HESA Committee Report

ANALYSIS OF IMPLEMENTATION

HEALTH HUMAN RESOURCES

Overall, there has been substantial progress in meeting the 2004 Accord health human resources (HHR) commitments, with progress in HHR planning reported in every jurisdiction across Canada.  The majority of the jurisdictional HHR Action Plans were posted on the Health Council’s web site by December 2005.  The two remaining jurisdictions (British Columbia and the Yukon) are in the final stages of their consultation processes and will release plans shortly. 

The jurisdictional Action Plans build on the health renewal agenda established in the 2003 Accord and benefited from the work funded by the federal government through its pan-Canadian HHR Strategy.  It was agreed in the 2004 Accord that the HHR Action Plans would build on ongoing work in four areas (i.e., health labour relations, interdisciplinary (interprofessional) education, investments in post-secondary education, and credentialing of health professionals).  A few highlights follow:

• Partnering jurisdictions have access to information on health sector labour relations collected in a Cross-Jurisdictional Labour Relations Database which is supported by F/P/T funding.  British Columbia initiated this project in 2002 and continues to have the lead for database development and implementation across the country. 
• Interdisciplinary training(now referred to as Interprofessional) and investments in post-secondary education:  Jurisdictions are benefiting from twenty learning projects that have been funded through the HHR Strategy’s Interprofessional Education for Collaborative Patient-Centred Practice.  The goal of this initiative is to further interprofessional training in post-secondary education institutions so that health professionals have the attitudes, skills, knowledge and behaviours to work effectively in interprofessional teams.
• A new process for managing proposals to change entry-to-practice credentials for health professions was approved by F/P/T Ministers of Health in 2004 and is now contributing to HHR planning activities.  This process aims to provide a consistent, unbiased assessment of proposals, while still meeting jurisdictional requirements.

The F/P/T governments continue to implement the Pan-Canadian Framework for Collaborative HHR Planning.  This framework was funded and developed by the F/P/T Advisory Committee on Health Delivery and Human Resources and endorsed by the Council of Ministers of Health (Quebec agreed in principle) in June 2005.  The framework has an Action Plan with goals and objectives, as well as activities that have been designated as either short-, medium- or long-term priorities.

The Government of Canada allocated $75 million to the Internationally Educated Health Professionals Initiative.  The Initiative reflects collaboration among federal departments, P/T governments, regulatory bodies, educational institutions, employers, professional associations and immigrant settlement organizations and contributes to solutions to reduce HHR shortages in Canada.  It is aimed at immigrant health professionals who are living in Canada, but are unable to practice in their chosen professions.  The Initiative supports a range of upgrading programs, communication courses, assessment tools and other programs that are increasing access to licensure and employment in Canada among highly skilled immigrants.

The number of internationally educated health professionals (IEHP) who have been assessed has increased.  The Internationally Educated Health Professionals Initiative has allocated funding to Nova Scotia, British Columbia and Ontario through its provincial and territorial funding stream, to create new centres and services for IEHPs within their jurisdictions.  These centres provide front end information, counselling and referral to ensure that IEHPs can quickly access the services and supports they need.  In Ontario, federal funding has been allocated to expand assessment services at the Centre for the Evaluation of Health Professionals Educated Abroad to include professions beyond medicine.  This approach capitalizes on existing Ontario expertise in international medical graduate assessment and builds capacity for other health professions.

Alberta’s model for the assessment and integration of internationally educated nurses is being expanded to jurisdictions across Western and Northern Canada and in Nova Scotia.  In 2007/08, the Government of Canada, through the IEHPI, also funded a pilot project in the amount of $536,112 to allow internationally educated nurses to be assessed prior to immigrating to Canada, thereby expediting the licensure process.

The Faculty of Pharmacy at the University of Toronto is receiving $1,065,415 to develop and pilot a pan-Canadian orientation program for IEHPs.  This program meets a common need for a structured and systematic orientation to the many dimensions of practising as a health care provider in Canada. The program is being piloted at sites across the country and will also be offered through on-line delivery to allow the curriculum to be accessed  by all IEHPs seeking to practice in Canada regardless of geographic location, potentially including those individuals seeking information about the Canadian health care system before immigrating to Canada.

