Page 4: Health Canada – 2014–15 – Departmental Performance Report - Section II

• Previous Page
• Table of Contents
• Next Page

Section II: Analysis of Programs by Strategic Outcome

Strategic Outcome 1: A health system responsive to the needs of Canadians

Program 1.1: Canadian Health System Policy

Description

The Canadian Health System Policy program provides strategic policy advice, research, and analysis to support decision-making on health care system issues, as well as program support to provinces and territories, partners, and stakeholders on health care system priorities.

Mindful of equity, sustainability, and affordability Health Canada collaborates and targets its efforts in order to support improvements to the health care system such as improved access, quality, and integration of health care services.

Through the management of grants and contributions (Gs&Cs) agreements with key pan-Canadian health partners, the Canadian Health System Policy program contributes to priority health issues requiring national leadership and strong partnership.

The program objective is to support innovative health care policy and programs to help Canadians maintain and improve their health.

Performance Analysis and Lessons Learned

Health Canada successfully advanced health care innovation as an area of policy priority, building interest and generating connections in the health care community and other sectors. Health Canada managed new and existing funding agreements that advanced priority health issues, including the following funding:

• $8.1 million over two years to the Ontario Ministry of Health and Long-Term Care for three initiatives supporting internationally educated health professionals and their potential employers.
• $3 million over three years to the Canadian Hospice Palliative Care Association for "The Way Forward" initiative which supported the development of a framework to allow palliative care to be delivered in a broader range of settings and by a variety of providers, which includes best practices, priorities for action and a roadmap for implementation.
• $6.5 million over three years for McMaster University in support of innovative approaches to primary health care through the use of teams, system navigation and Electronic Medical Records (EMR), to ultimately improve health care performance.
• $3 million for a Pallium Foundation of Canada initiative to equip more front-line health care providers with the skills and knowledge needed to provide quality palliative care in a range of settings for people with life-threatening conditions.
• $1.6 million for the Canadian Medication and Incident Reporting and Prevention System project, through the Health Care Policy Contribution Program, to generate evidence on medication incidents in order to improve patient safety.
• $5 million for the first year of a five-year agreement for the Canadian Blood Services (CBS) to work on blood research and development.
• $14.3 million for the Mental Health Commission of Canada in support of public education and awareness on mental health issues, dissemination of mental health data and research, and policy development and collaboration with provinces and territories and mental health stakeholders to improve mental health outcomes of in Canadians. In addition, $2.5 million was provided to the Mood Disorders Society of Canada to develop initiatives to improve the treatment of depression, post-traumatic stress disorder, and other mood disorders.
• $5.4 million to support the Canadian Brain Research Foundation, which is managed by Brain Canada, an organization dedicated to advancing cutting-edge brain research.
• $3.43 million to CBS in the final year of the Organ and Tissue Donation and Transplantation program agreement.

In parallel to funding agreements, Health Canada continued working to modernize processes for the management of Gs&Cs. For example, this included the implementation of a pilot for an automated system for data collection analysis and reporting on performance.

The Department also continued to monitor and analyse pharmaceutical trends and worked with Canadian and international partners to raise the awareness of the impact of high cost drugs on drug expenditure and drug coverage and to explore policy options to manage this pressure more effectively.

Sub-Program 1.1.1: Health System Priorities

Description

Through the Health System Priorities program, Health Canada works closely with provincial and territorial governments, domestic and international organizations, health care providers, and other stakeholders to develop and implement innovative approaches, improve accountability, and responses to meet the health priorities and health services needs of Canadians. Key activities include increasing the supply of health professionals, timely access to quality health care services, and accelerating the development and implementation of electronic health technologies.

The program also manages Gs&Cs agreements on a number of health care priorities, such as Canada Health Infoway (CHI), the Canadian Institute for Health Information (CIHI), Mental Health Commission of Canada, and the Canadian Partnership Against Cancer (CPAC), to support health care services for all Canadians. 

The program objective is to ensure that Canadians have access to quality and cost-effective health care services.

This program uses funding from the following transfer payments: Brain Canada Foundation, Canadian Agency for Drugs and Technologies in Health (CADTH), CIHI, CPAC, Canadian Patient Safety Institute (CPSI), Health Council of Canada, Health Care Policy Contribution Program, Mental Health Commission of Canada, Mood Disorders Society of Canada, CHI, and Canadian Foundation for Health Care Improvement (CFHI).

Performance Analysis and Lessons Learned

In 2014-15, Health Canada continued to provide support and work collaboratively with pan-Canadian health organizations to strengthen healthcare innovation. In particular, the Department:

• Collaborated with CHI to advance electronic health systems, as important components of innovation in healthcare. As of March 2015, 91% of Canadians have components of an EMR available to their health professionals, and close to 20,000 physicians have enrolled in jurisdictional programs for physician office systems. Additional information is available in Infoway's annual report.
• Continued to fund the CPAC, in the amount of $241 million over five-years ending in 2017. CPAC has advanced cancer control in Canada, yielding health system improvements including enhanced development and implementation of knowledge, best practices and guidelines.
• Amended the Health Canada - CIHI agreement with a one year extension to permit them to conduct a strategic planning session and to provide funds for increased monitoring and surveillance of prescription drug abuse.
• Conducted an Evaluation of the Health Information Initiative. Results showed that the Program was successful in increasing awareness and understanding.
• Provided funding and support to the CPSI to advance efforts to improve patient safety and quality in Canada.
• Maintained collaborative working arrangement with the Canadian Foundation for Healthcare Improvement (CFHI), including discussions for renewed federal funding.
• Expanded the mandate of the Common Drug Review (CDR) to cover biologic and orphan drugs and added the pan Canadian Oncology Review (pCODR) program to the CADTH's suite of programs. As a result the review and recommendation approaches for CDR and pCODR can be more effectively aligned and this should over time lead to more consistent formulary listing decisions across participating federal, provincial and territorial jurisdictions.

Sub-Program 1.1.2: Canada Health Act Administration

Description

The administration of the Canada Health Act involves monitoring a broad range of sources to assess the compliance of provincial and territorial health insurance plans with the criteria and conditions of the Act, working in partnership with provincial and territorial governments to investigate and resolve concerns which may arise, providing policy advice and informing the Minister of possible non-compliance with the Act, recommending appropriate action when required, and reporting to Parliament on the administration of the Act. 

The program objective is to facilitate reasonable access to insured health care services without financial or other barriers.

Performance Analysis and Lessons Learned

In line with the Canadian Health System program objective, the aim of the Canada Health Act is to facilitate reasonable access to medically necessary hospital and physician services for all Canadians. The Act sets out the criteria and conditions provinces and territories must comply with to receive the full amount of the Canada Health Transfer they are entitled to during a given fiscal year. 

Canada Health Act compliance issues that are considered for the purpose of this reporting exercise are those that were raised or resolved during the reporting period, as well as ongoing issues that resulted in the application of deductions to Canada Health Transfer payments to a province or territory. Issues are considered concluded once a province or territory has made a commitment to take definitive action to eliminate the circumstances that led to a compliance issue.

For the most part, Canada Health Act compliance issues are related to inappropriate patient charges by providers of insured health services (i.e., hospitals, clinics and physicians). There are albeit fewer instances where one or more Canada Health Act criteria (e.g., comprehensiveness, portability and accessibility) are involved.

The responsibility for ensuring that providers of insured services operate in compliance with the requirements of the Act rests with the provinces and territories. Health Canada does not have jurisdiction over providers of insured services, nor does it have formal investigative powers to collect information on various practices that may be inconsistent with the requirements of the Act. As a result, federal officials must work collaboratively with their provincial and territorial counterparts to investigate and resolve compliance issues. Compliance investigations are complex and often sensitive in terms of privacy. They often require extensive research and negotiations between government officials and providers of services before they can be concluded. 

During 2014-15, six compliance issues were addressed, with four being concluded (67%). Health Canada is still in consultation with the respective provincial health ministries on the two outstanding issues.

Program 1.2: Specialized Health Services

Description

The Specialized Health Services program supports the Government of Canada's obligation to protect the health and safety of its employees and the health of visiting dignitaries.

Health Canada delivers counselling, organizational development and critical incident support services to federal government departments through a network of contracted mental health professionals and also provides immediate response to employees following traumatic incidents in the workplace.

Health Canada delivers medical services to federal public servants who may be exposed to specific health risks due to their type of work. By providing occupational and psycho-social health services to federal public servants, Health Canada pro-actively contributes to reducing the number of work days lost to illness across the federal government.

Health Canada also arranges for the provision of health services for Internationally Protected Persons (IPP) who have come to Canada for international events, such as meetings or official visits by government leaders or the Royal Family. An IPP is a representative of a State, usually Heads of State and/or Government, members of the Royal Family, or officials of an international organisation of an intergovernmental character.

The program objective is to ensure continuity of services and the occupational health of federal public servants who can deliver results to Canadians in all circumstances and to arrange health services for IPPs.

Performance Analysis and Lessons Learned

Health Canada continued to provide occupational health and psycho-social support to public servants to ensure continuity of service to Canadians. The program successfully met its operational targets in Employee Assistance Services (EAS), the Public Service Occupational Health Program (PSOHP) and the IPP health services program.

In 2014-15, Health Canada negotiated additional Interdepartmental Letters of Agreements (EAS service contracts) with the Canada Council for the Arts, Financial Consumer Agency of Canada and the Office of the Communications Security Establishment Commissioner. In addition, in response to a request from Veterans Affairs Canada, EAS services were enhanced to extend the Employee Assistance Program and bereavement services for their populations. Also of note, EAS' trauma response services were provided to federal public servants and their families as a result of the New Brunswick RCMP and Ottawa war memorial shooting incidents.

Health Canada experienced an increase in revenue for EAS from $12.2M in 2013-14 to approximately $14 million in 2014-15. This increase is due in large part to increased interest in EAS services, including the Specialized Organizational Services. As a result of recommendations from the EAS evaluation, a new case management system is being developed to improve data collection and analysis. In addition, EAS continued to monitor and provide input regarding the program's role within the Treasury Board Secretariat (TBS) led Workplace Wellness and Productivity Strategy.

While requests to PSOHP for communicable disease related services decreased, the number of health evaluations completed meets the completion rate for fiscal year 2013-14. In addition, respondents to the PSOHP Client Feedback Survey indicated a 91% satisfaction rate with the quality of services received.

Health Canada developed 100 health contingency plans for IPPs and their families visiting Canada in 2014-15. A new service delivery model was developed for the provision of food surveillance services, resulting in access to more than 30 Environmental Officers across the country. The new model will be fully implemented in 2015-16.  

Health Canada continued to partner with the TBS and other departments to contribute to the Government of Canada's Workplace Wellness and Productivity Strategy. Through its active participation, Health Canada supported the continuous development and improvement of new and existing services and programs for the purpose of maximizing wellness and productivity amongst federal employees.

Program 1.3: Official Language Minority Community Development

Description

The Official Language Minority Community Development program involves the administration of Health Canada's responsibilities under Section 41 of the Official Languages Act. This Act commits the federal government to enhancing the vitality of Official Language Minority Communities (OLMC) and fostering the full recognition and use of English and French in Canadian society.

This program includes: consulting with Canada's OLMC on a regular basis; supporting and enabling the delivery of contribution programs and services for OLMC; reporting to Parliament and Canadians on Health Canada's achievements under Section 41; and, coordinating Health Canada's activities and awareness in engaging and responding to the health needs of OLMC.

The program objectives are to improve access to health services in the minority official language communities and to increase the use of both official languages in the provision of health care services.

This program uses funding from the following transfer payment: Official Languages Health Contribution Program (OLHCP).

Performance Analysis and Lessons Learned

Under the OLHCP, 12 contribution agreements totalling $72.7 million were signed with the following postsecondary institutions for 2014-15 to 2017-18 to train French-speaking health professionals outside Quebec: Association des collèges et universités de la francophonie canadienne; Société éducative de l'Île-du-Prince-Édouard; Université Sainte-Anne; Collège Communautaire du Nouveau-Brunswick; Centre de formation médicale du Nouveau-Brunswick; Université de Moncton; La Cité collégiale; Université Laurentienne de Sudbury; Université  d'Ottawa; Collège Boréal d'arts appliqués et de technologie; Université Saint-Boniface; University of Alberta (Campus Saint-Jean).

An agreement for $16.3 million was signed with McGill University to improve the availability of health professionals for Quebec's English-speaking population.

Agreements totalling $2.7 million were signed, for 2014-15 to 2016-17 to support innovative projects to increase access to healthcare services for Francophones outside of Quebec and Anglophones living in Quebec. The recipients were: Association of Faculties of Medicine of Canada; Health Prince Edward Island; Centre communautaire Sainte-Anne; AMI-Québec; Ottawa Regional Cancer Foundation; La Fédération des parents du Manitoba; Association canadienne française de l'Alberta régionale de Calgary.

With Health Canada's funding support:

• One hundred and fifty (150) health professionals from Quebec completed language training.
• Eight hundred and seventy (870) French-speaking students graduated in health disciplines in 98 postsecondary programs in 11 colleges and universities located outside of Quebec.
• A 2015 evaluation was completed for McGill University on incentive bursaries provided to Quebec English-speaking health system graduates (2011-14), encouraging them to practice in regions outside of Montreal. Findings showed that 88% were practicing in these regions, after completing the stipulated one year period.
• Thirty-eight (38) community-based networking partnerships maintained across Canada, and in 14 health administrative regions of Quebec, supporting collaboration with health services stakeholders to improve access to health services in English and French-speaking communities.
• The Community Health and Social Services Network and the Ministère de la Santé et des Services sociaux partnered to develop accreditation procedures and recommendations for the use of English language interpreters for health and social services in Quebec facilities.
• The Société Santé en français introduced new mental health first aid training adapted to the French-speaking minority communities; these workshops were delivered by the Mental Health Commission of Canada. 
• Health Prince Edward Island is incorporating a language identifier on its provincial health insurance card in order to improve and foster the delivery of health services in French.

Strategic Outcome 2: Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians

Program 2.1: Health Products

Description

The Department of Health Act, and the Food and Drugs Act and Regulations provide the authority for Health Canada to develop, maintain, and implement a regulatory framework associated with a broad range of health products that affect the everyday lives of Canadians, including pharmaceutical drugs, biologics and radiopharmaceuticals, medical devices, and natural health products.

Health Canada verifies that the regulatory requirements for the safety, quality, and efficacy of health products are met through risk assessments, including monitoring and surveillance, compliance, and enforcement activities.

In addition, Health Canada provides evidence-based, authoritative information to Canadians and key stakeholders, including health professionals such as physicians, pharmacists and natural health practitioners, to enable them to make informed decisions.

The program objective is to ensure that health products are safe, effective, and of high quality for Canadians.

Performance Analysis and Lessons Learned

The Canadian health product industry compliance rating was 97%, demonstrating a consistently high level of compliance.

To enhance the integrity of the health product supply chain in Canada and improve the oversight of the ingredients found in health products, the Active Pharmaceutical Ingredients regulations were implemented by Health Canada.

The Protecting Canadians from Unsafe Drugs Act (Vanessa's Law) received Royal Assent in November 2014. It amended the Food and Drugs Act to improve Health Canada's ability to collect post-market safety information, and take appropriate action when a serious risk to health is identified. It includes a new requirement for certain healthcare institutions to provide Health Canada with information on serious adverse drug reactions and medical device incidents.

New information technology infrastructure tools were implemented across all relevant inspection programs to better support inspections, establishment licensing and incident case management. In addition, the Inspection Tracker and the Drug and Health Product Inspection database have been posted online to provide Canadians with information about Health Canada's inspections as well as a snapshot of current inspection issues that Health Canada is monitoring. Health Canada also began creating Inspection Report Cards for all drug inspections and posting them in the Drug and Health Product Inspection database shortly after each inspection.

