to ISC on the percentage of the value of contracts awarded to Indigenous businesses for monitoring and consolidating publication.
• Contracts over $10,000 would also be publicly disclosed quarterly to ensure transparency and accountability.
• The proposed approach will be phased in for federal departments and agencies by 2023-2024, with some key exceptions to reflect operational requirements.

Lead Departmental Official
John Giraldez
Director, Business Development Directorate
Email: john.giraldez@sac-isc.gc.ca
Telephone: 873-353-3618

Snapshot

Education and skills training are a shared undertaking among federal, provincial and territorial governments, and Indigenous communities. Indigenous Services Canada (ISC) continues to shift its approach to supporting the delivery of education services, towards co-developed and distinctions-based strategies that focus on regional solutions. Indigenous Services' education services include the following areas:

• Elementary and Secondary Education Program supports elementary and secondary education for eligible First Nations students ordinarily resident on-reserve.
• High-Cost Special Education Program provides support for eligible First Nations students with moderate to profound high-cost special education needs to access support services, such as specialized programming, remedial instruction, clinical services, and resource teacher staffing.
• Education Partnerships Program supports the establishment of partnerships between any combination of First Nations organizations and schools, provincial education systems and Canada; supports the development of capacity of First Nations organizations to deliver education services; and funds the development of technical tables and education agreements to improve education services.
• Innovation in Education Program supports the development and implementation of First Nations innovative education programs, which aim to improve education outcomes for First Nation communities, schools and students.
• Research and Learning Program supports research projects that contribute to educational initiatives that are positively impacting First Nations students and their education outcomes.
• First Nations and Inuit Youth Employment Strategy provides First Nations and Inuit youth with work experience, information about career options, and opportunities to develop skills to help gain meaningful employment and develop careers.

Financial Profile

• Total expenditures: $2.4 billion (2019–2020)

Context

Recent data^{Footnote 1} indicates that:

• In 2016, the high school completion rate for the overall Indigenous population (aged 25 to 64) was 74.4%, 14.8 percentage points lower than non-Indigenous Peoples (89.2%).
• High school completion rates increased between 2006 and 2016 for both Indigenous and non-Indigenous Peoples (aged 25 to 64), however, the increase among the overall Indigenous population was larger than non-Indigenous Peoples, thereby narrowing the education gap by 4.5 percentage points.
• High school completion rates remain lowest for First Nations on-reserve and Inuit (aged 25 to 64), at 57.0% and 56.1%, respectively.
• In general, high school completion rates are higher for women than men (aged 25 to 64), however, this gap is wider among the overall Indigenous population than the non-Indigenous population, at 6.3 and 2.9 percentage points respectively. The gender gap in high school completion rates is highest among First Nations on-reserve, at 52.9% for men and 61.0% for women, and lowest among Inuit, at 55.0% and 57.1%.
• In 2016, post-secondary completion rates were lowest among First Nations on-reserve and Inuit, at 36.7% and 7.6% respectively, gaps of 28.8 and 27.9 percentage points with the non-Indigenous population (65.5%)

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The Elementary and Secondary Education Program provides funding to support kindergarten to grade 12 education for First Nations students, schools and communities.
• ISC provides funding directly to First Nation recipients and First Nations education organizations designated by First Nations to support students living on-reserve who attend First Nation-operated schools on-reserve.
• For students who attend provincially-operated schools, ISC provides the tuition amount charged by the province.
• For students who attend private/independent schools, ISC provides funding up to the tuition rate that would be charged at the nearest provincial school to the student's home community.
• Additionally, there are seven federally-operated schools on-reserve (one in Alberta and six in Ontario) that ISC administers.
• For Self-Governing and Modern Treaty Partners that have opted to draw down on elementary/secondary education authorities, funding has been transferred to Crown-Indigenous Relations and Northern Affairs Canada on an ongoing basis for inclusion in their Grant agreements and is no longer reflected in ISC core funding for education.

Top Key Current Files or Projects

• Historically, funding for students attending provincial schools compared to on-reserve schools was inconsistent, with an outdated historical base and proposal-based funding that was not evenly distributed between regions nor between First Nations within regions.
• On April 1, 2019, ISC launched a new funding approach that aims to provide schools on-reserve with funding that is more comparable to funding in provincial education systems.
• This interim regional funding formula approach uses student enrolment from the previous year for the funding calculation.
• The interim regional funding formula includes national enhancements that provide funding for full-day kindergarten (ages four and five) as well as funding for language and culture up to $1,500 per student, per year.
• Budget 2021 announced further investments in K-12 education, which includes:
  • $112 million in 2021-2022 to extend COVID-19 support so children on-reserve can continue to attend school safely, including Personal Protective Equipment for students and staff, laptops to support online learning, and more teachers and other critical staff;
  • $726 million over five years, starting in 2021-2022, and $181.8 million ongoing, to enhance funding formulas in critical areas, such as student transportation; ensure funding for First Nations schools remains predictable from year to year; and increase First Nations control over First Nations education by concluding more Regional Education Agreements;
  • $350 million over five years, starting in 2021-2022, to expand access to adult education by supporting First Nations people on-reserve who wish to return to high school in their communities and complete their high school education; and
  • $515 million over five years, starting in 2021-2022, and $112 million ongoing, to support before and after-school care for First Nations children on-reserve.

Key Milestones

• Since April 2019, core education funding is updated annually to better reflect student enrolment and other factors, guided by the principles of transparency, predictability and stability.
• COVID-19 emergency funding in 2020-2021 and 2021-2022 was provided to First Nations to address the needs of First Nations students and schools.
• Before- and after-school care funding was provided to First Nation-operated schools for 2021-2022.
• Budget 2021 initiatives, such as refinements to transportation, will continue to be implemented throughout the year.

Results and outcomes

In 2020-2021, ISC funded almost 500 First Nation-operated education programs across the country and approximately 109,000 First Nations students living on-reserve attending schools both on- and off reserve. National kindergarten to grade 12 education funding has increased by 52.1% from 2015-2016 to 2020-2021 for students living on-reserve.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The Education Partnerships Program supports collaboration between First Nations, federal and provincial governments as well as the territories and other stakeholders to advance First Nations control over elementary and secondary education and student achievement through three components:
  • Partnerships: supports formalizing partnerships between any combination of First Nations' education organizations and schools, provincial education systems and Canada.
  • Structural Readiness: strengthens the organizational capacity of First Nations organizations to deliver education services and provides one-time startup costs for school board-type entities.
  • Regional Education Agreements: supports First Nations' tables to assess the provincially-comparable funding formula and undertake costing exercises for additional funding to further address student attainment needs, and to develop regional education agreements that target regional education priorities.

Top Key Current Files or Projects

• ISC is supporting First Nations in developing regional education agreements, which support greater First Nation control of education, set out responsibilities, accountability mechanisms, and provincial partnerships.
• ISC is currently reviewing the Education Partnerships Program. The review seeks input from First Nations recipients as to the strengths, challenges, and program improvement requirements. It is anticipated that the review will confirm the need for ISC to seek additional funding to support predictable school-board administration type costs.

Key Milestones

• Discussions are underway with approximately 75 First Nations and First Nations education organizations to advance education agreements across the country. In 2021-2022, four additional agreements are expected to be concluded.

Results and outcomes

Since April 1, 2019, eight regional education agreements have been signed that represents approximately 22,000 students. These agreements are administrative arrangements that will result in First Nations-designed education systems to support self-determination and potentially address specific needs as identified by First Nations.

• In addition to the regional education agreements, the Education Partnerships Program has also helped to establish two new school systems:
  • the Manitoba First Nations School System (2017) manages education programs and services for approximately 1,700 students; and
  • the Maskwacîs Cree School System in Alberta (2018) provides education programming and supports to approximately 3,100 students.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The High-Cost Special Education Program provides support for eligible First Nations students with moderate to profound high-cost special education needs to access support services, such as specialized programming, remedial instruction, clinical services, and resource teacher staffing.
• Provides additional investments to recipients who provide services for students who ordinarily live on-reserve and whose special education needs cannot be met within the current resources that are available for the general student population.

Top Key Current Files or Projects

• ISC is working with the Assembly of First Nations, which is leading a comprehensive review of the High-Cost Special Education program, including examining funding and service gaps for First Nations high-cost special education.

Key Milestones

• During 2021-2022, the High-Cost Special Education Program will remain consistent with 2020-2021 to allow time for the completion of a comprehensive program review. This will include working closely with the Assembly of First Nations and other partners. The review recommendations may include policy changes to address implementation.

Results and outcomes

• In 2018-2019, ISC funded approximately 14,000 First Nations students with high-cost special needs.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The Research and Learning Program supports research projects that contribute to educational initiatives that are positively impacting First Nations students and their educational outcomes.
• The Innovation in Education Program supports the development and implementation of First Nations innovative education program pilots. For example, projects related to technology, land-based learning, Indigenous language and culture, which aim to improve education outcomes for First Nation communities, schools and students.

Top Key Current Files or Projects

• In 2021-2022, ISC continues to support the regionalization of this program, which enables regions and First Nations partners to support projects that examine best practices in First Nations education, innovative approaches to education programming and First Nations research methodologies.
• As the Research and Learning Program ($1.5 million) and Innovation in Education Program ($6.0 million) moved from a national to a regionalized process in 2019-2020, each region functions differently. The methodology of the proposal review process varies across regions.

Key Milestones

• First Nations organizations and ISC regional offices are currently reviewing 2021-2022 project proposals.

Results and outcomes

• The program is a small part of broader efforts to improve First Nations elementary and secondary education. Activities are expected to support improving the overall quality of education in First Nations and to contribute to the following specific expected outcomes:
  • First Nations have increased education system capacity;
  • First Nations carry out activities to increase capacity and have flexibility to meet their education system needs and priorities;
  • education services and resources better reflect student needs, culture and language;
  • First Nations students participate and progress in their elementary and secondary education; and
  • First Nations on-reserve students achieve levels of secondary education comparable to non-Indigenous students in Canada.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The program aims to improve the socio-economic outcomes for First Nations by supporting First Nations in providing eligible students with funding to access education opportunities at the post-secondary level through two streams:
  • The Post-Secondary Student Support Program provides First Nations students with funding for academic and living expenses.
  • The University and College Entrance Preparation Program provides First Nations students with funding for academic and living expenses to support First Nations students in university and college entrance preparation programs to attain the academic level required for entrance into a degree or diploma credit program.
  • Both streams are administered directly by First Nations and organizations designated by First Nations, which make decisions on selecting students for funding and funding levels provided. This is consistent with the principle of First Nations control of First Nations education.
• For Self-Governing and Modern Treaty Partners that have opted to draw down on post-secondary education authorities, funding has been transferred to Crown-Indigenous Relations and Northern Affairs Canada on an ongoing basis for inclusion in their grant agreements and is no longer reflected in ISC base funding for education.

Top Key Current Files or Projects

• Budget 2021 invested $131 million over two years ($65.5 million each year), starting 2021-2022, to support First Nations post-secondary students during the COVID-19 pandemic. This builds upon the $65.5 million in Emergency funding that was also provided for First Nations post-secondary students, in 2020-2021.
• Budget 2019 invested $320 million over five years to increase the number of First Nations students that receive post-secondary funding and,$7.5 million over three years, starting 2019-2020, to First Nations to engage with First Nations on the development of long-term regional post-secondary education models, such as comprehensive student supports and new delivery models.

Key Milestones

• ISC is engaging with First Nations to develop comprehensive First Nations regional post-secondary education models, which will be accessible to all status First Nations (registered Indians). This may include First Nations Treaty-based, regional, or self-government-based post-secondary education models to enable First Nations control of First Nations education. Models may include funding to support students, First Nations institutes, adult education and facilities, and community-based programming.

Results and outcomes

• Reporting for fiscal year 2020-2021 is currently underway and the number of First Nations post-secondary students that received funding is expected to be between 26,000 and 29,000.
• As a result of the COVID-19 pandemic, recipients faced delays in submitting their reports to ISC.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The Post-Secondary Partnerships Program supports First Nations to define their own partnerships with institutions to increase the availability of post-secondary education programs tailored to First Nation cultural and educational needs. The overall aim of the program is to increase the number of First Nations students pursuing post-secondary education and thereby contribute to closing the education attainment gap.
• This program is a First Nations-directed and regionally delivered program, with criteria established by First Nations or organizations designated by First Nations.
• It is proposal-driven and the level of funding allocated to recipients is based on the number and quality of proposals submitted relative to the available funding.

Top key current files or projects

• In 2020-2021, the Post-Secondary Partnerships Program eligibility narrowed in scope so that only First Nations-established post-secondary institutions and First Nations-directed community programming providers are now eligible to receive funding.
• Further changes to the Post-Secondary Partnerships Program may also result from the engagement work currently underway with First Nations to develop comprehensive First Nations regional post-secondary education models as stated under the previous section.

Key Milestones

• While the program has evolved to focus on First Nations institutions and improved, regionalized, First Nations control, the ongoing post-secondary First Nations engagement is expected to provide further guidance on potential future options for this program. Specific baselines and targets will be co-developed with First Nations partners during this exercise.

Results and outcomes

• Reporting for fiscal year 2020-2021 is currently underway, and the number of post-secondary courses and community-based programming funded through the Post-Secondary Partnerships Program is expected to be approximately 100, in line with previous years. As a result of this funding, ISC expects that the number of First Nations students pursuing post-secondary education will increase, thereby helping to close the education attainment gap.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the strategies

• ISC supports the Inuit and Métis Nation Post-Secondary Education Strategies that provide funding for academic and living expenses to Inuit and Métis Nation students pursuing post-secondary education.
• These new strategies were the first time that ISC supported Métis Nation post-secondary students. They also expanded ISC support to all Inuit no matter where they reside in Canada while transferring the control of Inuit student funding decision making to Inuit governments. The strategies also provide additional non-academic programs and service support for post-secondary students and education governance capacity, such as counselling, tutoring, mentoring, and tracking post-secondary data.

Top Key Current Files or Projects

• In 2019–2020, ISC began rolling out new investments to support an Inuit-led post-secondary education strategy ($125.5 million over ten years and $21.8 million ongoing) and a Métis Nation post-secondary education strategy ($362 million over ten years and $40 million ongoing).
• ISC continues to work with Inuit and Métis Nation partners on the design and implementation of their post-secondary education strategies.

Key Milestones

• ISC worked with Inuit and Métis Nations partners to co-develop the Inuit and Métis Nation Post-Secondary Education Strategies, including components for student support, community-based programs and services, and governance capacity.
• In 2019–2020, Métis Nation post-secondary students received financial assistance for post-secondary education, and Métis Nation partners began developing complementary programs and services.
• In 2019–2020, Inuit partners worked to develop supporting programs and services, and to prepare for implementation of their strategy.
• Beginning in 2020–2021, Inuit recipients provided financial assistance to Inuit post-secondary students for academic and living expenses associated with pursuing a post-secondary education credential.

