Question Period Note: Indigenous Health Services

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• We will work in full partnership with provinces, territories, and Indigenous Peoples to advance the outcomes we all want to see: better access to health services, where and when they are needed.
• In collaboration with Indigenous communities and organizations, ISC supports access to health services for Indigenous Peoples.
• Health services are either funded for delivery by Indigenous communities and organizations or directly provided by ISC employees in areas where access to provincial and territorial services are limited.
• ISC is also working with Indigenous leaders to support self-determined approaches and transferring the responsibility for service delivery to Indigenous partners – who know best how to design, deliver, plan and administer health services to their communities.

ISC is supporting and empowering Indigenous Peoples to independently deliver services and address the socio-economic conditions in their communities.

ISC delivers Indigenous Health Services in the following areas:

Primary care services

Clinical Client Care Program
The Clinical Client Care program provides emergency services (triage, life sustaining care and emergency evacuation services), urgent care (assessment and treatment of new or worsening symptoms), and non-urgent care (routine checkups, maternal-child health, chronic disease prevention and management, etc.) in 79 remote and isolated health facilities and two hospitals in First Nations communities across Canada (AB, SK, MB, ON, QC).

Community Oral Health Services
ISC funds or directly provides Community Oral Health Services in 335 communities in AB, SK, MB, ON, QC and Atl. Community Oral Health Services focus on the prevention of dental disease at an early age and the promotion of good oral health practices and also include clinical care, emergency services.

eHealth
The eHealth Program Services improves the efficiency of health care delivery to First Nations individuals, families, and communities through the use of digital health/virtual care technologies for the purpose of defining, collecting, communicating, managing, disseminating, and using data. Front-line care providers are therefore able to better deliver health services in First Nations communities through eHealth partnerships, technologies, tools, and services.

Communicable Disease Control

Public health services are delivered under the Communicable Disease Control and Management (CDCM) Program, in collaboration with First Nations and Inuit, provincial/territorial authorities and other federal departments and agencies. The CDCM program aims to reduce the incidence, spread, and human health impacts of communicable diseases, such as: Tuberculosis (TB), vaccine preventable diseases (VPDs) – including immunizations, and sexually transmitted and blood-borne infections (STBBIs) – including HIV/AIDS and hepatitis C. ISC does not have public health legislation that applies on reserve and is guided by provincial/territorial legislative frameworks.

Joyce’s Principle

Joyce’s Principle was developed in pursuit of justice and in honour of Joyce Echaquan, following the racist treatment she endured by hospital staff and her subsequent death on September 28, 2020. The Coroner’s inquest into Joyce Echaquan’s death produced a final report in 2021 that found racism and prejudice from hospital staff contributed to her death. Joyce’s Principle aims to guarantee to all Indigenous Peoples the right of equitable access to social and health services, as well as the right to enjoy the best possible physical, mental, emotional and spiritual health. It also requires the recognition and respect of Indigenous People’s traditional and living knowledge in all aspects of health.

Investments in Addressing Anti-Indigenous Racism in Health Systems

In response to the death of Joyce Echaquan, Budget 2021 provided $126.7 million over three years (2021-22 to 2023-2024) to foster health systems free from racism and discrimination experienced by Indigenous Peoples. With Budget 2021, Indigenous Service Canada supported Indigenous partners to hire new Indigenous Health System Navigators and Patient Advocates, to increase Indigenous representation in the health professions, to expand services and supports for Indigenous midwives and doulas, and to improve access to pre-natal, postpartum and birth supports for First Nations, Inuit and Métis. As a result of Budget 2021 investments, Indigenous Services Canada has supported over 100 Indigenous partners and health organizations to implement over 150 Indigenous-led initiatives across Canada. These initiatives work to improve access to high quality and culturally safe health services for Indigenous Peoples across all provinces and territories, and in urban settings. Building on the success from Budget 2021 investments, Budget 2024 has reinvested $167.6 million over the next five years, starting in 2024-25, to continue supporting patient advocates, health system navigators, midwives, and birth support workers, as well as initiatives to increase Indigenous representation in the health professions.

Distinctions-based Indigenous Health Legislation

The 2021 mandate letter for the Minister of Indigenous Services commits 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 2020 Fall Economic Statement announced $15.6 million over 2 years to support this work.

From winter 2021 to fall 2022, regional and national First Nations, Inuit, Métis, and partners with an intersectional lens led numerous engagements with their communities on the vision for distinctions-based Indigenous health legislation. A national summary report, What we heard: Visions for Distinctions-based Indigenous Health Legislation, was published in January 2023.

From fall 2022 to June 2023, ISC supported distinctions-based+ co-development processes, which focused on translating what was heard through engagement into proposed legislative options. In total, 14 co-development tables were launched with First Nations, Inuit, Métis partners, and partners with an intersectional lens. Participation in the co-development tables provided an opportunity to help identify the federal legislative measures necessary for supporting Indigenous-led approaches to improve health equity.

