Page 5: Health Canada – 2015-16 – Departmental Performance Report – Section III

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Section III : Analysis of Programs and Internal Services

Programs

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 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 managed initiatives and new and existing funding agreements that advanced priority health issues, including the following:

• The Advisory Panel on Healthcare Innovation made its report public in July 2015, offering its recommendations on how government can support innovation.
• Health Canada, in partnership with Justice Canada, supported the development of legislation on medical assistance in dying and is committed to meeting the palliative and end-of-life care needs of Canadians.

• Health Canada continued to work with Canada Health Infoway to support the implementation and adoption of digital health information technologies, in collaboration with provinces, territories and other stakeholders. As of March 2016, 94% of Canadians have components of an Electronic Health Record available to their health professionals, and support has been given to over 38,000 clinicians in community-based and ambulatory settings for the adoption and use of electronic medical record systems. Additionally, to enhance patient safety, system efficiency and access to care, Budget 2016 committed $50 million to Canada Health Infoway to support short-term digital health initiatives in e-prescribing and telehomecare.
• During 2015-16, the Canadian Institute for Health Information (CIHI) developed a new strategic plan to make health information a catalyst for change in the health care system. The Health Canada - CIHI contribution agreement was amended with a one year extension to provide funding of $78.5 million in 2016-17 during which CIHI will continue its work on health system performance measurement and prescription drug abuse monitoring and will develop an implementation plan for its new strategic direction in relation to potential Health Accord priorities.
• Health Canada provided $47.5 million in funding to support the Canadian Partnership against Cancer which has, through collaboration with key stakeholders including the provinces and territories, accelerated uptake of new knowledge and coordinated approaches to advance cancer control in Canada.
• Health Canada provided $19 million in funding for 24 contribution agreements under the Health Care Policy Contribution Program and advanced health care innovation and health system renewal through collaborative working arrangements with provinces, territories, academic institutions, and non-governmental organizations.
• Health Canada signed a new agreement with the Canadian Foundation for Healthcare Improvement that will provide $14 million over two years to help support health system innovations that improve health care delivery. The agreement provided $2 million for 2015-16 and will provide $12 million for 2016-17.
• $14.25 million was provided 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 Canadians.

In parallel to funding agreements, Health Canada continued working to modernize processes for the management of Grants and Contributions (Gs&Cs). For example, the Grants and Contributions Information Management System (GCIMS), was implemented, allowing improved delivery of Gs&Cs.

The Department also continued to monitor and analyze emerging trends and drivers in health technology policy and worked with Canadian and international partners to explore health technology management approaches to advance this area in Canada.

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 occupational health and occupational hygiene consultative services to ensure that public servants meet medical requirements to safely and effectively perform their duties and to prevent work-related illness and injury. Health Canada pro-actively contributes to reducing the number of work days lost to illness across the federal government through the provision of occupational and psychosocial health services to federal public servants. 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. IPP are representatives of a State, usually Heads of State and/or Government, members of the Royal Family, or officials of an international organization 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

In 2015-16, Health Canada continued to provide occupational health and psychosocial support to public servants to ensure continuity of service to Canadians. The program successfully met its operational targets in Employee Assistance Services and the Public Service Occupational Health Program. In addition, Health Canada developed 70 health contingency plans for Internationally Protected Persons and their families visiting Canada in 2015-16. The new service delivery model was implemented for the provision of food surveillance services, where training was offered to the new network of 42 Food Surveillance Officers across the country. Health Canada also continued its partnership with the Treasury Board Secretariat (TBS) related to the Workplace Wellness and Productivity Strategy to support 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 and fostering the full recognition and use of English and French in Canadian society. This program includes: consulting with Canada's official language minority communities on a regular basis; supporting and enabling the delivery of contribution programs and services for official language minority communities; 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 official language minority communities. 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

In 2015-16, Health Canada continued to provide support to improve access to health services in the minority official language communities through the OLHCP. In particular, the Department:

• Continued to manage the OLHCP and provided over $37M in contribution funding to community and government organizations in order to improve access to health care in official language minority communities across Canada.
• Health Canada officials participated in national and regional events organized by official language minority community stakeholders, including annual general meetings and board meetings of recipient organizations of the OLHCP. Official language minority community representatives were able to share their concerns and promote their interests in the health sector with Health Canada's senior management on several occasions.
• Health Canada provided $7.085 million to the Société Santé en français (SSF) and $5.085 million to the Community Health and Social Services Network (CHSSN). Member networks of SSF and CHSSN produced health guides and directories of health services available in the minority language and organized forums for official language minority community stakeholders and the general population. Networks implemented several projects in partnership with provincial/territorial health systems.
• Health Canada provided $17.3 million to the Consortium national de formation en santé and its member institutions for French-language health programs in colleges and universities outside Quebec, and $4.43 million to McGill University. In 2015-2016, 787 students graduated from the 100 French-language academic health programs funded by Health Canada in 11 colleges and universities located outside of Quebec.
• Seven specialized French second-language courses were provided to health sector students at McGill University to integrate them into the Quebec labour force as bilingual health services providers.
• McGill University allocated $175,000 in bursaries to 21 students from selected Quebec regions with English and French language skills. An evaluation of this bursary program released in May 2015 revealed that 88% of bursary recipients over the 2011-14 period were working in those Quebec regions for longer than the one-year bursary requirement period.
• Health Canada provided $2.49 million to government and community organizations to carry out innovative health services access and retention projects, including new recipients. For example:
  • A project with the Association of Faculties of Medicine of Canada integrating French-speaking medical graduates from Canada's English-language universities and Quebec universities into French linguistic minority communities identified over 550 Francophone and Francophile learners across 13 faculties of medicine. In 2015-16, 16 students received internship placements in French linguistic minority communities (11 different facilities in eight cities), and 332 students participated in training sessions.
  • Funding for a project sponsored by the Association canadienne-française de l'Alberta Régionale de Calgary led to the opening of a multidisciplinary medical clinic for the French-speaking community of Calgary on May 1, 2015.

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 96%, demonstrating a consistently high level of compliance.

As part of the implementation of the new powers under the Protecting Canadians from Unsafe Drugs Act (Vanessa's Law), a Guide to New Authorities was developed and posted for consultation. The final version was posted on the Health Canada web site in July 2015. This guide supports Health Canada's Health Products and Food Branch, in applying the new authorities in a manner that is informed, fair, consistent, and effective. In addition, work continued on the development of quality management system documents to support processes for mandatory recalls.

In support of the Transparency and Openness Framework, Health Canada carried out activities such as posting on a quarterly basis a table of health product advertising complaints, as handled by the Department, and posting of Summary Safety Reviews. For the latter, stakeholders found these postings pertinent, relevant, and useful, and the plain language is highly valued.

For inspections of health product establishments, Health Canada has launched the Drug and Health Product Inspections Database which lists all inspections including inspection ratings and observations. Following each inspection, an Inspection Report Card is posted which summarizes the observations and the measures taken by Health Canada.

In addition, the complete drug dataset is now available through the Drug and Health Product Register.

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

In the latest "World Ranking of Food Safety Performance" report published by the Food Institute of the University of Guelph and the Conference Board of Canada (2014), Canada ranked number 1 overall amongst 17 Organization for Economic Cooperation and Development (OECD) countries for its food safety performance, which includes Canada's ability to respond to food safety recalls.

A key performance target in the area of food safety and nutrition was met, as an assessment of the use of Canada's Food Guide reported that 40% of Canadians use the Food Guide to make healthy food choices/behaviours. The Department launched the "Eat Well Plate" online tool and "My Food Guide" mobile application to help Canadians access and apply Health Canada's dietary guidance.

Health Canada pre-published proposed changes to the Food and Drug Regulations to update nutrition information on food labels in Part I of the Canada Gazette on June 13, 2015. Updates were related to updating the basis of the % Daily Values to be in line with current population dietary recommendations and updating the list of nutrients required to be shown in the Nutrition Facts table. Proposals also included requiring a more uniform serving size to be used for similar foods, improving the legibility of the list of ingredients and related allergen statements, and introducing a new disease risk reduction claim. Feedback received during the comment period is under review.

The second phase of the Nutrition Facts Education Campaign (NFEC: Focus on the Facts) was launched in 2015, with a focus on Serving Size and % Daily Value.

Health Canada developed and promoted factsheets and web content, e.g. Focus on the Facts: How to Use Serving Size and % Daily Value, as well as a stakeholder toolkit of resources.

