Appearance before the Standing Committee on Indigenous and Northern Affairs on the Administration and Accessibility of Indigenous Peoples to the Non-Insured Health Benefits Program, May 6, 2022

Logistics

Date: Friday, May 06, 2022

Time: 1 p.m. to 2 p.m.

Location: 197 Sparks, Wellington Building, Room 415 / Videoconference (Zoom)

Subject: Administration and Accessibility of Indigenous Peoples to the Non-Insured Health Benefits Program

Context

INAN adopted the following motion on February 1, 2022:

That, pursuant to Standing Order 108(2), the committee undertake a study to review the healthcare rights of Indigenous Peoples through the accessibility and administration of the Non-Insured Health Benefits program (NIHB), as it pertains to implementation of the Truth and Reconciliation Commission Calls to Action on Health (#18 to 24), specifically, recognizing existing First Nations, Métis and Inuit traditional counsellors as culturally relevant mental health supports to be accessible through Non-Insured Health Benefits program (as affirmed by the Truth and Reconciliation Call to Action #22), medical escorts for patients required to travel to access health care, and redressing the delay of compensation for service providers creating a flight of available health providers for Non-Insured Health Benefits users; that the committee invite the Minister of Northern Affairs and the Minister of Indigenous Services, health care providers, representatives of Indigenous communities, and government officials to examine this issue; that the committee hold a minimum of six meetings on this issue; and that the committee report its findings and recommendations to the House; and that, pursuant to Standing Order 109, the committee request that the government table a comprehensive response to the report.

NIHB Study - Current Status

INAN began its study of the Administration and Accessibility of Indigenous Peoples to the NIHB Program on April 29. Questions were raised on medical transport, whether improvements were made to the program, traditional healers, medical escorts, service providers dropping out of the program, and whether Indigenous counsellors should be paid like mental health workers.

The NIHB study continued on May 3. The committee asked about the percentage of people in Nunavut who qualify for NIHB, approval of escorts, solutions for remote communities that have fewer services, traditional counsellors, how NIHB should be restructured, and recruiting Indigenous medical professionals.

Below is a list of organizations that have appeared on the study and the key points raised to date:

Assembly of First Nations

• NIHB funding must be matched to health needs on an ongoing cycle to ensure sustainability of the program;
• A long-term strategy must be developed for funding promised on realistic expenditures and utilization projections; and
• The Government of Canada support through policy and funding the formal inclusion of the traditional healing in the NIHB program.

Inuit Tapiriit Kanatami

• The majority of Inuit rely on non-insured health benefits and access a range of medically necessary health care products and services;
• Inuit beneficiaries face barriers in accessing and receiving NIHB program benefits due to the existing program structure, its restrictive policies and administrative processes; and
• there's a clear need for the development and implementation of Inuit-specific goals and objectives to address barriers to care and to provide timely, responsive and equitable access to NIHB by Inuit, no matter where Inuit reside.

Métis National Council

• Self-determined Métis version of the non-insured health benefits will work towards improved health and well-being for Métis
• Métis non-insured health benefits should be financially sustained by federal financial resources, coordinated with provincial authorities and private insurance providers

Government of Nunavut

• Some NIHB services have not been fully covered, resulting in the territory losing hundreds of millions of dollars covering costs
• Negotiations to resolve these issues are ongoing; however the 2020-21 fiscal year funding increases to the NIHB program is a positive outcome.
• Milestone, long-term agreement is being sought but noted that there are questions around the parameters of the NIHB on services being sustainable long-term.

Government of the Northwest Territories

• Northwest Territories administers the NIHB on behalf of Canada, and the current agreement on this expires this year.
• There are issues with Indian Act status being disputed and thus preventing access to some benefits for some people
• There are complaints around who is allowed to be non-medical escort and the length of time it requires to obtain approval for non-medical escorts.

Government of the Yukon

• The government of Yukon has a patchwork of policies, legislation, and relationships. A better coordinated approach would be preferred. A lack a capacity and coordination creates unnecessary barriers to consistency in care.
• It wants to adopt harm-reduction approaches for various treatments
• Yukon's unique situation could contribute to finding broader solutions and that they remain committed to tri-partite tables to make programs better.

Canadian Medical Association

• Health systems should be patient centered and focused on getting people the services they need
• Supports an increase and integration of resources for better coordination of care because the current system is fragmented
• Addressing NIHB is key to addressing health inequities faced by Indigenous peoples
• Need a mature, centralized, coordinated digital process so things don't slip through the cracks or face undue delays

Indigenous Physicians Association of Canada

• Need for distinctions based data collection, there are a few areas where additional support is needed: Communicable diseases; Mental health; and Social determinants of health.
• Quality control and quality improvement of services are important aspects of system transformation

Dr. James Makokis (appeared as an individual)

• NIHB is not covering enough. He said it has recommended people reuse catheters. A cancer patient was only covered to have their bandages changed once per day
• NIHB should be evaluated by users and Indigenous scholars, and ultimately changed to meet the real needs of Indigenous peoples.

Recent INAN Studies

During INAN's study of the 2021-22 Supplementary Estimates (C) and the 2022-23 Main Estimates (March 25), Minister Hajdu received questions on boil water advisories, housing in Quebec, elder care in Nunavut, mental health, infrastructure in Métis settlements, out-of-court settlements, and the Indigenous business procurement target. Minister Vandal received questions on diesel in northern communities and the Nutrition North Canada program.

INAN studied the Effects of Housing Shortage on Indigenous Peoples in Canada from March 4 to April 26. When Minister Hajdu appeared on March 4, she was asked about tuberculosis, the Departmental Plan, long-term care for seniors, and whether adequate accounting for population growth is factored into the Estimates.

Previous to the housing study, INAN studied Barriers to Indigenous Economic Development from February 4 to March 1, 2022. The ISC and Northern Affairs Ministers appeared with officials on February 11. Minister Hajdu was asked about Indigenous businesses, procurement, closing socio-economic gaps, and economic development. Minister Vandal was asked about contaminated sites, diesel in northern communities, and the Aboriginal Youth Strategy.

INAN Membership

It should be noted that besides the two meetings INAN held on NIHB, the members of the Committee have been largely silent on the issue of NIBH. However, some have expressed concerns about general health services for Indigenous peoples.

MP Gary Vidal (CPC), critic for Crown-Indigenous Relations, has expressed concern of the tuberculosis outbreaks in his riding recently. "We have dozens of outbreaks, over 100 cases and many of them are children. These outbreaks underscore the need for the government to step up and act on its previous commitments to TB elimination. Indigenous Services Canada admitted that the development of a TB reduction action plan for first nations was not completed as promised. Canada must reaffirm its commitment to address the health inequities that allow TB to persist in northern Saskatchewan and all of Canada. (INAN, March 4, 2022)"

MP Lori Idlout (NDP), critic of Crown-Indigenous Relations and Northern Affairs Canada, recently said in the House of Commons that there is a lack of health resources in northern communities. "In Nunavut, out of the 25 communities, there is only one community equipped with lab technicians. Back in November, of the said eight lab technicians, five had resigned. Also, in January, the Government of Nunavut had decided to ration its testing for COVID-19 to only health care providers in Nunavut … Nunavut residents deserve to have access to rapid tests." (March 25, 2022)

MP Jenica Atwin (LIB), has expressed interest in the government's anti-racism strategy in health care for Indigenous peoples. She recently asked Minister Hajdu about the implementation of Joyce's Principle. "I'm wondering if there are any updates or momentum you could point to and share with the committee and whether the anti-racism strategy is perhaps impacting service delivery in the health care field for Indigenous peoples across the country. (INAN, March 25, 2022)"

MP Marilène Gill (BQ), critic of Crown-Indigenous Relations and Northern Affairs, has indicated concern about the federal government's health transfer payments to Quebec. "If we were to ask the Government of Quebec or the Quebec National Assembly whether Quebec needs Canada to tell us how to run our health care system, an area that does not fall under federal jurisdiction at all, we would be told that Quebec is happy with its own standards…All we need is for the money to come back to Quebec and to the provinces because all of the premiers have been calling for health transfers." (Hansard, January 31, 2022)

MP Jamie Schmale (CPC), critic for Indigenous Services, has also expressed concern about the federal government's heath are transfers to the provinces. He recently expressed concerns in the House of Commons that the pandemic did not result in an increase in health transfers. "The one thing that did not happen was increases in health care transfers to the provinces beyond what was already previously budgeted for ... If it was truly a pandemic of health care resources, which I agree it was, why was health care not the number one item increased in the spending priorities of the government during the pandemic?" (Hansard, March 28, 2022)

MP Jaime Battiste (LIB), Parliamentary Secretary to the Minister of Crown-Indigenous Relations, spoke in the House of Commons about government investments in health for Indigenous women. "When we look at the budget, we also have to look at the investments we have made toward housing, the investments we have made toward Jordan's principle and the investments we have made toward mental health. These will all help indigenous women." (Hansard, April 26, 2022)

Meeting Proceedings

The meeting is scheduled from 1 p.m. to 3 p.m. on May 6, 2022 and will be a hybrid meeting (in person and Zoom). The ISC Minister and officials will appear during the first hour only. Representatives from the First Nations Health Authority, First Nations of Quebec and Labrador Health and Social Services Commission and Nishnawbe Aski Mental Health and Addictions Support Access Program will appear in the final hour.

ISC witnesses are asked to arrive at Room 415 or log into the Zoom meeting no later than 12:30 p.m. The House of Commons will send the Zoom link directly to the witnesses.

The Chair will call the meeting to order and provide instructions for the meeting proceedings. He will then introduce the witnesses and invite the Minister to deliver her opening remarks.

It is recommended that all speakers speak slowly and at an appropriate level to ensure they are heard by the interpreters. All witnesses are asked to mute their microphones unless they are speaking.

Simultaneous translation will be available. Officials appearing in person may speak in the official language of their choice. Witnesses appearing via Zoom are asked to respond to questions in either English or French, but to limit switching back and forth between languages as this often creates technology/interpretation challenges.

Following the opening remarks, there will be rounds of questions from Committee members (as listed below).