The "Drug and Health Product Register" was officially launched on February 12, 2015, a new web tool designed to provide Canadians with easy access to consumer-friendly information on medicines and vaccines in order to better ensure the health and safety of themselves and their families.

As part of increasing transparency, the information available on line for Adverse Event reports was changed to make data publically available when that information is submitted as part of an adverse reaction report. The On-line Adverse Event information is updated quarterly.

An evaluation was completed for the Food and Consumer Safety Action Plan. Protecting Canadians from health and safety risks associated with food, consumer products, and health products continues to be a priority of the federal government. Furthermore, the activities initiated under the FCSAP are well-aligned with the strategic outcomes of the partners and with federal roles and responsibilities.

Sub-Program 2.1.1: Pharmaceutical Drugs

Description

The Food and Drug Regulations provide the regulatory framework to develop, maintain and implement the Pharmaceutical Drugs program, which includes pharmaceutical drugs for human and animal use, including prescription and non-prescription drugs, disinfectants, and sanitizers with disinfectant claims.

Health Canada verifies that regulatory requirements for the safety, quality, and efficacy of pharmaceutical drugs are met through risk assessments, including monitoring and surveillance, compliance, and enforcement activities.

In addition, the program provides information to Canadians and key stakeholders, including health professionals, such as physicians and pharmacists, to enable them to make informed decisions about the use of pharmaceutical drugs.

The program objective is to ensure that pharmaceutical drugs in Canada are safe, effective and of high quality.

Performance Analysis and Lessons Learned

The first expected result target was not met as 75% of the submissions received met the regulatory requirements compared to the target of 80%. Health Canada held a workshop with the generic industry focussed on improving the quality of drug submissions. The benefits of this workshop are anticipated to be seen in 2015-16. The second expected result target was met as 80% of identified risks were communicated within the service standard. In April 2014, Health Canada started publishing safety summary reviews to the MedEffect Canada website. The publication of review information and associated risk mitigation outcomes ensures transparency and dissemination of safety information to Canadians. Health Canada has now centralized its risk communications process and is meeting service standards.

Under the commitment to use and integrate foreign regulatory information to assist in health product market authorization reviews, Health Canada took a leadership role in international collaborative activities in the review of generic drugs. Under the International Generic Drug Regulators Program, Health Canada launched an information sharing pilot with the European Union that involves receiving scientific assessments of drug applications seeking marketing authorization in "real time". Under the Australia, Canada, Singapore, Switzerland Consortium, tools such as templates, guidelines, and a common lexicon are being developed to facilitate work sharing. In 2014-15, under the Regulatory Cooperation Council (RCC) initiative, Canada and the United States (U.S.) had one simultaneous veterinary drug approval, and nine drugs submitted for parallel review.

As part of the commitment to improving the safe use of drugs by making drug labels and safety information easier to read and understand:

• The Regulations Amending the Food and Drug Regulations (Labelling, Packaging and Brand Names of Drugs for Human Use) were published in Canada Gazette II in July 2014.
• The revised Guidance for Industry: Drug Brand Name Review was posted on the Health Canada website to provide direction to industry in meeting Look-alike Sound-alike brand name assessment requirement.

As part of the commitment to provide Canadians and medical professionals with the most up-to-date drug safety information, Health Canada has published 20 prescriptions and one non-prescription Summary Safety Reviews in plain language for Canadians.

Sub-Program 2.1.2: Biologics & Radiopharmaceuticals

Description

The Food and Drug Regulations, Safety of Human Cells, Tissues and Organs for Transplantation Regulations, and the Processing and Distribution of Semen for Assisted Conception Regulations provide the regulatory framework to develop, maintain, and implement the Biologics and Radiopharmaceuticals program, which includes blood and blood products, viral and bacterial vaccines, gene therapy products, tissues, organs, and xenografts, which are manufactured in Canada or elsewhere.

Health Canada verifies that regulatory requirements for the safety, quality, and efficacy of biologics and radiopharmaceuticals are met through risk assessments, including monitoring and surveillance, compliance, and enforcement activities.

In addition, the program provides information to Canadians and key stakeholders, including health professionals such as physicians and pharmacists, to enable them to make informed decisions about the use of biologics and radiopharmaceuticals.

The program objective is to ensure that biologics and radiopharmaceuticals in Canada are safe, effective and of high quality.

This program uses funding from the following transfer payments: CBS: Blood Safety and Effectiveness Research and Development, and Contribution to Strengthen Canada's Organs and Tissues Donation and Transplantation System.

Performance Analysis and Lessons Learned

The target for the first expected result was met as 99% of submissions met regulatory requirements. The target for the second expected result was exceeded as 100% of identified risks were communicated. In April 2014, Health Canada started publishing safety summary reviews to the MedEffect Canada website. The publication of review information and associated risk mitigation outcomes ensures transparency and dissemination of safety information to Canadians. Health Canada has now centralized its risk communications process and is meeting service standards.

As part of the commitment to improving the framework for regulating human blood and its components, the final Guidance Document on Blood Regulations was published in October, 2014. The Department continues to assist stakeholders with complying with the Blood Regulations.

All changes in oversight required by the blood regulations have been fully implemented and integrated into ongoing inspection operations.

Although Health Canada planned to modernize the regulatory framework for radiopharmaceuticals by bringing this class of drugs under the Drug Identification Number scheme, the work has been delayed and will be incorporated into broader regulatory modernization work in the upcoming year.

To increase transparency of Health Canada's decisions following reviews, Summary Safety Reviews along with a list of ongoing safety reports were developed and posted.

As a result of recommendations from the Biologics Evaluation, a process was established for post-market groups to solicit feedback from pre-market regarding review recommendations.

Sub-Program 2.1.3: Medical Devices

Description

The Medical Devices Regulations provide the regulatory framework to develop, maintain, and implement the Medical Devices program, which includes medical devices used in the treatment, mitigation, diagnosis, or prevention of a disease or an abnormal physical condition in humans.

Health Canada verifies that regulatory requirements for the safety, quality, and efficacy of medical devices are met through risk assessments, including monitoring and surveillance, compliance, and enforcement activities.

In addition, the program provides information to Canadians and key stakeholders, including health professionals, such as physicians and pharmacists, to enable them to make informed decisions about the use of medical devices.

The program objective is to ensure that medical devices in Canada are safe, effective and of high quality.

Performance Analysis and Lessons Learned

The target for the first expected result was met. For review decisions 96% of applications met regulatory requirements. Efforts to adapt an electronic review environment are underway and manufacturers are now required to submit applications in electronic formats, which should contribute to improved first review performance in 2015-16. The target for the second expected result was met as 100% of identified risks were communicated. In April 2014, Health Canada started publishing safety summary reviews to the MedEffect Canada website. The publication of review information and associated risk mitigation outcomes contributes to transparency and dissemination of safety information to Canadians. Health Canada has now centralized its risk communications process and is meeting service standards.

As part of the commitment to align Health Canada with other international organizations, the Department worked closely with the U.S., Australia, and Brazil on the Medical Device Single Audit Program, a three-year pilot program which began in January 2014, with the goal to provide a single efficient audit of medical device manufacturers. A single regulatory audit that meets the requirements of each jurisdiction will allow more efficient use of resources and result in more timely access to products for Canadians.

Health Canada also participated in an international consortium of regulatory authorities committed to establishing a single audit program helping to enable market access to participating countries.

Health Canada implemented a regional pilot program to align application format requirements with international regulators. A common approach with minimal regional variations may encourage manufacturers to enter the Canadian market improving access for Canadians.

Sub-Program 2.1.4: Natural Health Products

Description

The Natural Health Product Regulations provide the regulatory framework to develop, maintain and implement the Natural Health Products program, which includes herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics, amino acids, and essential fatty acids.

Health Canada verifies that regulatory requirements for the safety, quality, and efficacy of natural health products are met through risk assessments, including monitoring and surveillance, compliance, and enforcement activities.

In addition, the program provides information to Canadians and key stakeholders, including health professionals such as pharmacists, traditional Chinese medicine practitioners, herbalists and naturopathic doctors, to enable them to make informed decisions about the use of natural health products.

The program objective is to ensure that natural health products in Canada are safe, effective and of high quality.

Performance Analysis and Lessons Learned

As a measure of industry applicants' understanding of regulatory requirements, 94% of natural health product submissions reviewed resulted in a new or amended product licence. The performance result is a direct reflection of the Department's collaborative approach to licensing. By maintaining open lines of communication with applicants, the Department helps industry understand and comply with regulatory requirements; as a result, 10,092 natural health products were licensed or amended during the fiscal year.

The sub-program continues to work toward aligning standards of evidence for products of similar risk; thus allowing for reduced red tape and faster market access for industry for some low-risk product groups, such as sunscreens, while continuing to ensure that the health and safety of Canadians remains the priority.

Highlights included:

• Consulting on a revised approach to site licensing, including conducting a small pilot project to evaluate the feasibility and effectiveness of using third parties for assessing the Good Manufacturing Practice compliance status of Natural Health Products sites.
• Consulting on a new Consumer Health Products Framework aimed providing a consistent approach to products of similar risk (natural health products, cosmetics, non-prescription drugs, disinfectants) whereby requirements would be proportional to the benefit, harm, and uncertainty profile of the products.
• Publishing a new Application Management Policy and implementing new service standards (10-30-180 days) for natural health products. A webinar series was offered to assist stakeholder's understanding of the revised policy.

Health Canada continued to publish a six-month activity calendar for Natural Health Products that presents an overview of anticipated review activities, publications, workshops and meetings, including new or updated product monographs.

From lessons learned in other product lines, a significantly increased Natural Health Products file tracking architecture was implemented for signal assessments, Periodic Safety Update Report, Risk Management Plans and ad hoc reviews of Natural Health Products. Also, an initiative was launched to work more closely with pre-market directorates to obtain consensus on risk mitigation actions. These initiatives have allowed the program to surpass the newly established surveillance review target of 90% of files meeting target review deadlines, and has greatly improved the ability to deal with Summary Safety Review development.

Program 2.2: Food Safety and Nutrition

Description

The Department of Health Act and the Food and Drugs Act provide the authority for Health Canada to develop, maintain, and implement a regulatory framework associated with the safety and nutritional quality of food. Food safety standards are enforced by the Canadian Food Inspection Agency.

Health Canada develops and promotes evidence-based, national healthy eating policies and standards for Canadians and key stakeholders, including non-governmental organizations, health professionals, and industry associations to enable all stakeholders to make informed decisions about food and nutrition safety as well as healthy eating.

The program objectives are to manage risks to the health and safety of Canadians associated with food and its consumption, and to enable Canadians to make informed decisions about healthy eating.

Performance Analysis and Lessons Learned

The first performance target is considered to be met (see note above on an equivalent survey result).

The second performance target of 40% was surpassed as a Health Canada research study conducted in January 2015 indicated that 65% of respondents report using Health Canada's Nutrition Facts table "always" or "often" when purchasing food.

Work continued to amend Divisions 15 and 16 of the Food and Drug Act to eliminate redundancies, provide clarity for stakeholders and help realize the efficiencies provided by the new Marketing Authorization authorities for food additives. Regulations for Division 15 were published in Canada Gazette, Part I for public consultation. The proposal aimed to bring together existing rules for contaminants and certain adulterants into a single list that would be incorporated by reference into Division 15 of the Food and Drugs Regulations. The regulations also included a proposal to repeal provisions within Schedule E that limits the sale of saccharin as a top sweetener in Canada.

With respect to assessing and managing the risks associated with the priority chemicals under the Chemical Management Plan, Health Canada:

• Published the draft screening assessment report for Ethyl Carbamate in Canada Gazette, Part I in July 2014.
• Published the draft screening assessment report for Aromatic Azo and Benzidine-based substance grouping (Amaranth, Tartrazine, New Coccine/Orange II) in Canada Gazette, Part I in October 2014.
• Held technical Consultations on arsenic and lead tolerances in fruit juice, fruit nectar, beverages when ready-to-serve, and water in sealed containers.
• Published updated risk management commitments for bisphenol A (BPA) in infant formula in December.

An evaluation was completed for the Food and Consumer Safety Action Plan. Protecting Canadians from health and safety risks associated with food, consumer products, and health products continues to be a priority of the federal government. Furthermore, the activities initiated under the FCSAP are well-aligned with the strategic outcomes of the partners and with federal roles and responsibilities.

Sub-Program 2.2.1: Food Safety

Description

The Food and Drug Regulations provide the regulatory framework to develop, maintain, and implement the Food Safety program.

The program is the federal health authority responsible for establishing standards, policies, and regulations pertaining to food and nutrition safety; as well as for conducting reviews and for assessing the safety of food ingredients, veterinary drugs for food producing animals, food processes, and final foods. The program conducts risk assessments pertaining to the chemical, microbiological, and nutritional safety of foods. In addition, the program plans and implements food and nutrition safety surveillance and research initiatives in support of the Department's food standard setting mandate.

The program objective is to plan and implement food and nutrition safety standards to enable Canadians to make informed decisions about food and nutrition.

Performance Analysis and Lessons Learned

The department exceeded its performance target as 100% percent of all Health Risk Assessment requests from the Canadian Food Inspection Agency and federal/provincial/territorial partners were responded to within service standards.

The Department held a series of informal roundtable discussions and launched an online survey to obtain feedback from Canadian parents and consumers on how to improve the way nutrition information is provided on food labels, followed by a more formal consultation.

Guidance was issued to the food industry on:

• Safe Cooking and Handling Labelling for Raw Ground Meat and Raw Ground Poultry to provide consistent and appropriate safety information to consumers.
• The labelling requirements for Mechanically Tenderized Beef sold in Canada to ensure that industry properly understands the requirements and to ensure that consumers are able to easily identify Mechanically Tenderized Beef and follow the safe cooking instructions provided on the label.

Health Canada developed a format for plain language summaries of Novel Food Decision Documents to provide Canadians with a better understanding of how these foods are approved in Canada. The first plain language summary of a Novel Food Decision Document was published for in March for the Arctic Apple approval.

By leveraging existing service delivery models and solutions developed and implemented within Health Canada, the Department implemented a submission management database to monitor and track its pre-market submissions. The database contains pending and approved submissions for food additives, novel foods and infant formula since April 2014. In addition, a business intelligence tool was implemented in conjunction with the submission management database which provided business analytics and performance reporting capabilities for the three mandatory pre-market submission types above. Further refinements to both tools were also implemented, which will allow the on-boarding of other pre-market submission types in the future.

Sub-Program 2.2.2: Nutrition Policy and Promotion

Description

The Department of Health Act provides the authority to develop, maintain and implement the Nutrition Policy and Promotion program.

The program develops, implements, and promotes evidence-based nutrition policies and standards, and undertakes surveillance and monitoring activities. It anticipates and responds to public health issues associated with nutrition and contributes to broader national and international strategies.

The program works collaboratively with other federal departments/agencies and provincial/territorial governments, and engages stakeholders such as non-government organizations, health professionals, and industry associations to support a coordinated approach to nutrition issues.

The program objective is to target both Canadian intermediaries and consumers to increase knowledge, understanding, and action on healthy eating.

Performance Analysis and Lessons Learned

The Department exceeded its performance targets. An assessment of the use of Canada's Food Guide reported that 89% of targeted stakeholders integrate Health Canada healthy eating knowledge products, policies, and/or education materials into their own strategies, policies, programs and initiatives that reach Canadians. Integration varied across public, private, not for profit sectors.

A more regular review cycle was implemented to ensure Canada's dietary guidance remains scientifically sound, relevant and useful.

During 2014-15, several activities were undertaken to further the implementation of the evidence review cycle:

• The findings from the evidence review cycle were analysed.
• An assessment of the use of Canada's Food Guide was released.
• A stakeholder workshop was hosted at the Canadian Public Health Association's annual conference.