Health Canada has established directions moving forward in regards to the sodium reduction initiative, the elimination of trans fat initiative and for the introduction of new restrictions on the commercial marketing of unhealthy foods and beverages to children.

An evaluation was completed for the Nutrition Policy and Promotion Program (NPPP). The findings noted that the NPPP is one of the key players that contribute to addressing Canadians' need for information on nutrition and healthy eating.

Program 2.3: Environmental Risks to Health

Description

The Canadian Environmental Protection Act, 1999, 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 in Canadian communities. The program objective is to protect the health of Canadians through the assessment and management of health risks associated with environmental contaminants, particularly 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 met its program objective of protecting the health of Canadians through the assessment and management of health risks associated with chemical substances and providing expert advice and guidelines to partners on the health impacts of environmental factors such as air and water contaminants and a changing climate.

In 2015-16 Health Canada continued to implement the Chemicals Management Plan (CMP). Health Canada planned to assess the potential health and ecological risks associated with approximately 1,500 substances between April 1, 2011 and March 31, 2016. Through the substance groupings and rapid screening initiatives, Health Canada published Draft Screening Assessment Reports (DSARs) for 48 substances in 2015-16 (3% of total), thus increasing the cumulative completed DSARs rate to 97%. In addition, Health Canada published Final Screening Assessment Reports (FSARs) for 75 substances in 2015-16 (5% of total), thus increasing the cumulative completed FSARs rate to 33%. Although the risk assessment work had been completed, Health Canada did not meet its performance target for the publication of existing substance risk assessments in 2015-16. This was due to a number of factors, including the need to address recommendations from the evaluation of CMP2 to review and streamline processes leading to publication. Dedicating significant resources to improving our departmental systems, including the implementation of a new workflow and file management tool, was required given the increased volume and diversity of assessment publications expected in CMP3. Health Canada anticipates that the backlog of CMP2 publications will be eliminated in 2016-17.

One final risk management instrument and one amendment to a final risk management instrument were also published for existing substances deemed harmful to human health in 2015-16. As well, 100 % (465) of new substances for which notification has been received from industry of their manufacture or import were assessed within targeted timelines in 2015-16 and 100 % (9) of new substances assessed to be harmful to human health also had control measures developed within mandated timeframes.

In 2015-16, the department conducted health risk assessments, health benefit analysis, research and outreach in support of the Air Quality Management System. This included Canadian Ambient Air Quality Standards, the development of Residential Indoor Air Quality guidelines and guidance, actions to reduce emissions from transportation and industrial sources, and increased coverage and awareness of the Air Quality Health Index. The air program did not fully meet planned targets for providing health guidance or health assessments. This, in part, reflects that planned targets are generally the culmination of long, collaborative processes, involving scientific assessment, peer review, and significant consultation with stakeholders. Health Canada anticipates that these planned assessments and distribution of guidance products will be completed in 2016-17.

Health Canada also protected the health of Canadians in 2015-16, by finalizing four health-based drinking water guidelines/guidance documents approved by provinces/territories, which are used as the basis for drinking water quality requirements across Canada.

Extreme heat events, sometimes called 'heatwaves', are a growing risk to the health of Canadians. Climate change is increasing the frequency of such events in many communities across Canada, often with the most impact being felt by vulnerable populations such as seniors and children. Heat-related deaths and illnesses and the exacerbation of existing health conditions, can be reduced through community based actions that alert the public when dangerously hot conditions are forecast and by designing cooler communities that promote mitigating actions such as planting shade trees and replacing concrete and paved surfaces with green spaces. Health Canada continued its support of the development and implementation of Heat Alert and Response Systems along with provincial-wide systems in Manitoba and Alberta. In Ontario, a consistent and coordinated province-wide approach has been developed to harmonize heat-related alerting, communications and response activities, with 11of Ontario's public health units located within the footprint of the (Para) Pan American Games piloted having harmonised heat and air quality alerting and messaging over the 2015 heat season.

Health Canada also continued to provide expert advice and oversight to minimize the risks to Canadians posed by environmental factors through two key horizontal, multi-departmental programs. The Environmental Assessment Program continued to provide support and technical advice (relating to air/water quality, country foods, noise and radiation) on proposed projects undergoing environmental assessment review across Canada. The Contaminated Sites Program continued to meet its Federal Contaminated Sites Action Plan commitments with the provision of scientifically sound expert support and 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.