Committee members will pose their questions in the following order:

• First round (6 minutes for each Party)
  • Conservative Party of Canada
  • Liberal Party of Canada
  • Bloc Québécois
  • New Democratic Party of Canada
• Second round
  • Conservative Party of Canada (5 minutes)
  • Liberal Party of Canada (5 minutes)
  • Bloc Québécois (2.5 minutes)
  • New Democratic Party of Canada (2.5 minutes)
  • Conservative Party of Canada (5 minutes)
  • Liberal Party of Canada (5 minutes)

The meeting can be viewed on ParlVU, however there may be an up to 70-second delay in the webcast. A real time audio line will be shared if one is provided for this meeting.

Partner Engagement

In partnership with the Assembly of First Nations we working to review the NIHB Program.

It provided partners an opportunity identify and address gaps in benefits and streamline service delivery to be more responsive to client needs. This collaborative work has resulted in tangible change such as additional supports for expectant mothers so that they do not have to travel alone if they need to travel outside of their communities to deliver their babies.

The NIHB Program also engages regularly with Inuit Tapiriit Kanatami to discuss Inuit-specific issues.

With the signing of the 2017 Canada-Métis Nation Accord, we have begun to transfer funding for distinctions-based Métis-specific programming to Métis governments.

ISC's Mental Wellness Programming

As someone has worked on the issue of mental health and substance use - and hears stories from communities each time a tour - I am acutely aware that there is no one single approach or program that can address the varied, complex and interconnected drivers of mental wellness.

My department is working closely with First Nations, Inuit and Métis partners to improve service delivery which means, supporting increased access to quality, culturally-grounded, wrap-around care such as Nishnawbe Aski Nation's Choose Life program.

It means making sure that federally funded programs provide flexible supports to organizations that support people to stay connected to their cultural, traditional healing and traditional ways of being. For example, under our Government, for the first time, coverage was provided for traditional healer services in support of mental wellness.

We have made significant recent investments to improve mental wellness in Indigenous communities to a total of about $645 million in 2020-21. Budget 2022 proposes to commit an additional $227.6 million over two years for trauma-informed, culturally appropriate, Indigenous-led services to improve mental wellness.

These investments included a renewal of essential services such as crisis lines and mental health, cultural, and emotional support to former Indian Residential Schools and federal Day Schools students and their families as well as those affected by the issue of Missing and Murdered Indigenous Women and Girls.

Medical Transportation

Medical transportation is essential for rural and isolated communities, and while provinces and territories manage the delivery of physician and hospital care, we know that this is not always possible.

In 2020 to 2021 NIHB invested $525.7 million in medical transportation, or 35.3% or the total NIHB expenditures. This, along with other prenatal supports ensure that families get the support when they need it.

Dental

The NIHB dental program is universal - this means that it covers all eligible First Nations and Inuit individuals regardless of age, income or other measures of socio-economic need. Recipients do not pay deductibles or copayments, and have no annual maximum.

In 2016, NIHB established an external advisory committee to support the improvement of oral health outcomes, and we are committed to working with other partners to take best practices as we look to explore dental coverage for all Canadians.

Conclusion

Mental wellness, medical transportation, and dental are just 3 examples of the comprehensive supports provided through NIHB.

We know there is more work to be done and I am committed to improve services for all Indigenous communities. I am pleased to have the Valerie Gideon, Associate Deputy Minister and Scott Doidge, Director General, Non-Insured Health Benefits in the room with me.

As well, Dr. Evan Adams, Deputy Chief Medical Officer of Public Health who you heard from earlier this week as well as Keith Conn, Assistant Deputy Minister, First Nations and Inuit Health Branch are on video to assist me in responding to your questions.

Meegwetch. Nakummek. Marci. Thank you. Merci.

Issue Summary

Overview of the Non-Insured Health Benefits (NIHB) Program, including benefit areas, client profile, utilization and expenditures.

Key Messages

• The NIHB Program provides clients (registered First Nations and recognized Inuit) with coverage for a range of health benefits.
• Benefits under NIHB 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.

Background

The NIHB Program provides 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.

Current Status

Additional Information

Issue Summary

Overview of the process for billing the Non-Insured Health Benefits (NIHB) program for the Pharmacy, Dental, Medical Supplies and Equipment, Vision Care and Mental Health Counselling Benefits and the service delivery standard for Express Scripts Canada (ESC) to process payments.

Key Messages

• Express Scripts Canada (ESC), through the Health Information and Claims Processing Services (HICPS) contract, has been administering provider payments for NIHB's Pharmacy, Dental, and Medical Supplies and Equipment benefits since 2009.
• A new version of the HICPS contract and system was implemented on June 29, 2020 and was expanded to also include Vision Care and Mental Health benefits.
• Enrolled providers now have greater choice to submit claims to the NIHB program for payment. ESC accepts claims by fax or mail, using Electronic Data Interchange (EDI) software, and as of June 29, 2020, providers can now submit claims electronically via a secure web account on the ESC website.
• Electronic claims are automatically adjudicated in real time, and ESC's service standard for processing faxed or mailed claims is three business days.
• Payments are made on a bi-weekly basis by direct deposit or cheque, depending on the provider's preference.
• Although there were some delays in payment for the Vision Care and Mental Health Counselling benefits between July and October 2020 related to the transition to the new HICPS contract, ESC has consistently maintained its required service delivery standard since October 30, 2020.
• From June 29, 2020 to April 13, 2022, $1,805,533,933 in NIHB benefit claims have been processed and paid to providers and clients through the ESC contract.

Background

The new version of the HICPS system was implemented on June 29, 2020. Although the Pharmacy, Dental, and Medical Supplies and Equipment benefits have been administered through the HICPS contract since 2009, this was the first time Mental Health and Vision Care benefits had been included. At the time of transition, a backlog developed for provider enrolments, claims processing, and call-centre services, which resulted in the service delivery standards set out for Express Scripts Canada in the HICPS contract not being met.

The service levels experienced by providers were not adequate, and ESC sent out an apology letter to Mental Health Counselling and Vision Care providers on August 24, 2020. ESC hired additional resources, and was able to meet their contracted service standard as of Oct 30, 2020. ESC has maintained its levels since that time.

Current Status

In total, there are approximately 49,000 service providers currently registered with the NIHB Program.

ESC is maintaining its payment processing service delivery standards and there are no payment backlogs for the Pharmacy, Dental, Medical Supplies and Equipment, Vision Care, or Mental Health benefits.

Issue Summary

The Non-Insured Health Benefits (NIHB) Program provides registered First Nations and recognized Inuit in Canada with coverage for a range of health benefits including pharmacy (prescription and over the counter medication), dental care, vision care, medical supplies and equipment, and mental health counselling.

The NIHB Program also provides coverage of medical transportation to access health services that are not available to the client locally. This includes health services provided as insured services by the province or territory (such as physician, hospital care and tests) as well as NIHB Program benefits noted above. Medical transportation coverage is also provided for ambulance (air, ground) copayments or costs that would otherwise be charged to the client.

Key Messages

• Medical transportation is necessary to ensure individuals have access to health services that are not available locally, and particularly for those in remote and isolated Indigenous communities.
• The NIHB Program's medical transportation benefit coverage includes the cost of transportation (air, ground, water), as well as accommodations and meals.
• For clients who require assistance to travel, such as for translation or personal care, coverage is also provided for a non-medical escort such as a family member, chosen by the client, to accompany them.

Background

In 2020 to 2021, Non-Insured Health Benefits Medical Transportation expenditures were $525.7 million or 35.3% of total NIHB expenditures.

NIHB medical transportation benefits are intended to assist eligible clients to access medically necessary health services that cannot be obtained on reserve or in their community of residence. Medical transportation benefits are managed by Indigenous Services Canada's regional offices, or by First Nations or Inuit Health Authorities, organizations or territorial governments who manage the benefit through contribution agreements. Contribution agreements for the management of medical transportation benefits by First Nations bands, territorial governments and other organizations represents the largest component, accounting for $278.7 million, or 53.0% of total benefit expenditures.

Medical transportation benefits include:

• ground travel (private vehicle, commercial taxi, fee-for-service driver and vehicle,
• band vehicle, bus, train, snowmobile taxi, and ground ambulance)
• air travel (scheduled flights; chartered flights; helicopter; and air ambulance)
• water travel (motorized boat; boat taxi; and ferry)
• living expenses (meals and accommodations)
• transportation costs for health professionals to provide services to isolated communities

Medical transportation benefits may be provided for clients to access the following types of medically-required health services:

• medical services insured by provincial/territorial health plans (e.g., appointments with physician, diagnostic tests, hospital care)
• alcohol, solvent, drug abuse and detox treatments
• traditional healers
• eligible benefits and services covered by the NIHB Program

Medical transportation benefits may also be provided for a medical escort, such as a nurse, or a non-medical escort, such as family member or caregiver, to travel with a client who needs assistance. As of 2017, NIHB provides coverage for a non-medical escort for all pregnant women who require transportation outside their community to deliver their babies.

In addition to client travel, medical transportation expenditures also include costs associated with transporting health care professionals to under-serviced and/or remote and isolated communities to facilitate access to medically necessary services.

NIHB Program Medical Transportation coverage has no parallel coverage in either public or private plans. Any Provincial/Territorial program coverage (e.g. Ontario Northern Health Travel Grant) is typically geographically limited; based on a grant/flat rate per km, and may require client deductibles (e.g. client pays initial cost or minimum annual distance) and/or provide limited to no coverage for accommodations or meals. Some coverage may be provided to social assistance recipients on a case-by-case basis, however, aside from Ontario, provinces and territories exclude NIHB eligible clients from the provincial health benefits coverage available to other provincial social assistance recipients.

Current Status

Issue Summary

The Non-Insured Health Benefits (NIHB) Program provides registered First Nations and recognized Inuit in Canada with coverage for a range of health benefits including pharmacy (prescription and over the counter medication), dental care, vision care, medical supplies and equipment, mental health counselling and medical transportation to access health services, which is not available locally.

In 2017, NIHB received new funding to expand the NIHB mental health counselling benefit as well as to begin to fund contribution agreements with First Nations and Inuit organizations for traditional healing in support of mental health.