In August 2023, ISC released a “Key Legislative Elements” document, outlining proposed preambular recognitions, purpose, and measures for the bill. The document generated extensive feedback and reaction from First Nations, Inuit, and Métis partners, as well as partners with an intersectional lens. ISC facilitated 27 discussions and received 39 written submissions from partners related to the co-development process, the legislative approach generally, as well as perceived lack of federal commitment in the elements themselves.

Based on the feedback, the Minister of Indigenous Services sought and secured the authority from the Prime Minister for more time, the opportunity to pursue separate and distinct health policy and/or legislative options with First Nations, Inuit, and Métis partners, and to adjust the co-development approach to improve transparency and collaboration with partners.

With the Prime Minister’s authority, Canada continues to meet regularly with interested First Nation, Inuit, and Métis partners, to establish next steps towards improving access to high-quality and culturally-relevant health services.

Health Transformation

Budget 2024 committed $104.9 million over 5 years to support Health Transformation initiatives across Canada. This is in addition to investments from Budget 2018 ($71.1 million over 3 years) and Budget 2021 ($107.1 million over 3 years). This funding continues to support First Nation-led organizations to establish partnerships, build public service capacity, and strengthen provincial partnerships as they prepare to assume control over the design, delivery, management and administration of federally-funded health services. The First Nations Health Authority is the existing example of a First Nations health model that exercises control over the design, delivery and management of federally-funded health services for over 200 communities, and receives direct funding from Canada.

Budget 2024 investments are supporting six active Health Transformation projects that have made significant progress and represent more than 150 First Nations. They are:
• Keewatinohk Inniniw Minoayawin (KIM) Inc. and Southern Chiefs Organization (SCO) in Manitoba;
• Tajikeimɨk in Nova Scotia;
• Nishnawbe Aski Nation in Ontario;
• La Commission de la Santé et des Services Sociaux des Premières Nations du Québec et du Labrador in Quebec; and
• Battleford Agency Tribal Chiefs in Saskatchewan.

Battleford Agency Tribal Chiefs was onboarded in 2023. The remaining projects are further advanced through the Health Transformation process and are actively pursuing service transfer. SCO and KIM signed Agreements in Principle separately with ISC on June 26, 2024 and April 2025. Tajikeimɨk is expect to conclude its Agreement in Principle in the coming months. All three of these partners have stated that they are three to five years from full transfer.

Indigenous Health Equity Fund

Through Budget 2023, the Government of Canada is providing $2 billion over 10 years through the Indigenous Health Equity Fund, which is intended to support distinctions-based, Indigenous-led approaches to increasing access to quality and culturally safe health care services.

Budget 2023 indicated that funding was effective as of 2023-24, but given the time required for engagement with First Nations, Inuit, and Métis partners on the design and implementation of the program, this funding was reprofiled to start in 2024-25 up until 2033-34. This ten-year profile will provide Indigenous partners with a stable, predictable and flexible source of funding to support their health planning and priorities.

The program is divided into two funding streams:
1) Distinctions-Based Funding: $190 million annually (or 95%) is being distributed directly to First Nations, Inuit, and Métis communities in support of their health priorities; and
2) Targeted Initiatives Funding: $10 million annually (or 5%) is being provided to Indigenous organizations to support innovative, and short-term projects focused on targeted priorities, such as Indigenous women’s health and 2SLGBTQQIA+.

In 2024-25, the Indigenous Health Equity Fund’s Targeted Initiatives supported 31 projects based on submissions from a wide range of Indigenous organizations. These projects represent a total expenditure of $11.0M over three years. Funding is supporting a wide range of diverse Indigenous-led priorities, including mental wellness, digital health, women’s health, and anti-Indigenous racism.

Home and Long-Term Care

First Nations and Inuit Home and Community Care Program
A FNIHB flagship program, the First Nations and Inuit Home and Community Care Program (FNIHCC) ) supports Indigenous employers in the provision of a continuum of home and community health care services that are comprehensive, culturally sensitive, and accessible, and that respond to the unique health and social needs of First Nations and Inuit.

Co-developed with the Assembly of First Nations (AFN) and Inuit Tapiriit Kanatami (ITK) in 1999, the FNIHCC program offers primary health care services through Indigenous health service operators. The FNIHCC Program is almost completely transferred with a wide coverage area; 98% of First Nation communities and 100% of Inuit communities, in 624 First Nations and Inuit communities, primarily funded through contribution agreements.It provides a coordinated system of health services that enable First Nations and Inuit of all ages with disabilities, chronic or acute illnesses, and the elderly, to receive the care they need in their homes and communities. Home and Community Care services are delivered primarily by home care registered nurses and trained and certified personal care workers. Service delivery is based on assessed need by a qualified and registered health professional, and follows a case management process.

The objectives of the FNIHCC program are to provide access to a range of home and community care services to First Nations or Inuit community members living in a First Nations or Inuit community; assist First Nations and Inuit living with chronic and/or acute illness in maintaining optimum health, well-being and independence in their homes and communities; ensure that all clients with an assessed need for home care services have access to a comprehensive continuum of services within the community, where possible; assist clients and their families to participate in the development and implementation of the client’s care plan to the fullest extent possible and to utilize community support services where available and appropriate in the care of clients; and continue to build the capacity within First Nations and Inuit communities to facilitate the delivery of home care services that enable program monitoring, evaluation, research, and the definition of best practices.