Results and outcomes

• Reporting for the first year of these strategies, 2020–2021, is currently underway with the expectation that these investments will provide approximately 200 eligible Inuit students and 700 Métis Nation students with post-secondary education funding.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the program

• The First Nations and Inuit Youth Employment Strategy is a component of the broader Youth Employment and Skills Strategy, led by Employment and Social Development Canada, which supports employment and skills development opportunities for First Nations and Inuit youth between the ages of 15 and 30.
• The proposal-based strategy funds First Nation and Inuit communities, governments and organizations, not-for-profit associations and private sector employers to better support First Nations and Inuit youth, particularly those facing barriers, to participate in the labour market. There are two streams:
  • First Nations and Inuit Skills Link Program supports First Nations and Inuit youth to acquire essential job-related skills, learn about career options, and prepare for employment.
  • First Nations and Inuit Summer Work Experience Program supports First Nations and Inuit youth to acquire skills, prepare for full-time employment and earn income.

Top Key Current Files or Projects

• In 2021-2022, ISC is planning engagement with Indigenous partners on the modernization of the First Nations and Inuit Employment Strategy to align the strategy with the modernized broader Employment and Social Development Canada-led Youth Employment and Skills Strategy and to better meet their needs.
• A pilot project has been implemented in 2021-2022 to strengthen the working relationship between the First Nations and Inuit Youth Employment Strategy and Income Assistance programs to provide support to 2,000 First Nations youth between the ages of 18 and 30 to support self-sufficiency and transition to the workforce or return to school as a means to restore pre-COVID-19 employment levels.

Key Milestones

• ISC is planning to launch its 2022-2023 First Nations and Inuit Youth Employment Strategy call for proposals in late fall 2021.
• By 2022–2023, ISC expects to update the design of the First Nations and Inuit Youth Employment Strategy based on the outcome of the engagement process.

Results and outcomes

• Since its launch in 1997, the strategy has provided close to 150,000 skills experience and summer work opportunities to First Nations and Inuit youth.
• Each year, the strategy supports more than 600 First Nation and Inuit communities to design and implement projects that provide skills development and employment opportunities to Indigenous youth.
• Reporting for fiscal year 2020-2021 is currently underway and is expected to be similar to historic numbers of participants (roughly 12,000 First Nations and Inuit youth served – 5,000 in the Summer Work Experience program, and 7,000 in the Skills Link program).

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the service

• Canada's emergency management system is being challenged as the frequency, intensity, duration, and complexity of natural disasters are increasing exponentially, in large part due to the impacts of climate change.
• First Nations on-reserve are 18 times more likely to be evacuated than off-reserve residents and are more vulnerable due to socio-economic factors that could have adverse effects on their preparation and response capacity.
• Indigenous Services Canada (ISC) is the single window for funding for emergency on-reserve (preparation, mitigation, response, and recovery), delivered through grants and contribution agreements.
• The Emergency Management Assistance Program delivers funding to Canada's 634 on-reserve First Nation communities, including 18 on-reserve communities in the Yukon and Northwest Territories, for all-hazards emergencies, such as wildfires and floods. The Emergency Management Assistance Program was most recently leveraged to provide supports to First Nations on-reserve during the COVID-19 pandemic who were not covered under the First Nations and Inuit Health Branch's funding and services mandate for health emergencies.
• The objectives of the services are to protect the health, well-being and safety of First Nations residents on-reserve and their infrastructure from natural or accidental hazards; and assist in the remediation of critical infrastructure and community assets impacted by emergency events.
• ISC reimburses First Nations partners, provincial and territorial governments and other third-party service providers or non-government organizations (such as the Canadian Red Cross) for 100% of eligible costs incurred in the delivery of emergency management services to First Nation communities.

Financial Profile

• In 2020–2021, ISC spent $143 million on preparedness, mitigation, response, and recovery activities on-reserve.
• Due to the unpredictable nature of emergency events, an annual funding process is in place to access budget for response and recovery.

Top Key Current Files or Projects

• Canada experienced an unprecedented wildfire season in 2021, with the highest number of wildland fire emergencies in the last decade. These events highlighted the urgent need for a more comprehensive emergency management approach to improve preparedness, response and the resiliency of communities, including First Nations, to these events.
• Supporting First Nations' self-governance and integration in the context of emergency management through the transition from bilateral emergency management service agreements with provinces, territories and third party organizations to more inclusive multilateral agreements, in which First Nations are engaged as full and equal partners.
• Funding First Nations-led emergency management projects focusing on mitigation and preparedness to increase community resilience and capacity, and integrate Indigenous knowledge, skills and abilities to prepare for, respond to and recover from emergency events.
• Continued enhancement of culturally competent and holistic response and recovery supports (including mental health and wellbeing supports, child-friendly spaces during evacuations, translation services, cultural continuity supports) available to First Nations partners.
• Revision of the program's Terms and Conditions to permanently include health emergencies and work more closely with the ISC's Health Emergency Management team to create a more holistic approach to emergency management.
• Getting evacuees back to safer and more resilient communities.
• Continued and active engagement in response efforts and emergency management initiatives with key partners and departments, such as Public Safety Canada, Natural Resources Canada, the Department of National Defence, provinces and territories, National Indigenous Organizations, and the Canadian Red Cross, among others.

Key Milestones

• Budget 2019 invested $259 million over five years to:
  • help develop local capacity to respond to and recover from emergency events across the country;
  • engage First Nations in the development of tri/multilateral emergency management service agreements in all regions; and
  • address wildfire prevention and mitigation.

Results and outcomes

• In 2021-2022, as of September 1, 2021, 15,598 First Nations residents have been evacuated. As a result of enhanced service delivery, approximately 88% of these evacuees were returned home within 60 days.

*Due to the unprecedented wildland fire situation impacting numerous First Nations in Canada in summer 2021, especially in British Columbia, getting information regarding exact numbers and repatriation dates of evacuees has not been possible.

• As of September 1, 2021, in 2021-2022, 97 communities have received funding support for activities, such as: Emergency Management planning, wildfire risk assessments, and tsunami early warning systems.
• A new service delivery approach has been adopted to provide streamlined and culturally competent emergency response and recovery services to First Nations partners.

Lead Departmental Official
Kenza El Bied
A/Director General
Sector Operations Branch – Regional Operations Sector

About the Program

• Strong, effective, and sustainable governments are critical to First Nations in taking greater control over the decisions that affect their lives, achieving socio-economic progress and overall well-being, and advancing the gradual transfer of departmental responsibilities.
• Indigenous Services Canada (ISC) supports First Nations in the implementation of strong, effective and sustainable governments through the provision of grants and contributions that provide:
  • funding to 581 First Nations to support governance and administration;
  • funding to over 550 First Nations and organizations for employee benefits to support them in attracting and maintaining qualified staff;
  • project-based funding supporting over 500 projects annually to enhance the capacity of First Nation and Inuit communities to perform core functions of governance; and
  • funding to support 80 tribal councils for local aggregate service delivery for First Nations.

Financial Profile

• Expenditures in fiscal year 2020-2021 were $422 million.

Top Key Current Files or Projects

• A comprehensive review of First Nations governance expenditures was completed in September 2018, which found that the Band Support Funding program was only covering about 33% of what First Nations were spending on governance expenditures. Strategies to modernize supports for core governance and administration are in development.
• Budget 2018 provided funding to support community-led planning pilot projects, and communities have until August 2022 to report. This endeavor will demonstrate the impacts of community-led planning on overall governance capacity.
• Budget 2021 identified new investments of $151.4 million (over five years) to provide wrap-around supports for First Nations with the greatest community development needs. This initiative is in development.

Key Milestones

• ISC has invested $48.4 million (over two years) in supplemental funding for governance capacity development in First Nation and Inuit communities (Economic and Fiscal Snapshot 2020).
• ISC has also invested $33.5 million (over two years) to reimburse First Nations under the Default Prevention and Management Policy for intervention costs (Economic and Fiscal Snapshot 2020).
• Budget 2021 identified $104.8 million (over two years) to address an ongoing shortfall in Indigenous Governance and Capacity, and the funding has been secured.

Results and outcomes

• Through targeting governance capacity funding to First Nations in greatest need, from 2017 to 2020, 33% of First Nations in Default Management under the Default Prevention and Management Policy successfully implemented management action plans and their level of intervention deescalated.

Lead Departmental Official
Kenza El Bied
A/Director General
Sector Operations Branch – Regional Operations Sector

About the Program

• The New Fiscal Relationship is focused on achieving sufficient, predictable and sustained funding for First Nation communities. It is founded on mutual accountability, whereby First Nations are primarily accountable to their own citizens.
• The New Fiscal Relationship also underpins progress toward the elimination of socio‐economic gaps between First Nations and non-Indigenous Peoples and in successful service transfer.

Key Current Files or Projects

• ISC provides a 10-year grant to eligible First Nations. Eligibility is based on standards co-developed with the First Nations Financial Management Board. With recommendations from the First Nations Financial Management Board, eligible First Nations with adequate financial capacity can be offered their funding through a 10-year grant. The grant provides predictable and flexible funding for a suite of services (such as education, income assistance, assisted living, and more), with greatly reduced reporting requirements. The grant empowers First Nations to assume greater responsibility for the design and delivery of services, as well as allocate funding based on community priorities.
• ISC has been working with its partners to co-develop the National Outcomes-Based Framework, which will measure and report on closing the socio-economic gaps between First Nations and non-Indigenous Peoples.
• As ISC seeks to transfer its service delivery to Indigenous communities and Indigenous-led organizations, it is developing options for additional Indigenous-led institutions, such as a First Nations Auditor General and Indigenous statistical functions to provide further support to the fiscal relationship.
• The First Nations Financial Transparency Act requires First Nations to make their audited consolidated financial statements and schedules of remuneration and expenses of Chiefs and councilors available to their members.

Key Milestones

• ISC established the 10-year grant for eligible First Nations on April 1, 2019, and 117 First Nations are currently receiving the grant. Callouts are annually made to invite more First Nations to apply for the 10 year grant.
• Engagements with program officials and technical experts on the National Outcomes-Based Framework have been completed. Several preliminary engagements with First Nations leaders and communities have taken place and further engagements are planned. The framework is currently expected to be completed in June 2022.
• Five First Nations were part of pilot project to work towards the reform of the Default Prevention and Management Policy. Funding has also been provided for fiscal year 2021-2022 and the next to the First Nations Financial Management Board to continue this pilot project with another 20 First Nations, and also to pilot a shared service concept in the provision of financial management services to First Nations.
• The Assembly of First Nations-ISC Joint Advisory Committee on Fiscal Relations provided interim recommendations to the Minister of Indigenous Services and the National Chief in June 2019. These recommendations are being used to inform potential options for the next phase of new fiscal relationship co-development work.

Results and outcomes

• The 10-year grant advances self-determination by providing funding flexibility and increasing First Nations' control over the design, delivery and management of services. In the long term, First Nations receiving the grant are expected to experience an improvement in socio-economic outcomes and an accelerated closure of gaps with non-Indigenous Peoples.
• The reporting burden for First Nations receiving the 10-year grant has been reduced by 92% for the funding areas covered by the grant.
• Since 2015, the number of First Nations in default under the Default Prevention and Management Policy has decreased by 32% (from 154 to 105).
• Compliance with the First Nations Financial Transparency Act was 99% in 2013-2014. Compliance fell to 64% in 2019-2020, largely due to issues related to capacity or community emergencies, including the COVID-19 pandemic.

Lead Departmental Official
Lynne Newman
Director General, Fiscal Arrangements
Strategic Policy and Partnerships Sector

Snapshot

Indigenous Services Canada (ISC) works with First Nations, Inuit, other federal departments, and provincial and territorial partners to support healthy First Nation and Inuit individuals, families, and communities. In recent years, there has been a stronger emphasis on distinctions-based approaches, which has seen the scope of programming and funding, in some cases, expand to Métis Nations. Working with these partners, ISC strives to improve health outcomes, provide access to quality health services, and support greater control of the health system by Indigenous Peoples.

Jurisdiction for health is shared by Indigenous, federal, provincial and territorial governments. Under the terms of the Canada Health Act, provincial and territorial governments provide universal insured health services to all provincial and territorial residents, including First Nations, Inuit, Métis, and other Indigenous Peoples. ISC funds or directly provides health programs and services for First Nations and Inuit that supplement those provided by provinces and territories in the areas of Primary Health Care, Community Based Health, Public Health, Health Infrastructure Support, and Non-Insured Health Benefits. ISC also supports communicable disease and health emergency preparedness, mitigation, response, and recovery activities.

ISC also supports First Nation, Inuit, and Métis communities and organizations throughout the COVID-19 pandemic through the provision of flexible and distinctions-based funding, surge infrastructure, healthcare workers, and supplies, and public health training and guidance.

First Nations and Inuit health has improved in recent years, however, gaps remain between the overall health status of Indigenous and non-Indigenous Peoples. ISC's health services include the following:

• Healthy Living Program: ISC 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 amongst First Nation and Inuit individuals, families and communities.
• Health Emergency Management: Through investments in emergency preparedness and mitigation initiatives, ISC supports First Nation communities in building resiliency against emergency events, including natural and health emergencies.
• Healthy Child Development: Through its Healthy Child Development services, ISC provides support for healthy pregnancies, births, and child development in First Nation and Inuit communities.
• Environmental Public Health: Delivered in First Nation communities south of 60° parallel, ISC's Environmental Public Health Services assist First Nations in the identification and prevention of environmental health hazards in natural and built environments.
• Climate Change and Health Adaptation Program: ISC provides funding for community-based adaptation projects directed towards addressing health risks due to climate change.
• Mental Wellness: Guided by the First Nations Mental Wellness Continuum Framework and the National Inuit Suicide Prevention Strategy, which were developed by Indigenous partners, the Mental Wellness Program funds culturally competent, community-based mental wellness services for First Nations and Inuit, which includes supports to address the impacts of the opioids crises and the COVID-19. Moreover, in the wake of the investigation and confirmation of unmarked graves of missing children at former Indian Residential Schools, the Mental Wellness Program also provides funding to expand access to trauma-informed health and cultural supports.
• Communicable Disease Control and Management: This overarching program incorporates multiple public health programs directed towards the mitigation of underlying risk factors, promotion of public education and awareness, and identification of health risks.
• Primary Health Care: ISC's primary health care programming supports the delivery of, and access to, high quality health programs, services and initiatives in remote and isolated First Nation communities.
• Community Oral Health Services: Through its community oral health programming, ISC facilitates access to oral health care services for First Nation and Inuit communities. A key component of the program is the involvement of community members and other health care service providers in the service delivery process.
• The First Nations and Inuit Home, Community Care and Long-Term Care Program: ISC provides a continuum of basic home and community care services that support First Nations and Inuit of all ages, including seniors and those living with disabilities, acute or chronic illness, to receive care in their communities.
• Jordan's Principle: Implemented in memory of Jordan River Anderson, the Government of Canada is legally responsible for ensuring that all First Nations children have access to the health, social, and educational products, supports, and services that they need. A similar Inuit Child First Initiative is currently under development with Inuit partners.
• Inuit Child First Initiative: The Inuit Child First Initiative was jointly announced by Inuit Tapiriit Kanatami and ISC on September 10, 2018, it supports parents and guardians in accessing the health, social and educational products and services that Inuit children need, when they need them. Until a long-term Inuit-specific approach can be developed to support Inuit children, Inuit leaders have agreed that a model similar to Jordan's Principle will be available for Inuit children.
• Non-Insured Health Benefits Program: ISC provides registered First Nations and recognized Inuit with coverage for a range of health benefits, including prescription drugs and over-the-counter medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access health services that are not locally available.
• Health Transformation: ISC supports First Nations organizations and institutions to advance their efforts to build capacity to develop new governance models that enable the full transfer of control over federal health services to First Nations partners. This work will ensure that First Nations-led organizations control the delivery, design and management of programs and services so they can meet their communities' health and wellness needs.
• Anti-Indigenous Racism in Canada's Health Systems: Indigenous Peoples in Canada continue to experience disadvantage, discrimination, and violence due to systemic and overt racism in Canada's health systems. ISC, along with Health Canada, and external partners, aims to address anti-Indigenous racism in Canada's health systems more broadly through:
  • support for the integration of cultural safety throughout health systems;
  • increased Indigenous representation in health professions;
  • improved supports for Indigenous patients;
  • increased accountability; and
  • demonstrated federal leadership.