Key Messages

• The NIHB Program provides clients (registered First Nations and recognized Inuit) with coverage for a range of health benefits, including mental health counselling benefits.
• Clients receive coverage for professional mental health counselling provided by licensed professionals.
• In 2017, the Government of Canada provided funding to expand the NIHB mental health counseling benefit and to include, for the first time, the services of traditional healers to address mental health needs.
• Traditional healer services for mental health counselling for NIHB clients are being offered through projects by First Nations and Inuit partners that respect their unique cultural contexts.
• Resources and services are being delivered by community-based First Nations and Inuit recipient organizations.
• Funding recipient organizations have the flexibility to determine appropriate providers of traditional healing services in support of mental wellness, to compensate them in a manner that is culturally appropriate and to define the types of activities that traditional healers may undertake.

Background

The NIHB Program provides clients (registered First Nations and recognized Inuit) with coverage for a range of health benefits, including mental health counselling benefits.

Since 2014, Indigenous Services Canada's (ISC) First Nations and Inuit Health Branch (FNIHB) has been engaged with the Assembly of First Nations (AFN) in an ongoing Joint Review of the NIHB Program. As part of this joint engagement work, a joint review of the mental health counselling benefit was completed.

One of the recommendations resulting from the joint review of the mental health counselling benefit as a call for action to provide coverage of mental health counselling services provided to NIHB clients by traditional healers and Elders.

In 2017, the Government of Canada provided an additional $86M over five years to expand the NIHB mental health counseling benefit and to include, for the first time, the services of traditional healers to address mental health needs.

Traditional healer services are provided through First Nations and Inuit community-based organizations to support culturally-appropriate design and delivery.

This is one of the ways in which the Government of Canada is working in partnership to implement Truth and Reconciliation Commission (TRC) Call to Action 22: "We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients."

Current Status

There are currently organizations in all regions of Canada receiving NIHB funding for traditional healing services in support of mental health.

NIHB also supports access to traditional healing services through the medical transportation benefit, which provides eligible clients with coverage for transportation to access health services not available locally, including traditional healing services.

Additional Information

Coverage is provided to all NIHB eligible clients for professional mental health counselling by licensed professionals under the mental health counselling benefit. Every 12 months, coverage is available for up to 22 hours of counselling with an eligible provider. The first two hours do not require prior approval, to facilitate timely access to services. Additional hours are available on a case-by-case basis.

To be eligible as a mental health counselling provider, professionals must be licensed by the legislated regulatory body in the province where the service is provided. Eligible mental health counselling providers include Psychologists, Social Workers, and Psychotherapists (or their equivalent legislated designation). In some provinces, provincial law recognizes other designations, such as Registered Psychiatric Nurses. In areas where access to legislated, regulated professionals is limited, the Program may recognize counselling providers who are certified by a non-legislated self-regulatory body (such as the Canadian Counselling and Psychotherapy Association's Canadian Certified Counsellor designation), on an exception basis. 

Mental Health Counselling benefit coverage may be provided to clients through a private sector professional enrolled to bill the NIHB Program directly on a fee-for-service basis, or through a provider contracted by the Program to travel to a community, or through a community-managed (contribution agreement) arrangement.

Issue Summary

Sexual and gender minority populations experience some health disparities and unique health issues. Benefit coverage provided through the Non-Insured Health Benefits (NIHB) Program includes services and treatments to meet the health needs of 2SLGBTQQIA+ people.

Key Messages

• NIHB Program coverage addresses the diverse health needs of eligible First Nations and Inuit, including 2SLGBTQQIA+ people.
• NIHB covers treatments for the prevention and treatment of HIV, which disproportionately affects men who have sex with men.
• NIHB covers medications and medical equipment for gender affirmation.
• NIHB enrolls eligible providers to directly bill the Program, so clients do not have to pay up front for services.

Background

Some key health issues for 2SLGBTQQIA+ populations are:

• HIV – gay, bisexual, and other men who have sex with men (gbMSM) are the population most affected by the Human Immunodeficiency Virus (HIV). In 2016, gbMSM accounted for 48% of new HIV cases in Canada, while making up just 3% to 5% of the adult male population.
• Gender-affirming health needs – transition-related or gender-affirming medical care – designed to align physical characteristics with gender identity – may be a critical health need for some transgender people.

Current Status

• NIHB covers many medications for the treatment of HIV infection.These medications are fully covered as open benefits, so prior approval is not required.
• Pre-exposure prophylaxis (PrEP) can prevent HIV infection for individuals who are at high risk. NIHB covers Truvada as an open benefit. It is covered for both the treatment or prevention of HIV infection, and prior approval for coverage is not required.
• NIHB covers gender-affirming medications. Most are covered without prior approval for an NIHB client with a prescription. Once a prescriber has indicated a client is undergoing gender-affirming treatment, a wide range of potentially useful medications are also covered for that client, without requiring additional paperwork from the prescriber.
• NIHB covers items to support gender identity under the medical supplies and equipment benefit. These are open benefits, so no prior approval is needed within Program price and quantity guidelines. Examples include upper body garments (e.g., binders), lower body garments (e.g. gaffs), packers, bra inserts and stand-to-pee (STP) devices. Refer to section 9.6 of the Self-care equipment and supplies benefits list for a complete list of items covered. 
• Gender-affirming surgeries and other treatments may be covered as insured services by provincial or territorial health plans. Through the medical transportation benefit, NIHB provides coverage for eligible clients to travel for medical services that are not available locally. This can include travel out of province or even out of country to access specialized medical services (including gender-affirming surgery) when the service is insured through a provincial or a territorial public health plan.

Issue Summary

Overview of the Non-Insured Health Benefits (NIHB) Program dental benefit.

Key Messages

• The NIHB Program provides clients (registered First Nations and recognized Inuit) with coverage for a range of dental benefits, including orthodontic services.
• The NIHB Program is considered one of the most comprehensive public dental benefit programs in Canada, when compared with public provincial and territorial dental programs.

Background

NIHB dental benefit covers a broad range of dental services, including diagnostic (i.e. exams and x-rays), preventive (i.e. cleanings), restorative (i.e. fillings), endodontic (i.e. root canals), periodontal (i.e. deep scaling), removable prosthodontic (i.e. dentures), oral surgery (i.e. extractions), orthodontic (i.e. braces) and adjunctive services (i.e. sedation).

All registered First Nations and recognized Inuit residents of Canada are eligible for NIHB dental benefits regardless of age, location or income level; unless otherwise covered under a separate agreement with federal or provincial governments or through a separate self-government agreement.

NIHB dental expenditures totalled $236.3 million in 2020/2021. Fee-for-service dental costs represented the largest dental expenditure component, accounting for $210.9 million (89.3%).

NIHB enrolled dental providers: 14,857 active providers (had at least one claim for the period), April 2019 to March 2021.

Current Status

• In Canada, the cost of dental care is generally the responsibility of the individual. Many may benefit from coverage provided through private dental care plans (62%), which are often available through employment. Others (6%) may be eligible for coverage under one of the provincial/territorial dental plans, as most provinces/territories provide some sort of coverage either for children, seniors and/or low-income/social assistance recipients. For a large percentage of individuals (32%), out-of-pocket payments are the only way to afford dental care, as they have no dental insurance (CHMS 2007-2009).
• The NIHB Program is universal, meaning that it covers all eligible First Nations and Inuit clients regardless of age, income or other proxy measures of socio-economic need.
• NIHB clients do not pay deductibles or co-payments.
• NIHB has no annual maximum per client.
• NIHB provides coverage of travel costs to access dental services when not provided in community of residence.
• NIHB provides coverage for eligible services up to the maximum fees specified in the NIHB Regional Dental Benefit Grids.
• The NIHB Program encourages dental providers to enroll with the Program in order to bill the Program directly and not to balance-bill clients, so that clients do not face charges at the point of service.

Additional Information

Issue Summary

The Government of Canada has announced a National Dental Care Program to be rolled-out over the next five years; on an income-based model.

Key Messages

• How the National Dental Care Program will be managed and implemented is still unknown.
• The Non-Insured Health Benefits (NIHB) Program is monitoring the situation to determine how this new program will interact with the NIHB dental benefit.
• All registered First Nations and recognized Inuit residents of Canada are eligible for NIHB dental benefits regardless of age, location or income level; unless otherwise covered under a separate agreement with federal or provincial/territorial governments or through a separate self-government agreement.
• The NIHB Program is considered one of the most comprehensive public dental benefit programs in Canada, when compared with public provincial and territorial dental programs.

Background

The Government of Canada has announced a National Dental Care Program for middle- and low-income Canadians. The proposed dental program would start with those under 12 years old in 2022, then expand to under-18-year-olds, seniors and persons living with a disability in 2023. Full implementation would be rolled out in 2025.

The National Dental Care Program would be restricted to families with an income of less than $90,000 annually, with no copays for anyone who receives under $70,000 for an annual income.

Current Status

• The NIHB dental benefit provides coverage for services that meet client needs across the lifespan, including children, youth, adults, and elders.
• NIHB Program is universal, meaning that it covers all eligible First Nations and Inuit clients regardless of age, income or other proxy measures of socio-economic need.
• NIHB clients do not pay deductibles or co-payments.
• NIHB has no annual maximum per client.
• NIHB provides coverage of travel costs to access dental services when not provided in community of residence.

Issue Summary

The Non-Insured Health Benefits (NIHB) Program pharmacy benefit provides comprehensive coverage for pharmaceutical products, including prescription drugs, over-the-counter medications and nutrition supplements.

Key Messages

• NIHB formulary listing decisions are evidence based. The Program is advised by the NIHB Drugs and Therapeutics Advisory Committee, which is comprised of highly qualified practicing health professionals, including First Nations physicians and pharmacists.
• NIHB participates in federal/provincial/territorial drug review processes through the Canadian Agency for Drugs and Technology in Health. NIHB also represents federal drug plans at the pan Canadian Pharmaceutical Alliance where pharmaceutical price negotiations take place
• Overall, the NIHB pharmacy benefit is designed in a manner that is less restrictive than other public drug plans in Canada. For instance, NIHB does not limit access by age or medical condition and has no cost-sharing mechanisms such as a deductibles or copayments. NIHB listings are targeted to meet the specific needs of clients, including over-the-counter medications, which are generally not included in other drug plans.

Background

The NIHB Pharmacy benefit provides comprehensive coverage for pharmaceutical products – prescription drugs, over-the-counter medications and nutrition supplements – for nearly 900,000 First Nations and Inuit across Canada through over 9,000 registered service providers. At $551M in prescription drug expenditures in 2020/21, the NIHB Pharmacy Benefit is one of the largest publicly funded drug plans in the country.