Research on air quality and health generated 60 (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, identified mortality risk estimates for fine particulate matter (PM2.5) which were included in the Global Burden of Disease estimates. The Global Burden of Disease is considered to be the "largest and most comprehensive effort to measure epidemiological levels and trends worldwide".

Health Canada completed 100% (290) 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, a technical guide for applications of gene expression profiling in human health risk assessment of environmental chemicals was developed and recognized by the Society of Toxicology as one of the top 10 best published papers in 2015 for advancing the science of risk assessment. The publication contains a checklist for regulators for a variety of quality checks on genomics data and describes best practices for analysis and interpretation.

Health Canada released the Third Report on Human Biomonitoring of Environmental Chemicals in Canada which presents national biomonitoring data on the Canadian population's exposure to chemicals, collected as part of the Canadian Health Measures Survey.

Program 2.4: Consumer Product and Workplace Chemical

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 Canadian Consumer Product Safety Act and the Food and Drugs Act and its Cosmetic Regulations. Health Canada's efforts are focused 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 2015-16, Health Canada, working with its partners, continued to implement the Food and Consumer Safety Action Plan, in part through the Canadian Consumer Product Safety Act which provides Health Canada with a robust set of tools to engage in active prevention, targeted oversight and rapid response to address dangers to human health or safety that are posed by consumer products. Health Canada took action on non-compliant consumer products and cosmetics within the service standard approximately 85% of the time. Health Canada now reports on a broader spectrum of risk management actions, including those linked to incidents and those on unregulated products (in addition to those on regulated products). 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 continued posting the results of its cyclical enforcement activities on the web, along with quarterly incident report data, so that relevant consumer product information is readily available to the Canadian public.

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. Health Canada also provided guidance to support the implementation of the Globally Harmonized System (GHS) of classification and labelling of chemicals, and delivered on its commitments under the Regulatory Cooperation Council (RCC) work plan for workplace chemicals.

Health Canada triaged mandatory and voluntary incident reports to detect potentially unsafe consumer products and cosmetics at the earliest stage possible. When appropriate, these reports were then sent for risk assessment, risk management or placed under surveillance. In 2015-16, Health Canada received and processed 2,078 reports (54% from industry, 46% from consumer).

Canada's regulatory requirements for cribs, cradles and bassinets are among the most stringent in the world. However, Health Canada identified safety concerns associated with these products that needed to be addressed. To address these safety concerns, proposed new Cribs, Cradles and Bassinets Regulations were published in Canada Gazette, Part I for public consultation on July 25, 2015. In addition, in August 2015, a Notice of Intent was published in Canada Gazette, Part I notifying interested parties that Health Canada is considering further risk management actions to help reduce the risk of strangulation to children in Canada posed by corded window covering products, including proposing amendments to the Corded Window Covering Products Regulations.

To advance joint activities, inform decision-making and support product safety activities, Health Canada continued to work with its international counterparts, including participating in the International Consumer Product Health and Safety Organization symposium, the Organization for Economic Cooperation and Development Working Party on Consumer Safety, Third North America Consumer Product Safety Summit which examined progress under their Cooperative Engagement Framework, and the United Nations Sub-Committee on Classification and Labelling of Chemicals, as well as the RCC with respect to the work plan for workplace chemicals.

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, 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, including prescription drug 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

There are few other countries that have been as successful as Canada in lowering smoking rates and shifting public attitudes regarding tobacco. The 2013 results from the Canadian Tobacco, Alcohol and Drugs Survey found that 15% of Canadians were current cigarette smokers, this is down from 22% in 2001, and is the lowest national smoking rate ever recorded. Furthermore, the prevalence rate for teens aged 15-17 is 6%, which is the lowest it has ever been. The 2012-17 Federal Tobacco Control Strategy (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. For example, amendments to further restrict the use of flavour additives (with some exceptions) in certain types of cigars that made them more appealing to youth came into force on December 14, 2015.

Despite this success, there are over 5 million tobacco users in Canada. Furthermore, the decline in the rate of tobacco use among youth has slowed down. Given the significant health, economic and social costs, Health Canada will continue to take decisive action to help protect young people and others from inducements to use tobacco products and help users quit.