The Department continued to collaborate with stakeholders to help increase Canadians' awareness, understanding and knowledge of healthy eating, including topics such as nutrition labelling, sodium reduction and food skills.

In 2014-15, Health Canada:

• Developed the next phase of the Nutrition Facts Education campaign focusing on Serving Size and the Percent Daily Value.
• Developed and disseminated a tool that assesses partnerships with the food industry to ensure potential conflicts of interest are considered and that benefits outweigh risks. A similar tool was also developed to assess collaboration with researchers.
• Continued to work with provincial/territorial, public health authorities, health organizations and retailers to foster a better understanding of how to increase accessibility and availability of nutritious foods - a commitment in the Curbing Childhood Obesity framework.
• Developed a new tool called the Eat Well Plate, which emphasizes healthy food choices. The Plate concept and related messages aim to help consumers visualize a healthy meal; it conveys proportions of food groups in a healthy eating pattern, with a focus on vegetables and fruit. The accompanying Eat Well Plate e-tool provides consumers with simplified educational messages to help them apply Health Canada's dietary guidance.
• Released new components of the Eat Well and Be Active Educational Toolkit to promote the use and understanding of Canada's Food Guide and Tips to Get Active, including new activity plans, teacher supplements, and improved image gallery and ready to use presentations.
• Provided updates and added new content to the Healthy Eating Toolbox, including Vegetable and Fruit fact sheet, Hydration fact sheet, Healthier Grocery Shopping.

Program 2.3: Environmental Risks to Health

Description

The Canadian Environmental Protection Act and the Department of Health Act provide the authorities for the Environmental Risks to Health program to assess and manage the health risks associated with climate change, air quality, drinking water quality, and chemical substances. This program activity links closely with Health Canada's Health Products, Food Safety and Nutrition, Consumer Product Safety and Pesticides program activities, as the Food and Drugs Act, the Pest Control Products Act, and the Canada Consumer Product Safety Act provide the authority to manage the health risks associated with chemical substances in products in the purview of these program activities.

Key activities include: risk assessment and management as well as research and bio-monitoring of chemical substances; provision of technical support for chemical emergencies that require a coordinated federal response; development of guidelines on indoor and outdoor air quality; development and dissemination of water quality guidelines; and, supporting the implementation of heat alert and response systems (HARS) in Canadian communities.

The program objective is to protect the health of Canadians through the assessment and management of health risks associated with chemical substances and to provide expert advice and guidelines to partners on the health impacts of environmental factors such as air and water contaminants and a changing climate.

Performance Analysis and Lessons Learned

Health Canada protected the health of Canadians through the assessment and management of health risks associated with chemical substances, and provided expert advice and guidelines to partners on the health impacts of environmental factors such as air and water contaminants and a changing climate.

Health Canada continued to implement the Chemicals Management Plan (CMP). For existing substances, five final risk management instruments, covering six substances, were published for substances deemed harmful to human health (and three of these five instruments covering four substances met the timeframe of publication for final risk management instruments within 18 months following publication of the proposed instrument). For new substances, seven substances were determined to be potentially harmful to human health and 100% of these substances had at least one risk management instrument developed within the mandated timeframe. Combined results for existing substances and new substances risk management reflected 11 of 13 (85%) substances risk managed in 2014-15, with the final two substances currently undergoing internal approval.

In 2014-15, the Department also conducted health risk assessments, health benefit analysis, research and outreach in support of the development of Residential Indoor Air Quality Guidelines, regulations to reduce emissions from transportation as well as proposed health-based Canadian Ambient Air Quality Standards (CAAQS) for sulphur dioxide and nitrogen dioxide, and increased coverage and awareness of the Air Quality Health Index (AQHI). Health Canada also protected the health of Canadians by finalizing five health-based drinking water guidelines/guidance documents approved by provinces/territories and six guidance documents for contaminated sites. For environmental assessments, three out of five guidance documents were completed and await publication (Air Quality, Water Quality and Radiological Effects), while the remaining two are undergoing internal approval. In summary, 18 of 20 guidance materials were completed in 2014-15, accounting for the 90% actual completion rate.

Sub-Program 2.3.1: Climate Change and Health

Description

The Climate Change and Health program supports actions to minimize the impact of climate change on the health of Canadians under the federal Clean Air Agenda.

A key activity in the delivery of this program is the Heat Resiliency Project, which aims to inform and advise public health agencies and Canadians on adaptation strategies to respond to extreme heat events.

This includes: development of community-based HARS; development and dissemination of training tools, guidelines, and strategies for health professionals; collaboration with key stakeholders and partners to assess and reduce vulnerabilities to extreme heat; and scientific research on health impacts of extreme heat to support evidence based decision-making.

The program objective is to help Canadians adapt to a changing climate through measures intended to manage potential risks to their health associated with extreme heat events.

Performance Analysis and Lessons Learned

The program met its target of 12 communities with HARS. Extreme heat poses a growing risk to the health and well-being of Canadians, as climate change is expected to produce heat events with greater intensity, frequency and duration. By implementing appropriate preparation measures such as effective HARS, the health risks of extreme heat can be minimized. In support of the previous fiscal year results, Health Canada shifted its efforts from supporting the development of community-based HARS in at-risk communities to the development of provincial-level systems that would complement the system that is continuing to be supported in Manitoba.

The program continued to assist public health authorities to gain knowledge and prepare to address health impacts during extreme heat events. In 2014-15, research continued with Ontario and Alberta identifying public health actions that should be triggered when a heat alert is declared. In addition, the program worked with 10 Ontario public health authorities and the Pan American Games organising committee to establish heat alert and communications tools to protect athletes and spectators from heat-related illness. This project will inform the broader goal of establishing a provincially consistent approach to HARS in Ontario.

The program also supported knowledge translation and capacity building on an international scale. In conjunction with the Pan American Health Organisation, Health Canada provided assistance to the small island state of Dominica to conduct a climate change and health vulnerability assessment. Within a North American context, the program continued to coordinate the North American Climate Change and Human Health Working Group. This unique group is able to convene policy leads on climate change, human health and meteorological information between Canada, U.S. and Mexico in order to coordinate research, build capacity and exchange information.

Leveraging data collected during heat events was also explored with key partners. These partners were engaged in the interest of data exchange and development to optimize public health activities leading up to and during heat events.

Enhancing community resiliency to extreme heat involves participation of all levels of government and the general public. Success in this program is due to the acknowledgement that the collaborative processes between federal and provincial and local governments, involving a wide range of stakeholders, have been the key to developing HARS, as well as providing technical advice to public health and health professionals.

Sub-Program 2.3.2: Air Quality

Description

The Air Quality program assesses the health risks of indoor and outdoor pollutants, and develops guidelines and standards under the Canadian Environmental Protection Act, 1999. These efforts support the Government of Canada's Clean Air Regulatory Agenda, implemented in partnership with Environment Canada, to manage the potential risks to the environment and to the health of Canadians associated with air quality.

The program provides health-based science and policy advice that supports actions by all levels of government to improve air quality and health of Canadians. Key activities include: leading the development of health-based air quality standards and guidelines for indoor and outdoor air; determining the health benefits of proposed actions to reduce air pollution; conducting research on the levels of exposure and health effects of indoor and outdoor air pollutants to inform the development of standards, guidelines, regulations and other actions; and, implementing the AQHI in partnership with Environment Canada.

The program objective is to assess the impacts of air pollution on health and to provide guidance to governments, health professionals and the general public on how to minimize those risks.

Performance Analysis and Lessons Learned

The ongoing roll out of the AQHI across Canada and other public outreach products improves the ability of Canadians to manage and reduce their exposure to air pollutants on a day-to-day basis. Progress was made to increase the percentage reach to 69%. The expectation is for AQHI's reach to increase to 80% of Canadians by March 31, 2016.

Early and ongoing engagement of all levels of government, non-governmental organizations and industry continues to be essential to ensuring effective actions to address air quality. In 2014-15, Health Canada continued to support implementation of the national Air Quality Management System (AQMS) by: co-leading the multi-stakeholder development of a new CAAQS for sulphur dioxide; conducting health risk assessments to support upcoming development of a CAAQS for nitrogen dioxide; and reviewing the current 2020 standards for fine particulate matter and ozone. As well, the Department worked with Environment Canada and provincial and territorial partners on the implementation of the 2014-17 workplan for the Mobile Sources Working Group under the AQMS to address air pollutants from mobile sources (e.g. motor vehicles).

Health Canada also provided significant monitoring infrastructure, knowledge transfer, and health advice to support local management of the Iqaluit waste facility fire, as part of our on-going support of and cooperation with provincial and territorial partners in response to emergency events.

Significant progress was made on a number of health risk assessments, including diesel fuel, nitrogen dioxide and acetaldehyde, although these progressed more slowly due to the complexities of the analyses. A generic, industrial sector assessment methodology and a rapid screening technique for volatile organic compounds (VOC) were used to improve the efficiency of carrying out certain health assessments. Health Canada also initiated a process to develop a standard to manage VOC emissions from certain building products, led by the Canadian Standards Association.

The air program did not fully meet planned targets for providing health guidance to reduce the risks posed by air pollutants as a number of urgent issues required reallocation of resources, including providing significant monitoring and health advice to support local management of the Iqaluit waste facility fire. There were also additional complexities in risk assessments and re-scheduling of risk management actions by our partners that resulted in delays in completing work in anticipated timelines.

A number of research studies demonstrated improved air quality through the application of ventilation intervention strategies, one of which was quickly implemented by the Ottawa-Carleton District School Board. Continued publication of study results in credible scientific journals ensures that Health Canada science contributes to the body of knowledge on the impacts of air quality on health.

Research on air quality and health generated 95 (100% of planned) knowledge transfer activities including client meetings, reports, publications and presentations. For example, the Canadian Census Health and Environment Cohort study (CanCHEC), a national study examining the long-term effects of exposure to combustion-related pollution from outdoor sources conducted in Canada, provided evidence that was instrumental in developing new CAAQS for fine particulate matter (PM2.5) at levels lower than previously thought to be of concern for health (i.e. 10 ug/m3).

Sub-Program 2.3.3: Water Quality

Description

The Water Quality program works with key stakeholders and partners such as the provinces and territories, under the authority of the Department of Health Act, to establish guidelines for Canadian drinking water quality, as well as recreational water and household reclaimed water. These guidelines are used by provinces and territories as the basis for establishing their water quality requirements.

The program also works with national and international standard-setting organizations to develop health-based standards for materials that come into contact with drinking water, and works with partners to develop strategies and tools to enhance the safety of small community drinking water supplies.

In the delivery of this program, key activities include the development and dissemination of water quality guidelines/technical guidance documents, strategies and other tools.

The program objective is to help manage potential risks to the health of Canadians associated with water quality.

Performance Analysis and Lessons Learned

The Water Quality program met its target of five final drinking water quality guidelines/guidance documents approved by provinces and territories. They are: toluene, ethylbenzene, xylenes, tetrachloroethylene (guidelines); and boil water advisories (guidance document). These guidelines are used as the basis for drinking water quality requirements across Canada. In order to achieve this commitment on an ongoing basis, the program works on 20-30 risk assessments simultaneously at any one time. This involves multiple partners/stakeholders to review and discuss scientific, technical and practical aspects for the active risk assessment documents at various stages of development.

The Department, in collaboration with Public Health Agency of Canada (PHAC), also continued to expand the Canadian Network of Public Health Intelligence's drinking water application to more locations. The drinking water application tracks drinking water advisories and the reasons for which they were issued. This will allow the Department to identify trends over time, including reasons for advisories.

Sub-Program 2.3.4: Health Impacts of Chemicals

Description

The Canadian Environmental Protection Act, 1999 provides the authority for the Health Impact of Chemicals program to assess the impact of chemicals and manage the potential health risks posed by new and existing substances that are manufactured, imported, or used in Canada. This program activity links closely with Health Canada's Health Products, Food Safety and Nutrition, Consumer Product Safety and Pesticides program activities, as the Food and Drugs Act, the Pest Control Products Act, and the Canada Consumer Product Safety Act provide the authority to manage the health risks associated with chemical substances in products in the purview of these program activities.

The Chemicals Management Plan (CMP), implemented in partnership with Environment Canada, sets priorities and timelines for risk assessment and management for chemicals of concern, as well as the supporting research and bio-monitoring initiatives.

In addition to the above risk assessment and management activities, this program provides expert health-based advice and support to other federal departments in carrying out their mandates as well as provides technical support for chemical emergencies that require a coordinated federal response.

The program objective is to identify and manage health risks to Canadians posed by chemicals of concern.

Performance Analysis and Lessons Learned

In 2014-15, Health Canada continued to implement the CMP. Through the substance groupings and rapid screening initiatives, Health Canada completed draft screening assessment reports (DSARs) for 1,057 substances - 70% of the overall goal of 1,500 substances by March 31, 2016, bringing the cumulative total to 95% as of March 31, 2015. In addition, the cumulative completion rate for final screening assessment reports (FSARs) reached 28% by March 31, 2015. Health Canada is targeting to have the FSARs for approximately 90% of the 1,500 substances published by March 31, 2016.

100% (501) of new substances to the Canadian market were also assessed within targeted timelines in 2014-15. Furthermore, 100% (7) of new substances assessed to be harmful to human health had control measures developed within mandated timeframes. Success was due to the existence of a developed program, early identification of priorities and performance targets, ongoing tracking of progress and adjustment of resources as needed to meet targets.

In 2014-15, analysis of data received under the second phase of the Domestic Substances List Inventory Update (DSL IU2) was completed. The data is being used to update the commercial status of the substances that are remaining priorities for assessment; inform the priority setting for the next phase of the CMP; and support subsequent risk assessment and risk management activities where appropriate.

Health Canada completed 100% (365) of planned knowledge transfer activities such as client meetings, reports, publications and presentations in support of research and monitoring and surveillance activities for the CMP. For example, seven journal articles were published related to the Maternal-Infant Research on Environmental Chemicals study, a national biomonitoring study studying the exposure of pregnant women and their children to priority environmental contaminants and the potential health effects.

The implementation of the Phoenix information and workflow management software has helped the program meet these goals. Communication of progress to stakeholders in a meaningful way was also important, as was the understanding that different stakeholders engage and/or take proactive action at different stages of the CMP cycle. The publication of a regular CMP progress report has been well received by stakeholders as well.

Environmental Assessment and Federal Contaminated Sites Programs

The Environmental Assessment Program provided support and advice on 69 out of 74 projects across the country currently undergoing environmental assessment review (~45 in 2014-15), on effects related to air and water pollution, the contamination of country foods and exposure to noise and radiation. Under the Federal Contaminated Sites Action Plan (FCSAP), Health Canada met all the targets set for the provision of site-specific advice to federal Custodian departments for the assessment, mitigation and risk management of legacy contaminated sites to reduce risks to human health and federal liabilities.

Program 2.4: Consumer Product and Workplace Chemical Safety

Description

The Consumer Product and Workplace Chemical Safety program supports efforts to protect Canadians from unsafe products and chemicals.

The Consumer Product Safety program supports industry's responsibility for the safety of their products and consumers' responsibility to make informed decisions about product purchase and use, under the authorities of the Canada Consumer Product Safety Act and the Food and Drugs Act and its Cosmetic Regulations. Health Canada's efforts are focussed in three areas: active prevention; targeted oversight; and, rapid response.

The Hazardous Products Act and the Hazardous Materials Information Review Act provide the authorities for the Workplace Chemical Safety program to maintain a national hazard communication standard of cautionary labelling and material safety data sheets for hazardous chemicals supplied for use in Canadian workplaces and to protect related confidential business information.

The program objectives are to protect Canadians by managing the potential health and safety risks posed by consumer products and cosmetics in the Canadian marketplace and from hazardous chemicals in the workplace.