Drugs must be authorized for sale by Health Canada in order to be eligible for coverage through NIHB. In determining whether and how to provide coverage through its Drug Benefit List (or formulary), as well as to promote alignment in coverage, NIHB participates in federal/provincial/territorial drug review processes through the Canadian Agency for Drugs and Technology in Health. NIHB also represents federal drug plans at the pan Canadian Pharmaceutical Alliance where pharmaceutical price negotiations take place.

Current Status

Issue Summary

Implementation of national pharmacare is a key priority of the Government, which is being led by the Health Portfolio. National pharmacare would have impacts for Indigenous peoples and Indigenous Services Canada (ISC), which includes the Non-Insured Health Benefits (NIHB) Program.

Key Messages

• NIHB is closely monitoring and participating in the health portfolio's work to advance the implementation of national pharmacare.
• While the Advisory Council on Implementation of National Pharmacare was not given a mandate to make recommendations on the NIHB Program, NIHB participated in the consultations led by the Advisory Council in 2018/19, as did Indigenous stakeholders.
• NIHB engages in regular bilateral and multilateral dialogue with Health Canada, the Canadian Agency for Drugs and Technology and provincial and territorial partners as the development of a national formulary, creation of the Canadian Drug Agency and establishing a national drugs for rare diseases strategy proceeds.
• NIHB remains actively committed to participating in national initiatives as is appropriate within the Program's existing mandate.

Background

• A seven-member Advisory Council, led by Dr. Eric Hoskins, was launched by the government in June 2018 with the mandate to consult Canadians and deliver recommendations on how to implement a national pharmacare program. The final report was published in June 2019. The report recommended that the government create a universal and publicly-funded pharmacare program delivered by provinces and territories. Implementation of a national pharmacare program, as outlined in the Council's report, is envisioned as an 8-year endeavour that will transform pharmaceutical management in Canada.
• The implementation of a national pharmacare program will have impacts for Indigenous peoples. Consultation with Indigenous stakeholders in Canada was included in the mandate of the Advisory Council. During the consultation period, the Council met with Indigenous leaders, communities, governments and representative organizations. The final report from the Advisory Council did not speak to whether and how Indigenous peoples would participate in national pharmacare but instead recommended the federal government work with First Nations, Inuit and Métis governments and representative organizations to develop a framework that considers whether and how they will participate in national pharmacare. Health Canada is responsible for consultations as they move forward with their strategic initiatives to implement national pharmacare.

Current Status

• Health Canada is currently engaged in the development of a national formulary, creation of the Canadian Drug Agency and establishing national drugs for rare diseases strategy.
  • National Formulary: the Canadian Agency for Drugs and Technology in Health (CADTH) has established a pan-Canadian Advisory Committee on a Framework for a Prescription Drug List. The committee is due to present a final report in Spring 2022.
  • Canadian Drug Agency: Budget 2019 provided Health Canada with $35 million over four years, starting in 2019–20, to establish a Canadian Drug Agency Transition Office to work with provinces, territories, and other partners to develop a vision and mandate for the Canadian Drug Agency.
  • Drugs for Rare Disease Strategy: Funding for this strategy was initiated in Budget 2019, which proposed to invest up to $1 billion over two years, starting in 2022-23, with up to $500 million per year ongoing. Consultations were completed on 2021, with a 'What We Heard' report available publicly.

Issue Summary

Indigenous Services Canada, First Nations and Inuit Health Branch (ISC-FNIHB) and the Assembly of First Nations (AFN) are engaged in a Joint Review of the NIHB Program. This note provides background and current information on this collaborative process, including recent related Ministerial correspondence from the Chiefs of Ontario.

Annex A: "NIHB Progress List" highlights some of the changes made over a five year period from 2017-2021, many in direct response to Joint Review recommendations.

Key Messages

• Together with the AFN, ISC-FNIHB is engaged in a Joint Review of the NIHB Program.
• Reviews of most benefit areas are complete, and the implementation of joint recommendations is well underway.
• Indigenous Services Canada remains committed to the AFN-FNIHB Joint Review of the NIHB Program and ongoing collaboration with First Nations and Inuit partners for the continual improvement of the Program.
• Of note, in response to a joint review recommendation, Budget 2017 provided new funding for NIHB to introduce coverage for mental health counselling provided by traditional healers.

Background

• In January 2013, the AFN National Chief wrote to the Minister of Health and informed her of a resolution that called for a joint review of the NIHB Program.
• The Joint Review began in the fall of 2014, with the mandate to undertake a comprehensive analysis of the NIHB Program in order to identify and implement actions that enhance client access to benefits, identify and address gaps in benefits, and streamline service delivery to be more responsive to client needs.
• To this end, each benefit area is systematically examined in a collaborative process, resulting in joint recommendations and action items.
• Oversight of the Joint Review is provided by a Steering Committee comprised of ten members each appointed by the AFN and FNIHB, and co-chaired by one of the FNIHB Assistant Deputy Ministers.
• Initially expected to be a two year process, the Joint Review elicited a high level of interest from NIHB stakeholders, prompting the AFN to implement an extensive and multi-faceted engagement process from 2015-2017, obtaining input from clients, communities and benefit providers.
• In 2018, the AFN passed resolution no. 74/2018 which recognized the progress and achievements of the Joint Review and called for a longer-term approach and commitment to continue working together.

Current Status

• Reviews of the mental health counselling, dental, vision care, pharmacy and medical supplies and equipment benefits are now complete. The review of the medical transportation benefit is in progress, and some broader Program-wide issues remain to be discussed.
• During the COVID-19 pandemic, the Joint Review Steering Committee meetings have decreased in frequency and duration. The two virtual meetings held during the pandemic largely focused on COVID-19 related issues.
• Meanwhile, the NIHB Program continues to implement many improvements to benefit coverage and administration. Annex A highlights some of the changes made over a five year period from 2017-2021, many in direct response to Joint Review recommendations.

Additional Information

Issue Summary

In line with the Minister of Indigenous Services' mandate letter supporting the use of distinctions-based approaches, many recent FNIHB policy and funding authorities have included Métis coverage (e.g., Mental Wellness Supports, Health Legislation Engagement, and Anti-Indigenous Racism). However, these positive Métis developments have highlighted the fact that FNIHB does not currently have a transfer payment authority to flow health funding directly to Métis governments and organizations. Currently, funding for Métis governments and organizations flows under the Urban Programming for Indigenous Peoples (UPIP), which is a time limited program and does not clearly outline the scope of eligible FNIHB services and activities. UPIP has been renewed for one year and will be sunsetting March 31, 2023.

Key Messages

• The Government of Canada recognizes the importance of working in collaboration with partners to improve access to high quality services for First Nations, Inuit and Métis.^{Footnote 1}
• As ISC's vision is to "support and empower Indigenous peoples to independently deliver services and address the socio-economic conditions in their communities," much of FNIHB's funding for Métis has been transferred to Métis governments who each have their own respective service delivery infrastructure – locals/offices across each province that deliver programs and services to Métis.
• The Government will continue to work towards improving the relationship and exploring how the needs of the Métis can be met.

Background

• Since the signing of the 2017 Canada-Métis Nation Accord^{Footnote 2}, ISC-FNIHB has begun to transfer funding for distinctions-based Métis-specific programming to Métis governments for their own delivery of Métis programs and services. New funding relationships are being established with Métis governments and organizations by the ISC-FNIHB program areas, with amendments for time-limited programming being incorporated into existing funding arrangements. Typically, departmental officials reach out to the Métis partners to discuss the process to access these funds, which are proposal driven. Métis recipients submit a proposal for one- or multi-year activities for their respective Métis government and funds are transferred via UPIP.

Current Status

Additional Information

• The Manitoba Métis Federation has indicated in their State of the Nation Address (2021) that they will be actively seeking to change FNIHB's name to include 'Métis', in addition to 'First Nations' and 'Inuit'. They plan to work toward Métis-specific and local clinical health services including: clinics, nursing stations, laboratories, homecare, hospital funding, long-term care and soft care costs, as well as a data-sharing policy (on population health surveillance, infectious disease management and immunization records).
• This government's commitment to a renewed relationship with the Métis Nation has opened the conversation on the relationship between Métis and Canada on health matters. We are working with the Métis governments to make progress in a meeting their health needs either through direct investments like we did through COVID and ICSF or through partnership work to ensure their vaccination needs were met by the provinces and territories. We have made commitments to support Métis Mental Wellness strategies and Anti Indigenous racism in health systems. We are working with them on the engagement for Distinctions based Indigenous health legislation to hear more about their vision of health services. This work needs to be done in alignment with PTs as we all have a role to play in improving health outcomes for Métis.

Issue Summary

Interpretation of Treaty Right to Health has important implications for the health care system. Indigenous groups have long asserted that the federal government has an obligation to fund or deliver health services on reserve. The federal government's longstanding position is that health services and funding are provided by the federal government to Indigenous Peoples on a discretionary, policy basis, and not in fulfilment of any treaty or other legal obligation.

Key Messages

• The Government of Canada acknowledges the challenges faced by Indigenous Peoples, including First Nations, Inuit and Métis in accessing culturally-safe health care. Canada is committed to working in partnership to advance the priorities Indigenous Peoples put forward when it comes to health care.
• Treaty rights discussions and rights recognition discussions are ongoing with Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC) and are a key aspect of the federal government's commitments to a renewed nation-to-nation, government-to-government relationship with Indigenous Peoples.
• The Government of Canada recognizes the potential to build a legislative basis to improve access to high-quality and culturally-relevant health services for Indigenous Peoples.
• The Government of Canada is committed to a dialogue with Indigenous partners that will work towards a mutually agreeable Indigenous health legislation that is respectful of treaty rights and relationships with Indigenous Peoples.