Context

Recent data indicates that:

• First Nations and Inuit populations are affected by major health issues, including lower life expectancy, higher rates of chronic illnesses (e.g., diabetes) and communicable diseases (e.g., tuberculosis, HIV/AIDS), higher infant mortality rates and higher suicide rates, relative to the broader Canadian population.
  • In 2011, the life expectancy for First Nation males and females was 72.5 and 77.7 years, respectively. The life expectancy for Inuit males and females was 70.0 and 76.1 years, respectively. This was 8.9 (95% CI 8.1; 9.7) and 9.6 (95% CI 8.7; 10.5) years shorter than for non-Indigenous males and females. Life expectancy at age 1 for the Inuit household population was 70.0 years for Inuit males and 76.1 years for Inuit females, which is 11.4 (95% CI 9.2; 13.6) and 11.2 (95% CI 8.3; 14.2) years shorter than for the non-Indigenous population.
  • In 2015-2016, 15.9% of First Nation adults living on-reserve reported having diabetes and 17.2% reported having high blood pressure. In 2012, the prevalence of diabetes for First Nation adults living off-reserve was 10.3%. For diabetes, this is approximately three to four times higher than in the general Canadian population (five percent for all adults in Canada [age standardized]). As for blood pressure, it is comparable or higher in the general population.
  • From 2004-2006, the infant mortality rates for First Nations and Inuit were 2.1 and 2.8 times higher than the non-Indigenous population.
• In 2018, the active tuberculosis incidence rate among Inuit living in Inuit Nunangat was more than 300 times the rate for Canadian-born non-Indigenous Peoples.
• From 2011-2016, Statistics Canada data indicated that the suicide rate among non-Indigenous Peoples was eight deaths per 100,000 person-years at risk (number of deaths per person per year). This compares to:
  • First Nations: First Nation peoples were three times more likely to commit suicide, at 24.3 deaths per 100,000 person-years at risk. The suicide rate for First Nation people living on a reserve was twice as high as those living off-reserve.
  • Inuit: The rate for Inuit was around nine times higher than for non-Indigenous Peoples, at 72.3 deaths per 100,000 person-years at risk.
  • Métis: The rate for Métis was around twice as high as the rate of non-Indigenous Peoples, at 14.7 deaths per 100,000 person-years at risk.
• In 2015–2016, 22.6% of First Nation people 18 years of age and over in First Nation communities identified the unavailability of a doctor or nurse as a barrier to health care.

Lead Departmental Official
Julien Castonguay
Director General
Strategic Policy, Planning and Information
First Nations and Inuit Health Branch

About the Program

The Healthy Living Program funds and supports a suite of culturally relevant community-based programs and services as well as policy areas that address greater risks and poorer health outcomes associated with chronic diseases and injuries among First Nation and Inuit individuals, families and communities. ISC funded programs, services, initiatives and strategies are directed at promoting healthy behaviours and creating supportive environments through healthy eating; food security; physical activity; commercial tobacco use prevention, education, protection and cessation; chronic disease prevention; management and screening; and injury prevention.

Top Key Current Files or Projects

• Aboriginal Diabetes Initiative: Supports community-based health promotion and disease prevention services delivered by trained community diabetes workers and health service providers in over 400 First Nation and Inuit communities.
• Nutrition North Canada Nutrition Education Initiatives (ISC's component): ISC funds and supports culturally appropriate retail and community-based nutrition education initiatives in 113 isolated northern First Nation and Inuit communities to complement the retail subsidy component administered by Crown-Indigenous Relations and Northern Affairs Canada.
• Canada's Tobacco Strategy: With enhanced funding through Budget 2018, ISC is supporting the engagement of national and regional Indigenous organizations for the development and implementation of distinctions-based strategies to reduce commercial tobacco use.

Key Milestones

• In 2019–2020, ISC partnered with the Raven Indigenous Impact Foundation, the Lawson Foundation, Aki Foods (an Indigenous social enterprise), and six First Nation communities to generate outcome-based funding models to reduce diabetes. This effort is aimed at supporting innovative and transformative approaches for First Nations-led solutions to address the burden and complexity of chronic diseases.
• ISC has continued to support Health Canada as the federal lead on cannabis, facilitating Indigenous engagement and supporting the development of Indigenous educational materials for communities.

Results and outcomes

• The prevalence of diabetes among First Nation adults living on-reserve has remained steady at approximately 19 to 20% over the past 14 years. Some studies are showing type 2 diabetes among First Nations being diagnosed at an increasingly younger age with greater severity at diagnosis, rates of complications, and poorer treatment outcomes. This confirms the need for redoubling efforts to reduce the burden of diabetes.
• Between 2014-2015 and 2019-2020, funding recipients delivered over 16,500 nutrition education activities, such as: promotion of healthy food knowledge; food skills development; in-store taste tests and grocery store tours; and traditional food harvesting and preparation.
• Food security is foundational to health and wellness, and a critical issue for Indigenous Peoples, and especially pronounced in northern and isolated communities. Concerns for food security have been further magnified during the COVID-19 pandemic. Food insecurity is ranging from 15% to 63% in Indigenous households versus eight percent in general non-Indigenous households.
• Over the last five years, 16 tobacco cessation projects and three strategies reached close to 60% of First Nation and Inuit communities. Recent results show an almost double increase in the number of indoor and outdoor smoke-free spaces in communities. There were 173 new smoking-related community resolutions that also passed. Overall, the tobacco cessation rate among individuals who participated in ISC funded services is considered a significant success and surpasses estimated cessation rates among other segments of the non-Indigenous population.
• Despite a decline in smoking over the last two decades, smoking rates among Indigenous Peoples continue to be far more prevalent compared to the non-Indigenous population. First Nations, Inuit, and Métis experience smoking rates of 53.5%, 74.3%, and 36.3%, respectively, compared with 15% for non-Indigenous population. Smoking rates among First Nation, Inuit, and Métis women who are pregnant are 37.5%, 69.9%, and 34.4%, respectively.
• Vaping is also emerging as a significant public health concern. While Indigenous-specific data is not available, studies report a 74% increase in vaping among youth in Canada. Recent cases in the United States of acute pulmonary illnesses and at least one death reportedly linked to the use of vaping products have prompted Health Canada to issue advisories that Canadians who use vaping products to monitor themselves for symptoms of pulmonary illness, and to seek medical attention if they have concerns, and that non-smokers, pregnant women and youth should not vape.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health and Executive Director
Office of Population and Public Health
First Nations and Inuit Health Branch

About the Program

• As part of the broader emergency management services by ISC, it has a role in preventing and addressing health emergencies in First Nation communities.
• Health emergencies may include:
  • public health emergencies, such as the spread of communicable diseases (measles, HIV, etc.) pandemics, food and water contamination, environmental health hazards (mold, air quality, etc.), and other health emergencies, such as suicide clusters and opioid crises; and
  • health aspects of natural disasters, including risks related to the continuity of health care for those with existing medical conditions, as well as the public health and mental wellness impacts of community evacuations and emergencies.

Top Key Current Files or Projects

• Supporting the regions and communities throughout the COVID-19 response, including how to prepare for and respond to other emergencies with health components (e.g., fire or flood evacuations) in the context of COVID-19.
• Streamlining emergent issues related to COVID-19 outbreaks, including mental wellness and infrastructure, the COVID-19 vaccine rollout, and the intersection between health and environmental emergencies (i.e., COVID-19 and wildfires) to facilitate coordinated emergency response efforts.
• Facilitating access to human resources, such as immunizers, to support the COVID-19 vaccine rollout in communities through internal and external recruitment, public health funding, and leveraging existing government contracts.
• Supporting increased First Nations capacity through community-led health emergency preparedness and mitigation activities.
• Working through regional partnership tables with First Nations partners to determine funding allocations for First Nations health emergency management on-reserve.
• Supporting knowledge transfer and exchange activities for First Nation communities to share lessons learned and best practices around health emergency management.

Key Milestones

• Provided virtual Psychological First Aid training to First Nation and Inuit communities through the Canadian Red Cross, including 60 spots in an instructor-led virtual session and 2,270 licenses for self-directed learning.
• Provided funding for the Help Desk for Indigenous Leadership operated by the Canadian Red Cross, which has responded to 14,761 requests from Indigenous leaders between May 2020 and August 2021. The Canadian Red Cross has leveraged a new collaboration with the First Nations Health Managers Association to support in awareness and cross posting of basic information for the Help Desk. Collaborating with the First Nations Health Managers Association has provided broader access to the Help Desk service as the First Nations Health Managers Association is able to communicate directly with their Health Manager members, allowing communities more access to the services and tools developed.
• Continued collaboration with other departments responsible for emergency management to better support communities in an integrated manner.
• Established a National First Nations Health Emergency Management Network to provide a coordinated approach to emergency preparedness and response for First Nation communities before the COVID-19 pandemic.
• Building health emergency management capacity in regional and national offices to support First Nations Health Emergency Management Coordinators and to establish relationships with partners involved in Emergency Management.
• Provided Table Top Exercise training in January 2021 to Regional Health Emergency Managers as an additional support to communities in their training efforts.

Results and outcomes

• Increased First Nation community confidence and resiliency in planning for, and responding to, emergency events.
• Increased First Nations capacity to assume responsibility for Health Emergency Management Services.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health and Executive Director Office of Population and Public Health
First Nations and Inuit Health Branch

About the Program

• Healthy Child Development's suite of services support healthy pregnancies, healthy births, and healthy child development in First Nation and Inuit communities through programs that include Maternal Child Health, Canada Prenatal Nutrition, Aboriginal Head Start on Reserve, and Fetal Alcohol Spectrum Disorder.
• ISC provides funds to support and improve the health outcomes for First Nation and Inuit infants, children, youth, families (including pregnant women) and communities through access to a basket of supports with areas of focus that include prenatal health, nutrition, early literacy and learning, physical, emotional, and mental health.

Top Key Current Files or Projects

• Indigenous Early Learning and Child Care Framework: Announced in September 2018, the Indigenous Early Learning and Child Care Framework coordinates the existing early learning and child care programs of First Nations and Inuit Child Care Initiative, Aboriginal Head Start on Reserve, and Aboriginal Head Start in Urban and Northern Communities within the three federal partner departments of Employment and Social Development Canada, ISC, and Public Health Agency of Canada, respectively. It also provides new funding to enable greater control for First Nation, Inuit and Métis communities and organizations to build upon existing programming foundations, to enact their vision for high quality, culturally strong, early learning and child care.
• Midwifery: The first federal investment in Indigenous midwifery of $6 million over five years in Budget 2017 has provided an opportunity for First Nation and Inuit communities to identify needs and future prospects for innovation in midwifery. ISC will build upon these investments with an additional $26 million over three years to further expand and enhance Indigenous midwifery and doula services to First Nations, Inuit and Métis.

Key Milestones

• Implementation of the Indigenous Early Learning and Child Care Framework and associated investments for Aboriginal Head Start on Reserve announced in September 2018.
• Advancement of midwifery demonstration and development of projects, which will improve access to pre-natal, post-natal, and birth supports. The National Aboriginal Council of Midwives worked collaboratively with partners to develop a core competency framework for Indigenous midwives as well as a community readiness guide and workbook to support communities in restoring community-based midwifery and birthing services.
• A survey of First Nation children and youth is being planned and will be conducted by the First Nations Information Governance Centre to better understand the needs of children and youth and what services they are accessing, such as through Jordan's Principle.

Results and outcomes

• In 2017-2018, Healthy Child Development services were offered in over 371 First Nation communities, in addition to those communities served in the North and by the First Nations Health Authority in British Columbia.
• Through the Maternal Child Health Program, 7,389 participants received home visits, 6,806 women were reached through the pre- and post-natal nutrition programming, and 13,313 children participated in the Aboriginal Head Start on Reserve program during the 2017-2018 reporting period. (These figures do not include communities in British Columbia or the North.)
• Midwifery demonstration and development projects supported with Budget 2017 funding have raised community awareness of traditional birthing knowledge, protocols and practices; designed and delivered doula training programs; established an innovative on the land birthing program in partnership with a local hospital; and developed new partnerships with health authorities and community-based programs to improve service delivery.
• Evidence from the First Nations Regional Longitudinal Health Survey suggests that Aboriginal Head Start on Reserve has a positive impact on the promotion of Indigenous languages and cultures. For example, a significantly higher percentage of children who had attended Aboriginal Head Start on Reserve had some knowledge of a First Nations language, and a significantly higher percentage of children who had attended Aboriginal Head Start on Reserve took part in traditional activities, such as singing, drumming and dancing, outside of school hours at least once a week, compared to those who never attended Aboriginal Head Start on Reserve. Having a strong sense of cultural identity has been shown to positively influence outcomes for Indigenous youth.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health & Executive Director Office of Population & Public Health
First Nations and Inuit Health Branch

About the Program

• Environmental Public Health Services are delivered in First Nation communities south of 60° to identify and prevent environmental hazards in the natural and built environments that could adversely affect the health of community residents.
• Core areas of focus are drinking water, wastewater, solid waste disposal, food safety, housing, facilities inspections, environmental communicable disease control, community-based research in the assessment of environmental hazards exposure and emergency preparedness and response.
• Services delivered include professional inspections in schools, day cares and restaurants and inspecting houses to evaluate indoor air quality, overcrowding, and general safety so as to prevent injury, illness and death.
• Most services are delivered directly to communities and residents by Environmental Public Health Officers, who are certified public health inspectors that can be employed by ISC or directly by tribal councils or First Nations organizations.
• As front-line professionals in pandemic response, the services Environmental Public Health Officers are providing include but are not limited to:
  • outbreak investigation and management in coordination with local and regional public health response teams;
  • inspections, assessment or monitoring in facilities and homes to minimize further transmission;
  • inspections of high-risk public facilities (e.g., long-term care facilities) and other facilities (e.g., schools) to verify the implementation of prevention measures;
  • surge capacity in community COVID-19 rapid testing programs; and,
  • surge capacity in the delivery and administration of COVID-19 vaccines.
• In addition to direct services, the First Nations Environmental Contaminants Program is a community-based research initiative that assists First Nation communities in assessing the extent of their exposure to environmental contaminants and the potential for associated risk to their health and well-being.

Top Key Current Files or Projects

• Working directly with First Nations to assist communities in monitoring drinking water quality at tap in all water systems, which includes providing advice and guidance about drinking water safety and wastewater disposal, and reviewing infrastructure project proposals from a public health perspective.
• Analyzing Environmental Public Health data and developments in science to inform current and future infrastructure investments, shifting from reactive to proactive.
• In collaboration with the Regional Operations Sector, other government departments, and partners, implementing the recommendations of a Deep Dive on housing and related health and social outcomes and preparing for service delivery by First Nations.
• Working with the Assembly of First Nations on their 10 Year Housing and Infrastructure Strategy.
• Supporting a large scale multi-disciplinary cross-sectional study (2020-2031) in collaboration with four leading Canadian Universities and the Assembly of First Nations to assess environmental conditions of First Nation children and their exposure to environmental chemicals across Canada – the Food Environment Health and Nutrition of First Nations Children and Youth study.