Health Canada 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. Harm reduction is an important part of a comprehensive approach to drug control. A number of harm reduction initiatives have been undertaken, for example, Health Canada made naloxone, an overdose-reversing drug, available without a prescription at the federal level, specifically for emergency use outside a hospital setting, which has resulted in increased access to the drug to help address the growing number of opioid overdoses in Canada. In addition, Health Canada has authorized two supervised consumption sites. Activities in 2015 focused on a continued effort to streamline and increase the transparency of the processes to authorize and issue licenses, permits, registrations and authorizations to perform legitimate activities with controlled substances and precursor chemicals. Health Canada continued to work with partners and regulated parties to reduce the risk of diversion of controlled substances and precursor chemicals by promoting and monitoring compliance with the Controlled Drugs and Substances Act and its regulations. Prescription Drug Abuse activities continued in 2015-16 under the NADS framework. These included a community pharmacy inspection program, as well as support for the Canadian Institute for Health Information to develop Canadian standards and indicators for more coordinated data collection on prescription drug abuse.

Program 2.6: Radiation Protection

Description

The Department of Health Act, the Radiation Emitting Devices Act, and the Comprehensive Nuclear-Test-Ban Treaty Implementation Act provide 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 Safety Commission's Nuclear Safety and Control Act to 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

Health Canada is the lead federal department responsible for coordinating the response to a nuclear emergency under the Federal Nuclear Emergency Plan. As part of a series of exercises to test the revised Federal Nuclear Emergency Plan (5^th edition), Health Canada participated in Exercise 'Intrepid' 15 in New Brunswick with response partners including the Province of New Brunswick and the Point Lepreau Nuclear Generating Station. In addition, Health Canada participated in a workshop and a table top exercise in British Columbia for emergencies involving a nuclear powered vessel. Health Canada also conducted a number of drills to identify any problems, inadequacies, or gaps in preparedness and response plans so that these issues may be resolved prior to a real emergency.

Health Canada prepared for and was ready to respond, according to national and regional health portfolio emergency response plans, to chemical and radiological emergencies during the Pan Am and Parapan Am Games held in July and August 2015.

The Department continued to increase awareness of the risks, health impacts and mitigation strategies related to indoor air exposure of radon gas - the leading cause of lung cancer for non-smokers. Health Canada supported and participated in the 3rd annual National Radon Action Month in November 2015 led by the New Brunswick Lung Association. Take Action on Radon outreach activities were conducted in January and February 2016 through social media and public outreach activities that included presentations and the distribution of radon awareness materials at home shows, conferences, and community and health centres. 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 activities listed above, there were a number of guidance documents, fact sheets and brochures completed to support the National Radon Program outreach activities.

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.

Health Canada responded to 879 public inquiries associated with radiation emitting devices. Many of the inquiries related to the potential health effects of electric and magnetic fields, ultraviolet, infrared and visible light radiation from consumer devices and manmade environmental sources. Health Canada also completed all requested assessments and/or inspection reports from institutions and responded to 224 inquiries from stakeholders. Most inquiries from stakeholders were for elaboration/interpretation of regulatory requirements under the Radiation Emitting Devices Act.

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 (NAFTA), Organization for Economic Cooperation and Development (OECD), Regulatory Cooperation Council (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 delivered on its responsibilities under the Pest Control Products Act through the evaluation and re-evaluation of pesticide products, compliance and enforcement, and outreach and risk reduction strategies, while maintaining quality and exceeding performance targets on all core regulatory activities.

The Department collaborated with the U.S. Environmental Protection Agency (U.S.-EPA) on RCC commitments, aligned regulatory approaches with OECD and NAFTA countries, and aligned the revised re-evaluation work plan with other international regulatory jurisdictions. Furthermore, Health Canada contributed to standard setting bodies on pesticides, and provided technical expertise on Maximum Residue Limits to Agriculture and Agri-Food Canada to address trade irritants.

Health Canada advanced science and science policy, both domestically and internationally, through numerous collaborative initiatives with standard setting bodies and regulatory counterparts, including conducting neonicotinoid pollinator risk assessments and publishing interim risk assessments with the U.S.-EPA and California Department of Pesticide Regulation; collaborating with Environment Canada to revise approaches for pesticide risk assessments for amphibians; leading the development of OECD guidance documents to further reduce, refine or replace animal studies, when applicable; engaging experts on an approach to regulating the potential use of modern technology (i.e., RNAi) in agriculture; and participating in partnership with Agriculture and Agri-Food Canada, the Canadian Food Inspection Agency, the Department of Fisheries and Oceans, and the U.S.-EPA on a variety of science policy files such as Dual Property Products, Risk Reduction Program, Invasive Species, and Aquaculture.