Performance Analysis and Lessons Learned

In 2014-15, Health Canada took action on non-compliant consumer products and cosmetics approximately 96% of the time within the service standard, much higher than the expected target of 85%. Health Canada continued to monitor the efficiency of its risk management operational procedures to ensure prompt action is taken to reduce the risks posed by dangerous consumer products and cosmetics in the Canadian marketplace. In the spirit of regulatory openness and transparency, Health Canada began posting the results of its cyclical enforcement activities on the web so that compliance information is readily available to the Canadian public. Additionally, a new enforcement approach was piloted at Canada's ports of entry to implement more active prevention techniques in the cyclical enforcement projects, and new inspection approaches were initiated to further evaluate the ability of industry to meet Canada Consumer Product Safety Act requirements.

Health Canada provided protection of industry confidential business information in accordance with the requirements of the Hazardous Materials Information Review Act, while also ensuring critical health and safety information was available to workers. The Globally Harmonized System (GHS) of Classification and Labelling of Chemicals for workplace chemicals was implemented on February 11, 2015 as part of the Canada-U.S. RCC Action Plan. The implementation of the GHS delivers on the RCC's key initiatives of reducing the regulatory compliance burden, increasing protection of workers, and supporting cooperation with major trading partners.

Sub-Program 2.4.1: Consumer Product Safety

Description

The Canada Consumer Product Safety Act and the Food and Drugs Act and its Cosmetic Regulations provide the authorities for this program to support industry's responsibility for the safety of their products and consumers' responsibility to make informed decisions about product purchase and use. Health Canada's efforts are focussed in three areas: active prevention; targeted oversight; and, rapid response.

Through active prevention, the program works with industry, standard setting bodies and international counterparts to develop standards and guidelines and share best practices as appropriate. The program also promotes consumer awareness of the safe use of certain consumer products to support informed decision-making.

Through targeted oversight, the program undertakes regular cycles of compliance and enforcement in selected product categories, and analyses and responds to issues identified through mandatory reporting, market surveys, lab results and other means.

Under rapid response, when an unacceptable risk from consumer products is identified, the program can act quickly to protect the public and take appropriate enforcement actions - including issuing consumer advisories, working with industry to negotiate recalls or other corrective measures.

The Program's objective is to manage the potential health and safety risks posed by consumer products and cosmetics in the Canadian marketplace.

Performance Analysis and Lessons Learned

Health Canada develops and makes available online numerous guides for industry including Small and Medium-sized Enterprises to help them better understand their obligations under the Canada Consumer Product Safety Act and its regulations.

In January 2015, Health Canada released an Industry Guide for the Classification of Cribs, Cradles, Bassinets and Related Products. This guide was in response to a need identified by industry to provide direction on classifying products according to the definitions for "crib", "cradle" and "bassinet" under the Cribs, Cradles and Bassinets Regulations. Members of industry were surveyed on the effectiveness of the Guide. 100% of respondents agreed that the Guide increased their understanding of how to classify their product as per the definitions in the regulations and 91% of respondents agreed that the information was presented in a clear and organized manner.

Health Canada triaged mandatory and voluntary reports to detect potentially unsafe consumer products and cosmetics at the earliest stage possible. These reports were then sent for appropriate risk assessment, risk management or placed under surveillance. In 2014-15, Health Canada received 1,924 reports (61% from industry, 39% from consumer) and triaged 99% of these reports within the service standard, exceeding the performance target of 90%.

Partnering with the U.S and Mexico, Health Canada led the development of joint presentations at two key North American consumer product trade shows - the first time the three agencies have worked together on a technical presentation to industry members. A trilateral presentation on strollers took place at the ABC Kids Expo in Las Vegas in September 2014, while Canada-U.S. toy safety was presented at the North American International Toy Fair in New York City in February 2015. All three countries also participated in an OECD international outreach campaign on button batteries and laundry detergent packets. In support of continued international cooperation on cosmetic regulations, Health Canada hosted the 8^th International Cooperation on Cosmetic Regulation (ICCR) meeting in July of 2014, with representation from the U.S., Japan, the European Union, Brazil and China.

The risk-based approach across all sub-program activities was advanced. The Consumer Product Safety Risk Assessment Framework was developed in December 2014 and the summary was posted on the Health Canada website in March 2015. The sub-program continues to strengthen its surveillance reports and ad hoc analytical activity requests to inform its outreach and compliance and enforcement activities.

Sub-Program 2.4.2: Workplace Chemical Safety

Description

The Hazardous Products Act and the Hazardous Materials Information Review Act provide the authorities for this program to protect the health and safety of Canadian workers.

Under the Hazardous Products Act, Health Canada regulates the sale and importation of hazardous chemicals used in Canadian workplaces by specifying the requirements for cautionary labelling and material safety data sheets.

Under the Hazardous Materials Information Review Act, Health Canada administers a timely mechanism to allow companies to protect confidential business information, ensuring industry competitiveness, while requiring that all critical hazard information is disclosed to workers.

This program sets the general standards for the Workplace Hazardous Materials Information System (WHMIS) - a system based on interlocking federal, provincial, and territorial legislation that ensures the comprehensibility and accessibility of labels and material safety data sheets, the consistent application of classification and labelling criteria, and the alignment across Canada of compliance and enforcement activities.

The program objective is to ensure a coordinated national system that provides critical health and safety information on hazardous chemicals to Canadian workers.

Performance Analysis and Lessons Learned

Of the completed claims for exemption under the Hazardous Materials Information Review Act, 77% were registered within the seven-day service standard over the course of the year. Organizational and business process changes implemented through the course of 2014-15 resulted in some initial delays given the adjustments that needed to be made. However, the process improvements were evident by the last quarter, during which 94% of claims were registered within the seven-day service standard. These process improvements will ultimately improve Health Canada's ability to meet the performance target of 100% for the registration of claims for exemption under Hazardous Materials Information Review Act.

On February 11, 2015, the Government of Canada published the Hazardous Products Regulations in the Canada Gazette, Part II which, in addition to the amendments made to the Hazardous Products Act, modified the WHMIS 1988 to incorporate the GHS for workplace chemicals (WHMIS 2015). By adopting the GHS, Canada has achieved the Canada- U.S. RCC Joint Action Plan objective of reducing trade barriers and providing benefits for all stakeholders by reducing costs for suppliers, and ensuring employers and workers have access to consistent and coherent hazard information. The two countries will continue to align and synchronize the implementation of the GHS.

Program 2.5: Substance Use and Abuse

Description

Under the authority of several Acts, the Substance Use and Abuse program regulates tobacco products and controlled substances.

Through the Tobacco Act and its regulations the program regulates the manufacture, sale, labelling and promotion of tobacco products. The program leads the Federal Tobacco Control Strategy (FTCS), the goal of which is to further reduce the prevalence of smoking through regulatory, programming, educational and enforcement activities.

Through the Controlled Drugs and Substances Act and its regulations, the program regulates access to controlled substances and precursor chemicals to support their legitimate use and minimize the risk of diversion for illicit use. As a partner department under the National Anti-Drug Strategy (NADS), the program supports prevention, health promotion, treatment initiatives, and enforcement with the goal of reducing substance use and abuse.

In addition, the program provides timely, evidence-based information to key stakeholders including, but not limited to, law enforcement agencies, health professionals, provincial and territorial governments and Canadians.

The program objective is to manage risks to the health of Canadians associated with the use of tobacco products, and the illicit use of controlled substances and precursor chemicals.

Performance Analysis and Lessons Learned

Health Canada has continued to make progress on priorities related to tobacco control and combatting substance use and abuse. 

The first biennial Canadian Tobacco, Alcohol and Drugs Survey 2013 was released in February 2015. The survey, conducted by Statistics Canada on behalf of Health Canada, focuses on smoking behaviors, alcohol use, illicit drug use, and prescription drug abuse in Canadians 15 years of age and older.

Few other countries have been as successful as Canada in lowering smoking rates and shifting public attitudes about tobacco. Smoking prevalence is now at its lowest-ever overall rate. The 2013 survey results found that 15% of Canadians were current cigarette smokers, down from 22% in 2001 and the lowest national smoking rate ever recorded. Further, the prevalence rate for teens aged 15-17 is 6%, the lowest it has ever been. 

The 2012-17 FTCS refocused activities in tobacco control to continue the downward trend in smoking prevalence, including investments in new priorities for young adults and First Nations and Inuit populations with higher smoking rates. Health Canada, which leads the FTCS, undertook a variety of regulatory, programming, educational and enforcement activities to further reduce smoking prevalence.

Health Canada also continued to undertake a wide range of activities with respect to controlled substances through the Controlled Drugs and Substances Act and under the federal NADS, which was expanded in 2014 to include prescription drug abuse. Activities in 2014 focussed on ongoing enforcement of the Controlled Drugs and Substances Act, raising public awareness about the harmful effects of prescription drug abuse and marijuana, and providing support for the development of tools and community-based initiatives focussed on the prevention and treatment of illicit drug use and prescription drug abuse. 

The 2013 survey results found that the use of at least one of six illicit drugs in the past 12 months (cannabis, cocaine or crack, speed, ecstasy, hallucinogens or heroin) was reported by 11% of Canadians, and is not different from 2012. 25% of youth (aged 15-24) also reported using psychoactive drugs at least once in the past 12 months. The most commonly reported illicit drugs after cannabis (cocaine/crack, meth/crystal meth, ecstasy, hallucinogens, salvia, inhalants, heroin and pain relievers, stimulants or sedatives) were estimated to be less than 1%. There were no changes in prevalence of use of any of these drugs individually, between 2013 and 2012.

Sub-Program 2.5.1: Tobacco

Description

The Tobacco Act provides the authority for the Tobacco program to regulate the manufacture, sale, labelling, and promotion of tobacco products.

The program also leads the FTCS, in collaboration with federal partners as well as provincial and territorial governments, which supports regulatory, programming, educational and enforcement activities.

Key activities under the Strategy include: compliance monitoring and enforcement of the regulations under the Tobacco Act and associated regulations; monitoring tobacco consumption and smoking habits; and, working with national and international partners to ensure that Canada meets its obligations under the Framework Convention on Tobacco Control.

The program objective is to prevent the uptake of tobacco use, particularly among youth, help those who currently use tobacco to quit and protect Canadians from exposure to tobacco smoke.

Performance Analysis and Lessons Learned

National smoking rates continue to be at their lowest level ever recorded. In 2014-15, Health Canada provided funding to provinces and territories to support the pan-Canadian, toll-free Quitline number and portal, and continued to work with First Nation communities as well as partners in the public and private sectors on projects to promote healthy living and prevent chronic diseases caused by tobacco.

Health Canada, in collaboration with the Canadian Cancer Society, also launched the "Break it Off Campaign" in Vancouver in January 2014 during National Non-Smoking Week. The Break it Off Campaign is a young adult tobacco cessation, awareness and marketing campaign that will run until 2017.

Health Canada also conducted compliance monitoring and enforcement activities pursuant to the Tobacco Act. Inspections found 4% of regulated tobacco products examined were non-compliant with the Tobacco Act and its regulations.

Health Canada distributed over 80,699 tobacco publications and responded to over 500 public enquiries on tobacco issues in 2014-15. Furthermore, Health Canada contributed, as a key facilitator, to the working group report on the implementation of Articles 9 and 10 of the tobacco product regulations and disclosure of the Conference of the Parties to the World Health Organization Framework Convention on Tobacco Control.

Finally, the proposed Order Amending the Schedule to the Tobacco Act and the associated Regulatory Impact Analysis Statement was pre-published in the March 7, 2015 edition of the Canada Gazette, Part I. The proposal concerns the protection of youth from inducements to use tobacco products by further limiting the availability of flavoured cigar types that are attractive to youth.

Sub-Program 2.5.2: Controlled Substances

Description

Through the administration of the Controlled Drugs and Substances Act and its regulations, the program authorizes the possession, production, provision and disposition of controlled substances and precursor chemicals.

Key activities include: maintaining and updating the Schedules for controlled substances and precursor chemicals; administering regulations for licensing and compliance monitoring activities; analyzing seized materials; providing training and assistance in investigating and dismantling of clandestine laboratories (Drug Analysis Services); monitoring the use of drugs through surveys; and working with national and international partners in the development of sound and scientifically based recommendations for the analysis of Illicit drugs available to Drug Analysis Laboratories worldwide.

As a partner in the NADS, Health Canada supports initiatives related to illicit drugs including: education; prevention; health promotion; and treatment for Canadians, as well as compliance and enforcement initiatives.

The program objective is to authorize legitimate activities with controlled substances and precursor chemicals, while managing the risks of diversion, abuse and associated harms.

This program uses funding from the following transfer payments: Drug Strategy Community Initiatives Fund, Drug Treatment Funding Program, and Grant to the Canadian Centre of Substance Abuse.

Performance Analysis and Lessons Learned

Pursuant to its role as a regulator under the Controlled Drugs and Substances Act, Health Canada continued to conduct annual compliance monitoring and enforcement activities for controlled substances and precursor chemicals. Less than 1% of inspected parties were found to be non-compliant with the Controlled Drugs and Substances Act and its regulations.

In 2014-15, 46 projects were supported under the Drug Strategy Community Initiative Fund (DSCIF), including 6 projects targeting the prevention of prescription drug abuse. Projects reported reaching over 89,400 youth, parents, teachers and other community organizations and individuals. A 2014-15 evaluation of DSCIF concluded that DSCIF was successful at enhancing capacity among targeted populations; reducing risk-taking behaviours associated with substance use; increasing the uptake of health promotion, prevention knowledge and resources; and increasing community engagement. The program has begun actions for all areas identified in the management response and action plan.

Limited performance data was available in 2014-15 to support reporting against the Drug Treatment Funding Program (DTFP) outcomes due to the majority of 13 contribution agreements being signed late in the fiscal year. However, some projects reported improved collaboration and knowledge exchange and access to evidence-informed information. Projects have also reported consulting over 1,700 individuals reaching over 40,000 individuals.

In late 2014-15, DSCIF and DTFP were merged into one program - the Anti-Drug Strategy Initiatives (ADSI).

Health Canada undertook consultations related to regulating tamper-resistant properties for prescription drugs at high risk of abuse, and for regulating dangerous precursor chemicals and synthetic drugs.

Health Canada also continued to implement the new Marihuana for Medical Purposes Regulations (published in the Canada Gazette, Part II in June 2013). As part of the ongoing implementation, the Program carried out significant compliance and enforcement activities, including conducting regular unannounced inspections. For 2014-15, 246 inspections were conducted. In addition, there were five recalls of dried marijuana, and 22 warning letters were sent regarding non-compliant advertising activities.

Health Canada supported the parliamentary process for Bill C-2, which amended the Controlled Drugs and Substances Act to set out specific criteria that applicants must address before seeking an exemption from Health Canada to create a supervised consumption site.

Health Canada also launched a new public awareness campaign that focused on drug abuse issues.

Program 2.6: Radiation Protection

Description

The Department of Health Act, the Radiation Emitting Devices Act, and the Comprehensive Nuclear-Test-Ban Treaty Implementation Actprovide the authority for the Radiation Protection program to monitor, regulate, advise, and report on exposure to radiation that occurs both naturally and from man-made sources. In addition, the program is licensed under the Canadian Nuclear Commission's Nuclear Safety and Control Actto deliver the National Dosimetry Service, which provides occupational radiation monitoring services.

The key components of the program are environmental monitoring, provision of technical support for a radiological/nuclear emergency that requires a coordinated federal response, occupational safety, and regulation of radiation emitting devices.

The program objective is to inform and advise other government departments, international partners, and Canadians in general about the health risks associated with radiation, and inform Canadians of strategies to manage associated risks.

Performance Analysis and Lessons Learned

Heath Canada completed the targeted number of guidance documents, which were used to support National Radon Program outreach activities and to increase Canadians' awareness and understanding of risks related to radiation emitting devices.