Key Milestones

• Implementing next steps of a ten year community-based participatory total diet study that collected baseline data of the diets of First Nations, overall well-being and food security status, food-related exposure to environmental contaminants and provided representative data on First Nations' body burden of mercury in the proximity of First Nation communities.
• Key results and recommendations of the First Nations Food, Nutrition and Environment Study, for which ISC is implicated, were published on June 28, 2021, in the special issue of the Canadian Journal of Public Health, Volume 112, Supplement Issue 1. The report consolidates findings for eight Assembly of First Nations regions as well as provides key findings and recommendations for governments and decision makers. The study was implemented by the University of Ottawa, University of Montreal and the Assembly of First Nations. A final report on key findings and recommendations will be formally released in fall 2021.
• The 2022-2023 Call-for-Proposals for the First Nations Environmental Contaminants Program was launched in summer 2021.
• Supporting the community of Wabaseemoong First Nations and researchers working on their behalf in accessing mercury related human health data, in keeping with the Privacy Act, including ongoing human biomonitoring for mercury and providing mercury risk communication materials as well as technical expertise on the broader mercury file. The same support has been provided to Grassy Narrows with respect to data, and offered with respect to ongoing human biomonitoring.

Results and outcomes

• Recent investments providing ongoing funding to support the work of Environmental Public Health Officers as they relate to drinking water and wastewater, thereby helping to ensure the safe delivery of health and social services on-reserve at current level.
• Updated guidance and tools to support the safe delivery of health services for clients and health professionals (e.g., environmental public health inspectors, nurses, community-based water monitors) during the pandemic. This work remains ongoing as the country moves from pandemic to endemic, and as the science evolves.
• Over 100 long-term drinking water advisories have been lifted since 2015.
• ISC also continues to work with all communities facing short-term drinking water advisories to prevent them from becoming long term. Over 180 short-term drinking water advisories have been lifted since 2015.
• All First Nation communities have access to trained personnel (Community-Based Drinking Water Quality Monitor or an Environmental Public Health Officer) to sample and test drinking water quality at the tap. In 2019-2020, public water systems on-reserve were sampled on average at 82% of the recommended frequency for bacteriological parameters in the Guidelines for Canadian Drinking Water Quality. As a result of enhanced capacity First Nations' and ISC's ability to detect potential problems sooner has improved.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health and Executive Director Office of Population and Public Health
First Nations and Inuit Health Branch

About the Program

• ISC is working with First Nations to increase the resilience of high-risk communities to the impacts of climate change and has provided direct funding for climate resilience, through the First Nation Infrastructure Fund. Structural mitigation projects aimed at reducing the impacts of climate change include dikes, sea walls, natural infrastructure, firebreaks, and erosion-control measures, among others.
• ISC also provides funding to First Nation communities to develop information and tools to support the identification of climate change impacts and adaptation measures. The long-term outcome of these programs is to increase resilience to climate change impacts by implementing adaptation measures. This includes energy efficiency and alternative energy projects featuring solar, hydroelectric and wind power, amongst others, as well as projects fostering reliable energy systems. It also includes projects to mitigate the effects of climate change.
• The Climate Change and Health Adaptation Program for First Nations and Inuit funds community-based projects that focus on addressing a risk to health that comes from a changing climate. There are two streams for the program:
  • Climate Change and Health Adaptation Program North; and
  • Climate Change and Health Adaptation Program South for First Nations South of the 60° parallel.
• The Climate Change and Health Adaptation Program was stabilized in 2021 with $22.7 million over five years, beginning in 2021-2022, and $5.2 million ongoing to support First Nations and Inuit at current levels as they manage the health impacts of climate change; such as access to country food, impacts of extreme weather events, and mental health impacts of climate change on youth.

Top Key Current Files or Projects

• The 2021 Call for Proposals for projects south of the 60° parallel is currently underway.
• ISC participates in the Pan-Canadian Framework on Clean Growth and Climate Change, which includes supporting Indigenous communities in accessing available funding.
• ISC is leading work to support the integration of a climate change lens into federal Indigenous health policies, programs and services.

Results and outcomes

• As of March 31, 2021, ISC has provided funding to support 61 structural mitigation and related feasibility and design projects, 35 of which are complete. These projects will benefit 63 First Nation communities serving approximately 70,000 people.
• Since 2016, ISC has invested in energy projects to enable communities to transition away from diesel dependency and to improve energy efficiency within First Nation communities. Ongoing and completed projects include energy efficiency projects, such as lighting system upgrades, fuel oil switching to natural gas, and alternative energy projects, such as solar, hydroelectric, and wind power.
• As of March 31, 2021, ISC has provided funds to support 81 energy and related feasibility and design projects, 52 of which are complete. These projects will benefit 79 First Nation communities serving approximately 93,000 people.
• As of March 31, 2021, 34% of First Nation and Inuit communities were covered by climate change health adaptation funded projects. The program is unique among adaptation programs in that it focuses on supporting community-driven health research and adaptation strategies. This allows communities to identify the areas of research and vulnerability-assessments that are of greatest importance to them.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health and Executive Director Office of Population and Public Health
First Nations and Inuit Health Branch

About the Program

• ISC supports access to culturally-relevant mental wellness services guided by priorities of First Nation and Inuit communities and organizations.
• Investments in mental wellness respond to the immediate mental wellness needs of communities by supporting Indigenous-led suicide prevention, life promotion and crisis response, including through crisis line intervention services, and enhancing the delivery of culturally-appropriate substance use treatment and prevention services in Indigenous communities. This funding also supports the provision of essential cultural, emotional and mental health supports to former Indian Residential Schools and Federal Indian Day Schools students and their families, as well as those affected by the issue of Missing and Murdered Indigenous Women and Girls.
• Access to mental wellness services for status-First Nations and recognized Inuit is also supported through the Non-Insured Health Benefits Program provides First Nation and Inuit individuals with coverage for professional mental health
  counselling and transportation to access this benefit, as well as access to traditional healers.
• ISC's work in mental wellness is guided by key documents developed by Indigenous partners, including the First Nations Mental Wellness Continuum Framework, Honouring Our Strengths, and the National Inuit Suicide Prevention Strategy.
• Several key factors are influencing a significant rise in demand for Mental Wellness services:
  • The COVID-19 pandemic is having profound impacts on mental wellness in Indigenous communities by magnifying existing mental health issues and inequities and creating new gaps and needs. Many mental wellness services continue to be accessible with some experiencing breaks in service, shifts in service delivery, or new innovative approaches to reach community members. An investment of $82.5 million was announced in August 2020 to help Indigenous communities adapt and expand mental wellness services, improving access and addressing growing demand, in the context of the pandemic.
  • Recent confirmations of unmarked burials of missing children at former Indian Residential Schools continue to have a profound impact (e.g., re-traumatizing Survivors and their families and destabilizing communities). An additional $107.3 million was announced in August 2021 to expand access to
    trauma-informed health and cultural supports, which provides former students and their families access to a suite of emotional, cultural and mental health support services.
  • Indigenous communities have been disproportionally affected by the opioid crisis, and the use of opioids and other substances continues to be a serious concern in some Indigenous communities, and more broadly during the ongoing pandemic. Through ISC's Opioid Action Plan, ISC provides funding to support First Nation and Inuit communities to respond to the crisis, through expanding access to harm reduction measures, including naloxone, and funding wraparound services at 72 opioid agonist therapy sites in areas of high need. Budget 2021 provides funding to enhance and expand wraparound supports at opioid agonist therapy sites.

Top Key Current Files or Projects

• Addressing the opioid crisis: Supporting the whole-of-government approach through enhanced prevention, treatment, harm reduction, and evidence-based initiatives, including investments in wraparound services at opioid agonist therapy sites serving Indigenous populations.
• Substance use treatment and prevention: Supporting community-based approaches to problematic substance use, including access to residential and outpatient treatment that is culturally-relevant.
• Intergenerational impacts: Trauma-informed health supports, cultural supports and mental health counselling are available for former students of Indian Residential Schools, and Federal Indian Day Schools and their families, as well as those impacted by the issue of Missing and Murdered Indigenous Women and Girls. The supports are available regardless of Indigenous status or place of residence.
• Mental wellness and life promotion: Supporting a variety of initiatives on mental wellness promotion, suicide prevention, life promotion, and crisis response, such as mental wellness teams, the Hope for Wellness Helpline, the National Inuit Suicide Prevention Strategy, the National Aboriginal Youth Suicide Prevention Strategy, and the Youth Hope Fund.
• Métis mental wellness: In recognition of the growing mental wellness needs linked to the COVID-19 pandemic, ISC has gone beyond its traditional health mandate to begin supporting Métis mental wellness, first through the Indigenous Community Support Fund, and subsequently through the one-time August 2020 COVID-19 mental wellness funding. Budget 2021 again referenced Métis linked to the mental wellness investment of $597 million over three years.

Key Milestones

• Renovating over 20 residential treatment centres across Canada, increasing access to treatment services, including related to opioids, and supporting on-the-land activities.
• Establishment of 25 new sites offering opioid replacement therapy and wraparound services by March 2023 from a baseline of 11 (2016–2017), and reduce critical property issues in ISC funded treatment centres.
• Supporting the implementation of the National Inuit Suicide Prevention Strategy led by the Inuit Tapiriit Kanatami ($50 million over ten years, $5 million per year ongoing).
• Supporting Indigenous communities in addressing the impacts of the COVID-19 pandemic on mental wellness through an investment in 2021 to help communities adapt and expand mental wellness services, improving access and addressing growing demand to meet needs.
• On August 10, 2021, in response to the ongoing process of investigating and confirming unmarked graves at the sites of former Indian Residential Schools, the Government of Canada announced one year of new funding to improve access to emotional, cultural, and mental health supports.

Results and outcomes

• Community-based programs for mental wellness are reaching over 400 communities across the country.
• Based on data from nine treatment centres, almost 400 youth per year received treatment with the majority accessing residential treatment.
• The number of mental wellness teams has grown from 11 teams supporting 86 communities to 63 teams providing support to 344 communities.
• Between the Hope for Helpline's launch in October 2016 and the end of July 2021, 66,925 calls have been received. Since its launch in April 2018, the online chat counselling services has been accessed 10,564 times.
• The number of Health and Cultural support workers has remained the same since 2011 (about 580 full and part time workers, or 480 full-time equivalents that are community-employed).
  • with 7,000 clients accessing Health and Cultural supports in 2006-2007, 60,000 in 2011-2012, and 120,000 in 2018-2019, the Indian Residential School Resolution Health Support Program has seen an increase of demand of approximately 1,715% from 2006-2007 to 2018-2019; and
  • the average number of clients per Health and Cultural support worker has almost doubled in recent years from an average of 131.3 clients per worker in 2011-2012 to an average of 250 clients per worker in 2018-2019.
• The number of registered psychologist and social workers supporting former students of Indian Residential School and their family, as well as Federal Indian Day School and those affected by Missing and Murdered Indigenous Women and Girls, is 2778.
  • between 2007-2008 and 2018-2019, over 634,000 hours of professional mental health counselling were provided through the Indian Residential School Resolution Health Support Program.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health and Executive Director Office of Population and Public Health
First Nations and Inuit Health Branch

About the Program

• ISC supports the control and management of communicable diseases among First Nations living on-reserve.
• Services include: immunization; addressing and preventing communicable disease emergencies; infection prevention and control; specific interventions for high-risk respiratory infections (including tuberculosis); and sexually transmitted and blood borne infections (including HIV/AIDS and Hepatitis C).
• Most services are delivered by community health workers. However, ISC still delivers some of activities directly through front-line public health personnel.
• Support is also provided to Inuit organizations to support the elimination of tuberculosis in Inuit Nunangat.

Top Key Current Files or Projects

• Supporting First Nation, Inuit, and Métis communities and organizations in their COVID-19 preparedness, response, and recovery:
  • conduct COVID-19 case surveillance and modelling, and support Indigenous-led, distinctions-based data initiatives;
  • manage the distribution of personal protective equipment and vaccine administration supplies;
  • support surge health human resources to support with vaccine administration in regions and in communities;
  • support collaboration and knowledge sharing across regions, Indigenous partners, federal counterparts, and provincial and territorial governments as necessary through the Health Emergency Management Network, Communicable Disease Emergency and Infection Prevention and Control Network, Communicable Disease Working Group, and two COVID-19 Vaccine Working Groups;
  • increase access, awareness, and vaccine confidence for COVID-19 vaccines; and
  • develop and/or disseminate public health and infection prevention control guidance.
• Support Inuit partners in efforts to eliminate tuberculosis as they implement their regional-specific action plans. Support First Nation and Inuit communities responding to tuberculosis outbreaks.
• Support First Nations and Inuit partners to improve access to community-based models for prevention, testing, treatment, as well as awareness programming to reduce stigma; and to improve patient outcomes and reduce transmission of sexually transmitted and blood borne infections.
• Support First Nations and Inuit partners to increase and maintain immunization rates to those comparable of the non-Indigenous population in Canada.
• Continued surveillance and epidemiological analysis of communicable disease and immunization data, including influenza, to inform policy and programming decisions.

Key Milestones

• Collaboration with Inuit Tapiriit Kanatami and other relevant partners through the Inuit Public Health Task Group to eliminate tuberculosis in Inuit Nunangat by 2030, and to reduce the incidence of active tuberculosis by at least 50% by 2025.
• Distributed 1908 orders of personal protective equipment and 254 orders of vaccine administration supplies to First Nation, Inuit, and Métis communities and organizations to support the COVID-19 response as of September 14, 2021.
• Increased progress towards the United Nations treatment targets through implementation of prevention initiatives, including:
  • 72 out of 82 communities in Saskatchewan have implemented full or partial Know Your Status programs;
  • the DRUM program expanded its reach within the five communities that it served in Alberta;
  • two communities in Alberta provided sexually transmitted and blood borne infections testing and treatment through the pilot Test and Treat program;
  • 70 Community Health Nurses received Test and Treat trainings in Alberta;
  • dry blood spot testing implemented in Ontario, Alberta, and Saskatchewan; and
  • continued support to the Canadian Aboriginal AIDS Network, the Native Women's Association of Canada, and Pauktuutit Inuit Women of Canada in development of culturally safe frameworks and projects to address sexually transmitted and blood borne infections.
• Developed a Communicable Disease Emergency Tabletop Exercise Toolkit to assist Indigenous communities in assessing their level of preparedness for a communicable disease emergency.