Efforts to increase the supply of health human resources in Canada are already showing progress.  As noted by the Canadian Institute for Health Information (CIHI), the number of practising physicians in Canada reached 62,307 in 2006, increasing by 4.9% since 2002, a rate that exceeds population growth (4.0%).  In addition, the supply of interns and residents has also been increasing.  In 2006, there were 8,563 interns and residents, an increase of 7.1% over the 7,997 that were in the system in 2005. ¹  As well, CIHI reports that in 2006 there were 325,299 nurses as opposed to 321,590 in 2005, an increase of 1.2%. ²

Specific Federal Commitments

There has been substantial progress in meeting federal commitments in the 2004 Accord.  The following is merely an overview:

• Accelerate and expand the assessment and integration of internationally trained health care graduates for participating governments:

Notable accomplishments have been achieved through the federal government’s $75 million Internationally Educated Health Professionals Initiative.  Early successes have resulted, in part, from effective collaboration between federal departments working in close partnership with P/T governments and a range of non-governmental organizations.  A sample of accomplishments include:

• The creation of web portals and other communication tools that provide access to clear and relevant information about licensure and practice in Canada.  For example, website traffic on www.img-canada experienced a 79% increase between July 2006 and June 2007 from the same time-period a year prior.
• Close to 4,000 internationally educated health professionals have benefited from newly created counselling and assessment services, and from centres offering specialized advice and programs on licensure and employment.
• A multi-media faculty development program for physicians has been developed and is now in use in every faculty of medicine across Canada.
• Upgrading orientation programs to quickly fill skill gaps are being developed for physiotherapists, nurses, midwives, medical laboratory technologists and medical radiation technologists.
• Targeted efforts in support of Aboriginal communities and Official Languages Minority Communities to increase the supply of health care professionals for these communities:

The federal government established the Aboriginal Health Human Resources Initiative (AHHRI), which identified four targets to reach its goals:

Double the number of Aboriginal health career scholarships/bursaries in 5 years: 

• The AHHRI has increased the amount of funding available to Aboriginal health career students from $500K in 2004 to its present level of $3M per year, tripling the number of bursaries and scholarships that are awarded each year.

Double the number of Aboriginal health professionals in 10 years:

• The increased number of bursaries and scholarships now being awarded is leading to increases in the number of Aboriginal health career students, which will translate into increases in the number of Aboriginal health career professionals over the next several years. 

Increase the number of certified health directors/administrators on reserves by one third in 5 years:

• Work is now underway with the Assembly of First Nations which will lead to the development and validation of core competencies for health managers on reserve within the next year.  This process will result in certification through accredited educational institutions for all First Nations health managers.

A 50% increase in the number of post-secondary educational institutions with support programs for Aboriginal health care students in five years.  

• Work is underway across Canada to implement student support programs for Aboriginal health career students.  They expect to meet this target in the next two to three years.

The P/T governments have participated in the AHHRI through representation on F/P/T  Advisory Committees to facilitate linkages to P/T health human resources plans.  As  well, Saskatchewan and Manitoba have formed strong partnerships with the First Nations and federal partners at the regional level to work jointly on a number of AHHRI projects.  British Columbia, through its recently signed Tripartite First Nations Health Plan, is also actively engaged in HHR planning with the AHHRI and First Nations.

Health Canada’s Official Language Minority Community Program was allocated $75 million over five years (2003/04 to 2007/08) to fund projects to improve access to health services (in the official language of choice) for those living in such communities.  The federal government is also funding two additional projects that target efforts to these communities:

Consortium National de Formation en santé is receiving $1 million over four years (2006/07 to 2009/10) from the Internationally Educated Health Professionals Initiative.  The project promotes training and integration of internationally trained francophone health care professionals who want to be licensed to practice in Canada. 

Consortium National de Formation en santé is receiving $1.2 million over six years (2007/08 to 2012/13) from the pan-Canadian HHR Strategy.  The project aims to encourage the planning and training of French-language HHR according to the current and future needs of the francophone linguistic minority communities. 

• Participate in HHR planning with interested jurisdictions. 

As noted above, the federal government is working collaboratively with the P/T governments to implement the pan-Canadian Framework for Collaborative HHR Planning.  An accompanying Action Plan focusses on four areas:  

• planning for the appropriate number and mix of health care professionals; working closely with employers and the education system to develop a workforce that has appropriate skills and competencies;
• achieving the appropriate mix of health care providers and deploying them in appropriate models of care, and
• building a sustainable workforce with healthy workplaces.