The Department continued to increase awareness of the risks, health impacts and mitigation strategies related to exposure to indoor air contaminants. Health Canada supported and participated in the 2^nd annual National Radon Action Month in November 2014 led by the New Brunswick Lung Association. The aim is to encourage all Canadians to test the levels of radon gas in their homes, and to reduce the radon levels if necessary

In support of increasing Canadians' awareness and understanding of risks related to radiation emitting devices, Health Canada concluded and published its preliminary findings from the Wind Turbine Noise and Health Study. In addition the Department updated its Radiofrequency Exposure Guidelines in a document entitled: Limits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHz - Safety Code 6 (2015). This code is accompanied by the Technical Guide for Interpretation and Compliance Assessment of Health Canada's Radiofrequency Exposure Guidelines, to assist users in understanding and assessing the safety of electromagnetic exposures in working and living environments.

Health Canada is also the lead federal department responsible for coordinating the response to a nuclear emergency under the Federal Nuclear Emergency Plan (FNEP). As part of a series of exercises to test the revised FNEP, 5^th edition, a national-level emergency preparedness exercise (Exercise Unified Response) was conducted in May 2014. Exercise Unified Response successfully validated the FNEP and results from this exercise will be used to identify areas for improvement, implement corrective actions, and support ongoing nuclear emergency preparedness.

Sub-Program 2.6.1: Environmental Radiation Monitoring and Protection

Description

The Environmental and Radiation Monitoring and Protection program conducts research and monitoring activities under the authority of the Department of Health Act and the Comprehensive Nuclear-Test-Ban Treaty Implementation Act. The program covers both naturally occurring forms of radioactivity and radiation, such as radon, and man-made sources of radiation, such as nuclear power.

In the delivery of this program, key activities include: implementing an education and awareness program on the health risks posed by radon in indoor air and how to reduce those risks; conducting research and risk assessment on the health effects of radiation; installing and operating monitoring stations to monitor for evidence of any nuclear explosion; and, reporting to the Comprehensive Nuclear-Test-Ban Treaty Organization and the International Atomic Energy Agency.

This program is also responsible for coordinating the FNEP. In the case of a radio-nuclear emergency that requires a coordinated federal response, Health Canada coordinates the federal technical/scientific support to provincial and territorial. 

The program objectives are to monitor and help inform Canadians of potential harm to their health and safety associated with environmental radiation.

Performance Analysis and Lessons Learned

As lead department for coordinating the federal response to a nuclear emergency, Health Canada conducted a number of exercises and drills, including a national-level exercise (Exercise Unified Response), to identify any problems, inadequacies, or gaps in preparedness and response plans so that these issues could be resolved prior to a real emergency. In preparation for the Pan-American and Para-Pan American Games to be held in July and August 2015 there were a number of meetings, drills and exercises to test arrangements and confirm roles and responsibilities, as well as training on emergency management applications.

Health Canada continued to meet international and national requirements related to environmental radiation monitoring. Environmental radiation monitoring activities support Canada's obligations under the Comprehensive Nuclear-Test-Ban-Treaty. 98% of national radionuclear and Comprehensive Nuclear-Test-Ban Treaty monitoring stations and laboratory capabilities were operational throughout the year.

The Department, in collaboration with key stakeholder partners, also continues to increase awareness on the health impacts related to indoor radon exposure and the actions Canadians can take to reduce their risk. In November 2014, Health Canada participated in the 2nd annual National Radon Action Month to encourage all Canadians to test the levels of radon gas in their homes and to reduce radon levels if necessary. As part of this initiative, 100% of targeted partners participated in education and awareness activities that included public presentations and the distribution of radon awareness materials at home shows, conferences, community and health centres.

The radon federal building testing program tested 2,500 federal buildings in 2014-15. Since the start of the program in 2007, approximately 17,500 federal buildings have been tested for radon. In addition, the database of indoor radon concentrations was maintained and updated as new information was acquired from radon surveys, radon measurement service providers and members of the public.

Sub-Program 2.6.2: Radiation Emitting Devices

Description

Under the authority of the Radiation Emitting Devices Act, this program regulates radiation emitting devices, such as equipment for clinical/analytical purposes (X-rays, mammography, ultrasound), microwaves, lasers, and tanning equipment.

In the delivery of this program, key activities include: compliance assessment of radiation emitting devices at federally regulated facilities, research into the health effects of radiation (including noise, ultraviolet, and non-ionizing radiation from wireless devices such as cell phones and WiFi equipment); and, development of standards and guidelines for the safe use of radiation emitting devices.

The program provides expert advice and information to Canadians, as well as to other Health Canada programs, federal departments, and provincial authorities so that they may fulfil their legislative mandates.

The program objective is to manage the risks to the health of Canadians from radiation emitting devices.

Performance Analysis and Lessons Learned

Health Canada responded to 654 public inquiries associated with radiation emitting devices (e.g. via the 1-800-O-Canada line, email, etc.). Many of the inquiries related to the potential health effects of electric and magnetic fields, ultraviolet, infrared and visible light radiation and acoustics from consumer devices and manmade environmental sources. While the program developed generic responses for general and repeated inquiries to better meet the five-day response standard, with the complexity of many of the inquiries, the response rate still exceeded the five day business standard that was in place for 2014-15 (76% of public inquiries were responded to within five business days). Health Canada has revised the target for 2015-16 from five to ten days to allow for adequate time for response. Health Canada also completed all requested assessments and/or inspection reports from institutions and responded to 230 inquiries from stakeholders. Most inquiries from stakeholders were for elaboration/interpretation of regulatory requirements under the Radiation Emitting Devices Act. In addition, a cyclical enforcement plan for radiation emitting devices regulated under the Radiation Emitting Devices Act was developed and implemented based on a risk evaluation of these products.

Health Canada also released its preliminary findings for the Wind Turbine Noise and Health Study. Health Canada, in partnership with Statistics Canada, had conducted a two-year study to better understand the impacts of wind turbine noise on health.

Sub-Program 2.6.3: Dosimetry Services

Description

The Dosimetry Services program monitors, collects information, and reports on the exposure to radiation of its clients, occupational radiation workers under the licence of the Canadian Nuclear Safety Commission's Nuclear Safety and Control Act, and/or provincial/territorial regulations.

Dosimetry is the act of measuring or estimating radiation doses and assigning those doses to individuals.

The National Dosimetry Services provides radiation monitoring services on a cost-recovery basis to Canadians exposed to ionising radiation in their places of work, and, the National Dose Registry provides a centralized radiation dose record system.

The program objective is to ensure that Canadians exposed to radiation in their places of work who are monitored by the Dosimetry Services program are informed of their radiation exposure levels.

Performance Analysis and Lessons Learned

Health Canada provided timely and reliable dosimetry services to 12,500 client groups. The Department processed and reported 91% of dosimeter readings to client groups and the National Dose Registry within 10 days of receipt and 100% of dose history reports were sent to clients within 10 days of receipt of request. 100% of overexposure readings were reported to Regulatory Authorities within 24 hours of dose information received into the National Dose Registry.

Program 2.7: Pesticides

Description

The Pest Control Products Act provides Health Canada with the authority to regulate and register pesticides, under the Pesticides program.

In the delivery of this program, Health Canada conducts activities that span the lifecycle of a pesticide, including: product assessment for health and environmental risks and product value; risk management; post market surveillance; compliance and enforcement; changes in use, cancellation, or phase out of products that do not meet current standards; and, consultations and public awareness building.

Health Canada is also an active partner in international efforts (e.g., North American Free Trade Agreement; Organization for Economic Cooperation and Development (OECD), RCC to align regulatory approaches. These engagements provide access to the best science available to support regulatory decisions and promote consistency in the assessment of pesticides.

The program objective is to protect the health and safety of Canadians and the environment relating to the use of pesticides.

Performance Analysis and Lessons Learned

Health Canada continued to deliver on its responsibilities under the Pest Control Products Act through the evaluation and re-evaluation of pesticide products (even while receiving a significant number of requests for special reviews), compliance and enforcement, and outreach and risk reduction strategies. Health Canada maintained quality and exceeded performance targets on all core regulatory activities through prudent management of its pesticide program.

Health Canada continued its international collaboration with partners in standardizing and harmonizing global approaches to modern science. Through both the Canada-U.S. RCC and the Organization for OECD, PMRA expanded the use of joint reviews, which facilitate same time access as competitors to new pesticide technology for Canadian growers. Furthermore, Health Canada has a close working relationship with the U.S.-EPA and collaborates with them on all new Active Ingredients. Partnerships with other North American and international regulators, as well as industry partners, have resulted in the development of a pollinator risk assessment framework resulting in mitigation measures to protect pollinators. The Department also completed an update to the Maximum Residue Limits database for various Crop Groups, which is pending release by Shared Services Canada. Four new active ingredients, along with their associated end use products, were reviewed via global/NAFTA joint-reviews.

Health Canada completed 100% of planned Active Prevention and Targeted Oversight program activities and continued with compliance and enforcement policy and procedure development, to support delivery of core regulatory activities. A new logic model related to compliance and enforcement activities and performance measurement framework was approved, and data sources for indicators were identified. Also, initiatives were undertaken with the U.S.-EPA and OECD to improve timely information sharing of global pesticide risk information on the illegal trade of pesticides.

Health Canada initiated work on the development of an IM/IT Framework while advancing specific Investment Plan projects in support of renewing core e-business systems that will ultimately strengthen reporting on the full product life cycle. Public consultation on a revised cost recovery regime was completed and a pre-proposal notice was published for consultation in March 2015. In early April 2015, the Pesticide Cost Recovery Official Notice of Fee Proposal was tabled in both Houses.

Strategic Outcome 3: First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status

Program 3.1: First Nations and Inuit Primary Health Care

Description

The Department of Health Act 1996, and the Indian Health Policy (1979) provide the authority for the delivery of the First Nations and Inuit Primary Health Care program to First Nations and Inuit in Canada. Primary health care includes health promotion and disease prevention, public health protection (including surveillance), and primary care (where individuals are provided diagnostic, curative, rehabilitative, supportive, palliative/end-of-life care, and referral services).

The Department administers contribution agreements and direct departmental spending related to child development, mental wellness and healthy living, communicable disease control and management, environmental health, clinical and client care, as well as home and community care.

The program objective is to improve the health and safety of First Nations and Inuit individuals, families, and communities.

Performance Analysis and Lessons Learned

The performance targets for First Nations and Inuit adults reporting being in excellent or very good health are on target for being met on March 31, 2017, as current data indicate that this is the case for 44% of First Nations and 42% of Inuit adults. 100% of primary care health care programs delivered to First Nations and Inuit incorporated cultural aspects into their programming, exceeding the target of 80%.

In 2014-15, Health Canada continued to enhance access to services to help strengthen primary care for First Nations and Inuit communities. For example, a draft set of core standards was completed and engagement was initiated with First Nations and Inuit stakeholders to ensure a shared vision and commitment to standards implementation.

Health Canada enhanced new models of care which involved a comprehensive series of interwoven reforms intended to strengthen service delivery, respond more effectively to health service needs, address system sustainability, foster healthy individuals, healthy families, and healthy communities and ultimately lead to a modern, sustainable, high quality health service in remote and isolated First Nations communities.

These reforms included reorienting service delivery models to interprofessional teams, addressing service access issues, optimizing technology, information management and infrastructure and strengthening community voice and a focus on population health.

Sub-Program 3.1.1: First Nations and Inuit Health Promotion and Disease Prevention

Description

The First Nations and Inuit Health Promotion and Disease Prevention program delivers health promotion and disease prevention services to First Nations and Inuit in Canada.

The program administers contribution agreements and direct departmental spending for culturally appropriate community-based programs, services, initiatives, and strategies. In the delivery of this program, the following three key areas are targeted: healthy child development; mental wellness; and healthy living.

The program objective is to address the healthy development of children and families, to improve mental wellness, and to reduce the impacts of chronic disease on First Nations and Inuit individuals, families, and communities.

Performance Analysis and Lessons Learned

Training performance targets for this expected result were exceeded as training was undertaken by 384 workers for healthy childhood development programs and 494 workers for healthy living programs. The target for certification was met as 77% of addictions counsellors in treatment centres were certified workers.

In 2014-15, the First Nations Mental Wellness Continuum Framework was finalized and released. The Framework will provide guidance at all levels with respect to First Nations mental wellness to strengthen programming, and support integration and alignment with community priorities along a continuum of care.

Implementation of the Honouring Our Strengths Addictions Framework continued across the continuum of care to support strengthened community, regional, and national responses to substance use issues. In addition, a draft five-year Prescription Drug Abuse Plan was developed to ensure the reimbursement of drugs subject to abuse are consistent with their legitimate role in therapy, and aligned with clinical practice guidelines and product monographs.

The National Aboriginal Youth Suicide Prevention Strategy supported 138 youth suicide prevention projects. These projects were diverse, firmly rooted in culture, based on community priorities, and focussed on reducing risk factors among First Nations and Inuit youth. Funding for 10 Mental Wellness Teams (MWT) continued, and a community of practice gathering for these teams also occurred, which supported knowledge exchange and the sharing of best and promising practices.

The First Nations and Inuit component of the renewed FTCS (2012-17) supports First Nations and Inuit communities in implementing evidence-based tobacco control strategies. In 2014-15, resources were transferred to the British Columbia (BC) First Nations Health Authority (FNHA), and the governments of Nunavut and the Northwest Territories to enhance tobacco control strategies for First Nations and Inuit within these jurisdictions. A call for proposals was also launched, which resulted in support for 16 comprehensive projects, proposed by First Nations and Inuit to reduce smoking rates in their communities in Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Atlantic Regions. A "Community of Practice" was established to support the tobacco projects, establish common performance indicators, and share best practices and available tools/services.

Health Canada is in the final stages of the development of a framework to support the prevention and management of chronic disease in First Nations communities.

Sub-Sub Program 3.1.1.1: Healthy Child Development

Sub-heading: Description

The Healthy Child Development program administers contribution agreements and direct departmental spending to support culturally appropriate community-based programs, services, initiatives, and strategies related to maternal, infant, child, and family health. The range of services includes prevention and health promotion, outreach and home visiting, and early childhood development programming.

Targeted areas in the delivery of this program include: prenatal health, nutrition, early literacy and learning, and physical and children's oral health.

The program objective is to address the greater risks and lower health outcomes associated with First Nations and Inuit infants, children, and families.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

Healthy Child Development programs, such as Maternal Child Health, Canada Prenatal Nutrition (First Nations and Inuit component), Aboriginal Head Start on Reserve, Fetal Alcohol Spectrum Disorder programs, and the Children's Oral Health Initiative, have increased access to services that support healthy outcomes. In 2014-15, the Department exceeded the target of 7,982 women accessing Prenatal and Postnatal Health, including Nutrition (specifically the Canada Prenatal Nutrition Program) by over 1,000 women. Increased access is important, as receiving healthy pregnancy and infancy services has been shown to improve health outcomes for women and infants, by reducing pregnancy complications and having healthier gestational weight gains.

In addition, 13,981 children accessed early literacy and learning through the Aboriginal Head Start on Reserve program. Opportunities for Aboriginal children to learn about their language and culture are important in supporting their connectedness to their community, which can build resiliency and promote better health. Evaluations have demonstrated that Aboriginal Head Start on Reserve has been successful in producing positive changes in children's levels of physical activity, cultural activities and reading.

Oral Health and developmental health screening are important for a child's overall health. Rates for dental surgical procedures were lower for children in communities with the Children's Oral Health Initiative when compared to those without. In addition, the oral health target of 18,780 First Nations and Inuit children accessing Children's Oral Health Initiative was exceeded by over 1,000. Communities with Maternal Child Health programming were more likely to screen for developmental milestones, prenatal risk factors and existing health conditions compared to those without. 

These community-led, culturally-relevant programs and services support First Nations and Inuit children and their families in reaching their full potential. At the same time, ensuring equitable access to Healthy Child Development programs and services for communities continues to be a priority.