Results and outcomes

• COVID-19-specific outcomes:
  • as of August 31, 2021, 95% of First Nation peoples living on a reserve who tested positive for COVID-19 have recovered; and
  • as of August 31, 2021, the COVID-19 case fatality rate among First Nation peoples living on a reserve is 61% of the case fatality rate in the non-Indigenous population.
• Reduced incidence, spread and health impacts of communicable diseases in Indigenous communities:
  • elimination of tuberculosis in Inuit Nunangat by 2030, and to reduce the incidence of active tuberculosis by at least 50% by 2025 (compared to 2016 rates).
    • 2016 rate: 168.7/100,000.
    • 2018 rate: 194.3/100,000.
    • Note that the Inuit Tapiriit Kanatami Framework on Tuberculosis Elimination was not finalized until 2018 and Inuit regional action plans were completed in 2020. The most recent data available is in 2018. This data is unpublished (source: Inuit Tapiriit Kanatami tuberculosis Inuit Strategy Update, email March 19, 2021).
  • reduced rates of tuberculosis in First Nations communities.
    • 2018 rate (First Nations (status) on-reserve): 20.6/ 100,000,
    • 2016 rate (First Nations (status) on-reserve): 35.5/100,000,
    • 2012 rate (First Nations (status) on-reserve): 22.4/ 100,000,
    • 2018 rate (First Nations (status) off-reserve, excluding Quebec): 13.0/ 100,000,
    • 2016 rate (First Nations (status) off-reserve, excluding Quebec): 16.0/ 100.000,
    • 2012 rate (First Nations (status) off-reserve, excluding Quebec): 18.2/ 100,000,
    • this data is unpublished (source: Tuberculosis data from the Canadian Tuberculosis Reporting System, 2018);
  • reduced rates of newly reported cases of HIV among First Nations; and
  • progress towards the United Nations AIDS targets.

Lead Departmental Official
Dr. Tom Wong
Chief Medical Officer of Public Health and Executive Director Office of Population and Public Health
First Nations and Inuit Health Branch

About the Program

• ISC supports primary health care service delivery in remote and isolated First Nation communities. These services are mainly delivered by a team of nurses and include diagnostic, curative, rehabilitative, supportive, palliative/end-of-life care, and referral services.
• Services are provided by qualified health providers who have the necessary competencies and meet the regulatory and legislative requirements of the province in which they practice.
• The national office in collaboration with regional offices provide oversight for all programs, including the delivery of primary care services under the Clinical and Client Care Program.
• The services are funded in 74 nursing stations and five health centres with a treatment component in five regions. ISC directly employs or contracts nurses and other health workers in 51 remote/isolated communities located in Alberta (four); Manitoba (21); Ontario (24); and Quebec (two). Grants and contribution funding is provided to an additional 28 First Nation communities to deliver these services in Alberta (one); Saskatchewan (12); Manitoba (one); Ontario (five); and Quebec (nine).
• ISC is also responsible for two federal hospitals located in Manitoba.
• As of March 25, 2021, the Primary Health Care Nursing Operational Vacancy Rate is 60%. The Primary Health Care Operational Vacancy Rate represents a snapshot in time of the front line workforce occupancy rate across 45 Nursing Stations in the regions of Ontario and Manitoba.
• Primary Health Care Nursing Operational Occupancy Target: will target to have 80% of its Primary Health Care Nursing positions occupied at all time by an ISC employed nurse.

Top Key Current Files or Projects

• 2021 Nursing Recruitment and Retention Strategy: A modern strategy focused on five key pillars: (1) recruit and retain the "right" health human resources; (2) modernization of ISC's practice environment; (3) ensure the physical, cognitive, and emotional wellbeing of our workforce; (4) become a future labour workforce influencer; and (5) nimble and agile SURGE response.
• National Patient Safety Incident Management Process: Implement a consistent and reliable process for reporting and analyzing of patient safety incidents to remediate and prevent future occurrences.
• Nursing Education: Support the delivery of mandatory and other training for all ISC employed nurses through the provision of curricula, tracking and reporting mechanisms to retain nurses and train newly recruited nurses.
• Pharmacy Services and Medication Management: Provide professional practice guidance and advice though activities on topics, such as patient safety/incident management, antimicrobial resistance, accreditation/quality improvement, drug shortages, and controlled substances audits.
• Clinical Practice Guidelines and Development of a Learning Management System: Provide an integrated platform to share clinical support tools, and to provide training resources for the First Nations and Inuit Health Branch /agency and transferred nurses working in remote/isolated First Nation communities.
• Nursing Services Response Centre: Centrally coordinate a dedicated team to support front-line nurses to navigate various corporate services issues while they are working in community.
• Centre for Nurse Recruitment: A continuous, national, external selection process for the recruitment of experienced nurses to deliver healthcare services in remote/isolated First Nation communities.
• Nurse Relief Coordination Unit: Implement regional contracts to provide temporary nursing services to supplement the ISC nursing workforce.

Key Milestones

• In March 2020, the COVID-19 action plan for pharmacy services was developed to ensure adequate supply of medications that may be required due to the potential increase of respiratory illness, as well as to identify non-formulary alternatives to mitigate supply shortages during the pandemic.
• An initial town hall discussing the release of the ISC Nursing Workforce Survey for ISC employed nurses was held on October 5, 2020. Subsequent town halls have been held in order to strengthen linkages and provide information and resources for the National Nursing workforce. Nursing Services Awards were held on May 10, 2021, using a virtual platform, in order to respect public health guidelines. The Nursing Service Awards, along with the town halls, are used to communicate information to nurses, to recognize the achievements of the nursing workforce, and to also promote a dialogue between nurses and the national office.
• In 2020, the Clinical and Client Care Pharmacy Unit supported the regions in managing drug shortages in remote and isolated First Nations health facilities and providing subsequent patient management as outlined in the First Nations and Inuit Health Branch Action Plan on addressing National Drug Supply Shortages.
• In March 2020, the Clinical and Client Care Pharmacy Unit employed risk mitigation and allocation strategies to discourage the practice of stockpiling to prevent unintended supply disruptions at nursing stations. These measures were required to ensure equitable distribution to all health facilities and effectively respond to the increased requirements in communities that are dealing with COVID-19 outbreaks.
• In March 2020, an ISC patient safety incident management process was developed with the plan to implement a patient safety incident reporting tool.
• In July 2020, updated the First Nations and Inuit Health Branch Policy and Procedures on Controlled Substances for First Nations Health Facilities where the health services and pharmacy services are managed by ISC.
• In 2020-2021, 147 Front Line Nurses were hired as a result of referrals from the Centre for Nursing Recruitment. The number of hires represents the staffing actions in addition to express staffing actions processed by the National Administration Unit.
• The Nursing Workforce Survey, Phase 1: completion of a preliminary survey of nurses currently working for ISC.
• The Nursing Services Response Centre Phase 3 is underway with the finalization of functional support teams and establishment of tracking and reporting systems.
• The adoption of a digital nursing recruitment platform in July 2020 that expedites candidate application, evaluation and hiring processes across Canada.

Lead Departmental Official
Robin Buckland
Director General and Chief Nursing Officer
Office of Primary Health Care
First Nations and Inuit Health Branch

About the Program

• ISC funds community-based oral health services with a focus on children and dental therapy. The range of services include prevention and health promotion, outreach and home visiting, treatment, and referrals.
• ISC employs over 80 oral health practitioners, and many other professionals are hired directly by the community through Contribution Agreements.

Key Milestones

• An overarching framework was developed in August 2018 with First Nations and Inuit partners to provide a strategic roadmap towards improving oral health.
• ISC has implemented strategies to improve oral health data collection, reporting and analysis in order to better inform program decisions making based on evidence.
• Training and calibration of all oral health professionals for consistency in oral screening is planned to resume when it is safe to do so based on COVID-19 public health guidance.
• ISC will also be supporting the First Nations Information and Governance Centre and the Assembly or First Nations toward funding the First Nations Oral Health Survey.

Results and outcomes

• Implementing the Budget 2017 commitment to reach 383 communities by the year 2021-2022, an increase from 237 communities in 2016-2017.
• Increase the target age group for children in some jurisdictions beyond age seven where the capacity exists.
• Improve the recruitment and retention of oral health practitioners through innovative means, including by partnering with professional associations, such as the Canadian Dental Hygienists Association and universities, such as with the University of Saskatchewan (in partnership with the Northern Inter-Tribal Health Authority and Saskatchewan Polytechnic). Partnership with these two organizations is established to support the development of a full proposal to establish a dental therapy training program with one of the main goals to have Indigenous graduates return to work in their communities.

Lead Departmental Official
Robin Buckland
Director General and Chief Nursing Officer
Office of Primary Health Care
First Nations and Inuit Health Branch

About the Program

• ISC funds a continuum of home and community care services in First Nation and Inuit communities, including in-home nursing and personal care, in-home respite services, and palliative and end of life care for persons of all ages.
• Clients range in age from infants to elderly, with the majority of clients (60%) being over 55 years of age.
• Long-term care services in Indigenous communities are currently provided through a mix of authorities including provincial and territorial services, and ISC's Assisted Living Program.

Top Key Current Files or Projects

• Workforce development: Enhanced training of personal care providers, and addressing issues of recruitment and retention of qualified personnel.
• Aligning ISC funded health and social services: Streamlining administrative processes for communities. Collaborative work is underway to identify ways to increase efficiencies within current resources, including better alignment and potential formal integration of these two programs. This work has begun with identification of indicators, which will capture data for areas providing similar services.
• Co-development of options for long-term care with First Nations and Inuit: Working together to identify and address deficiencies in the long-term care system, ISC is following the lead of First Nation and Inuit partners and communities to engage on, and develop models that expand access to long-term care services.

Key Milestones

• Supporting communities affected by the COVID-19 pandemic, ISC launched a Supportive Care Initiative to financially assist communities that incurred pandemic-related costs to keep their communities safe.
• ISC is working with regional and National Indigenous Organization partners to coordinate online discussions regarding the Indigenous-led long-term care engagement.

Results and outcomes

• In 2018–2019, the program provided one million hours of home care services to 20,504 First Nation and Inuit individuals.
• The distribution of hours of care by type were: assisted living, such as home support and meal preparation (53%); personal care (16%); nursing services (12%); case management (11%); in-home respite (seven percent); and professional therapies (one percent).
• Home care visits were provided by client type as follows: long-term supportive care (34%); maintenance (30%); acute care (23%); rehabilitation (eight percent); end-of-life care (1.5%); and other reasons (3.5%).

Lead Departmental Official
Robin Buckland
Director General and Chief Nursing Officer
Office of Primary Health Care
First Nations and Inuit Health Branch

About the initiative

• Jordan's Principle is a legal rule named in memory of Jordan River Anderson, a First Nation child from the Norway House Cree Nation in Manitoba, who died in 2005 at the age of five in the hospital, while the provincial and federal governments could not agree on who was financially responsible for his care.
• Jordan's Principle supports families in accessing products and services for First Nation children and youth to help with a wide range of health, social and educational needs. It is a legal obligation ordered by the Canadian Human Rights Tribunal that responds to the unmet needs of First Nation children, no matter where they live in Canada.
• The full implementation of Jordan's Principle is the third Call to Action from the Truth and Reconciliation Commission's Final Report.
• Determinations for requests respect Canadian Human Rights Tribunal-ordered timelines, for:
  • Individual Requests – 12 hours for an urgent and 48 hours for a non-urgent; and,
  • Group Requests – 48 hours for an urgent and seven days for a non-urgent.
• Engagement with First Nations partners in respect of the implementation of Jordan's Principle is grounded by the 2018 Canadian Human Rights Tribunal 4 February 1, 2018 ruling ordering Canada to consult not only with the Commission, but also directly with the Assembly of First Nations, the First Nations Child and Family Caring Society, the Chiefs of Ontario, and Nishnawbe Aski Nation. The Consultation Protocol, signed in March 2018 ensures that consultations are carried out in a manner consistent with the honour of the Crown and to eliminate discrimination substantiated in the January 2016 Canadian Human Rights Tribunal decision.
• The governance structures in place to assist the implementation of Jordan's Principle, include the:
  • National Advisory Committee on Child and Family Services;
  • Consultation Committee on Child Welfare;
  • Jordan's Principle Operations Committee; and
  • Jordan's Principle Action Table.
• Jordan's Principle recognizes that First Nation children may require access to government services that exceed the normative standard of care, as ordered by the Canadian Human Rights Tribunal.
• Pursuant to the Canadian Human Rights Tribunal May 26, 2017 decision, the Government of Canada is to ensure substantive equality in the provision of services to the child, to ensure cultural appropriate services and to safeguard the best interest of the child. Equivalent provincial and territorial normative standards are to be considered the ‘floor' rather than the standard.
• Jordan's Principle requests go through three levels of decision making: regional, escalations and appeals. Consistent with the departmental direction, requests are only denied by ISC senior level officials.
• Should a denial be upheld by the Appeals Committee, requesters have the option to bring a request for Judicial Review in the Federal Court.
• Following Canadian Human Rights Tribunal 36 in November 2020, Canada has expanded eligibility under Jordan's Principle to children who are recognized as members by their nation regardless of where they live in Canada as well as children that have one parent or guardian who is registered or eligible to be registered under the Indian Act, on an ongoing basis.
• However, the Government of Canada has filed a notice of application for judicial review of the Tribunal's decision. Final decision on this judicial review is pending.
• Deciding who belongs to a First Nation community is complex and the Government of Canada firmly maintains that the decision as to who qualifies as a First Nation child should not be determined through litigation before the Canadian Human Rights Tribunal.
• The expanded eligibility for Jordan's Principle for children recognized by their nations will remain in effect regardless of the outcome of the judicial review.

Top Key Current Files or Projects

• An arm's length Appeals Secretariat composed of 12 professional consultants from regulated and certified disciplines from health, education and social sectors, is currently being implemented via a phased-in approach.
• The Choose Life Initiative, a needs-based application process specific to 49 Nishnawbe Aski Nation communities and tribal councils in Ontario was launched in 2017.
• Under Jordan's Principle, the initiative provides immediate funding relief to support First Nations developed community-based life-promotion and suicide prevention programs and services for the children and youth. Jordan's Principle has committed more than $297 million in funds for the Choose Life Initiative to date.

Key Milestones

• In January 2016, the Canadian Human Rights Tribunal made findings of discrimination against Canada regarding the complaint filed by the Caring Society and the Assembly of First Nations. The Government of Canada was ordered to:
  • cease its discriminatory practices;
  • reform the federal First Nations Child and Family Services Program;
  • cease applying its narrow definition of Jordan's Principle (limited to children with multiple health conditions involving several providers); and
  • take measures to immediately implement the full meaning and scope of the Principle.
• In November 2017, the Canadian Human Rights Tribunal ordered Canada to apply Jordan's Principle equally to all First Nation children, on- or off reserve, not just limited to those children with disabilities, or those with discrete short-term issues.
• In February 2018, a National Call Centre for Jordan's Principle requests was established, which is available 24 hours a day, seven days.
• In November 2020, Canada has expanded eligibility under Jordan's Principle to children who are recognized as members by their nation regardless of where they live in Canada on an ongoing basis.