The Department met all timelines for providing information and/or responses to auditors and evaluators, including the Management Response Action Plans, and in some instances, delivered on commitments (i.e. consulting on the elimination of conditional registrations, launching a mobile app to improve communication of re-evaluation decisions, including an update on the current re-evaluation work plan in the Pesticide Program annual report) prior to the tabling of the report in Parliament.

Along with completing the statutory review and legislative amendments to the Pest Control Products Act, Health Canada initiated a number of program and policy changes to the re-evaluation program including the publication of a new five-year work plan, a consultation document on a Management of Pesticide Re-evaluation policy, and a new policy on phase-outs.

Finally, the Department completed proposals to modernize the Pesticide Cost Recovery Regime, for government consideration in 2016-17.

Program 3.1: First Nations and Inuit Primary Health Care

Description

The Department of Health Act 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

Health Canada has taken steps to improve primary healthcare service delivery and ensure that First Nations in remote and isolated communities have access to quality health services. A particular area of focus for the Department in 2015-16, has been addressing health human resource challenges in communities. Specifically, a Nurse Recruitment and Retention Strategy was launched in 2015, which included a successful marketing campaign and a new streamlined Human Resources process that have expanded the pool of qualified nurses.

A National Education Policy has been developed to identify required mandatory training to support nurses in maintaining skills needed to provide quality primary care services in remote settings.

Interdisciplinary health teams have also been put in place to support primary care services provided to communities. For example, paramedics are working in Alberta to support primary care nurses and Ontario has increased the number of Nurse Practitioners working in remote and isolated communities. Complementary health professionals such as Nurse Practitioners and paramedics are qualified to perform a broader scope of practice within clinical health care teams. The inclusion of mental wellness teams, Elders and others such as occupational therapists has further expanded the services provided in communities.

Steps have been taken to support mental wellness issues, which have become critical for many communities, especially those in isolated and remote areas. The government has announced new funding for four crisis response teams in Ontario, Manitoba and Nunavut where the need is greatest; 32 additional mental wellness teams for communities most at-risk; training for existing community-based workers to ensure that care services are provided in a culturally appropriate and competent way; and the establishment of a 24-hour culturally safe crisis response line. New measures will also involve working in close collaboration with Inuit partners to develop a community-led suicide prevention approach.

The Department has sought to better align health care services with our partners and establish effective coordinating mechanisms to address inter-jurisdictional challenges, including engaging in trilateral forums and similar mechanisms for coordinated planning with partners.

Under the Health Service Integration Fund (HSIF), FNIHB supported a total of 53 projects to advance integration initiatives. For example, in 2015-16 HSIF funded a project in Alberta to develop a joint application between First Nations and the federal and provincial governments to access the Indian Registry System and strengthen the capacity of all partners to access, analyze, and share First Nations health information.

Another project in New Brunswick has developed and begun implementing an integrated mental wellness service delivery model involving three First Nations communities, a local National Native Alcohol and Drug Abuse Program (NNADAP) treatment centre, and a New Brunswick Health Authority.

Work is also underway to develop regulations under the Safe Drinking Water for First Nations Act through engagement with First Nations partners. It should also be noted that all First Nations community sites now have access to a trained Community-Based Water Monitor or an Environmental Health Officer to sample and test drinking water quality.

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 British Columbia (BC) (as of July 2013, NIHB will no longer pay premiums for First Nations residents of BC, who will become clients of the First Nations Health Authority 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 non-insured health benefits 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

Health Canada continues to engage First Nations and Inuit partners on improving the delivery of NHIB to First Nations and Inuit. Priorities for delivery improvements were identified through Joint Review processes with the Assembly of First Nations (AFN) and the Inuit Tapiriit Kanatami (ITK). The AFN-NIHB Joint Review Steering Committee completed a review of NIHB mental health benefits. Activities are now underway to implement the recommendations. Work has also begun on reviews of the medical transportation and dental care benefits. The Inuit-NIHB Senior Bilateral Committee progress continues based on a workplan of priority issues outlined by Inuit Regions.