A 2014 Evaluation of the Healthy Living and Healthy Child Development Clusters highlighted the need to strengthen collaboration between partners to ensure sustained partnerships and program integration. Based on these findings, Health Canada will work with other federal departments to map out current federal children and education programming for First Nations living on reserve, to support improved community planning, leveraging of existing resources and provincial partnerships, were feasible. Additionally, Health Canada is finalizing an Oral Health Strategic Action Plan as a guiding tool to strengthen partnerships and collaboration for oral health services.

Sub-Sub Program 3.1.1.2: Mental Wellness

Sub-heading: Description

The Mental Wellness program administers contribution agreements and direct departmental spending that supports culturally-appropriate community-based programs, services, initiatives and strategies related to the mental wellness of First Nations and Inuit. The range of services includes prevention, early intervention, treatment, and aftercare.

Key services supporting program delivery include: substance abuse prevention and treatment (part of NADS), mental health promotion, suicide prevention, and health supports for participants of the Indian Residential Schools Settlement Agreement.

The program objective is to address the greater risks and lower health outcomes associated with the mental wellness of First Nations and Inuit individuals, families, and communities.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

In 2014-15, 60% of treatment centre clients terminated substance use of at least one substance after completing treatment, which exceeds the 30% target. In addition, 94% of treatment centre clients reduced substance use of at least one substance after completing treatment, well exceeding the 50% target. 138 projects provided suicide prevention programs, exceeding the target of 115.

The Mental Wellness programs contributed to improving the quality and availability of comprehensive mental health and addictions services through its investments in 2014-15. Areas of focus included the reduction of substance use, certification of addictions counsellors and development of a suicide prevention project in First Nations and Inuit communities.

In 2014-15, the First Nations Mental Wellness Continuum Framework was finalized and is intended to guide communities, tribal councils, health authorities, provincial and territorial governments, and federal departments on how to adapt, optimize and realign programs and services to be more responsive and flexible in meeting the needs of First Nations peoples. A governance structure comprised of key stakeholders at the national, regional and community level was created to help guide the implementation of the First Nations Mental Wellness Continuum Framework. Work also continued with the Inuit Tapiriit Kanatami toward the development of an Inuit Mental Wellness Continuum Framework.

A community of practice was established to support 10 MWT. First Nations experts shared information on key issues related to MWTs' program and service delivery (e.g. culture as intervention), including promising practices and lessons learned. Other accomplishments that supported MWT included the finalization and dissemination of suicide prevention learning modules and funding of the First Nations Wellness/Addictions Counsellor Certification Board to provide relevant certification and training that is specific to traditional First Nations healing philosophy.

In 2014-15, Health Canada continued to support the provision of professional counselling, cultural and emotional support services to former Indian Residential School students and their families. This included investing in more than 120 First Nations and Inuit community-based organizations to make cultural and mental health support services available to eligible clients.

Addiction prevention and treatment programming was effectively delivered through a network of 44 treatment centres in the majority of First Nations and Inuit communities across Canada.

Sub-Sub Program 3.1.1.3: Healthy Living

Sub-heading: Description

The Healthy Living program administers contribution agreements and direct departmental spending that supports culturally appropriate community-based programs, services, initiatives, and strategies related to chronic disease and injuries among First Nations and Inuit.

This program aims to promote healthy behaviours and supportive environments in the areas of healthy eating, physical activity, food security, chronic disease prevention, management and screening, and injury prevention policy.

Key activities supporting program delivery include: chronic disease prevention and management, injury prevention, the Nutrition North Canada-Nutrition Education Initiative, and the First Nations and Inuit component of the FTCS (being implemented in 2012-13).

The program objective is to address the greater risks and lower health outcomes associated with chronic diseases and injuries among First Nations and Inuit individuals, families, and communities.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

Diabetes is a significant health concern among First Nations, who experience rates of diabetes three-four times higher than the rate among non-Aboriginal Canadians. In 2014-15, Health Canada continued to invest in the Aboriginal Diabetes Initiative (ADI), which aims to reduce Type 2 diabetes through health promotion and disease prevention activities. ADI was provided in 89.1% of communities in comparison to the target of 90%, representing over 600 First Nations and Inuit communities. ADI benefits these communities by increasing awareness and knowledge of risk factors and diabetes prevention approaches, and by providing access to diabetes prevention, screening, and management services.

The types of activities supported through ADI are widely recognized as effective interventions, and the majority of provinces and territories developed similar diabetes initiatives which emphasize the importance of prevention and health promotion.

Investments in 2014-15 contributed to increased access to community-based physical activity programming and services. Examples of activities in First Nations and Inuit communities included regional-wide school-based physical activity challenges, the certification of fitness leaders, delivery of traditional and non-traditional physical activities, and healthy weight programs. Investments also contributed to enhanced access to nutrition education activities to promote healthy eating and increased access to nutritious foods.

Under the ADI, 87.7% of communities delivered healthy eating activities, and 86.1% delivered physical activity projects. These results significantly exceeded their respective targets of 66% and 63%. The presence of regional multidisciplinary teams (which included nutrition and physical activity expertise) helped promote healthy eating and physical activity at the community-level through skills and capacity development. The community health planning process also supported the creation of community linkages and partnerships with other program areas and outside partners. Through Nutrition North Canada, Health Canada provided additional supports for community-based nutrition education in 78 isolated northern First Nations and Inuit communities. Notwithstanding gains made, factors such as poverty and food insecurity continue to challenge the adoption of healthy lifestyles and improved health outcomes.

A recent evaluation (2014) of the Healthy Living and Healthy Child Development Clusters reported that the Healthy Living program has made considerable progress toward promoting healthy behaviours in First Nations and Inuit communities. However, the evaluation also highlighted the need to sustain efforts to improve access and quality of programs and services. Health Canada has undertaken an initiative to implement accreditation and service delivery standards to support improvements in quality and access, and will develop standards specific to healthy living programming.

Sub-Program 3.1.2: First Nations and Inuit Public Health Protection

Description

The First Nations and Inuit Public Health Protection program delivers public health protection services to First Nations and Inuit in Canada. In the delivery of this program, the key areas of focus are communicable disease control and management, and environmental public health.

The First Nations and Inuit Public Health Protection program administers contribution agreements and direct departmental spending to support initiatives related to communicable disease control and environmental public health service delivery including public health surveillance, research, and risk analysis. Communicable disease control and environmental public health services are targeted to on-reserve First Nations, with some support provided in specific instances, (e.g., to address tuberculosis), in Inuit communities south of the 60^th parallel. Environmental public health research, surveillance, and risk analysis are directed to on-reserve First Nations, and in some cases, (e.g., climate change and health adaptation, and biomonitoring), also to Inuit and First Nations living north of the 60^th parallel.

Surveillance data underpins these public health activities and all are conducted with the understanding that social determinants play a crucial role. To mitigate impacts from factors beyond the public health system, the program works with First Nations, Inuit, and other organizations.

The program objective is to address human health risks for First Nations and Inuit communities associated with communicable diseases and exposure to hazards within the natural and built environments by increasing community capacity to respond to these risks.

Performance Analysis and Lessons Learned

The target for the first expected result was exceeded as there were 81% of First Nations communities with integrated Pandemic Preparedness/Response Plans and Emergency Preparedness/Readiness Plans.

In 2014-15, Health Canada supported public health measures to prevent and control cases and outbreaks of communicable diseases on-reserve; promoted public education and awareness to encourage healthy practices; strengthened community capacity; undertook monitoring, surveillance and reporting of communicable disease; and, provided a liaison and coordination function for all-hazard emergency management. For example, Health Canada and the Assembly of First Nations launched a partner engagement process to solicit the participation of a broad range of partners in the development of the Sexually Transmitted and Blood Borne Infections (STBBI) Framework. A partner engagement questionnaire was developed and distributed to assess successes, gaps and challenges in STBBI programming.

A Tuberculosis Monitoring and Performance Framework was developed to provide guidance for an enhanced approach to the monitoring of communities experiencing outbreaks or ongoing high incidence of tuberculosis. As well, an educational tool entitled Talking Tuberculosis: An Educational Resource was developed to assist community health professionals in raising awareness and educating community members about tuberculosis.

Health Canada continued to fund 16 community-based research and assessment projects that enable northern First Nations and Inuit communities to develop climate change adaptation strategies and action plans.

Health Canada assists First Nations communities in establishing drinking water quality monitoring programs, and has established a target of 50.6% on-reserve public water systems that are tested four times per month or 48 times in a year, in accordance with the national testing guidelines for monitoring frequency. In 2014-15, this target was not attained, as only 42% of on-reserve public water systems met this recommended frequency. However, this indicator only captures the percentage of communities that met the standard, and does not provide a global picture of the monitoring frequency of all on-reserve public water systems. The average monitoring frequency of all on-reserve public water systems was 38 weeks out of the recommended 48 weeks (or 79%) in 2014-15. Although there has been progress, compliance with monitoring frequency as outlined in the Guidelines for Canadian Drinking Water Quality continues to present logistical challenges associated with the management of very small water systems located  in rural or remote locations.

Health Canada did enhanced the capacity of First Nations communities to monitor drinking water quality by providing ongoing access to a trained community-based Water Monitor or Environmental Health Officer in 100% of First Nation communities, in accordance with the established target.

Sub-Sub Program 3.1.2.1: Communicable Disease Control and Management

Sub-heading: Description

The Communicable Disease Control and Management program administers contribution agreements and direct departmental spending to support initiatives related to vaccine preventable diseases, blood borne diseases and sexually transmitted infections, respiratory infections, and communicable disease emergencies. In collaboration with other jurisdictions communicable disease control and management activities are targeted to on-reserve First Nations, with support provided to specific instances, (such as to address tuberculosis), in Inuit communities south of the 60^th parallel. Communicable Disease Control and Management activities are founded on public health surveillance and evidence-based approaches and reflective of the fact that all provincial and territorial governments have public health legislation.

Key activities supporting program delivery include: prevention, treatment and control of cases and outbreaks of communicable diseases; and, public education and awareness to encourage healthy practices.

A number of these activities are closely linked with those undertaken in the Environmental Health program (3.1.2.2), as they relate to waterborne, foodborne and zoonotic infectious diseases. 

The program objective is to reduce the incidence, spread, and human health effects of communicable diseases for First Nations and Inuit communities.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

In 2014-15, the rate of adherence target was exceeded, as 92.1% of patients diagnosed with active tuberculosis completed treatment. Targets to increase awareness among health care providers and caregivers of the importance of immunization were also exceeded. For example, 93% of on-reserve caregivers recognized the importance of childhood vaccination (target 85%) and 94% of health care providers serving First Nations and Inuit communities use Health Canada immunization education and awareness materials (target 70%).

A recent evaluation (2014) of the Communicable Disease Control and Management Programs and services for First Nations and Inuit communities noted progress toward increasing uptake of communicable disease prevention and control measures as well as improving public awareness and knowledge of communicable diseases. The evaluation recommended that Health Canada continue efforts to ensure consistency in training and support for community health staff to continue to build community capacity and strengthen the program's ability to address diverse community-needs.

In 2014-15, Health Canada undertook two key initiatives to build community capacity. To enhance the integration of Pandemic and Emergency Preparedness Plans, Health Canada developed a communicable disease plan improvement cycle guidance document which delineates national, regional, and community activities in plan development, and in strengthening and testing processes. These plans were shared with First Nations communities as a public health tool to be used in nursing stations and health centres.

In 2014-15, Health Canada worked closely with partners to prepare for a potential case of Ebola presenting in a First Nations community. This included the development and implementation of a comprehensive train-the-trainer approach, procurement of enhanced personal protective equipment and training of 988 frontline health care professionals on its proper use across six Health Canada regions, and the BC FNHA.

Sub-Sub Program 3.1.2.2: Environmental Public Health

Sub-heading: Description

The Environmental Public Health program administers contribution agreements and direct departmental spending for environmental public health service delivery. Environmental public health services are directed to First Nations communities south of the 60^th parallel and address areas such as: drinking water; wastewater; solid waste disposal; food safety; health and housing; facilities inspections; environmental public health aspects of emergency preparedness response; and, communicable disease control. Environmental public health surveillance and risk analysis programming is directed to First Nations communities south of the 60^th parallel, and in some cases, also to Inuit and First Nations north of the 60^th parallel. It includes community-based and participatory research on trends and impacts of environmental factors such as chemical contaminants and climate change on the determinants of health (e.g., biophysical, social, cultural, and spiritual).

Key activities supporting program delivery include: public health; surveillance, monitoring and assessments; public education; training; and, community capacity building.

The program objective is to identify, address, and/or prevent human health risks to First Nations and Inuit communities associated with exposure to hazards within the natural and built environments.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

The target for the expected result was exceeded as 26 community-based/participatory research reports on environmental health hazards were available (as compared to the target of 25 reports).

In 2014-15, Health Canada supported the development of regulations under the Safe Drinking Water for First Nations Act . This included the development and launch of a consultation and engagement strategy in collaboration with Aboriginal Affairs and Northern Development Canada (AANDC) to solicit feedback on existing regulations from First Nations partners, and to share knowledge on drinking and wastewater regulations.

Health Canada produced a video on mould in collaboration with the Canada Mortgage and Housing Corporation for contractors and building maintenance staff in communities. The video was shared with First Nations community leaders and provided education and awareness on the causes of mould in buildings, where to look for root causes, and how to prevent and treat.

Health Canada continued to support community-based projects to monitor exposure to environmental hazards and the impacts of climate change. A child biomonitoring health survey pilot study for children 3-19 years was established with the Centre Hospitalier Universitaire du Québec - Université Laval. In addition, the First Nations Food, Nutrition and Environment Study released its 2011-12 report for Ontario. These results have helped strengthen evidence-based decision-making and will be used to target food security and nutrition intervention activities in FNIHB's community programs and to plan further environmental studies in the most affected First Nation populations.

Sub-Program 3.1.3: First Nations and Inuit Primary Care

Description

The First Nations and Inuit Primary Care program administers contribution agreements and direct departmental spending. These funds are used to support the staffing and operation of nursing stations on-reserve, dental therapy services and home and community care programs in First Nation and Inuit communities, and on-reserve hospitals in Manitoba, where services are not provided by provincial/territorial health systems. Care is delivered by a collaborative health care team, predominantly nurse-led, providing integrated and accessible health care services that include: assessment; diagnostic; curative; case-management; rehabilitative; supportive; respite; and, palliative/end-of-life care.

Key activities supporting program delivery include Clinical and Client Care in addition to Home and Community Care.

The program objective is to provide primary care services to First Nations and Inuit communities.

Performance Analysis and Lessons Learned

In 2014-15, Health Canada met its target of the 365.8 utilization rate per 1,000 of the eligible on-reserve population for home and community care and clinical and client care. Additionally, the target for coordinated responses was exceeded as 57% of First Nations communities had collaborative service delivery arrangements with external primary care service providers.

Health Canada continued with the implementation of a multi-faceted nurse recruitment and retention strategy for remote and isolated First Nation communities. For example, in 2014-15, staffing tools and mechanisms were streamlined, including the design and implementation of a fast and efficient recruitment process with continuous intake of applications received online via the "Apply Now!" interactive tool. In addition, a Relief Nursing Coordination Unit was established to alleviate pressure on regions and introduce standardization. The unit is managing national nursing relief service contracts in three regions: Manitoba, Ontario and Quebec.

Efforts began in 2014-15 to develop an accreditation strategy to address the challenges to increasing the number health facilities entering the accreditation process.

Collaborative initiatives have taken place to support linkages between Health Canada, provincial services, organisations and regulatory bodies. For example, Health Canada worked with colleges and universities on access to nursing program offerings as well as the recruitment of nurses. Activities to strengthen collaboration and improve information sharing and partnerships are ongoing.