Background

• Treaties are agreements made between the Government of Canada, Indigenous groups and often provinces and territories that define ongoing rights and obligations on all sides. These agreements set out continuing treaty rights and benefits for each group.
• Canada recognizes that First Nations, Inuit and Métis have an inherent right of self-government protected by Section 35 of the Constitution Act, 1982. Canada recognizes that First Nations, Inuit and Métis have the right to govern themselves in relation to matters that are internal to their communities, integral to their unique cultures, identities, traditions, languages and institutions, and with respect to their special relationship to their land and their resources.
• Indigenous groups see Treaties as a central element of an on-going and evolving relationship with Canada between sovereign nations, and that historical Treaty provisions should have a modern interpretation and be forward-looking.
• Indigenous groups have long asserted that the federal government has an obligation to fund or deliver health services on reserve. This claim is often expressed as the "treaty right to health".
• Only Treaty 6 alludes to the subject matter of health in what has been commonly referred to as a "medicine chest clause". The clause calls for the provision of a box of medicinal ingredients to be made available to the Treaty 6 First Nations at the direction of the Indian Agent. Similar verbal undertakings may have been made by treaty commissioners in negotiations relating to Treaties 7, 8, 10 and 11, which span parts of Saskatchewan, Alberta, British Columbia and the Northwest Territories.
• With respect to the treaty right to health protected by Section 35 of the Constitution Act, 1982, no court has recognized a treaty right of Indigenous Peoples to comprehensive health care services.
• The Supreme Court of Canada has never considered the nature and meaning of the clause or the broader question of a treaty right to health for any First Nations.
• In 1966, the Saskatchewan Court of Appeal ruled that the medicine chest clause should be given its literal meaning (provision of certain medicines at the direction of the Indian Agent) and that it does not give rise to a federal legal obligation to provide a complete range of health care services to Treaty 6 First Nations.
• Over the years, a number of key initiatives have advanced the grounds of Indigenous health rights. These include the Truth and Reconciliation Commission (TRC) of Canada's Call to Actions (CTAs), the National Inquiry into Missing and Murdered Indigenous Women and Girls, and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP).
• In June 2015, the TRC concluded and issued its Final Report and CTAs. The CTAs #18-24 are specifically related to health and call for a number of actions including to recognize and implement the health-care rights of Indigenous Peoples as identified in international law, constitutional law, and under the Treaties.
• In September 2016, the Government of Canada launched an independent national inquiry into Missing and Murdered Indigenous Women and Girls. The final report states that addressing violence against Indigenous women, girls, and 2SLGBTQQIA people must also address their rights to health.
• The United Nations Declaration on the Rights of Indigenous Peoples Act advances the implementation of the Declaration as a key step in renewing the Government of Canada's relationship with Indigenous Peoples. This Act requires the Government of Canada, in consultation and cooperation with Indigenous Peoples to take all measures necessary to ensure the laws of Canada are consistent with the Declaration.
• In December 2021, the Government of Canada reiterated its committed to "fully implement Joyce's Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples".

Current Status

• Treaty rights discussions and rights recognition discussions are ongoing with CIRNAC and are a key aspect of the federal government's commitments to a renewed nation-to-nation, government-to-government relationship with Indigenous Peoples.
• To date, the First Nations and Inuit Health Branch's involvement in Modern Treaties has been focussed at the community level or with Treaty groups, based on the results of negotiations specific to existing programs and services. There has not been a broader discussion related to Treaty Rights to Health or the federal role in Indigenous health within a Nation-to-Nation approach.
• Significant and long-standing gaps persist between Indigenous and non-Indigenous Peoples in Canada in accessing high quality, culturally relevant health services.

Issue Summary

All Canadians have the right to health, as defined and protected by international human rights treaties that Canada has ratified. Despite this, good health in Canada is treated as a privilege instead of a right. As a privilege, health care is administered like any other social service, in part, dependent on political will.

Key Messages

• Canada's universal, publicly funded health care system is a source of pride for Canadians, who have access to medically necessary hospital and physician services based on medical need and not on ability to pay. The Canada Health Act articulates what Canadians hold dear, including shared values of fairness and equity.
• Canada will continue to work closely with provincial and territorial governments, Indigenous partners, key stakeholders and communities across the country to advance priorities that promote and protect the health of all Canadians.
• Canada will also continue to work together with Indigenous partners, and provinces and territories to improve access to high quality services for First Nations, Inuit and Métis, to support self-determination and Indigenous-led service delivery, and to address the fundamental issue of closing socio-economic gaps.

Background

Current Status

• Canada's public health system is rooted in the principles of equity and fairness and the overall notion that access to health care should be based on need and not on the ability to pay.
• However, Canada still faces structural challenges regarding services that are not covered by public health insurance; disparities among provinces and territories; poor access to health care by certain segments of the population, including Indigenous Peoples; and lack of parity between physical and mental health.
• Canada remains committed to human rights and advancing health equity, which requires an understanding of who is being left behind and why, as well as addressing the broader social and economic determinants that drive equity. This is why Canada is continuing to strengthen the monitoring and reporting of health inequalities in Canada, and assessing the effectiveness of policies, and programs in collaboration with provincial and territorial governments and stakeholders.
• Canada is committed to work in partnership with and increase funding to provinces and territories to strengthen our universal public health system, ensure health care workers are supported and recruited across the country and advance an integrated, comprehensive and patient-centric strategy, harnessing the full potential of data and digital systems. This includes:
  • Investing in initiatives to help speed access to care for critical services;
  • Supporting provinces and territories to hire new family doctors, nurses and nurse practitioners, and expanding primary care health teams in rural communities
  • Expanding virtual care;
  • Strengthening compliance with and modernizing the interpretation of the Canada Health Act on matters of extra billing for publicly insured services; and
  • Expediting work to create a world-class health data system that is timely, usable, open-by-default, connected and comprehensive.
• To help expand the delivery of high-quality, accessible and free mental health services, including for prevention and treatment, Canada is also committed to establishing a permanent, ongoing Canada Mental Health Transfer.
• Canada is also working with provinces and territories to improve infection prevention and control measures, identify shared principles, and develop national standards and a Safe Long-Term Care Act to ensure seniors get the care they deserve.
• Canada is also committed to ensuring that all Canadians have access to the sexual and reproductive health services they need, no matter where they live, by reinforcing compliance under the Canada Health Act, developing a sexual and reproductive health rights information portal, supporting the establishment of mechanisms to help families cover the costs of in vitro fertilization, and supporting youth-led grassroots organizations that respond to the unique sexual and reproductive health needs of young people.
• Canada has committed to implement national universal pharmacare, including a Canadian Drug Agency, a national formulary, a national strategy for drugs for rare diseases, and a Canada Pharmacare Act.
• Canada continues to accelerate the implementation of the Truth and Reconciliation Commission's Calls to Action, including Call to Action #18:
  • We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.
• Canada is also committed to fully implement Joyce's Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples.
• Canada also continues to fully implement the United Nations Declaration on the Rights of Indigenous Peoples Act to ensure the inherent rights of Indigenous peoples are respected and promoted, including as it relates to health, e.g., Article 24:
  • 24 1. Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services.
  • 24.2. Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.
• In short, all health-related research, policy and program development, and legislation (new or amendments) must be undertaken in a manner that respects and promotes the self-determination efforts of Indigenous Peoples.

Issue Summary

In order to redress the legacy of residential schools and advance the process of Canadian reconciliation, the Truth and Reconciliation Commission (TRC) made 94 recommendations. Calls to Action (CTA) 18-24 pertains to health. At the federal level, Crown Indigenous Relations and Northern Affairs Canada (CIRNA) coordinates reporting on the TRC's Calls to Action, gathering input from across the federal government on an annual basis. A public update on the CTAs has not been provided/released since August 2021. CTA #22 is the Call to Action most directly implicating the work of the Non-Insured Health Benefits (NIHB) program. Specifically, traditional healer services for mental health counselling for NIHB clients are offered through projects by First Nations and Inuit partners that respect their unique cultural contexts.

Key Messages

• The First Nations and Inuit Health Branch (FNIHB) and Indigenous Services Canada (ISC) has been actively engaged in work that aims to fulfill Indigenous health related CTAs, ranging from provision of quality health care in remote and isolated First Nations communities and reserves, to engaging with Indigenous partners on the development of future health legislation and policy.
• Relevant Budget 2022 investments include: $227.6 million to maintain trauma-informed, culturally appropriate, Indigenous-led services to improve mental wellness; $190.5 million for the Indigenous Community Support Fund to help Indigenous communities and organizations mitigate the ongoing impacts of COVID-19; and $268 million to provide high-quality health care in remote and isolated First Nations communities on reserves.
• The NIHB program addresses CTA#22 (valuing and using "Aboriginal healing practices") through its traditional healer services for mental health counselling (for eligible NIHB clients).

Background

FNIHB provides input to Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC) annually, related to the progress on the TRC's CTAs. This reporting is expected to move to a quarterly basis in the upcoming year. Key initiatives relating to CTAs 18-24 are:

18. We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

• Co-development of distinctions-based Indigenous health legislation: working with First Nations, Inuit and the Métis Nation, this initiative aims to improve access to high-quality and culturally-relevant services. The Government of Canada will recognize and protect the health of Indigenous peoples on an equitable basis and support greater Indigenous control over the design and delivery of health services.
• Addressing anti-Indigenous racism in Canada's health systems: In working with Indigenous partners and health professionals, institutions and accreditation bodies, as well as provinces and territories, the Government of Canada is committed to instilling a zero tolerance approach to racism against Indigenous peoples in health systems across the country. In Budget 2021, the Government of Canada committed to provide $126.7 million over three years to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe. Funding was provided to regions and organizations under four key areas of investment:
  1. Midwifery and doula expansion
  2. Navigators and Advocates
  3. Cultural Safety Partnership Fund
  4. Indigenous Health and Human Resources and Training of Community Based Workers and Health Managers.
• Jordan's Principle: In December 2021, the Parties to the Canadian Human Rights Tribunal complaint reached Agreements in Principle on Long Term Reform, that includes a work plan that identifies operational, policy, and accountability improvements that ISC has committed to implement. Canada is currently implementing Canadian Human Rights Tribunal ruling 41, amended on consent January 18, 2022, to fund major capital for spaces that support the delivery of Jordan's Principle services.