Federal populations

The federal government has direct healthcare responsibilities on two fronts.  It is responsible for ensuring delivery of health services to specific client groups within the Canadian population and for the overall health of the Canadian population in the context of pandemic outbreaks and domestic healthcare crises.

In 2005 the six permanent members of the Federal Healthcare Partnership (Citizenship and Immigration, Correctional Service, National Defence, Health Canada, the Royal Canadian Mounted Police and Veterans Affairs) developed and published a HHR Action Plan - Status Report.  In July 2006, the Federal Healthcare Partnership established a Health Human Resources Committee to: 

• identify and deal with common challenges related to health human resources in their respective healthcare programs;
• allow a better understanding of barriers/obstacles federal organizations are experiencing; and
• provide recommendations to address issues faced by personnel in the health services sectors who are delivering care to populations under federal jurisdiction.

As a first priority, the Committee completed a pilot project to study recruitment and retention of federally employed physicians.  A final report, entitled Study on Recruitment and Retention of Federal Physicians, was published in March 2007.  It provides valuable information from each of the six federal organizations regarding shortages of federally employed physicians.  The study also identifies key challenges facing federally employed physicians and puts forward six recommendations for facilitating recruitment and retention of physicians for the federal public service.

Future Progress

F/P/T Collaboration: 

The F/P/T Advisory Committee on Health Delivery and Human Resources is currently implementing the pan-Canadian Framework for Collaborative HHR Planning.  The Action Plan, which includes short-, medium- and long-term priorities, is being used to guide priority setting for the next phase of the Strategy. Health Canada will continue to promote collaboration with health stakeholders.  It will also extend collaboration to the education and labour market sectors.

Internationally Educated Health Professionals Initiative:

A key focus for the internationally educated health professionals initiative (IEHPI) will be the harmonization of assessment standards and processes for internationally educated nurses and international medical graduates (IMGs) across the country.  Building on the important foundational work that has been achieved to date on creating a more streamlined, consistent and transparent approach to IMG assessment, work will focus on both the assessment of IMGs into the postgraduate medical training system and the completion of “practise ready” assessments that will enable IMGs to fast-track through the licensure process and enter practice.

A further focus for the IEHPI will be the full implementation of the over 50 programs that have been launched since the initiative began.  These will create new bridging programs; centralize and make more easily accessible information sources for internationally educated health professional; build collaborative partnerships; and transfer knowledge across jurisdictions and professions. 

Health Canada, in partnership with other federal departments, will continue to bring together provinces/territories and health professions on an annual basis to share progress on the IEHPI, facilitate linkages and undertake strategic planning to identify common policy priorities in working to accelerate and expand the assessment and integration of internationally educated health professionals in Canada.

Reporting Commitments

Twelve out of fourteen jurisdictions completed HHR Action Plans and these are posted on the Health Council of Canada’s web site.  The two remaining jurisdictions (British Columbia and the Yukon) are in the final stages of their consultation processes and will release plans shortly.

Stakeholder Perspectives

Health Council of Canada comments

The Health Council’s 2005 Annual Report acknowledges the important role of HHR, saying that training of health professionals in teams in sufficient numbers was an urgent priority and that  “without sufficient providers of care working together, all other efforts will flounder.”  The report outlines five priority areas to improve Canada’s health care workforce:

• Focus aggressively on increasing the number of interprofessional education and training programs available in Canada.
• Clarify and report to the public on who will provide what services, especially in Primary Health Care.
• Remove barriers to optimizing skills sets.
• Integrate provincial, territorial and regional health workforce plans.
• Make decisions about supply in conjunction with addressing scopes of practice issues.

The Health Council’s 2006 Annual Report highlights HHR improvements including progress in implementing interprofessional education programs, increased medical and nursing school enrolments, the initiation by P/Ts of recruitment and retention strategies, and the establishment of a Pan-Canadian Human Resources Planning Framework.

In the same report, the Council also expressed concern over issues such as competition for HHR among jurisdictions, the lack of well defined recruitment and retention targets in some provinces, and the absence of a national plan for future delivery models. 

The Council’s analysis led to two key recommendations:

• Promote coordinated national/provincial/territorial strategies on HHR, with specific targets based on the health care needs of their populations, and create a national coordinating mechanism; and
• Develop appropriate measurement tools so that Canadians can evaluate whether investments in health human resources are resulting in improved patient access, better coordination of care, and improved outcomes.