Sub-Sub Program 3.1.3.1: Clinical and Client Care

Sub-heading: Description

The Clinical and Client Care program is delivered by a collaborative health care team, predominantly nurse-led, providing integrated and accessible health and oral health care services that include assessment, diagnostic, curative, and rehabilitative services for urgent and non-urgent care.

Key services supporting program delivery include: triage, emergency resuscitation and stabilization, emergency ambulatory care, and out-patient non-urgent services; coordinated and integrated care and referral to appropriate provincial secondary and tertiary levels of care outside the community; and, in some communities, physician visits and hospital in-patient, ambulatory, and emergency services.

The program objective is to provide clinical and client care services to First Nations individuals, families, and communities.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

Health Canada's performance on clinical and client care services is focussed on those communities in Alberta, Manitoba, Ontario, and Quebec regions where Health Canada directly delivers Clinical and Client program services. Health Canada exceeded the target as 43.8% of the eligible on-reserve population accessed clinical and client care services. Based on data limitations, communities from Manitoba were not included in this result. 

11.1% of urgent clinical and client services were provided in nursing stations, a shortfall from the targeted 30%. The gap may be partially explained by data limitations, as data for the entire fiscal year was not available for Ontario. Based on lessons learned from data collection challenges, a new Nursing Station Report Template has been developed to collect more complete data in future years.

Health Canada funded or delivered primary care services, including 24/7 access to emergency services, in 80 remote and isolated First Nations communities, where access to provincial or territorial health care services is limited. Health Canada funded another nine communities through the B.C. FNHA.

The modernization of the CPGs was initiated, including the establishment of a contract to update the evidence in the CPGs and to develop supporting tools. To support this work, an Advisory Committee was created to provide expertise and guidance.

Health Canada adapted education materials for the prevention of antimicrobial resistance (AMR) and distributed them to nursing stations to promote appropriate use of antibiotics and prevent AMR. On-line resources on AMR were also made available for practitioners.

Sub-Sub Program 3.1.3.2: Home and Community Care

Sub-heading: Description

The Home and Community Care program administers contribution agreements with First Nation and Inuit communities and territorial governments to enable First Nations and Inuit individuals with disabilities, chronic or acute illnesses, and the elderly to receive the care they need in their homes and communities. Care is delivered primarily by home care registered nurses and trained certified personal care workers.

In the delivery of this program First Nations and Inuit Health Branch provides funding through contribution agreements and direct departmental spending for a continuum of basic essential services such as: client assessment and case management; home care nursing, personal care and home support as well as in-home respite; and, linkages and referral, as needed, to other health and social services. Based on community needs and priorities, existing infrastructure, and availability of resources, the Home and Community Care program may be expanded to include supportive services. These services may include: rehabilitation and other therapies; adult day programs; meal programs; in-home mental health; in-home palliative care; and, specialized health promotion, wellness, and fitness services.

The program objective is to provide home and community care services to First Nations and Inuit individuals, families, and communities.

This program uses funding from the following transfer payment: First Nations and Inuit Primary Health Care.

Sub-heading: Performance Analysis and Lessons Learned

The targets for home and community care services were met, as the utilisation rate was 71.2 per 1,000 on-reserve population and the distribution of Home and Community Care hours of care provided for home care nursing was 8.6%. The service delivery arrangement target was exceeded, as 57% of communities had collaborative service delivery arrangements with external service delivery partners, in comparison to the target of 50%.

During 2014-15, the First Nations Home and Community Care program provided 1.8 million hours of care in 500 First Nation and Inuit communities. Additionally, a 10-year Plan was finalized to assist program staff, at all levels, to anticipate and respond to emerging health and demographic trends, complex and changing health needs, and other challenges related to the home care needs of First Nations and Inuit clients. The Plan reflects the priorities of First Nations and Inuit and takes into consideration the trends and projections of home care in Canada as part of the health care continuum. Each goal is client-focused and supports health providers in the provision of exemplary care that considers the assessed needs of the client as he/she navigates through the experience of illness and loss. The plan is expected to be a key resource that will enable program officials, home care staff and communities to adequately respond to future challenges in a strategic and integrated fashion over the next 10 years.

Program 3.2: Supplementary Health Benefits for First Nations and Inuit

Description

Under the Supplementary Health Benefits for First Nations and Inuit program, the Non-Insured Health Benefits (NIHB) Program provides registered First Nations and recognized Inuit residents in Canada with a specified range of medically necessary health-related goods and services, which are not otherwise provided to eligible clients through other private or provincial/territorial programs. NIHB include: pharmaceuticals; medical supplies and equipment; dental care; vision care; short term crisis intervention mental health counselling; and, medical transportation to access medically required health services not available on-reserve or in the community of residence. The NIHB Program also pays health premiums on behalf of eligible clients in BC (as of July 2013, NIHB will no longer pay premiums for First Nations residents of BC, who will become clients of the FNHA in accordance with the BC Tripartite Health Agreement and sub-agreements).

Benefits are delivered through registered, private sector health benefits providers (e.g., pharmacists and dentists) and funded through NIHB's electronic claims processing system or through regional offices. Some benefits are also delivered via contribution agreements with First Nations and Inuit organizations and the territorial governments in Nunavut and Northwest Territories.

The program objective is to provide NIHB to First Nations and Inuit people in a manner that contributes to improvements in their health status to be comparable to that of the Canadian population.

This program uses funding from the following transfer payment: First Nations and Inuit Supplementary Health Benefits.

Performance Analysis and Lessons Learned

71.2% of the eligible First Nations and Inuit population accessed at least one NIHB in comparison to the target of 72%. The actual results are in line with expectations given the demand-driven nature of NIHB and that the variance is less than one percent. Health Canada provided access to NIHB for over 824,000 eligible First Nations people and Inuit.

In 2014-15, Health Canada developed an interim five-year management plan for Supplementary Health Benefits. These efforts are focussed on addressing goals such as client health and safety, enhanced and streamlined access to benefits, reduced administrative costs and improved reporting.

In addition, NIHB's prescription drug abuse strategy and client safety were enhanced through the monitoring and surveillance of prescription drug utilization and prescribing patterns, including restrictions on opioids and other drugs of concern, delisting of medications at risk for abuse that no longer have a significant therapeutic role, and increased access to drugs with less abuse potential for those who need them. To support this function, work began on the development of a Sub-regional Prescription Drug Abuse Monitoring System. Program data showed a continued year over year decline in the number of clients identified as engaging in patterns of use that suggest potential prescription drug misuse.

A national mental health counsellor enrollment process for the NIHB and Indian Residential Schools Resolution Health Support Program was implemented. In support of the enrolment process, a national joint NIHB/Indian Residential Schools Resolution Health Support Program Guide to Mental Health Counselling was finalized and posted on the internet, and the provider enrollment form has been updated to include a section on cultural competency.

Other activities for 2014-15 included the provision of claims processing and associated services in the pharmacy, medical supplies and equipment, and dental benefits areas to support the implementation of the BC Tripartite Framework Agreement on First Nation Health Governance Health Canada. In this role, NIHB acted as a claims adjudicator and claims processing service provider to the BC FNHA as a transitional measure for these benefits.

Program 3.3: Health Infrastructure Support for First Nations and Inuit

Description

The Department of Health Act (1996), and the Indian Health Policy (1979) provide the authority for the Health Infrastructure Support for First Nations and Inuit program to administer contribution agreements and direct departmental spending to support the delivery of health programs and services.

The program promotes First Nation and Inuit capacity to design, manage, deliver, and evaluate health programs and services. To better meet the unique health needs of First Nations and Inuit individuals, families, and communities this program also supports: innovation in health program and service delivery; health governance partnerships between Health Canada, the provinces, and First Nation and provincial health services; and, improved integration of First Nation and provincial health services.

The program objective is to help improve the health status of First Nations and Inuit people, to become comparable to that of the Canadian population over the long-term.

Performance Analysis and Lessons Learned

Health Canada met the target of 100% of provinces and territories with multi-jurisdictional agreements to jointly plan, deliver and/or fund integrated health services for aboriginal Canadians. The target for the second expected result was exceeded as there were 331 communities that had Flexible or Block funding agreements, which allowed communities to design, deliver and manage their health programs and services, compared to the target of 310 communities.

In 2014-15, Health Canada fully implemented AANDC's risk management tool (the General Assessment) using the Grants and Contributions Information Management System (GCIMS). A common approach to default management using the Default Prevention and Management Policy and associated suite of tools has been in place since 2013. In 2014-15, internal processes for conducting joint assessments (for both risk and default management) and the protocol for routing/approvals between departments were enhanced based on specific regional structures within Health Canada and AANDC. These changes allowed for greater efficiencies and collaboration between departments for common recipients. 

A key challenge faced when conducting joint assessments for common Health Canada/AANDC recipients was overcoming programmatic differences between each department. Notwithstanding these challenges, a single federal standardized financial reporting protocol was implemented to avoid duplication and reduce the administrative burden for recipients. Health Canada will continue to work with AANDC to further align policies and processes. 

Following the transfer of the management and delivery of health programming to the First Nations Health Authority of BC, Health Canada has continued as a funder and a governance partner, supporting the integration and accountability processes.

Health Canada funded collaborative efforts with provinces for the expansion of eHealth technology to increase the overall effectiveness of the provision of services on reserves. FNIHB added 19 new telehealth sites in First Nations communities and worked with First Nations and provinces to leverage provincially interoperable Electronic Health Records (EMR) within communities. Health Canada supported First Nations communities in their efforts to engage with the provincial deployment of Panorama or provincially selected public health information systems. 

Sub-Program 3.3.1: First Nations and Inuit Health System Capacity

Description

The First Nations and Inuit Health System Capacity program administers contribution agreements and direct departmental spending focussing on the overall management and implementation of health programs and services.

This program supports the promotion of First Nations and Inuit participation in: health careers including education bursaries and scholarships; the development of, and access to health research; information and knowledge to inform all aspects of health programs and services; and, the construction and maintenance of health facilities. This program also supports efforts to develop new health governance structures with increased First Nations participation.

Program engagement includes a diverse group of partners, stakeholders, and clients including: First Nations and Inuit communities, district and tribal councils; national Aboriginal organizations and non-governmental organizations; health organizations; provincial and regional health departments and authorities; post-secondary educational institutions and associations; and, health professionals and program administrators.

The program objective is to improve the delivery of health programs and services to First Nations and Inuit by enhancing First Nations and Inuit capacity to plan and manage their programs and infrastructure.

Performance Analysis and Lessons Learned

The target for the first expected result was exceeded as 126 communities were accessing accredited health services in 2014-15, in comparison to the target of 77 communities. The target for safe health facilities was exceeded as 79% of the 24 health facilities that were subject to an Integrated Facility Audit did not have critical property issues, in comparison to the target of 58%.

In 2014-15, Health Canada held discussions with AANDC to collaborate on facilities inspections and to explore potential joint projects whereby efficiencies (and by extension, cost savings) could be realized.

The health facilities Long Term Capital Plan (LTCP) links program operating requirements, including current and future needs and risks, with specific capital project proposals. Health Canada used the LTCP as a tool to identify, assess, and prioritize capital projects for approval and implementation. In 2014-15, seven major multi-year projects and over 100 minor projects identified on the LTCP were funded.

In 2014-15, the regional LTCP planning cycle was synchronized with the new Health Canada-wide planning cycles and allowed for the capital planning to be fully integrated with other program planning processes. This improved efficiencies and provided clearer and timelier communication to First Nations partners. 

Health Canada continued to strengthen collaboration with AANDC for a comprehensive community development approach, based on the joint Community Development Framework.  Over 400 participants completed the associated training in 15 sessions over the 2014-15, with a strong emphasis on collaboration between organizations and with Aboriginal communities. Participants attended from Health Canada, AANDC, PHAC and other federal departments, as well as provincial health authorities.

Situational assessments with the regions were completed to inform the continued development of a surveillance and information framework that is aligned with First Nations/Inuit/provincial/ territorial surveillance strategies and relevant at the community and regional levels.

Sub-Sub Program 3.3.1.1: Health Planning and Quality Management

Sub-heading: Description

The Health Planning and Quality Management program administers contribution agreements and direct departmental spending to support capacity development for First Nations and Inuit communities.

Key services supporting program delivery include: the development and delivery of health programs and services through program planning and management; on-going health system improvement via accreditation; the evaluation of health programs; and, support for community development activities.

The program objective is to increase the capacity of First Nations and Inuit to design, manage, evaluate, and deliver health programs and services.

This program uses funding from the following transfer payment: First Nations and Inuit Health Infrastructure Support.

Sub-heading: Performance Analysis and Lessons Learned

Accreditation is a nationally and internationally recognized process that ensures a standardized level of quality in health planning, management and delivery of health services. By evaluating the quality of care and services they provide, and comparing against national standards of excellence, organizations are able to evaluate their clinical and operational performance. This provides them with a clear picture of their strengths and areas to be improved.

In 2014-15, Health Canada increased the number of community health centres in the accreditation process from 87 to 91, and increased the number of communities that receive primary health care services from fully accredited health centres to 126. In addition to the 60 accredited organizations, there are currently 45 addictions treatment centres and 1 nursing station in the accreditation process.

Health Canada continued to implement the Quality Improvement Framework by focussing on employee training. In 2014-15, training on tools and techniques to improve the way programs and services were developed and delivered to approximately 150 employees.

Sub-Sub Program 3.3.1.2: Health Human Resources

Sub-heading: Description

The Health Human Resources program administers contribution agreements and direct departmental spending to promote and support competent health services at the community level by increasing the number of First Nations and Inuit individuals entering into and working in health careers and ensuring that community-based workers have skills and certification comparable to workers in the provincial/territorial health care system. This program engages many stakeholders, including: federal, provincial and territorial governments and health professional organizations; national Aboriginal organizations; non-governmental organizations and associations; and, educational institutions.

Key activities supporting program delivery include: health education bursaries and scholarships; health career promotion activities; internship and summer student work opportunities; knowledge translation activities; training for community based health care workers and health managers; and, development and implementation of health human resources planning for Aboriginal, federal, provincial, territorial, health professional associations, educational institutions, and other stakeholders.

The program objective is to increase the number of qualified First Nations and Inuit individuals working in health care delivery.

This program uses funding from the following transfer payment: First Nations and Inuit Health Infrastructure Support.

Sub-heading: Performance Analysis and Lessons Learned

In 2014-15, the Aboriginal Health Human Resources Initiative (AHHRI) continued to increase the Aboriginal health workforce through 882 bursaries and scholarships awarded to health career students through a continued partnership with Indspire, an Indigenous-led Canadian registered charity. Exceeding the target of 425 bursaries and scholarships, Health Canada's investments supported students in health professions such as nursing and medicine, midwifery, physiotherapy, pharmacy, laboratory technology, and radiation technology. Additionally, AHHRI supported post-secondary educational support programs to colleges and universities, including bridging or access to post-secondary health programs, curriculum adaptation, mentoring, tutoring, exam assistance, and projects to enhance the cultural competency of future health care providers. 

The AHHRI also supported the First Nations Health Managers Association to provide training for First Nations community health managers, to improve the quality and management of health services in First Nations communities. In addition, AHHRI supported training for community-based workers.

Sub-Sub Program 3.3.1.3: Health Facilities

Sub-heading: Description

The Health Facilities program administers contribution agreements and direct departmental spending that provide communities and/or health care providers with the facilities required to safely and efficiently deliver health programs and services. Direct departmental spending addresses the working conditions of Health Canada staff engaged in the direct delivery of health programs and services to First Nations and Inuit.

Key activities supporting program delivery include: investment in infrastructure that can include the construction, acquisition, leasing, operation, maintenance, expansion and/or renovation of health facilities and security services; preventative and corrective measures relating to infrastructure; and, improving the working conditions for Health Canada staff so as to maintain or restore compliance with building codes, environmental legislation, and occupational health and safety standards.