19. We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.

• Work with First Nations Information Governance Centre to explore the development of an information strategy:
  • Budget 2021 commitment to invest $73.5M over three years for a First Nations Data Governance Strategy. These investments will create data strategies that will help build the needed capacity to ensuring continuous access to quality data that will support the indicators.
• Work with the Inuit Tapiriit Kanatami on the Inuit Health Survey:
  • Budget 2021 investments linked with the National Action Plan for the Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ peoples Federal Pathway include $8 million over three years for the Inuit data baseline capacity and development of Inuit data strategy.
• Support the Métis Nation to gather health data & develop a health strategy:
  • ISC will engage with the First Nations Information Governance Centre to explore the development of a data strategy that will be utilized by community home care programs for their future program planning and delivery.

20. In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.

• Co-development of distinctions-based Indigenous health legislation: As part of Indigenous Health Legislation initiatives, ISC-FNIHB is currently working with partners to address the distinct health needs of the Métis, Inuit, & off-reserve Indigenous Peoples. Engagement is underway with First Nations, Inuit, and Métis Nation partners to fully implement Joyce's Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples.

21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.

• In Nunavut, ISC has signed a contribution agreement with the Government of Nunavut and endorsed by Nunavut Tunngavik Incorporated to provide $42.1 million over 5 years for the design and construction of a Nunavut Recovery Centre in Iqaluit, and $9.7 million ongoing on an annual basis to support the operations of the Recovery Centre, expected to be completed in 2025. Located in Iqaluit, Nunavut, the Recovery Centre will be connected to services and community supports across the territory.
  • In August 2019, ISC, the Government of Nunavut, and Nunavut Tunngavik Incorporated signed the Joint Declaration of Intent that outlined the commitment of all partners to support Inuit in defining and taking action on their health priorities, and promotes culturally-relevant approaches which are informed by strong partnerships at the community and territorial level.
  • In October 2020, the trilateral Memorandum of Understanding and Contribution Agreement, between ISC, the Government of Nunavut, and Nunavut Tunngavik Incorporated was signed. This document outlined the roles and responsibilities for the construction and ongoing operations of the Nunavut Recovery Centre.
  • The realization of the Nunavut Recovery Centre is an integral part of a system wide Three-Pillar approach that also includes on-the-land treatment in all three regions of Nunavut and healing, and support to increase Inuit workforce development and capacity. The work to formalize these agreements builds on the approach developed from a feasibility study endorsed by the Government of Nunavut, Nunavut Tunngavik Incorporated, other Nunavut partners and the Government of Canada in February 2018 through the Nunavut Partnership Table on Health.
• The creation of a new Indigenous Healing and Wellness Centre in the Northwest Territories is being led by the Arctic Indigenous Wellness Foundation (AIWF), and is a direct response to this Call to Action. ISC has provided the Foundation $20,000 to undertake a scoping study for the Indigenous Healing and Wellness Centre, and continues to engage trilaterally with the Foundation and the Government of Northwest Territories to support moving this body of work forward.
• In the Yukon, ISC is engaging trilaterally with the Council of Yukon First Nations and the Government of Yukon to explore to explore opportunities for a Indigenous healing centre in Yukon.

22. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.

• Addressing anti-Indigenous racism in Canada's health systems: In the Budget 2021 commitment to provide $126.7 million over three years to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe, includes:
  • New midwifery investments will build on the early successes of three First Nation community demonstration projects, focused on restoring traditional Indigenous birthing knowledge and practices, and allow similar models of traditional birthing/Indigenous midwifery services to be developed by more communities over the next few years.
  • $37.8 million to improve supports and accountability by providing distinctions-based funding to Indigenous organizations for new Indigenous patient advocates that will allow Indigenous patients to more safely navigate federal, provincial and territorial health systems.

23. We call upon all levels of government to:

1. Increase the number of Aboriginal professionals working in the health-care field.
2. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
3. Provide cultural competency training for all healthcare professionals.
   • ISC will provide health human resource funding to support increasing Indigenous programming including the establishment of an Indigenous dental therapy program at the University of Saskatchewan in collaboration with Saskatchewan Polytechnic and the Northern Tribal Health Authority.
   • ISC has also partnered with the Canadian Nurses Association and the Canadian Indigenous Nurses Association to raise the profile of Indigenous nurses across the country through several activities, namely funding to develop a 5-year nursing program survey to understand the current and future state of Indigenous faculty and students engaged in those programs.

24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

• All medical and nursing schools in Canada are responsible for the response to Call to Action 24.

Current Status

• CIRNAC recently sent a request to relevant federal departments to update their progress on CTAs for the CTA placemat.
• The primary Budget 2022 investments impacting FNIHB's work related to CTAs 18-24 are:
  • $227.6 million over two years, starting in 2022–23, to maintain trauma-informed, culturally-appropriate, Indigenous-led services to improve mental wellness, and to support efforts initiated through Budget 2021 to co-develop distinctions-based mental health and wellness strategies.
  • $190.5 million in 2022–23 to ISC for the Indigenous Community Support Fund to help Indigenous communities and organizations mitigate the ongoing impacts of COVID-19, and $268 million to provide high-quality health care in remote and isolated First Nations communities on reserves.

Additional Information

CIRNAC has not updated their public information on CTAs progress since August 2021 – that info can be found here: Delivering on Truth and Reconciliation Commission Calls to Action

Issue Summary

Indigenous Peoples are at a greater risk of facing complex mental health and substance use issues than non-Indigenous populations in Canada. Addressing this issue needs a holistic, Indigenous-specific, strength-based, distinctions-based, trauma-informed, culturally-grounded, community-driven approach that supports Indigenous people, families, and communities. This approach must recognize the legacy of residential schools, day schools, the sixties' scoop, and other impacts of colonization as well as focus on the social determinants of health such as culture, language, self-determination, access to services and supports, poverty, housing and food security.

Key Messages

• Addressing inequities in mental wellness being experienced by Indigenous people, families and communities is a key priority for the Government of Canada.
• Indigenous Services Canada works closely with Indigenous partners and communities to support Indigenous-led, distinctions-based, holistic, culturally-grounded, trauma-informed and community-based approaches to mental wellness.
• The Government of Canada recognizes the pivotal role that intergenerational trauma and the social determinants of health, particularly culture, play in mental wellness outcomes of Indigenous populations.
• Budget 2021 announced $597.6M over three years for a distinctions-based mental wellness approach for First Nations, Inuit, and Métis. This included renewed funding to continue essential services such as crisis lines and mental health, cultural, and emotional support to former Indian Residential Schools and federal Day Schools students and their families as well as those affected by the issue of Missing and Murdered Indigenous Women and Girls.

Background

Mental wellness is a key priority for Indigenous leaders, organizations and communities. This is a priority shared by the Government of Canada. Indigenous Peoples are at a greater risk of facing complex mental health and substance use issues than non-Indigenous populations in Canada.

Addressing this issue needs a holistic, Indigenous-specific, strength-based, distinctions-based, trauma-informed, culturally-grounded, community-driven approach that supports Indigenous people, families, and communities. It also needs to address the legacy of residential schools, day schools, the sixties' scoop, and other impacts of colonization as well as focus on the social determinants of health such as culture, language, self-determination, access to services and supports, poverty, housing and food security.

The Government of Canada is focused on investing in Indigenous-led approaches to mental wellness that are culturally-relevant, trauma-informed and community-based. Indigenous Services Canada works closely with Indigenous partners at the national, regional and community levels and is guided by Indigenous-led frameworks such as the First Nations Mental Wellness Continuum Framework, Honouring Our Strengths, and the National Inuit Suicide Prevention Strategy.

The Government of Canada has made significant recent investments to improve mental wellness in Indigenous communities, with an approximate annual investment of $650 million in 2020-21. These investments are made to meet 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 mental health, cultural, and emotional support to former Indian Residential Schools and federal Day Schools students and their families as well as those affected by the issue of Missing and Murdered Indigenous Women and Girls.

Mental wellness supports are available through the Non-Insured Health Benefits (NIHB) and mental wellness funding through Jordan's Principle. The NIHB mental health counselling program provides coverage for professional mental health counselling to complement other mental wellness services that may be available to clients or in communities. The program provides eligible clients with coverage for benefits not available under other federal, provincial, territorial or private health insurance. Jordan's Principle makes sure all First Nations children living in Canada can access the products, services and supports they need, when they need them. Funding can help with a wide range of health, social and educational needs, including mental wellness supports. Requests for Inuit children can be made through the Inuit Child First Initiative.

Current Status

Indigenous populations have been disproportionately affected by the COVID-19 pandemic and the on-going opioid crisis. Inequities in mental wellness and opioid-related harms and deaths have worsened over the course of the pandemic. Many mental wellness services continued to be accessible during the pandemic with some experiencing, shifts in service delivery, or new innovative approaches to reach community members.

The Government of Canada announced an investment of $82.5M 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.

Budget 2021 announced $597.6M over three years for a distinctions-based mental wellness approach for First Nations, Inuit, and Métis. This included renewed funding to continue essential services such as crisis lines and mental health, cultural, and emotional support to former Indian Residential Schools and federal Day Schools students and their families as well as those affected by the issue of Missing and Murdered Indigenous Women and Girls.

The need for mental wellness supports further increased following confirmations of children's remains at former Indian Residential School sites across the country in 2021. In response, a new investment of $107.3M was announced in August 2021 for a one year expansion of trauma-informed mental health, emotional and cultural supports. Budget 2022 announced an investment of $227.6M over two years to maintain trauma-informed, culturally-appropriate, Indigenous-led services to improve mental wellness. Growing demand for these services is expected to continue.

Additional Information

Suicide prevention has been a longstanding priority for Indigenous communities in Canada. Suicide rates among Indigenous youth are among the highest in the world although there are substantial variations across communities. The Government of Canada recognizes that the root causes of Indigenous suicide are complex, with links to individual, family and community wellness; the legacy of colonization; and the Indigenous social determinants of health, such as self-determination, cultural continuity, housing, employment and income in communities.

To address the high rates of suicide that are happening in some Indigenous communities, the Government of Canada is supporting a variety of initiatives specific to life promotion and suicide prevention including launching the Hope for Wellness Helpline, supporting the implementation of the National Inuit Suicide Prevention Strategy, continuing to support the National Aboriginal Youth Suicide Prevention Strategy, and implementing the Youth Hope Fund. The Hope for Wellness Helpline provides immediate, culturally safe, telephone crisis intervention support for First Nations and Inuit, 24 hours a day, seven days a week (1-855-242-3310 or the online chat at hopeforwellness.ca), in English and French, and upon request in Cree, Ojibway, and Inuktitut.