Results and outcomes

• From July 2016 to June 30, 2021, Canada has approved over one million products, supports and services for First Nation children and youth under Jordan's Principle.
  • in fiscal year 2020-2021, 339,654 products and services were approved, a decrease of three percent compared to fiscal year 2019-2020.
  • in fiscal year 2019-2020, 350,078 products and services were approved, an increase of 149% compared to fiscal year 2018-2019.
  • in fiscal year 2018-2019, 140,332 products and services were approved, an increase of 83% compared to fiscal year 2017-2018.
  • in fiscal year 2017-2018, 76,891 products and services were approved, an increase of 1,456% compared to fiscal year 2016-2017.
  • in fiscal year 2016-17, 4,940 products and services were approved.
• A Client Satisfaction Survey of recipients of Jordan's Principle funding was completed in 2020 and 2021. The results of the 2021 Client Satisfaction Survey, which are anticipated to be released in fall 2021, found that:
  • 63% of respondents reported overall satisfaction with Jordan's Principle, no change from 63% in 2020;
  • 49% of respondents were satisfied and 27% dissatisfied with payment timelines for Jordan's Principle, compared to 44% and 36%, respectively, in 2020;
  • 60% of respondents found it easy or very easy to access information about Jordan's Principle, compared to 59% in 2020;
  • 44% of respondents found it easy or very easy to request products and services, compared to 43% in 2020;
  • 68% of respondents felt that their culture was respected, compared to 63% in 2020;
  • 76% felt that they were treated with respect and dignity when accessing Jordan's Principle, compared to 77% in 2020; and
  • compared to the 2020 Client Satisfaction Survey, the 2021 survey results contained similar response proportions for all core questions.
• A Client Satisfaction Survey of recipients of Jordan's Principle funding was completed in 2020 and 2021.
• ISC has worked in collaboration with the Jordan's Principle Operations Committee to deliver on various communications and marketing tactics on an ongoing basis to raise awareness of Jordan's Principle among First Nation families, communities, professionals, and other audiences.
• This includes tactics, such as: posting information online on Canada.ca, issuing social media posts through departmental channels and implementing several paid advertising campaigns from 2017 to 2021.

Future steps

• Jordan's Principle is request-driven and will continue to support the unmet needs of First Nation children. ISC is committed to ensuring that there is no disruption in services to First Nation children.
• Continued collaboration with First Nations partners to improve implementation.
• The Government of Canada will continue working with First Nations partners, provinces and territories to develop longer-term approaches to help better address the unique health, social, and education needs of First Nations children.

Lead Departmental Official
Robin Buckland
Director General and Chief Nursing Officer
Office of Primary Health Care
First Nations and Inuit Health Branch

About the Initiative

• The Inuit Child First Initiative was jointly announced by Inuit Tapiriit Kanatami and ISC on September 10, 2018.
• The Inuit Child First Initiative supports parents and guardians in accessing the health, social and educational products and services that Inuit children need, when they need them.
• Until a long-term Inuit-specific approach can be developed to support Inuit children, Inuit leaders have agreed that a model similar to Jordan's Principle will be available for Inuit children.

Top Key Current Files or Projects

• With support from ISC, Inuit leaders are assessing options to support the development of a long term approach for the Inuit Child First Initiative.
• Inuit Tapiriit Kanatami hosted an Inuit Child First Initiative Virtual Knowledge Forum in March 2021. The objectives included building awareness, identifying and sharing best practices and lessons learned, and develop goals for the longer-term approach.

Key Milestones

• As of September 2018, ISC began receiving individual and group requests for Inuit children under the Inuit Child Initiative on an interim basis.
• Requests for Inuit children are submitted through the national call centre, which is available 24 hours per day, seven days per week or by contacting federal Inuit Child First Initiative representatives.

Results and outcomes

• From April 1, 2019, to June 30, 2021, the Inuit Child First Initiative approved over 48,000 products and services for Inuit children.
• For the 2020-2021 fiscal year more than 26,000 products and services were approved for Inuit children. This represents over a 500% increase compared to the number of approved products and services in the last fiscal year (over 4,000 in 2019-2020).
• ISC has worked in collaboration with Inuit Tapiriit Kanatami to deliver on various communications and marketing tactics on an ongoing basis to raise awareness of the Inuit Child First Initiative among Inuit families, communities and other audiences. This includes tactics, such as: posting information online on Canada.ca, issuing social media posts through departmental channels, launching an Inuit Child First Initiative Public Service Announcement outreach campaign to communities across Inuit Nunangat, and implementing a paid advertising campaign in 2021.

Lead Departmental Official
Robin Buckland
Director General and Chief Nursing Officer
Office of Primary Health Care
First Nations and Inuit Health Branch

About the Program

• The Non-Insured Health Benefits Program provides clients (registered First Nations and recognized Inuit who reside in Canada) with coverage for a range of health benefits. Program benefits include prescription drugs and over-the-counter medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access health services not available locally.
• Non-Insured Health Benefits provides health benefits to eligible First Nations and Inuit clients in a manner that:
  • is appropriate to their unique health needs;
  • contributes to the achievement of an overall health status for First Nations and Inuit that is comparable to that of the Canadian population as a whole;
  • is sustainable from a fiscal and benefit management perspective; and
  • facilitates First Nations/Inuit control at a time and pace of their choosing.

Financial profile

Text alternative for Non-Insured Health Benefits expenditures by benefit ($ millions): 2020-2021

Note: figures do not include salaries, operating, or other overhead costs.
The pie chart shows the non-insured health benefits expenditures, in millions of dollars, by benefit type for 2020-2021.

Numerical values presented in the chart:
Description of Non-Insured Health Benefits expenditures by benefit

Medical transportation: $525.7 (35%) Pharmacy: $550.9 (37%)
Dental: $236.3 (16%)
Medical Supplies and Equipment: $51.5 (3%) Mental health: $74.0 (5%)
Vision: $39.9 (3%)
Other: $12.3 (1%)

Key current files

Joint Review of the Non-Insured Health Benefits Program with the Assembly of First Nations

• In 2013, the Minister of Health agreed to undertake a comprehensive Joint Review of the Non-Insured Health Benefits Program in partnership with the Assembly of First Nations. A review of each Non-Insured Health Benefits benefit area was to be undertaken, with the goal of identifying and implementing improvements that will identify and address gaps in benefits, enhance client access to benefits, and streamline service delivery to be more responsive to First Nations client needs.
• The Joint Review Steering Committee is comprised of equal representation of First Nations and Non-Insured Health Benefits staff, and is guided by an Elder.
• Joint reviews of the following Non-Insured Health Benefits benefit areas are now complete: mental health counselling, dental care, vision care, pharmacy, and medical supplies and equipment.
• Implementation of changes and improvements to Non-Insured Health Benefits, as identified through the Joint Review, is well underway.
• The sixth and final benefit review of Medical Transportation is underway; Joint Review engagement focused primarily on COVID-19 related issues during 2020-2021.

Health Information and Claims Processing Services

• Since 1990, the Non-Insured Health Benefits Program has retained the services of Canadian private sector contractors to provide claims processing and associated services through the Health Information and Claims Processing Services contract.
• Through the Health Information and Claims Processing Services contract, the contractor Express Scripts Canada provides the Non-Insured Health Benefits Program with a comprehensive suite of services for the pharmacy, dental, medical supplies and equipment, mental health counselling and vision care benefits that includes:
  • electronic claims adjudication;
  • secure web accounts for providers and clients to submit claims, view claims history, status of pending requests etc.;
  • provider enrolment administration;
  • communications; and
  • claims payment.
• While Express Scripts Canada provides administrative services, technical support and automated systems used to process and pay claims in accordance with Non-Insured Health Benefits Program policies, it does not include any decision making on behalf of Non-Insured Health Benefits. All prior approvals, provider enrolment approvals, policy decisions etc. remain with Non-Insured Health Benefits Program staff in Headquarters and regions.

Product listing agreements

• The Non-Insured Health Benefits Program is a leader for the Government of Canada in negotiating Product Listing Agreements, which are contracts between drug plans and drug manufacturers whereby lower drug prices are secured in the form of rebates negotiated between the parties.
• The Non-Insured Health Benefits Program has entered into 232 Product Listing Agreements to date. This has also resulted in clients having access to 254 new drugs, which have been added to the Non-Insured Health Benefits Drug Benefit List (formulary).
• Product Listing Agreements do not have an expiry; however, the Non-Insured Health Benefits Program may choose to renegotiate an agreement if there is a major change in the market for a particular drug, which does occur periodically.

Opioids

• Non-Insured Health Benefits provides a wide range of opioid agonist therapy coverage, including methadone, buprenorphine/naloxone (Suboxone and generics), slow-release oral morphine, buprenorphine extended release injections, and buprenorphine implants, enabling prescribers to choose the most appropriate treatment. Supervised injectable opioid agonist therapy (e.g., hydromorphone) may also be covered based on case-by-case review. Non-Insured Health Benefits will also consider coverage for new approved pharmaceuticals as they become available for problematic substance use treatment.
• Non-Insured Health Benefits provides coverage for naloxone nasal spray and injection kits as open benefits. Clients can also obtain naloxone from a pharmacy without a prescription.
• Since 2013, Non-Insured Health Benefits has been gradually lowering opioid dose amounts covered by the program and encouraged a slow taper to safer doses, while engaging with prescribers to prevent unsafe dose escalations. An opioid dispensing limit has also been put in place.
• Non-Insured Health Benefits has received requests for funding of the medications used for safer supply. Coverage for safer supply medications have been provided when within safety parameters recommended by the Non-Insured Health Benefits Drugs and Therapeutics Advisory Committee.
• Non-Insured Health Benefits has been working with First Nations and Inuit partners to introduce traditional healer services for mental health counseling for Non-Insured Health Benefits clients through projects developed by the partners that respect the unique cultural context of each region. These projects will inform next steps and future approaches to this type of service.

Key milestones/results and outcomes

• As a demand-driven program, Non-Insured Health Benefits will continue to provide supplementary health benefits to 898,839 First Nations and Inuit eligible clients (as of March 2021) eligible to receive benefits under the program.
• Non-Insured Health Benefits medical transportation expenditures increased by 8.5% in 2020 compared to the previous year. Over the past five years, overall medical transportation costs have grown by 42.9% from $375.9 million for 2015-2016 to $537.2 million for 2019-2020.
• Non-Insured Health Benefits mental health counselling expenditures increased by 29.2% during fiscal year 2019-2020. Over the past five years, overall mental health counselling costs have grown by 253.8% from $16.2 million in 2015-2016 to $55.1 million in 2019-2020. Budget 2017 provided funding to expand the benefit by removing the requirement that counselling be provided in response to a crisis.

Lead Departmental Official
Scott Doidge
Director General
Non-Insured Health Benefits
First Nations and Inuit Health Branch

Health Transformation

Anti-Indigenous Racism in Canada's Health System

Financial Profile

• The total expenditure for Individual Affairs Branch in 2020-2021 was $30 million. This excludes regional spending on service delivery.

Context

Recent data indicates that:

• The average annual number of newly registered individuals is 20,000 and there are just over 1,030,000 registered individuals on the Indian Register.
• On an annual basis, approximately 44,000 Secure Certificate of Indian Status are issued. Like all federal identity documents, the Secure Certificate of Indian Status requires renewal every ten years.
• There are 307 First Nations that signed the Historic Treaties (Numbered Treaties and Robinson Treaties) with the Crown that provide for annuities in perpetuity. There are approximately 614,000 registered individuals entitled to treaty annuities.
• Approximately $2.1 million is paid annually in treaty annuities to entitled First Nation individuals.
• The registered population is expected to grow at a steady pace until 2040 based upon the newly eligible population due to legislative amendments to remove sex-based inequities, the demographics of the registered population and the passing of status to subsequent generations.

Lead Departmental Official
Lori Doran
Director General
Individual Affairs Branch – Regional Operations Sector

Funds held in trust by Canada on behalf of First Nations (Trust / Indian Moneys)

About the service

• The Indian Act defines Indian moneys as, "all moneys collected, received or held by Her Majesty for the use and benefit of Indians or bands". These belong to First Nation bands or individuals and are held in trust, by Canada, within the consolidated revenue fund.
• The Indian Act identifies two categories of Indian moneys for bands. Capital moneys are derived from the sale of band land or assets or from non-renewable resources, such as oil and gas royalties. Revenue moneys are derived from all other types of band-generated revenues, such as the sale of renewable resources, leases and permits.
• Canada collects Indian moneys on behalf of First Nations pursuant to the Indian Act (reserve land instruments and other reserve land transactions, such as leases, permits, sale of surrendered lands, etc.) and the Indian Oil and Gas Act (royalties from oil and gas, surface leases and bonuses).
• These moneys are recorded as a Public Debt – therefore, a liability as these moneys are not assets belonging to Canada; they are moneys belonging to First Nations. Interest is paid on moneys held in Trust by Canada at a rate fixed by the Governor-in-Council. Interest accumulated in the accounts is compounded semi-annually.
• Efforts are being made to transfer control of revenue and capital funds to First Nations beyond the Indian Act
• First Nations can access their Indian moneys through a number of mechanisms:
  • First Nations Oil and Gas and Moneys Management Act;
  • First Nations Land Management Act (capital and revenue, except Oil and Gas revenues under the Indian Oil and Gas Act);
  • First Nations Fiscal Management Act (recent legislative amendments); and
  • Self-Government Agreements (capital and revenue moneys).

Top Key Current Files or Projects

• ISC is working with Indigenous, non-governmental, and governmental partners toward increased First Nations autonomy for access and management of Indian moneys through policy and legislative changes.

Key Milestones

• In 2015, ISC approved the Policy on the Transfer of Capital Moneys through paragraph 64(1)(k) of the Indian Act and has since been engaging First Nations on the policy's function and advantages.
  • the Policy enables self-determination while working within the framework of the Indian Act so that Canada no longer controls the management and expenditure of the capital moneys; and
  • some of the benefits include:
    • more flexibility and quicker access to their capital moneys,
    • ability to invest moneys more freely, and
    • potential for larger returns on moneys invested.
• In 2018, an option to more easily access capital moneys was adopted through legislative amendments to the First Nations Land Management Act and the Framework Agreement on First Nations Land Management.
• Also, in 2018, an option to access both capital and revenue moneys was adopted through legislative amendments to the First Nations Fiscal Management Act.

Results and outcomes

• Providing First Nations with options for self-determination in accessing and managing funds held in trust by Canada on behalf of First Nations.

Lead Departmental Official
Holly Beaton
Director
Trust Moneys, Estates and Treaty Annuities
Individual Affairs Branch - Regional Operations Sector

About the service

• Pursuant to the Indian Act, the Minister of Indigenous Services has exclusive jurisdiction and authority over estates of deceased people who were, or could have been, registered under the Indian Act and usually lived on a reserve. The Minister is also required to manage the estates of people who currently cannot manage their financial or legal affairs and usually live on a reserve, and may help manage the estates of minors registered under the act who usually live on a reserve.
• Services provided by the Estates Program include approving wills, appointing executors, acting as administrators of last resort, administering assets of minors and dependent adults, and working with First Nation communities to build capacity in the management of Estate Services. Estates management involves two main responsibilities that ensure the government fulfills its legal obligations under the Indian Act.
  • the management of decedent estates, pursuant to sections 42 to 50 of the Indian Act; and
  • the management of living estates pursuant to sections 51 and 52 of the Indian Act.

Top Key Current Files or Projects

• Establishing a clear path forward for the transfer of the management of Estate Services.
• Ensuring that eligible estates of deceased individuals receive timely support and due consideration under recent settlement agreements (e.g., Sixties Scoop and Day Schools settlement agreements).
• In response to COVID-19, measures have been put in place to allow for clients to use alternate methods of signature and commissioning of oaths on required documentation.