The program objective is to support the development and delivery of health programs and services through investments in infrastructure.

This program uses funding from the following transfer payment: First Nations and Inuit Health Infrastructure Support.

Sub-heading: Performance Analysis and Lessons Learned

The target for the first expected result was exceeded as 51% of "high priority" recommendations stemming from Integrated Facility Audits were addressed on schedule.

In 2014-15, Health Canada provided ongoing contributions to First Nations to support the delivery of major (construction) and minor (renovation and/or repair) projects related to health facility infrastructure. For major projects on the LTCP, of which most are multi-year, construction was completed for four projects, one three-year construction project was initiated, and two other construction projects were planned and designed (made shelf ready) so that construction may commence as funding becomes available. In addition, more than 100 minor projects were successfully delivered as planned and approved in the national LTCP.

First Nations continue to work through the challenges of delivering these projects, such as inclement weather and availability of service providers. These challenges become amplified when projects are delivered in remote and/or isolated communities. The impact of these challenges resulted in the shifting of some project timelines, but did not inhibit the overall program delivery for 2014-15.

Addressing deficiencies identified in Integrated Facility Audits is important to ensure health facilities are safe for those delivering health services to First Nation members. In 2014-15, Health Canada supported First Nations to address 45 deficiencies and will continue to work with First Nations to address the remaining deficiencies in a timely manner.

As of March 2015, 45 recipients had operations and maintenance plans in their signed contribution agreements, exceeding the target of 15. These agreements supported the building of community capacity to developed plans for managing the operations and maintenance of their Health infrastructure.

Sub-Program 3.3.2: First Nations and Inuit Health System Transformation

Description

The First Nations and Inuit Health System Transformation program integrates, coordinates, and develops innovative publicly funded health systems serving First Nations and Inuit individuals, families, and communities through the administration of contribution agreements and direct departmental spending.

This program includes the development of innovative approaches to primary health care, sustainable investment in appropriate technologies that enhance health service delivery, and support for the development of new governance structures and initiatives to increase First Nations and Inuit participation in, and control over, the design and delivery of health programs and services in their communities.

Through this program, Health Canada engages and works with a diverse group of partners, stakeholders, and clients including: First Nations and Inuit communities, tribal councils, Aboriginal organizations, provincial and regional health departments and authorities, post-secondary educational institutions and associations, health professionals and program administrators.

The program objective is that First Nations and Inuit health systems are more effective and efficient.

Performance Analysis and Lessons Learned

In 2014-15, the target for the expected result was met as 100% of provincial and territorial advisory committees were represented by key stakeholders in the integration of health services, including First Nations, Inuit, provincial and territorial representatives. For example, the Atlantic Region participated in trilateral health tables in Nova Scotia, Prince Edward Island and Newfoundland to support better integration of services for healthy First Nations and Inuit communities. The Keewatin Table Tripartite in Northern Ontario was established to address unique northern health issues, and the Nunavut Tripartite Health Table was set up to improve Inuit health through improved coordination and shared priority-setting. Alberta Region, in collaboration with Co-management, developed a joint action plan to improve the health of First Nations people. Other regions continued to engage their respective Provincial or Territorial organizations through a variety of mechanisms on collaborative approaches to planning and service delivery.

In 2014-15, Health Canada continued to advance its working relationships with First Nations and Inuit organizations and with provincial/territorial health systems at the national and regional levels. Nationally, an Engagement Protocol was developed by FNIHB and the Assembly of First Nations to support a mutually acceptable standard of engagement for FNIHB policy and program initiatives.

FNIHB continued efforts to streamline the administration of contribution agreements to support quality health services. FNIHB collaborated with AANDC to advance implementation of AANDC's General Assessment tool, and regions were able to complete a risk assessment for funding arrangements using a single tool. A General Assessment was established for FNIHB funding arrangements for fiscal year 2015-16.

Ongoing efforts to support innovation include working with First Nations, the provinces and territories, where possible, to deploy telehealth services and improve access to community-level health care and services in a fully integrated fashion. Health Canada maintained current investments and progress on eHealth to support and enable the delivery of modern primary and public health care services to geographically remote communities, raising the quality of health care for these communities.

Sub-Sub Program 3.3.2.1: Systems Integration

Sub-heading: Description

The Systems Integration program administers contribution agreements and direct departmental spending to better integrate health programs and services funded by the federal government with those funded by provincial and territorial governments.

This program supports the efforts of partners in health services, including: First Nations and Inuit, tribal councils, regional/district health authorities, regions, national Aboriginal organizations, and provincial/territorial organizations to integrate health systems, services, and programs so they are more coordinated and better suited to the needs of First Nations and Inuit. This program also promotes and encourages emerging tripartite agreements.

Two key activities supporting program delivery include: development of multi-party structures to jointly identify integration priorities and plans for further integrating health services in a given provincial and territorial; and, implementation of multi-year, large-scale health service integration projects consistent with agreed-upon priorities (i.e., a province-wide public health framework or integrated mental health services planning and delivery on a regional scale).

The program objective is a health system that is efficient and integrated resulting in increased access to care and improved health outcomes for First Nations and Inuit individuals, families, and communities.

This program uses funding from the following transfer payment: First Nations and Inuit Health Infrastructure Support.

Sub-heading: Performance Analysis and Lessons Learned

The target for the expected result was not met as 501 out of 518 communities or 97% of First Nations and Inuit communities involved in a Health Services Integration Fund project, affirmed an increase in collaboration among the respective jurisdictions involved in planning, delivering and/or funding health services (as opposed to the goal of 100% of communities). Seventy-seven projects under the Health Services Integration Fund were funded across all provinces and territories. These projects supported First Nations and Inuit communities and organizations to develop innovative approaches to integrate federal and provincial/territorial health services. Five hundred and eighteen communities were involved in integration activities with 47 separate regional health authorities and 18 non-governmental partners.

First Nations and Inuit at both regional and individual community levels, are building their own relationships with provinces (especially Regional Health Authorities), resulting in increased access and seamless care. New service agreements, protocols and models of care have been put in place as a result of Health Services Integration Fund funding.

Sub-Sub Program 3.3.2.2: e-Health Infostructure

Sub-heading: Description

The eHealth Infostructure program administers contribution agreements and direct departmental spending to support and sustain the use and adoption of appropriate health technologies that enable front line care providers to better deliver health services in First Nations and Inuit communities through eHealth partnerships, technologies, tools, and services. Direct departmental spending also supports national projects that examine innovative information systems and communications technologies and that have potential national implications.

Key activities supporting program delivery include: public health surveillance; health services delivery (primary and community care included); health reporting, planning and decision making; and, integration/compatibility with other health service delivery partners.

The program objective is to improve the efficiency of health care delivery to First Nations and Inuit individuals, families, and communities through the use of eHealth technologies for the purpose of defining, collecting, communicating, managing, disseminating, and using data.

This program uses funding from the following transfer payment: First Nations and Inuit Health Infrastructure Support.

Sub-heading: Performance Analysis and Lessons Learned

In 2014-15, 33 First Nations communities were using Panorama or equivalent public health information system, which exceeded the target of 24 communities. Panorama's Inventory module was deployed to seven First Nations depot sites in the Saskatchewan region and 11 First Nations communities in the Quebec region. Panorama's Immunization module was deployed in 15 First Nations communities.

In 2014-15, 250 telehealth sites were targeted to be implemented, based on the objective of implementing 10 new sites in addition to the existing 240 sites. This objective was exceeded as 19 new sites were implemented in Alberta, Saskatchewan, Manitoba and Quebec. The overall target of 250 was not achieved, as a number of sites within the existing 240 sites were not operational in 2014-15. These sites were not included in the results. In these cases, the equipment had been purchased but was not yet in use. Factors that impact operations include: delays in obtaining connectivity upgrades, tower installation, or certification by the provincial telehealth network; recruitment challenges; funding; and infrastructure issues.

Health Canada's progress towards the implementation of additional telehealth sites has highlighted the importance of investing the time to build effective relationships between federal, provincial and First Nations partners; developing human resource capacity on reserves; and, establishing provincial network access.

Lessons learned underscore that sustainable broadband connectivity is the key element for modernizing community-level health services delivery (especially telehealth) in First Nations communities. The quality of connectivity is directly linked to the quality and range of telehealth clinical services available to communities. Without broadband services, efforts to bring a modernized eHealth infostructure incorporating telehealth, public health surveillance such as the Panorama system, and Electronic Medical Records would not be possible.

Work began on the development of a First Nations EMR Strategy and a National EMR Project to advance this strategy. In addition, the multi-year EMR pilot in Manitoba region was advanced by initiating the privacy impact assessment and a procurement process to solicit bids from vendors to acquire an EMR solution.

Sub-Program 3.3.3: Tripartite Health Governance

Description

FNIHB's longer-term policy approach aims to achieve closer integration of federal and provincial health programming provided to First Nations, as well as to improve access to health programming, reduce instances of service overlap and duplication, and increase efficiency where possible.

The BC Tripartite Initiative consists of an arrangement among the Government of Canada, the Government of BC, and BC First Nations. Since 2006, the parties have negotiated and implemented a series of tripartite agreements to facilitate the implementation of health projects, as well as the development of a new First Nations health governance structure. In 2011, the federal and provincial Ministers of Health and BC First Nations signed the legally-binding BC Tripartite Framework Agreement on First Nation Health Governance.

This BC Tripartite Framework Agreement commits to the creation of a new province-wide FNHA to assume the responsibility for design, management, and delivery/funding of First Nations health programming in BC. The FNHA will be controlled by First Nations and will work with the province to coordinate health programming. It may design or redesign health programs according to its health plans. Health Canada will remain a funder and governance partner but will no longer have any role in program design/delivery.

Funding under this program is limited to the FNHA for the implementation of the BC Tripartite Framework Agreement.

The program objective is to enable the newly formed FNHA to develop and deliver quality health services that feature closer collaboration and integration with provincial health services.

This program uses funding from the following transfer payment: First Nations and Inuit Health Infrastructure Support.

Performance Analysis and Lessons Learned

In October 2014, Health Canada marked the one-year anniversary of the transfer of federal functions and operational responsibilities for the management and delivery of First Nations health programs and services in BC to a new FNHA.

The FNHA has successfully assumed the responsibilities for policy, planning, design and delivery of health programs and services and has initiated a gradual transformation in the way in which First Nations health programs are managed. The FNHA is working more closely with the provincial health system to improve the quality, accessibility and responsiveness of health care services through partnerships with the regional health authorities. First Nations are also in a position to incorporate their cultural knowledge, beliefs and values into the design and planning of their health programs and services.

In the post-transfer era, Health Canada's relationship with First Nations in BC has evolved. Health Canada remains a funder and a governance partner which provides support to the integration and accountability processes. Health Canada and the FNHA are also re-defining their partnership through collaborative planning and priority setting as well as exploring broader wellness approaches in health. In 2014-15, Health Canada met the target of undertaking 100% of planned partnership and engagement activities, as committed in section eight of the BC Tripartite Framework Agreement.

In 2014-15, Health Canada continued to advance its working relationships with First Nations and Inuit organizations and with provincial/territorial health systems at the national and regional levels. Nationally, an Engagement Protocol was developed by FNIHB and the Assembly of First Nations to support a mutually acceptable standard of engagement for FNIHB policy and program initiatives. Regionally, the Atlantic Region participated in trilateral health tables in Nova Scotia, Prince Edward Island and Newfoundland to support better integration of services for healthy First Nations and Inuit communities. 

The Keewatin Senior Trilateral Health Table was established to address Northern Ontario health challenges, as identified by Nishnawbe Aski Nation and Grand Council Treaty#3. The Nunavut Tripartite Health Table was established to improve health outcomes of Inuit in Nunavut by facilitating strengthened coordination efforts and identifying shared priorities and opportunities for action between Nunavut Tunngavik Inc., the Government of Nunavut and Health Canada. Alberta Region, in collaboration with Co-management, developed a joint action plan to improve the health of First Nations people. Other regions continued to engage their respective Provincial or Territorial organizations through a variety of mechanisms on collaborative approaches to planning and service delivery.

Internal Services

Description

Internal Services are groups of related activities and resources that are administered to support the needs of programs and other corporate obligations of an organization. These groups are Management and Oversight Services, Communications Services, Legal Services, Human Resources Management Services, Financial Management Services, Information Management Services, Information Technology Services, Real Property Services, Materiel Services, Acquisition Services, and Travel and Other Administrative Services. Internal Services include only those activities and resources that apply across an organization and not those provided to a specific program.

Performance Analysis and Lessons Learned

Health Canada worked to ensure that Canadians have access to the information they need to take action on their health and safety. Throughout the past year, numerous events, videos and social media initiatives were developed to support the Minister, as well as, to engage with and inform Canadians.

Health Canada increased the open and transparent access and exchange of information on Health Canada programs, policies and regulations by continuing to implement the Regulatory Transparency and Openness Framework and Action Plan, and by launching the Consultation and Stakeholder Information Management System.

Health Canada continued to move towards a common approach to regulatory risk communications by developing improved risk communications tools and mechanisms. Health Canada responded quickly and efficiently to the Ebola crisis and provided the communications response supporting the work of both Health Canada and PHAC.

Health Canada has also developed innovative communications products, services and channels including social marketing campaigns and initiatives to help raise awareness and knowledge of key health and safety such as Preventing Illicit Drug Use, Healthy Canadians Social Media, Tobacco Cessation, Ebola Recruitment, Antimicrobial Resistance, and Lyme Disease.

Through the Shared Services Partnership advances were made on government-wide modernization and transformation initiatives, including:

• Alignment with central agency direction to ensure readiness when these initiatives move forward for the deployment of a common e-mail platform, including a new Standard for E-mail Management, offering training sessions on managing e-mail effectively and regular e-mail messages to staff.
• Successful deployment of Windows 7 to network connected devices with the remaining devices.
• Assessment of all program areas for level of Record Keeping compliance in preparation for a Government of Canada records management system.
• Advancement in the migration of employees from landline to cellular technologies.
• Continued transition to a modernized workplace with projects to standardize and modernize work stations in various buildings in several regions.
• Successful testing of all systems related to a multi-departmental initiative (led by the Canada Border Services Agency) to implement a single window through which importers can electronically submit information necessary to comply with government import regulations.

Health Canada undertook the following initiatives that served to improve internal processes and provide better services to Canadians and clients:

• Successfully transitioned PHAC to the new GCIMS in partnership with AANDC. All 2014-15 payments were processed using GCIMS payment module.
• Continued implementation of Health Canada's Resource Management Directorate modernization to continuously improve processes to support resource management and financial analysis within Health Canada.
• Implemented the on-going risk-based monitoring strategy for Internal Controls over Financial Reporting for Health Canada's and PHAC's common key controls related to financial statements.
• Initiated the Planning for Enterprise Performance (PEP) project. In 2014-15, the PEP project succeeded in demonstrating the feasibility and enterprise-wide value in transforming existing Health Canada operational and financial businesses processes and systems, to create a standardized planning and reporting environment that fully integrates both the operational and financial information requirements of stakeholders across the Department within Health Canada's SAP platform. They will result in high degree of alignment between financial and non-financial planning and reporting activities and priorities in Health Canada and partner departments.
• In support of the Shared Services Partnership, the new Shared Travel Services products and tools such as Government Travel Card, Online Booking Tool, Travel Expense Management Tool and Travel Agency Services were successfully rolled out to both Health Canada and PHAC.
• Successfully migrated from Oracle Financial to SAP as AANDC which went live with SAP and the interface linkages with GCIMS in fiscal year 2014-15.

Health Canada is a participant in the 2013-16 Federal Sustainable Development Strategy and contributes to Theme IV (Greening Government Operations) targets through the internal services program.  Additional details on Health Canada's activities can be found in the Departmental Sustainable Development Strategy Supplementary Information Table.

• Previous Page
• Table of Contents
• Next Page