Issue Summary

On April 29, 2022, the Minister of Indigenous Services and the Minister of Northern Affairs will participate at the Indigenous and Northern Affairs Standing Committee regarding the motion submitted by Nunavut's Member of Parliament, Lori Idlout, that the committee undertake a study to review the healthcare rights of Indigenous Peoples through the accessibility and administration of the Non-Insured Health Benefits (NIHB) program. This issue sheet provides an overview of ISC's role in the Territories.

Key Messages

• In the territories, delivery of primary health services for all residents, including First Nations and Inuit, is the responsibility of territorial governments. However, to support the health needs of First Nations and Inuit in the territories, Indigenous Services Canada (ISC) funds and directly administers the delivery of complementary health services and initiatives for Indigenous northerners.
• Due to differing transfer and devolution landscapes in each of the territories, the manner by which ISC programs and services are delivered varies by territory.
  • For example, in the territories, ISC funds First Nations and Inuit organizations and territorial governments to support First Nations and Inuit home and community care, and delivery of community-based health promotion and disease prevention programs.
  • For ISC's Non-Insured Health Benefit's program, ISC jointly administers the program with the Governments of Nunavut and Northwest Territories, and solely administers it in Yukon through an ISC staffed Non-Insured Health Benefits Call Centre located in Whitehorse.
• ISC also takes a health leadership role in the territories by acting as a strategic enabler, advocating for First Nations and Inuit territorial partners, and working with other federal departments to support the inclusion of First Nations and Inuit health in national programs, broad arctic initiatives, and in support of self-government negotiations.

Background

Current Status

Additional Information

• ISC Health-Northern Region is managed out of its three offices, located in Whitehorse, Yellowknife and Ottawa.
  • Whitehorse Office (co-located with Public Health Agency of Canada): Non-Insured Health Benefits Medical Travel Call Centre, Indian Residential Schools (pan-territorial), Dental Clinic and Community-based Programs for Yukon.
  • Yellowknife Office: Community-based Programs for Nunavut and the Northwest Territories, Climate Change and Health Adaptation Program, and Northwest Territories Policy.
  • Ottawa Office: Regional Executive's Office, Policy, Non-Insured Health Benefits Program, Community-based Programs, Corporate and Financial Services.

Issue Summary

Overview of the Departmental supports in place to address the profound and far-reaching impacts of the COVID-19 pandemic.

Key Messages

• The health and safety of First Nations, Inuit and Métis individuals and communities is a top priority for the Government of Canada, and Indigenous Services Canada (ISC) acted quickly to provide supports and resources, such as personal protective equipment, cleaning supplies, training, and adaptation measures to help prevent COVID-19 cases in Long Term Care facilities in Indigenous communities.
• Throughout the pandemic, ISC has provided funding to Indigenous leadership and organizations, as well as the territorial governments with the flexibility needed to design and implement community-based solutions to prevent, prepare and respond to the spread of COVID-19 within their communities.
• ISC continues to support Indigenous communities and individuals in their COVID-19 preparedness, response and recovery.
• ISC recognizes the importance of vaccination against COVID-19 as well as the need for access to personal protective equipment (PPE) through the ISC Stockpile.
• ISC's Non-Insured Health Benefits (NIHB) Program continues to provide benefits and services to clients (registered First Nations and recognized Inuit) during the COVID-19 pandemic, and is making every effort to serve clients and providers in a timely manner.
• To date, ISC has provided $279.8 million to territorial Indigenous partners and governments to respond to the COVID-19 pandemic.

Background

ISC works closely with the Public Health Agency of Canada, other Government of Canada departments, and provincial and territorial governments as well as Indigenous partners to protect the health and safety of Indigenous peoples. This includes supporting Indigenous partners in responding to public health threats.

Current Status

Issue Summary

Jordan's Principle is a legal obligation of the Government of Canada to ensure all First Nations children living in Canada can access the products, services and supports they need, when they need them. Funding is demand-driven, and can help with a wide range of health, social and educational needs unmet through other programming at the federal, provincial/territorial, and/or local levels.

Jordan's Principle is named in memory of Jordan River Anderson. He was a young boy from Norway House Cree Nation in Manitoba.

Key Messages

• The Government of Canada is committed to the full implementation of Jordan's Principle, and to working with First Nations communities and partners to ensure that First Nations children can access the products, services and supports they need, when they need them.
• Jordan's Principle supports families in accessing products and services for First Nations children and youth to help with a wide range of health, social and educational needs.
• Between July 2016 and February 28, 2022, more than 1.35 million products, services and supports were approved under Jordan's Principle. These include speech therapy, educational supports, medical equipment, mental health services and more.
• While we continue to provide support to First Nations children through Jordan's Principle, we will also work 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.

Background

In 2005, at the age of five, Jordan River Anderson, a First Nations child from Norway House Cree Nation in Manitoba, died in the hospital while the provincial and federal governments could not agree on who was financially responsible for his home care in a medical foster home.

That year, the First Nations Child and Family Caring Society (Caring Society) released the Wen:De reports, among the policy recommendations was the concept of Jordan's Principle, a child-first principle to ensure that services for First Nations children are not delayed due to jurisdictional disputes.

In February 2007, the Assembly of First Nations (AFN) and the First Nations Child and Family Caring Society (Caring Society) filed a complaint with the Canadian Human Rights Commission (CHRC) that alleged that pursuant to section 5 of the Canadian Human Rights Act (the Act), Indian and Northern Affairs Canada (INAC) discriminates in the provision of child and family services to First Nations on reserve and in the Yukon, on the basis of race and/or national or ethnic origin, by providing inequitable and insufficient funding for those services. The implementation of Jordan's Principle was identified as a solution to jurisdictional disputes as part of this complaint.

On December 12, 2007, a Private Member's Motion No. 296 in support of Jordan's Principle was passed with unanimous support in the House of Commons in honor of Jordan River Anderson, "The government should immediately adopt a child first principle, based on Jordan's Principle, to resolve jurisdictional disputes involving the care of First Nations children."

In August 2007, the Government of Canada announced $11M in new funding to Health Canada for the implementation of Jordan's Principle. This implementation focused on jurisdictional disputes involving First Nations children living on-reserve with multiple disabilities requiring services from multiple service providers.

Under the federal response, no Jordan's Principle cases were identified (given the narrow scope) and the fund was eliminated. Requests for services that came forward were managed through federal/provincial contacts and services provided through existing programs.

The Truth and Reconciliation Commission released its Final Report in 2015. Call to Action #3 calls on "all levels of government to fully implement Jordan's Principle."

On January 26, 2016, the Canadian Human Rights Tribunal (CHRT) issued its first ruling with respect to the 2007 complaint by the Caring Society and AFN. The ruling substantiated the complaint and made a finding of discrimination against the Attorney General of Canada (for the Minister of Indian and Northern Affairs) that Canada was failing to provide an adequate level of child welfare services to First Nations families on reserve. The CHRT ordered Canada "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."

Since that time, the CHRT has issued many other orders, clarifying eligibility, establishing definitions and timelines, and most recently, ordering Canada to fund on-reserve capital projects to support the delivery of Jordan's Principle services (2021 CHRT 41).

Current Status

On December 31, 2021, two Agreements-in-Principle were reached between Canada, the AFN, the First Nations Child and Family Caring Society, the Chiefs of Ontario, the Nishnawbe Aski Nation and counsels for the AFN-Moushoom and Trout class actions (collectively, "the Parties"). One Agreement in Principle is for compensation for those harmed by discriminatory underfunding of First Nations child and family services and for those who were denied, or delayed in receiving services under Jordan's Principle. The other pertains to the long-term reform of the First Nations Child and Family Services Program and Jordan's Principle.

These Agreements-in-Principle provide a basis for final settlement agreements to be negotiated over the coming months. The Agreements-in-Principle include:

• $20 billion in compensation for First Nations children on-reserve and in the Yukon, who were removed from their homes between April 1, 1991 and March 31, 2022, and for their parents and caregivers. This also includes compensation for those impacted by the government's narrow definition of Jordan's Principle between December 12, 2007 and November 2, 2017, as well as for children who did not receive or were delayed receiving an essential public service or product between April 1, 1991 and December 11, 2007 and their families. Our shared goal is to achieve a settlement that can be delivered to families as soon as possible.
• Approximately $20 billion, over five years, for long-term reform of the First Nations Child and Family Services program and Jordan's Principle to ensure that the discrimination found by the CHRT never repeats itself. Canada will take urgent steps to implement the measures set out in the "Work Plan to Improve Outcomes under Jordan's Principle, based on Indigenous Services Canada's Compliance with the Tribunal's Orders." The Work Plan specifically includes commitments to:
  • Identify, respond to and report on urgent requests;
  • Develop and implement Indigenous Services Canada internal quality assurance measures, including training on various topics, a complaint mechanism, and an independent office to ensure compliance;
  • Ensure privacy is protected, that a least intrusive approach is used, and for the parties to engage the Privacy Commissioner;
  • Ensure that professional recommendations are respected, and that clinical case conferencing only takes place where reasonably required to ascertain needs;
  • Ensure that reapplications and/or cessation or disruption in funding, and/or payment procedures do not negatively impact First Nations children;
  • Increase national consistency and standards, especially with respect to group requests, develop and implement tracking to achieve this, and provide for re-review;
  • Increase specificity and personalization in denial rationales with prompt communication to requestor;
  • Implement "Back to Basics" approach and culture change to determination of Jordan's Principle requests; and
  • Identify mechanisms for off-reserve capital where required to provide safe, accessible, confidential, and culturally- and age-appropriate spaces to support the delivery of Jordan's Principle and confirmed through needs assessments and feasibility studies, in the course of negotiating a Final Settlement.
  • The Parties will discuss options for First Nations to take on a larger role in approving and delivering services, products and supports under Jordan's Principle. Following a needs assessment and feedback from First Nations and service providers, the Parties will develop an implementation approach for long-term reform of Jordan's Principle

Budget 2022 proposes to provide $4 billion over six years, starting in 2021-22, to ensure First Nations children continue to receive the support they need through Jordan's Principle. This funding will also support long-term reforms to improve the implementation of Jordan's Principle, which include the above Agreement in Principle deliverables and development and implementation of a "Back to Basics" Approach to Jordan's Principle to be co-developed with partners.

