HESA Committee Report

ANALYSIS OF IMPLEMENTATION

ACCESS TO HEALTH CARE IN THE NORTH

The federal and territorial governments are meeting their commitments on improving access to health care in the North. 

Following the Accord, the $150 million commitment became the Territorial Health System Sustainability Initiative (THSSI) and was divided into three separate funds:

1. Medical Travel Fund ($75 million over five years):  provided as an annual grant to each territorial government in order to offset the high cost of providing medical transportation.
2. Territorial Health Access Fund ($65 million over five years): provided equally to each territory to support health reform activities that address one or more of the following three broad goals:
• to reduce reliance over time on the health care system;
• strengthen community level services; and
• build self‑reliant capacity to provide services in‑territory.
3. Operational Secretariat Fund ($10 million over five years): provided to support the activities of the Federal/Territorial (F/T) Assistant Deputy Ministers’ Working Group, and to fund a number of pan‑territorial projects.

Medical Travel Fund

The Medical Travel Fund has been provided annually by the federal government to territorial governments.  The grant directly offsets territorial medical travel costs, allowing territories to re‑allocate resources to address other priorities.  Health Canada funds approximately 50 percent of medical transportation costs in each of the territories.

Territorial Health Access Fund

Each territory has developed and is implementing a Territorial Health Access Fund workplan to undertake long‑term health reforms.  Each territory has dedicated substantial resources from the THAF towards health human resources issues such as recruitment and retention, training, scope of practice/regulatory, and professional development.  Other THAF initiatives include the establishment of pilot projects for cancer screening, addressing mental health issues, enhancing emergency preparedness measures, and supporting a Nurse Info Line.

As part of their THAF workplan, the Northwest Territories is implementing an Integrated Service Delivery Model (ISDM) throughout their Health and Social Services System.  The ISDM emphasizes the importance of building regional and territorial support teams.  It has three key elements: service integration and professional collaboration; organizational integration; and a set of core services available within the health and social services system.  The ISDM is the guiding strategic direction within the NWT health and social services strategic plan, system action plan and the Regional Health Authorities strategic and business plans. 

The Yukon has initiated a comprehensive Health Human Resources (HHR) Strategy using THAF resources.  The strategy will establish Nurse Practitioner regulations, solidify baseline HHR information, examine and enhance physician and nursing retention activities, support medical, nursing and other health professional students, and strengthen professional development for existing care providers.

Nunavut is implementing a suite of education and training programs to develop local capacity in several health professions and para‑professions.  These include professional development courses for nurses for Neo‑Natal

Resuscitation, Emergency Pediatric Care and Acute Cardiac Life Support.  New diploma programs are being established for Mental Health and Community Therapy Assistants and the successful Nunavut Midwifery and Maternal Care Program is being expanded to additional communities.

Operational Secretariat Fund

An ADM‑level working group was established in late 2004 to support the management of the THSSI and undertake targeted “pan‑territorial” projects.  These projects allow territorial governments to collaboratively address common priorities and to work with the federal government to find solutions to long‑standing issues.  The following projects have been approved for funding and are at varying stages of implementation:

• an exploration of opportunities and best practices around children’s oral health;
• supporting the Arctic Health Research Network to become a self sustaining leader in pan‑territorial health research coordination and dissemination;
• a pan‑territorial mass media campaign to encourage healthy lifestyle choices; and
• an evaluation of territorial medical travel systems.

Reporting

While there were no specific reporting commitments identified in the Access to Care in the North section of the 2004 Accord, territories did make subsequent reporting and accountability commitments through the negotiating of specific agreements related to the $150 million Territorial Health System Sustainability Initiative. 

As per their funding agreements, Territorial governments are primarily responsible for reporting on the use of funds as part of their “regular annual reporting to residents.”  Each Territorial Governments’ annual Audited Financial Statements (i.e. Public Accounts) are required to reflect THAF, OS and Medical Travel Funding.  This is done at a high level and does not include any detail regarding specific expenditures under each fund.  2006-2007 statements were available in December 2007.  2007-2008 statements will be available by December 2008. 

Territories have also agreed to prepare an annual Progress Report to F/T Deputy Ministers of Health.  These reports, the first of which was forwarded to F/T Deputies in August 2007, highlight how the Territorial Health System Sustainability Initiative is helping to address challenges in the development and delivery of health care services in the North.

In addition, an evaluation process was agreed to by Federal and Territorial ADMs including both a Formative Evaluation (completed in December 2007) and a Summative Evaluation of the THAF and the Operational Secretariat Fund.  The results of the Formative Evaluation provide insight into the successes and challenges of territorial governments in implementing their respective THAF workplans and in working together to undertake pan‑territorial projects.

Although there is no formal evaluation of the Medical Travel Fund, territories have agreed to use Operational Secretariat Funding to undertake a comparative evaluation / assessment of their respective medical travel systems that will establish a base of information to inform decisions and identify best practices for managing these systems.  This work will be completed in 2008/09.

Future Work

In the Speech from the Throne on October 16, 2007, the Government committed to bringing forward an integrated Northern Strategy focussed on strengthening Canada’s sovereignty, protecting the environmental heritage, promoting economic and social development and improving and devolving governance.  Health Canada participates in DM- and ADM-level committees to develop the Strategy.

Health Council

The Health Council of Canada has not undertaken a separate review or made specific statements about the $150 million Territorial Health System Sustainability Initiative.