PACC Committee Report

RECOMMENDATION 8

That pending the completion of an assessment of capacity in conjunction with First Nations and Inuit communities, and implementation of a strategy to address it, Health Canada refrain from negotiating any further transfer agreements.

RECOMMENDATION 9

That Health Canada start specifying the human, financial, and technological resources that it devotes to building the capacity of First Nations and Inuit communities, both at the departmental and community levels, commencing with its report on plans and priorities for fiscal year 2002-2003.

RECOMMENDATION 10

That where the Department has concerns about the capacity of a First Nation community to deliver services in the short term, it revoke the delegated authority in order to protect the health of First Nations individuals, until such time as sufficient capacity to administer, deliver, and report on services and programs delivered can be created.

RECOMMENDATION 11

That Health Canada report the results of its capacity-building efforts in its annual performance report, beginning with the report for the period ending 31 March 2002.

The objective of the Department’s First Nations and Inuit Health “business line” is to provide programs and services to First Nations and Inuit communities and people that “address health inequalities and disease threats so that they may attain a level of health comparable with that of other Canadians.” As noted above, approximately half of the Department’s total expenditures are devoted to achieving this objective.

Given the cost and importance of this group of programs and services, it must be clearly stated that Parliament, First Nations and Inuit communities ― and indeed all Canadians ― deserve to know whether these objectives are being met. This, however, is not the case. Health Canada’s Performance Report for the period ending 31 March 2000 devotes slightly over 4 out of a total of 110 pages to Aboriginal health. These pages list “accomplishments” that consist exclusively of activities and processes. Results and outcomes are not mentioned. The actual status of Aboriginal health is not discussed and is reserved for an annex to the Report. Readers who do not look at the annex portion of the Report would thus never know if these “accomplishments” were having any impact at all on health inequalities and disease threats in First Nations and Inuit communities.

The Department knows that the status of Aboriginal health is not good. Although it only includes health status information in an annex toits performance report, it is willing to speak to it more directly in its report on plans and priorities, which supports its request for funding under its Estimates. In that document, the Department reports that levels of hypertension, arthritis, diabetes, and heart disease among First Nations are significantly above those found in the general population.[1] In the text of his opening comments to the Committee, the Assistant Deputy Minister provided further information on the status of Aboriginal health when he sought to describe challenges faced by the Department:

·        Death by injury to children is three to four times higher than for the general Canadian population.

·        Youth suicide rates are five to eight times higher.

·        Smoking rates are nearly double the Canadian rate.

·        Rates of diabetes [are] five times higher.

One might conclude from these figures that the Department’s efforts to “address health inequalities and disease threats so that they [First Nations and Inuit communities and people] may attain a level of health comparable with that of other Canadians” are not working. However, one might equally conclude ― if rates are high but in decline ― that the Department’s efforts are making a difference. But Parliament, First Nations and Inuit people, Canadians generally and even the Department itself cannot know this because Health Canada is not measuring and reporting the performance of its Aboriginal Health program in any kind of meaningful, systematic way.

In 1997, the Auditor General called on the Department to improve the measurement of the performance of community health programs. The Committee supported this recommendation. Agreeing with the Auditor General’s recommendation, the Department claimed that “recent improvements in both methodology and technology will assist the Department to work with First Nations to produce useful and meaningful measures” to determine the impact of its programs. In 1998, the Committee recommended that the Department provide information on the status of community health programs in its performance reports, specifying that information on health outcomes should be included. The Department replied that the “First Nations Health Information System will provide valuable information … such as immunization rates, rates of diabetes, and rates of communicable disease such as hepatitis A.”

Three years later, the Assistant Deputy Minister testified that the Department is “putting in place … a First Nations health information system which is a combination of a case file system, patient record system, and program record system.” He also agreed to provide the Committee, before the end of the year, with the list of indicators that will be used to guide evaluations of community health programs. In 1998, the Department told the Committee: “given that each program contributes to improved health, these broad measures of health status [derived from the First Nations Health Information System] provide an indication of the outcomes achieved.” The Committee expects the Department to support this assertion and therefore recommends:

RECOMMENDATION 12

That Health Canada use data collected by the First Nations Health Information System to demonstrate the health outcomes achieved by community health programs and the Non-Insured Health Benefits program. This analysis must appear in Health Canada’s performance reports beginning with the report for the period ending 31 March 2002.

The government’s new management framework requires that departments “be focused on the achievement of results and on reporting them in simple and understandable ways to elected officials and to Canadians.”[2] This requirement is further elaborated in the government’s new Evaluation Policy, which indicates: “public service managers are expected to define anticipated results, continually focus attention towards results achievement, measure performance regularly and objectively, and learn and adjust to improve efficiency and effectiveness.”[3] Under the terms of the Policy, departments are to “embed” evaluation into the lifecycle management of programs, establish ongoing performance monitoring and measurement practices, and evaluate programs “including those that are delivered through partnership arrangements.”[4] To meet the Policy’s objectives, departments are required to develop strategically focused, risk-based, evaluation plans and are to “make completed evaluation reports available to … the public with minimal formality.”[5] In its 7th Report (37th Parliament, 1st Session), the Committee generally endorsed the Policy and its objectives. The Committee accordingly recommends:

RECOMMENDATION 13

That Health Canada apply the requirements specified in the Evaluation Policy of the Government of Canada to its management of community health programs and the Non-Insured Health Benefits program.