Canada has been ordered (2022 CHRT 8) to fund and provide data in support of research to be conducted with the Institute of Fiscal and Democratic Studies to guide further development of the Long Term Approach to Jordan's Principle, and to engage with partners of the resources required in support of post-age of majority service navigation supports.

Additional Information

Issue Summary

Significant and long-standing gaps persist between Indigenous and non-Indigenous Peoples in Canada in accessing high quality, culturally relevant health services. There is no federal health legislation relating directly to Indigenous Peoples that provides clarity and certainty on the roles and responsibilities of different levels of government in health care for Indigenous peoples; nor is there legislation that ensures stable, predictable funding and services, or principles of care, that align with Indigenous cultures, values, and beliefs.

Key Messages

• The Government of Canada acknowledges the challenges faced by First Nations, Inuit and Métis in accessing culturally safe care. Canada is committed to working in partnership with Indigenous Peoples to advance their health priorities.
• The Government of Canada recognizes the potential to build a legislative basis to improve access to high-quality and culturally relevant health services for Indigenous Peoples.
• The co-development of such legislation is an opportunity to set out a process for ongoing collaboration; establish overarching principles as the foundation of health services for Indigenous Peoples; support the transformation of health service delivery; advance shared commitments to ongoing reconciliation efforts; and address systemic racism and service gaps within the health system.
• The Government of Canada is committed to a dialogue with Indigenous partners, and provinces and territories that will work towards a mutually agreeable Indigenous health legislation that is respectful of Indigenous priorities and views.

Background

• Health is a complex matter for which the provinces, territories and the federal government have some shared jurisdiction.
• Provinces and territories are responsible for health care delivery in their respective jurisdictions and receive transfer payments from the federal government to provide universally accessible and publicly insured health services to all residents, including Indigenous Peoples. However, provincial and territorial governments generally do not provide health services in Indigenous communities. To address this gap, the federal government, guided by the 1979 Indian Health Policy, has assumed a funding role and, in some cases, a direct delivery role for health services.
• Recent reports, including the Truth and Reconciliation Commission and the National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG), have identified significant gaps in health services between Indigenous and non-Indigenous people.
• In addition, Indigenous peoples and groups continue to raise, before the Government and the Courts, instances in which they have experienced racism through substandard care leading to death, misdiagnosis, or unnecessary and unwanted medical interventions.
• In 2019, the Prime Minister of Canada mandated the Minister of Indigenous Services to "co-develop distinctions-based Indigenous health legislation, backed with the investments needed to deliver high-quality health care for all Indigenous Peoples."
• The 2020 Fall Economic Statement announced $15.6 million over two years, starting in 2021-22 to advance the co-development of distinctions-based Indigenous health legislation.
• In January 2021, a federal engagement process to co-develop distinctions-based Indigenous Health legislation was launched following the national dialogue on Addressing Anti-Indigenous Racism in the Healthcare system.
• In December 2021, the Government of Canada reiterated its committed to "fully implement Joyce's Principle and ensure it guides work to co-develop distinctions-based Indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of Indigenous Peoples".
• The co-development of distinctions-based Indigenous health legislation is an opportunity to:
  • Address significant gaps in health outcomes that persist between Indigenous and non-Indigenous people in Canada;
  • Advance reconciliation and implement actions under the Truth and Reconciliation Commission (TRC), the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and MMWIG;
  • Take action to address racism, discrimination and systemic violence within the health system;
  • Support health transformation and Indigenous governments in assuming greater control of the design, administration, management and delivery of health services; and
  • Answer calls from Indigenous partners for healthcare services that are equitable, accessible, adequately and sustainably funded, and self-determined.

Current Status

• This initiative is currently in the engagement phase, and will be followed by a co-development phase and a drafting phase.
• The engagement approach is comprehensive, broad-based, and intended to be as inclusive as possible.
• Several engagement streams have been created to support participation, including:
  • Stream 1: Regional First Nations, Inuit, and Métis partners to highlight the voices of community members, leaders and health technicians.
  • Stream 2: A targeted call for proposals, focusing on hearing from unique intersectional voices, such as those of Indigenous women's organizations, urban Indigenous organizations, Indigenous youth organizations, 2SLGBTQQIA+ organizations, etc.
  • Stream 3: National First Nations, Inuit, and Métis Nation organizations.
  • Stream 4: ISC-hosted sessions to support the participation of Indigenous academics, legal experts, traditional knowledge keepers and Elders, youth, as well as some health professionals.
  • Stream 5: Engagement with Provinces & Territories via bi/multilateral meetings at the Ministerial, Deputy, Senior Assistant Deputy Ministerial and working levels.
  • Stream 6: A generic email inbox to support the participation of any other interested groups to learn more about the engagement process and submit their views should they wish.
• In February 2022, the Department, guided by an Elders Advisory Circle, hosted a virtual event, to hear from Indigenous academics, traditional knowledge keepers, students, and other partners committed to improving Indigenous wellness and provided participants with an opportunity to share wisdom to inform Indigenous health legislation. The National event was well attended and a report will be available in English, French, Mi'kmaq, Ojibway, Plains Cree, Inuktitut, and Michif.
• While only a relatively small portion of engagement reports have been received thus far, the following themes have emerged:
  • Ensuring a holistic approach to health, inclusive of Indigenous worldviews and the social determinants of health;
  • Building trust and strengthening federal-Indigenous relationships, including by ensuring federal accountability;
  • Focusing on community-based and community-led services;
  • Placing emphasis on the importance of traditional knowledge and practices;
  • Addressing racism and discrimination in care;
  • Addressing critical gaps in care (i.e. infrastructure, data, NIHB, continuing care, mental wellness, services for queer peoples);
  • Respecting Indigenous Peoples as Sovereign Nations;
  • Expanding service provision and eligibility for Métis peoples/governments; and
  • Implementing MMIWG, UNDRIP, Joyce's Principle and TRC.
• Indigenous Services Canada will continue to work in partnership with national and regional First Nations, Inuit and Métis rights holders and partners to support a coordinated approach for engagement on priorities for Indigenous health legislation and the eventual co-development of legislative options.

Issue Summary

First Nations, Inuit and Métis Peoples continue to endure racism and discrimination when seeking health services. Addressing anti-Indigenous racism will require the Government of Canada to work in partnership with provinces and territories, health system partners and educational institutions.

Key Messages

• The mistreatment and death of Joyce Echaquan of Manawan First Nation while at the Joliette hospital in Quebec should never happen again in this country.
• The Government of Canada has committed to addressing and ending anti-Indigenous racism in Canada's health systems in a way that is informed by the lived experiences of Indigenous Peoples.
• Action at all levels is required to make meaningful progress towards eliminating anti-Indigenous racism in Canada's health systems.

Background

On October 16 2020, the Ministers of Indigenous Services, Crown Indigenous Relations and Northern Affairs, and Health convened an urgent meeting, bringing together Indigenous, provincial and territorial governments and partners, and health practitioners and regulators to honour the life of Joyce Echaquan and to hear about the lived experiences of Indigenous patients and providers. The Rapporteur's Final Report was shared with meeting attendees.

On January 27 and 28, 2021, federal, provincial and territorial governments and Indigenous and health system partners met virtually to share both short and long-term concrete actions to eliminate anti-Indigenous racism in health systems. At this National Dialogue, the Minister of Indigenous Services Canada launched the engagement process for the co-development of distinctions-based Indigenous Health Legislation to deliver high quality healthcare for First Nations, Inuit and Métis.

A 3rd National Dialogue was held on June 28 and 29, 2021 to pursue collective actions related to four themes: increasing Indigenous representation in post-secondary health education, cultural safety and humility, traditional approaches to health, and safe patient navigation.

Key outcomes of this meeting included:

• The Government of Canada affirmed its commitment that the distinctions-based health legislation will be informed by the spirit and elements of Joyce's Principle;
• Continued leadership role of the federal government to address anti-Indigenous racism in health systems, including as a convenor to support organizations in their capacity to address systemic racism issues and advocacy/engagement;
• Need for focused regional distinctions-based approaches to address racism in the health system; and,
• Sharing of best practices and lessons learned in order for organizations and governments to collaborate in advancing their actions.

Joyce's Principle

In March 2021, the Atikamekw announced they are turning to the United Nations to obtain justice on behalf of Joyce Echaquan. Complaints will be brought before five special rapporteurs in advance of the United Nations Annual Forum for Indigenous Peoples. The intention is to encourage Ottawa and Quebec to implement Joyce's Principle and urge immediate action to end systemic discrimination against Indigenous Peoples.

The Québec Coroner's public hearing into the death of Joyce Echaquan was held in May and June, 2021, at the Trois-Rivières courthouse.

The final report was released on October 1, 2021. It concluded that the racism and prejudice Joyce Echaquan was subjected to contributed to her death and makes several recommendations. While none are directed towards the Government of Canada, some specific recommendations include:

• Recognize the existence of systemic racism within our institutions and make a commitment to contribute to its elimination.
• Ensure the effective integration of the Atikamekw liaison officer into the hospital, in particular by involving them with care teams.
• Include in the school curriculum training on the care of Indigenous patients that takes into consideration the realities of Indigenous communities.
• Establish with Indigenous communities a greater offer of internships for both nurses and medical residents.

Current Status

Additional Information

Issue Summary

Overview of the Non-Insured Health Benefits (NIHB) Program's results and public reporting.

Key Messages

• The NIHB Program has undergone various internal and external audits, including a number conducted by the Office of the Auditor General. All recommendations have been addressed.
• The NIHB Program publishes an annual report on the departmental website providing regional and national data on the client population, health benefit expenditures, and utilization trends.
• The Program also provides public reporting as part of the Annual Departmental Plan, Departmental Results Report and GCInfobase.

Background

Current Status

• Planning for the next evaluation of the NIHB Program is underway and will cover the period 2015-16 to 2021-22. Both the AFN and the ITK have been engaged in the development of the draft Terms of Reference for the evaluation.
• There are no current audits on the NIHB Program planned or underway.
• The NIHB Program's annual report for 2020 to 2021 was recently published online on the department's website. Work has begun on the 2021-22 annual report.

Committee Member Biographies