If pressed on primary healthcare services
• ISC is working hard to fund and deliver quality Clinical Client Care services, Community Oral Health Services and the eHealth Infostructure Program in Indigenous communities across Canada.
• Clinical Client Care services are funded or directly delivered in 79 remote and isolated First Nations communities.
• The eHealth Program provides funding to support the use of digital health/virtual care technologies on First Nation reserves south of 60.
• Community Oral Health Services is delivered in 335 First Nations and Inuit communities.

If pressed on Public Health Care Services / Communicable Diseases
• We are committed to ensuring equitable access to public health services and improving health outcomes for Indigenous populations.
• This includes supporting community-led responses to communicable disease outbreaks, and expanding access to services for tuberculosis, sexually transmitted and blood borne infections, and immunization.
• Improving health outcomes means addressing the social determinants of health and ensuring that services are culturally appropriate. This is why we continue to support preventative care, communicable disease control, and emergency health responses that are tailored to First Nations.

If pressed on Healthy Child Development
• The Government recognizes that a suite of services is needed to ensure that Indigenous children get a good start to life.
• That is why it supports programs and services promoting healthy pregnancies, births, and child development and early learning in First Nations and Inuit communities.
• Improved health outcomes for First Nations and Inuit infants, children, youth, families requires holistic interventions that provide access to supports in the areas of: pre- and post-partum care; pre-conception and reproductive health; nutrition; early literacy and learning; and, physical, emotional and mental health.

If pressed on Indigenous Early Learning and Child Care (Interdepartmental Initiative)
• The Government is committed to working with Indigenous partners on improving outcomes for children.
• That is why the government co-developed the Indigenous Early Learning and Child Care (IELCC) Framework in September 2018 with the Assembly of First Nations, Inuit Tapiriit Kanatami and the Métis National Council.
• The IELCC Framework reflects the unique needs and cultures of First Nations, Inuit and Métis and sets a vision for happy and safe Indigenous children and families, strong cultural identity, and a comprehensive and coordinated system that is anchored in self-determination, centered on children and grounded in culture.

If pressed on Joyce’s Principle
• The government is implementing Joyce's Principle to guarantee to all Indigenous Peoples the right to equitable access to social and health services, and to enjoy the best possible physical, mental, emotional and spiritual health.
• With the government’s support, the Manawan Atikamekw Council representing Joyce’s Nation, created the Joyce’s Principle Office: an organization that promotes Joyce’s Principle and carries out projects in line with its objectives.
• The Government is advancing Joyce’s Principle through Budget 2024 investments that address anti-Indigenous racism in health systems, as well as through the Indigenous Health Equity Fund.

If pressed on Addressing Anti-Indigenous Racism in Health Systems
• Budget 2024 provided new funding of $167.6 million over five years, starting in 2024-25, to combat anti-Indigenous racism in health systems and ensure Indigenous Peoples are treated with the respect and safety they deserve.
• Funding will continue to support Indigenous patient advocates, health system navigators, midwives and birth support workers, as well as initiatives to increase Indigenous representation in the health professions.
• Canada will continue working with provinces, territories and Indigenous leaders to discuss Indigenous health priorities, and investments in culturally relevant and safe health services.

If pressed on Distinctions-based Indigenous Health Legislation
• The government committed to co-developing new distinctions-based Indigenous health legislation to improve access to high-quality and culturally relevant health services, and to foster health systems that will respect and ensure the safety and wellbeing of Indigenous Peoples.
• The feedback received from Indigenous partners called for more time, the opportunity to develop separate First Nations, Inuit, and Métis policy and/or legislative options, as well as more openness and transparency in the co-development process.
• Canada continues to meet regularly with partners to establish next steps towards policy and/or legislative options that will improve access to high-quality and culturally relevant health services.

If pressed on Health Transformation
• Budget 2024 announced $104.9 million in new funding for Health Transformation over five years to continue to support First Nation partners to assume control over health service delivery.
• There has been significant progress made on Health Transformation projects with the signing of Agreements-in-Principle with the Southern Chiefs Organization in southern Manitoba in June 2024 and Keewatinohk Inniniw Minoayawin Inc. in northern Manitoba in March 2025.
• These are concrete examples of First Nations assuming responsibility and exercising self-determination in the delivery of health services and supports and bringing about the systemic change needed in health care to best meet the needs of their communities.

If pressed on Indigenous Health Equity Fund
• Starting in 2024-25, Canada is providing $2 billion over ten years through the Indigenous Health Equity Fund to improve Indigenous access to quality and culturally safe health services.
• This includes $190 million annually in distinctions-based funding for First Nations, Inuit, and Métis health priorities.
• This also includes $10 million annually in targeted initiatives funding for short-term innovative, Indigenous-led health projects.
• Taken together, the Indigenous Health Equity Fund is providing a foundation of predictable, flexible support for Indigenous health priorities.