Lead Departmental Official
Holly Beaton
Director
Trust Moneys, Estates and Treaty Annuities
Individual Affairs Branch - Regional Operations Sector

About the service

• Between 1850 and 1921, the Crown negotiated 13 treaties that promised annual payments to registered Indians who are affiliated with bands that are signatories to these treaties.
• The 13 treaties with provisions for annuities are: Robinson-Huron Treaty, Robinson-Superior Treaty, and Treaties No.1 to No.11 (collectively referred to as the "Eleven Numbered Treaties").
• ISC is responsible for the Crown's fulfillment of treaty annuity provisions in all treaty areas. Annuities for First Nations located in the Northwest Territories under Treaties 8 and 11 are dispersed by Crown-Indigenous Relations and Northern Affairs Canada on behalf of ISC.
• The vast majority of treaty annuities are paid in cash directly to entitled individuals during treaty day events, which are held in various urban centers and on-reserve across British Columbia, Alberta, Saskatchewan, Manitoba, the Northwest Territories, and Ontario. Payments are between $4 and $5 per individual annually, with the amount depending on the treaty. Some treaties provide for an additional cash payment to serving Chiefs and councilors.
• The issuance of treaty payments are both a legal obligation and a constitutionally protected treaty right.

Top Key Current Files or Projects

Lead Departmental Official
Holly Beaton
Director
Trust Moneys, Estates and Treaty Annuities
Individual Affairs Branch - Regional Operations Sector

About the service

• The Indian Registrar, supported by officers with devolved administrative responsibility, renders statutory decisions on entitlement to registration based on the provisions of the Indian Act, and maintains an accurate Indian Register that underpins billions of dollars in programming and services, and informs policy and program development.
• The Indian Registrar and the processing of entitlement decisions is based solely on the provisions of the Indian Act and is independent from Ministerial direction or interference.
• Registration under the Indian Act does not confirm whether an individual is Indigenous, but rather, whether an individual is entitled to registration under the legislated provisions in the Indian Act.
• Once registered, an individual may be entitled to a range of rights, services and benefits, including Non-Insured Health Benefits, funding for post-secondary education, and treaty annuities for those registered to eligible bands.
• ISC issues proof of registration documents, including the Secure Certificate of Indian Status (‘secure status card'), which is a federal identity document that facilitates access for those eligible to receive programs and services to which they are entitled.
• The service standard for processing registration applications is six months to two years, depending on the complexity of the application. Once registered, the service standard for processing secure status card applications is 12 to 16 weeks, or less, as ISC is currently processing applications at a much faster rate.
• The average annual number of newly registered individuals is 20,000 and there are just over 1,030,000 registered individuals on the Indian Register.
• On an annual basis, approximately 44,000 Secure Certificate of Indian Status are issued.

Top Key Current Files or Projects

Key Milestones

• As a result of Bill S-3, all known sex-based inequities in registration dating back to 1869 have been eliminated. A Report to Parliament, confirming this and providing an overview of the implementation of Bill S-3 was tabled on December 11, 2020, by the Minister of Indigenous Services.
• To address gaps in access and facilitate more timely service, digital options are also being developed for the Secure Certificate of Indian Status. In 2019, a mobile photo app was launched to allow individuals to submit digital photos at no cost, and includes a gender-neutral option.
• Additional modernization efforts, including digital and online solutions for application intake and processing, policy efficiencies and leveraging potential partnership capacities are underway.
• On February 1, 2019, in response to a Report from the Minister's Special Representative on border crossing issues, a machine-readable zone was introduced on the Secure Certificate of Indian Status to facilitate border-crossing.

Lead Departmental Official
Denis Poirier
Director
Operations Directorate
Individual Affairs Branch - Regional Operations Sector

About the service

• Under section 17 of the Indian Act, the Minister of Indigenous Services has exclusive authority to create new bands and amalgamate or divide existing bands if requested to do so by a group of individuals already registered as status Indians or on existing band lists.
• Under section 2 of the Indian Act, the Governor-in-Council has the exclusive authority to recognize a group of unrecognized individuals as a band, which subsequently grants them entitlement to Indian Status. ISC facilities their recognition process on the basis of historical evidence.
• The Individual Affairs Branch is currently revamping the 1991 New Bands Policy.

Top Key Current Files or Projects

Lead Departmental Official
Michael Walsh
Senior Director
Registration and Integrated Program Management
Individual Affairs Branch - Regional Operations Sector

Snapshot

Indigenous Services Canada works with First Nations on reserve to support adequate and sustainable housing, clean drinking water and community infrastructure such as schools, health facilities, roads, and wastewater systems, which are essential to healthy, safe and prosperous communities. Even with significant investments, work remains to close the gap and ensure adequate investments for major repairs and new builds. This is critical as we move to the gradual transfer of responsibilities in this area from Indigenous Services Canada to First Nations. Support for infrastructure on-reserve is provided through the following:

• Capital Facilities and Maintenance Program: The main pillar of the federal government's community infrastructure support for First Nations on reserve in the areas of housing, education facilities, water and wastewater systems, and other vital infrastructure such as roads, bridges, fire protection, etc. Funding is delivered and managed through regional investment plans that outline projects identified by First Nations. The Department is currently working with First Nations to review the existing policies, and to strengthen infrastructure services with the long-term objective of transferring control over service delivery to communities.
• First Nations Water and Wastewater Enhanced Program: The federal government is committed to strengthening water and wastewater infrastructure in communities, improving drinking water monitoring on reserve and continuing to work towards ending long-term drinking water advisories on public systems on reserve. Indigenous Services Canada works to improve water and wastewater infrastructure, support proper facility operation and maintenance, build capacity by enhancing water system operator training, and improving water monitoring and testing on reserve. This program is presently under review, with a long-term strategy for water and wastewater currently under development in partnership with First Nations.
• Circuit Rider Training Program: Through this long-term capacity building program, Indigenous Services Canada supports the training of First Nations drinking and wastewater systems operators. With the exception of Ontario and Alberta, the program is delivered by the regions through Tribal Councils, who in turn hold contracts with training service providers. With the support of government contribution agreements, Indigenous technical services organizations provide training to operators in Ontario and Alberta.
• First Nation On-Reserve Housing Program: Directs funding to First Nations for safe and affordable on-reserve housing, to build, maintain, and renovate houses, as well as contribute to insurance, debt servicing, and the development and implementation of a housing portfolio. The Department is currently investing in new and innovative housing projects on reserve that help build the capacity of First Nations to address their housing needs. Further, it is advancing the co-development of a First Nations Housing and Related Infrastructure Strategy with First Nations partners.
• First Nations Enhanced Education Infrastructure Fund: Investments support the creation of quality learning environments that are safe and healthy – promoting better educational outcomes for First Nation students living on reserve. This includes the construction, repair, and maintenance of education infrastructure, increasing funding to the Existing Education Infrastructure Fund as part of a long-term strategy to improve First Nations education infrastructure. Indigenous Services Canada has adopted a ‘school bundle approach' for multiple school projects, building meaningful relationships between First Nations, governments, and other partners.
• First Nation Infrastructure Fund: This proposal-based program pools funding from four major sources, maximizing financial impact, to support First Nations in improving and increasing public infrastructure on reserves and federal lands. The program supports the Pan Canadian Framework on Clean Growth and Climate Change, and is delivered by Regional Offices under the guidance of the Regional Infrastructure Delivery and Community Infrastructure Branches.
• Asset Management Program: Drawing on funds from Infrastructure Canada's Investing in Canada Plan, this program supports First Nations in their capacity building efforts to manage their infrastructure assets.
• Health Facilities Program: Designed to enhance the delivery of health programs and services through infrastructure by providing funding to eligible recipients for the design, construction, acquisition, expansion and/or renovation of health facilities. Funding can be applied towards a variety of eligible project-related expenses, including design work, leasing and fit-up costs, and costs associated with construction activities to renovate and/or repair existing health facilities, including remediating environmental and/or workplace health and safety issues.

Context

Recent data^{Footnote 2} indicates that:

• In 2016, 3.4% of Indigenous households lived in crowded dwellings (i.e., more than 1 person per room), compared to 1.8% of non-Indigenous households.
• 15% of Indigenous households lived in dwellings in need of major repairs in 2016, compared to 6% of non-Indigenous households.
• Since Budget 2016, and as of March 31, 2019, Indigenous Services Canada has invested $3.43 billion into 3,979 infrastructure projects, 2,425 of which have been completed in 611 First Nations communities serving approximately 462,000 people. Despite this, a substantial infrastructure deficit remains.
• As of July 11, 2019, 87 long-term drinking water advisories had been lifted. New data, as of August 2, 2019.^{Footnote 3}
• Approximately 38% (165 out of 430) of existing schools on reserves have been assessed to be in fair or poor conditions.

About the service

• ISC supports First Nations on-reserve and the funding of community infrastructure in four main areas: housing; education facilities; water and wastewater systems; and other infrastructure (such as roads and bridges, fire protection, etc.) under the umbrella of the Capital Facilities and Maintenance Program.
• Enhanced support for targeted infrastructure assets or services are provided through the following programs:
  • First Nations Water and Wastewater;
  • Circuit Rider Training;
  • First Nation On-Reserve Housing;
  • First Nations Enhanced Education Infrastructure Fund;
  • First Nation Infrastructure Fund; and
  • Health Facilities (administered by First Nations and Inuit Health Branch)
• The enabling legislation for ISC mandates the Minister to work toward the "gradual transfer of departmental responsibilities to Indigenous organizations"^{Footnote 4}. ISC is working with Indigenous organizations to reform and transfer infrastructure service delivery.

Top Key Current Files or Projects

• In partnership with First Nations organizations, ISC is undertaking a number of innovative initiatives that would facilitate the transfer of infrastructure service delivery to First Nations.
• ISC and Crown-Indigenous Relations and Northern Affairs Canada are working with Indigenous partners, on a distinctions basis, to assess and address critical infrastructure needs in First Nation, Inuit and Métis communities.

Key Milestones

• The key milestones of the Capital Facilities and Maintenance Program will be reflected in individual service lines.

Results and outcomes

• The results and outcomes of the Capital Facilities and Maintenance Program will be reflected in individual service lines.

Lead Departmenal Official
Nelson Barbosa
A/Director
Community Infrastructure Branch - Regional Operations Sector

About the service

• ISC is working with partners to strengthen water and wastewater infrastructure and build operator capacity in First Nation communities, improve drinking water monitoring on-reserve, and address all remaining long-term drinking water advisories on public systems on-reserve.
• ISC supports the delivery of water and wastewater services to First Nation communities through the First Nations Water and Wastewater Enhanced Program.

Top Key Current Files or Projects

• ISC is partnering with First Nation communities and organizations on new approaches to ensure that on-reserve water and wastewater systems are safe and better meet the unique needs of each community, with a view of eliminating and preventing long-term drinking water advisories. An action plan aimed at eliminating all long-term drinking water advisories affecting public systems on-reserve has been developed and is being implemented.
• ISC is working with the Assembly of First Nations on a long-term strategy to ensure the sustainability of water and wastewater infrastructure on-reserve while also charting the path to Indigenous control over water and wastewater programs and services. The Assembly of First Nations has led engagements with First Nations on the strategy for the past two years.
• First Nation communities and organizations have raised concerns with the Safe Drinking Water for First Nations Act (2013), and consequently, corresponding water regulations have not been developed. Since 2018, ISC has been supporting an Assembly of First Nations-led engagement processes for the review of the Act with the objective of developing new water legislation accepted by both the Government of Canada and First Nations.
• Several First Nations, together with the Minister of Indigenous Services, recently announced that an historic Agreement-in-Principle has been reached through a successful negotiation process to resolve national class action litigation related to safe drinking water in First Nation communities, with work continuing on finalizing a Settlement Agreement.
• ISC supports various organizations to undertake innovative initiatives and to build the capacity and diversity (including of women and youth) of water operators. ISC also recognizes success in water leadership through the annual National First Nations Water Leadership Award.
• Environmental Public Health Officers, certified public health inspectors, employed by ISC or First Nation communities, inspect, assess, investigate, and support education and awareness related to environmental hazards that can cause illness, disease, injury, and death from risks in the built and natural environment (e.g., schools and long-term care facilities). Environmental Public Health Officers work with First Nation communities to protect public health by assuring that verification monitoring programs are in place to provide a final check on the overall safety of drinking water at tap in all water systems, and providing public health advice and guidance about drinking water safety and wastewater disposal.
• ISC works together with First Nation communities and provides funding to Chief and Councils for drinking water monitoring through its Community-Based Water Monitor program. A key benefit of the program is that it enables First Nation communities to sample and test their drinking water for microbiological contamination where it is difficult or impossible to do so on a regular basis and/or to get the samples to a laboratory in a timely manner, and take ownership of water quality monitoring programs.
• ISC is working with the Atlantic First Nations Water Authority, a First Nations-led utility, to transfer water and wastewater service delivery in 15 First Nation communities in Atlantic Canada.

Key Milestones

• As of September 17, 2021, First Nations, with support from ISC, have lifted 115 long-term drinking water advisories since 2015.
• Since 2016, the Government of Canada has made over $5.2 billion in commitments to First Nations to build and repair water and wastewater infrastructure and support effective management and maintenance of water systems on-reserves. This includes new commitments made as part of Budget 2021 in which the Government of Canada has committed $1.043 billion over two years, starting in 2022-2023, to support water and wastewater projects.
• With the combined investments made as part of Budget 2019 and the 2020 Fall Economic Statement, by 2025, the Government of Canada will increase the annual funding that it provides to support the operations and maintenance of water and wastewater systems on a permanent basis by almost four times.
• Recent investments provide ongoing funding to support the work of Environmental Public Health Officers as they are related to drinking water and wastewater thereby, helping to ensure the safe delivery of health and social services on-reserve at current level. This is the first time that funding for this important public health function has been stabilized since the 1970's.

Results and outcomes

• Funding since 2016 has supported 751 water and wastewater projects. These projects serve approximately 464,000 people in 582 First Nation communities.
• This funding also supports the goal of ending long-term drinking water advisories on public systems on-reserve. Between November 2015 and September 17, 2021, the number of long-term drinking water advisories on public systems in First Nation communities has declined from 105 to 47. Over this period, 115 long-term drinking water advisories were lifted and 62 new long-term drinking water advisories were added. A further 192 short-term drinking water advisories were resolved, preventing them from becoming long term. The following table illustrates progress since 2015.
• Departmental data indicates that the percentage of high risk public water systems on-reserve has fallen from 27.8% in 2011-2012 to 14.8 percent in 2019-2020, while the percentage of low risk water systems has risen from 35.9% in 2011-2012 to 57.4% in 2019-2020.
• Similarly, the percentage of wastewater systems identified as high risk has fallen from 11.6% in 2011-2012 to 3.7% in 2019-2020, while the percentage of wastewater systems identified as low risk has increased from 46.6% in 2011-2012 to 47.7% in 2019-2020.
• Through joint efforts with First Nation communities, progress is being made. All First Nation communities have access to trained personnel (Community-Based Drinking Water Quality Monitor or an Environmental Public Health Officer) to sample and test drinking water quality at the tap. In 2019-2020, public water systems on-reserve were sampled on average at 82% of the recommended frequency for bacteriological parameters in the Guidelines for Canadian Drinking Water Quality. As a result of enhanced capacity, First Nations' and ISC's ability to detect potential problems sooner has improved.