Health Canada continues to work with expert advisors, stakeholders and other key players to identify further improvements to the NIHB Program. Ongoing improvements to the NIHB pharmacy program formulary management are achieved through working with expert advisors on NIHB's Drugs and Therapeutics Advisory Committee (DTAC). Additionally, NIHB is working to create the NIHB Oral Health Advisory Committee (NOHAC) which will be an external advisory body of oral health professionals and academic specialists who will bring impartial and practical expert opinions, advice, and recommendations to the NIHB Program to support the improvement of oral health outcomes of First Nations and Inuit clients.

The NIHB Prescription Monitoring Program (PMP) is designed to identify and address potential client safety concerns regarding clients receiving high doses of Stimulants, Benzodiazepines, Opioids and Gabapentin medications and/or prescriptions being obtained through multiple prescribers or multiple pharmacies. The Department has also put in place measures to identify and address potential abuse by conducting a systematic review of prescribing and dispensing activities and engaging prescribers and providers when concerning patterns are observed.

Program 3.3: Health Infrastructure Support for First Nations and Inuit

Description

The Department of Health Act 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.

Performance Analysis and Lessons Learned

Indigenous and Northern Affairs Canada (INAC) is a key federal partner in supporting improved outcomes for First Nations and Inuit people. Similar objectives and policy/program drivers mean that many of our efforts are mutually supporting with opportunities for greater alignment. To improve management practices for both departments, the Department continues to work with INAC towards greater harmonization of policies and procedures. One tangible outcome of these efforts has been Health Canada's adoption of the Grants and Contributions Information Management System (GCIMS), which is expected to facilitate the transfer of resources to First Nations and Inuit governments, increase transparency and accountability, and reduce processing time and duplication. Other potential streamlining/harmonization initiatives are under development as part of the ongoing joint engagement strategy with First Nations.

Additional standardized practices have been put in place to better align INAC and HC efforts. For example, common risk approaches such as a General Assessment risk assessment tool, the Default Prevention and Management policy and better coordination of recipient audits have all helped align efforts by streamlining and enhancing administrative and planning processes.

As part of the organization's commitment to support health infrastructure, the Department has reviewed and subsequently updated its management control framework for planning and managing capital contributions to support health infrastructure. The updated framework provides an overview of the structures, policies and processes related to the planning and management of capital funds and will act as a reference tool for Health Canada staff involved in delivering the Department's capital contributions program. In addition, a national tracking system has been implemented to record inspection findings and completion of major repairs and deficiencies identified in Facility Condition Reports. The Capital Protocol document has also been updated to ensure that new nursing stations continue to be built according to applicable building codes.

In addition, support for quality health services has been enhanced through the development of new frameworks such as the Monitoring and Performance Framework for Tuberculosis Programs for First Nations on-reserve. This framework was released in 2016 to improve health services and is a collaborative partnership with First Nations partners, TB experts, provincial authorities, and the Public Health Agency of Canada. Improvements to health services continue to advance. Two nursing stations have entered the accreditation process in Quebec, and support continues for other health centres already in the accreditation process. Nursing stations in Alberta and Ontario will also enter into the accreditation process in the coming year.

The Strategic Plan's commitment to improve efficiency through better quality and use of data has been further advanced by FNIHB through the development of regional surveillance plans, with each Region pursuing surveillance information in a manner appropriate for their regional context. The Department has also developed an Electronic Medical Records (EMR) Strategy, providing a strategic approach for EMR implementation initiatives.

In terms of supporting health human resources, the Department has invested in capacity development for First Nations health managers and community health workers. Specifically, under the Aboriginal Health Human Resource Initiative (AHHRI), the Branch supported community-based worker training, and continued to support post-secondary education of Indigenous students pursuing health professions through a contribution agreement with Indspire, an Indigenous-led registered charity that invests in the education of Indigenous people.

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. Internal services include only those activities and resources that apply across an organization, and not those provided to a specific program. The groups of activities 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; and Acquisition Services.

Performance Analysis and Lessons Learned

Advances to key internal services initiatives were made for Health Canada in 2015-16 through the Shared Services Partnership, including:

Human Resources

The Department continued to support a culture of high performance and learning through the development and implementation of new performance management tools, guidelines and outreach activities and launch of the Canada School of Public Service development programs. An assessment of the 2015-16 Performance Management Program has been conducted and will be finalized and reported in 2016-17.