Lead Departmental Official
Nelson Barbosa
A/Director General
Community Infrastructure Branch - Regional Operations Sector

Circuit Rider Training Program

First Nations On-Reserve Housing

First Nations Enhanced Education Infrastructure Fund

First Nations Infrastructure Fund

Infrastructure Service Delivery Transformation

Climate Change: Adaptation and Mitigation

Snapshot

• Delivery of social programs for Indigenous Peoples is a shared undertaking among federal, provincial and territorial governments and Indigenous communities. The Government of Canada funds or directly provides services for First Nations (primarily on-reserve) and Inuit that supplement those provided by provinces and territories. Provincial and territorial governments are the key providers of services to Indigenous Peoples off-reserve (including status and non-status First Nations, Inuit, and Métis). Many Indigenous governments and communities are also involved in directing, managing and delivering a range of services to their members.
• Indigenous Services Canada (ISC) funds the following key social services for Indigenous Peoples:
  • Income Assistance provides individuals and their families living on-reserve and Status Indians living in Yukon with funds to cover essential needs, such as food, clothing and shelter (rent and utilities) and special needs (e.g., doctor-recommended diets), similar to provincial and Yukon income assistance programming. The program also provides funding for case management and pre-employment supports to help individuals transition towards employment or education.
  • Child and family services agencies, are established, managed and controlled by First Nations and delegated by provincial authorities to provide prevention and protection services. In areas where these agencies do not exist, ISC funds services provided by provinces and the Yukon but does not deliver child and family services. These services are provided in accordance with the legislation and standards of the province or territory of residence. ISC uses a
    prevention-based funding model to support early intervention and alternatives to traditional institutional care and foster care, such as the placement of children with family members in a community setting.
  • Family Violence Prevention Program services help support Indigenous women, children, families, and Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex and/or asexual people who are affected by gender-based violence through various violence prevention projects and access to a network of emergency shelters across Canada, including in the North and in urban centres.
  • Assisted Living services provide non-medical social supports through in-home care, adult foster care or group homes, and long-term care facilities for residents on-reserve.
  • Urban Programming for Indigenous Peoples provides organizations, such as Friendship Centres, with funding to offer culturally-appropriate services to Indigenous individuals living off-reserve or moving to an urban area.
  • The Canada Child Benefit (Canada Revenue Agency) and the Old Age Security (Education and Social Development Canada) are also generally available on-reserve, but administered by other government departments.

Context

Recent data indicates that approximately:

• 40% of on-reserve households were in the "low income" category in 2015, more than three times the off-reserve proportion (40.4% versus 12.6%).
• Approximately 303,000 Indigenous youth (under 15 Years) will be of age to enter the labour market in the next decade compared to 239,995 ten years earlier.
• In Saskatchewan and Manitoba, one in three entrants to the labour force will be Indigenous within the next 15 years.
• In Canada, Indigenous children account for only 7.7% of the country's child population, but represent 52.2% of children in foster care (according to Census 2016).
• The number of Indigenous seniors is expected to double between 2016 and 2036, increasing in size from seven percent to 16% of the total Indigenous population 65 and over years.
• Sizable growth in the senior population has already been illustrated by growth in the Registered Indian senior population. Between 2006 and 2016, the number of Registered Indian seniors increased by 88.4%. Over the same time period, the number of Inuit seniors increased by 68.1%.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the Program

• Assisted Living provides supports for low-income people with chronic illness or disabilities living on-reserve to help them receive services in their communities.
• First Nations organizations are funded to deliver services in-home, including meal preparation and housecleaning, and also provide supports for people living in long-term care homes.

Top Key Current Files or Projects

• Rates of disability and chronic illness are much higher in First Nation communities. This combined with a growing and aging population is driving significant increases in service demand. ISC is taking steps to develop a sustainable service model.
• To better support First Nations and Inuit individuals living with chronic illnesses and disabilities, ISC is engaging with Indigenous partners and other stakeholders on how to improve long-term care in First Nation communities. This will enable the delivery of health and social services at all points along a continuum of care through a more holistic long-term care strategy.

Key Milestones

• Engagement on the long-term care strategy is ongoing.

Results and outcomes

• Assisted Living services are currently delivered to over 10,000 clients, connecting them to essential social support services.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the Program

• Family Violence Prevention Program helps improve the safety and security of Indigenous women, children, families, and Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex and/or asexual people through the provision of funding for violence prevention projects and funding the operations of a network of emergency shelters across Canada, including in the North and in urban centres.
• ISC also funds community-driven violence prevention initiatives, such as awareness raising, stress and anger management seminars and support groups.

Key Milestones

• The construction and funding for 12 new emergency shelters was announced in summer 2021.
• Planning is underway to prepare for a possible call for applications to fund the construction (led by the Canada Mortgage and Housing Corporation) and provide ongoing operational support (led by ISC) to at least 38 new emergency shelters and at least 50 transitional (second stage) housing across Canada, including in the North and in urban centres. Once launched, it is expected that there will be rolling intake of applications over three years.
• Development for a potential call for proposals is ongoing; funding will be available for violence prevention projects across Canada.

Results and outcomes

• The program provides financial support for culturally-appropriate violence prevention projects across Canada, such as public awareness campaigns, stress and anger management support groups, and community needs assessments.
• The program provides annual core funding to the National Aboriginal Circle Against Family Violence to act as a national coordinator by supporting shelters and their staff through training forums, prevention activities, research and collaboration with key partners.
• Funding is also provided to Métis organizations to support engagement and community prevention projects that raise awareness specific to Métis women, girls, and Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex and/or asexual people.
• The program supports the Moose Hide Campaign for activities that engage men and boys to take action against violence toward Indigenous women, girls, and Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex and/or asexual people.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the Program

• ISC provides funding, through the First Nations Child and Family Services Program, to First Nations child and family services agencies, which are established, managed and controlled by First Nations and delegated by provincial authorities to provide prevention and protection services. In areas where First Nation agencies do not exist, ISC funds child welfare services provided by the provinces and the Yukon, based on their legislation and standards.
• In Canada, Indigenous children account for only 7.7% of the country's child population, but represent 52.2% of children in foster care (according to Census 2016). In January 2018, ISC hosted an emergency meeting with partners to address the over-representation of Indigenous children in care and committed to the following six points of action:
  1. continuing the work to implement the orders of the Canadian Human Rights Tribunal, and reforming the Child and Family Services Program to make it truly child centered and community-directed;
  2. shifting the programming focus to prevention and early intervention to support parents and keep families together;
  3. supporting communities to exercise jurisdiction and explore the potential for co-developed federal child and family services legislation;
  4. accelerating the work of trilateral and technical tables;
  5. supporting Inuit and Métis Nation leadership to advance culturally appropriate reform of child and family services; and
  6. developing a data and reporting strategy with provinces, territories and Indigenous partners.
• As part of these reform efforts, Bill C-92, An Act respecting First Nations, Inuit and Métis children, youth and families was co-developed and introduced in Parliament on February 28, 2019. The Act received Royal Assent on June 21, 2019, and came into force on January 1, 2020.
• The Act affirms the rights of First Nations, Inuit and Métis to exercise jurisdiction over child and family services, contributes to the implementation of the United Nations Declaration on the Rights of Indigenous Peoples, and establishes national principles, such as best interests of the child, cultural continuity and substantive equality to help guide the provision of child and family services in relation to Indigenous children.
• The Act also aims to shift the focus toward prevention and early intervention, which could help to reduce the number of Indigenous children in care.
• Through the Community Well-being and Jurisdiction Initiatives Program, ISC is providing funding for the ongoing provision of culturally-appropriate prevention and well-being services to First Nation children and families on-reserve and in the Yukon. This funding may also be used by First Nations to expand the availability of prevention and well-being initiatives that are responsive to community needs, complement prevention programming provided by First Nations Child and Family Services agencies or provincial and territorial agencies, increase capacity in the area of child and family services prevention programming and support First Nations in the development and implementation of jurisdictional models.
• From 2018-2019 to 2019-2020, $211.7 million has been provided to First Nation communities through the Community Well-being and Jurisdiction Initiative Program.
• Through the July 2020 Economic and Fiscal Snapshot, Canada has committed more than $542 million over five years to support the implementation of the Act in full partnership with Indigenous partners, including nearly $73 million over five years to support Coordination Agreement discussions, $35 million for internal services, and nearly $10 million over two years to support engagement activities.

Top Key Current Files or Projects

• ISC is working with its partners toward a shared vision of an Indigenous child and family services system with a focus on prevention within strong communities.
• ISC will continue research with First Nations partners and other experts to further inform the development of options for a funding methodology for a reformed First Nations Child and Family Services Program.
• ISC is committed to seeking input from a diverse range of experiences and perspectives to help guide the ongoing implementation of the Act, including seeking input from Indigenous partners, provinces, and territories.
• To achieve this goal, nearly $10 million will be available over the next two years to support Indigenous-led engagement to advance the implementation of the Act, including through the establishment of distinctions-based governance engagement mechanisms. Through these mechanisms, in addition to other established protocols and working groups, ISC will be working directly with Indigenous partners at the community, regional and national levels to learn best practices, strengthen partnerships, discuss data sharing, and receive guidance on the overall implementation of the Act.

Key Milestones

• ISC will continue to implement the Canadian Human Rights Tribunal orders and seek to resolve any outstanding issues through collaborative partnerships with the Consultation Committee on Child Welfare and the National Advisory Committee on First Nations Child and Family Services.
• ISC will continue to support communities in their exercise of jurisdiction over child and family services and engage with Indigenous, provincial, and territorial partners on the co-development of governance engagement mechanisms to support the implementation of the Act.
• ISC will continue to lead distinctions-based working groups with Indigenous, provincial, and territorial partners to co-develop data and reporting strategies. The new strategies and approaches are designed to increase inter-jurisdictional data collection to deliver insights that will contribute to a better understanding of ways to reduce the over-representation of Indigenous children and youth in care.

Results and outcomes

• The Government of Canada has substantially increased funding for the First Nations Child and Family Services Program, from $676.8 million in 2015-2016 to $1.47 billion in 2019-2020, to meet the immediate service delivery needs for First Nations children and families, including for prevention.
• In April 2019, ISC launched an online prevention reporting tool intended to support communities and agencies in the collection of prevention data in a nationally consistent and robust manner. Ongoing efforts to implement this approach are crucial in order to be able to help develop links between prevention and protection reporting as well as analyze what activities are contributing to reducing the number of children in care, and supporting reunification of families.
• On January 1, 2020, An Act respecting First Nation, Inuit and Métis children, youth and families came into force. The Act was co-developed with First Nations, Inuit, and Métis partners, and is the culmination of extensive engagement in the summer and fall of 2018, which included more than 65 engagement sessions with nearly 2,000 participants. ISC also engaged with Indigenous partners and provincial and territorial representatives on the draft content of the proposed legislation in January 2019.
• The Act has seen strong interest from Indigenous communities in moving towards the exercise of jurisdiction under the Act. Notably:
  • ISC currently has 16 ongoing Coordination Agreement discussion tables (with one table completed), and ISC has received 52 notices of interest to exercise jurisdiction, representing more than 100 Indigenous groups and communities.
  • The first two Indigenous laws have come into force, namely Wabaseemoong Independent Nations' Customary Care Code in Ontario, and the Cowessess First Nation's Miyo Pimatisowin Act in Saskatchewan.
  • The first tripartite Coordination Agreement has been concluded with the Cowessess First Nation. Discussions with Wabaseemoong Independent Nations and potentially Splatsin in British Columbia are expected to conclude in the coming weeks, which will trigger requests for rapid approval of Coordination Agreements.
  • ISC has invested heavily in our relationships with provinces and territories, both bilaterally and through multilateral meetings, recognizing that their full engagement is critical to the success of this legislation.
  • The courts are recognizing the Act and its minimum standards when making important decision matters in relation to Indigenous children in care. There are 49 court cases that have referenced, interpreted and/or enforced the Act since it came into force, as well as two Federal Court cases and three Canadian Human Rights Tribunal cases.
• In November 2020, the Prime Minister announced over $542 million in funding to advance First Nations, Inuit, and Métis engagement to co-develop the implementation of the Act, and to support Indigenous communities and groups in building the capacity to establish their own child and family services systems. A total of 116 capacity-building proposals have been received, and 73 of these proposals have been approved. The total funding requested for fiscal year 2021-2022 is currently $80,465,422, and the total funding approved to date is $30,278,846. Based on the review of the 43 outstanding proposals received, it is expected that up to $47 million in additional funds for capacity-building could be approved in fiscal year 2021-2022.
• This funding supports the $3 billion already invested to improve the government's funding support for First Nations child and family services.
• Through Budget 2021, the government invested an additional $1 billion over five years, with $118.7 million ongoing, to increase funding to support First Nations child and family services.
• The first federal, provincial, territorial, and Indigenous meeting on the Act was held in May 2021, with many more meetings planned over the next few months.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the Program

• ISC funds First Nations and First Nations organizations to provide income assistance to eligible individuals and families who are resident on-reserve or Status Indians living in Yukon.
• Income assistance funds living expenses, such as food, clothing, rent, utilities, and essential household items.
• Case management supports are also provided to help individuals move into employment or education.

Top Key Current Files or Projects

• Expansion of case management supports to help individuals move into employment or education.
• Collaborate with First Nations partners on the development of options to make income assistance more effective in addressing the needs of individuals and families.

Key Milestones

• Collaborate with First Nations partners on the development of options for reform of income assistance in fiscal year 2021-2022.

Results and outcomes

• In 2017–2018, income assistance helped 81,104 clients and their dependents (150,080 people in total).
• In 2018–2019, case management supports were delivered in 157 First Nation communities.
• Between 2013 and 2017 more than 10,400 on-reserve young adults (aged 18 to 24) received case management supports, which helped approximately 7,400 youth to exit income assistance.

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector

About the Program

• Urban Programming for Indigenous Peoples is designed to assist First Nations (Status and non-Status), Inuit, and Métis living in or transitioning to urban centres. Urban Programming for Indigenous Peoples provides funding to organizations to help meet the needs of urban Indigenous Peoples and to address challenges faced by the most at-risk community members.
• Urban Programming for Indigenous Peoples provides $51 million in grants and contributions annually: $118.5 million over five years (2017-2022) received through Budget 2017, combined with the existing funding of $27.5 million in ongoing annual grants and contributions funding for the former Urban Aboriginal Strategy.
• In addition, Budget 2019 provided $60 million over five years (2020-2025) to support a new Infrastructure stream, which provides infrastructure investments for Friendship Centres and other Urban Programming for Indigenous Peoples recipients.
• Urban Programming for Indigenous Peoples consists of five funding streams: organizational capacity; programs and services; coalitions; research and innovation; and infrastructure.

Top Key Current Files or Projects

• Infrastructure: In December 2020, Urban Programming for Indigenous Peoples added a fifth Infrastructure funding stream to ensure that Indigenous Peoples have access to safer, more secure and more accessible facilities where Urban Programming for Indigenous Peoples programming is offered, and that service providers have enhanced capacity to deliver programs and services that respond to community needs.
• Program Renewal: A major portion ($23.7 million per year, 46%) of Urban Programming for Indigenous Peoples funding will sunset in March 2022. The Urban Programming for Indigenous Peoples team is working proactively with urban Indigenous partners and organizations to review funding needs

Key Milestones

• Supporting minor infrastructure investments (under $1 million) in essential health and safety and energy efficiency renovations (from fall 2019).
• Supporting major capital infrastructure investments (over $1 million) through the Urban Indigenous Capital Funding stream (from 2020 onwards).

Results and Outcomes

Lead Departmental Official
David Peckham
Assistant Deputy Minister
Education and Social Development Programs and Partnerships Sector