Information Management and Information Technology

Implementation of government-wide modernization and transformation initiatives to support departmental business and programs, which include:

• Alignment with central agency direction to ensure readiness for the deployment of a common email platform.
• Establishment of technology standards for Health Canada and PHAC that align with Government of Canada IT standards as part of the Strategic Technology and Application Renewal (STAR) project to support the migration of applications from legacy data centres to new enterprise data centres.
• Successful implementation of electronic 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.

Communications

Health Canada worked to ensure that Canadians had access to the information they needed 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 and inform Canadians.

The Department 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, promoting the Consultation and Stakeholder Information Management System, and showcasing science expertise across the Department. Health Canada also continued to implement the Government of Canada's Web Renewal Initiative, leading content migration to the health theme with 256 partners.

Health Canada continued to move towards a common approach to regulatory risk communications, providing risk communications training to employees, and expanding and leveraging existing partnerships outside the Department.

The Department developed innovative communications products, services and channels, including social marketing campaigns and initiatives to help raise awareness and knowledge of key health and safety issues such as Preventing Illicit Drug Use, Tobacco Cessation, Ebola Recruitment, Antimicrobial Resistance, and Lyme Disease.

Management and Oversight:

Several initiatives have been launched that seek to more closely integrate financial and non-financial planning and performance information for decision-making.

Health Canada has made good progress on the development of a Planning for Enterprise Performance (PEP) system. Business analysis was conducted allowing for work to begin on functional design for a new SAP planning and budgeting solution. The integration of operational and financial performance information is a complex undertaking requiring refinement of business processes and system re-design. Establishing a common business process will require active change management over the next 18 months. Progress to date includes:

• Examination of current processes and practices
• Drafting of future integrated and standardized process and practices
• Identification of required analysis to support system functions

The new Treasury Board Policy on Results will provide Health Canada with increased control to assess the quality, availability and utility of planned and actual performance information based on a standard performance measurement process now in place within the Department.

Following Health Canada's recognition in the 2014-15 Management Accountability Framework process in which the Internal Control Framework was considered a "notable practice", the Department continues to be commended in 2015-16 for its good work in the area of internal controls, including the implementation of a program to monitor the effectiveness of its internal controls over financial reporting. In addition, Health Canada participated in the government-wide working group on Policy on Internal Control and shared its experience with other departments and agencies.

Health Canada's 2015-2016 to 2019-2020 Investment Plan was renewed in April 2015. The Plan focuses on the renewal of real property infrastructure, the modernization of the department's IM/IT platforms to align with the Government of Canada's IT modernization strategies, including the modernization of corporate systems and software infrastructure, such as Single Window Initiative, upgrading the Windows operating system and the E-Mail Transformation, and continued investments in infrastructure with its partners that promotes access to telehealth and telemedicine services in remote communities, and also promotes the use and integration of electronic medical systems with provincial systems. Furthermore, the plan links investments to those priorities which support Health Canada's strategic outcomes while ensuring alignment with the Government of Canada cost containment initiatives, and the Shared Services Partnership within the Health Portfolio.

Migration of the Management of Contracts and Contributions System (MCCS) and the Lotus Notes Grants and Contributions Database (LNGCD) to the Grants and Contributions Information Management System (GCIMS) has been successfully completed. GCIMS is now being used in Health Canada as an integrated administrative tool to record, manage, process and report Grants and Contributions (Gs&Cs) transactions. All Gs&Cs payments for 2015-16 were successfully processed through GCIMS which has an automated interface with the departmental financial system SAP. Health Canada continues to collaborate with Indigenous and Northern Affairs Canada and other federal partners to further enhance the functionality of GCIMS.

Health Canada has been able to modernize many different areas of financial management such as the budget management process. A standardized practice has been created to ensure consistency throughout the department/branches by:

• Examining how budget management framework services are delivered to clients, with a focus on core activities, service levels and opportunities to improve analytics, and value added services to clients, that are affordable and risk based.
• Examining standards on how to approach the management variance report support and challenge function with clients so that there is a uniform level of support across the department and regions.
• Examining how budgets and horizontal initiatives are tracked through the financial coding and budget derivation tools.
• Looking at leveraging technology on the business process that would support the multi-year financial planning system, a system solution for tracking budgets and funding.

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