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GOVERNMENT RESPONSE TO THE
STANDING COMMITTEE ON HEALTH’S REPORT:
Promoting Innovative Solutions to Health Human Resources Challenges
The Government of Canada (GoC) acknowledges the extensive and valuable work undertaken by the Standing Committee on Health (hereafter referred to as “the Committee”) in its examination of health human resources (HHR) in Canada. In particular, the GoC would like to thank the Committee for drawing its attention to the World Health Organization’s (WHO) recommendations for addressing shortages in rural and remote areas.
The GoC shares the Committee’s interest in improving HHR capacity in Canada to better meet broad population health needs, as well as the health needs of specific communities, including official language minorities, rural, remote and Aboriginal communities.
The Committee’s recognition of the substantial federal investments and progress made in this area is appreciated. The GoC would like to take this opportunity to elaborate on its current approach to addressing HHR challenges and promoting innovation in HHR across a range of departments and program areas. The ultimate goal of these efforts is to support the delivery of appropriate, timely, and effective health care to the Canadian population.
The GoC assists in the financing of provincial/territorial (P/T) health care services, through:
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$38.5B in 2010-2011 through the Canada Health Transfer, including $13.1B through transferred tax points and $25.4B in cash support, set to grow by 6% annually until 2013/2014; and,
- Budget 2010 commitment of $60M over 2 years to consolidate progress made under the Territorial Health System Sustainability Initiative.
With respect to HHR specifically, the federal Government plays two key roles. First, the GoC employs approximately 3,500 health care providers directly and funds the delivery of certain health care services for First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces (CF) and the Royal Canadian Mounted Police (RCMP). Through the Federal Healthcare Partnership (FHP), the following departments and agencies work together to initiate and coordinate collective recruitment and retention activities, address HHR-related challenges and share best practices: Citizenship and Immigration Canada, Correctional Service Canada, Department of National Defence, Health Canada, Public Health Agency of Canada (PHAC), RCMP, and Veterans Affairs Canada (VAC).
Second, the GoC plays a leadership role by supporting a range of targeted projects and initiatives of national significance. These actions are undertaken in collaboration with the P/T governments and national stakeholders, and complement the substantial investments made by the P/Ts in HHR within their jurisdictions. Examples of key Federal investments include:
$20M annually for Health Canada’s Pan-Canadian Health Human Resource Strategy (HHRS);
$18M annually for Health Canada’s Internationally Educated Health Professionals Initiative (IEHPI);
$4M annually for the Public Health Agency of Canada’s Public Health Scholarship and Capacity Building Initiative;
$174.3M over 5 years (2008-2013) to support increased access to health services, including the recruitment and retention of health professionals, for official language minority communities;
$34.5 million over 5 years (2008-2013) to establish the Nursing Innovation Strategy for remote and isolated First Nation communities;
The Aboriginal Health Human Resources Initiative (AHHRI), which has been renewed for 2 years in Budget 2010; and,
Canada’s Economic Action Plan (Budget 2009) commitment of $50M over 2 years to work with P/T governments on the development and implementation of the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications.
Established evaluation processes already embedded in these programs continue to support ongoing performance monitoring and measurement.
In both roles, the GoC has made substantial investments across the following areas: effective HHR planning; innovations in HHR; supply and distribution of health care professionals; and, meeting the population health needs of specific communities. These four themes, which represent the GoC’s approach to addressing HHR challenges, address the seven chapters into which the Committee has organized its recommendations.
Five of the recommendations in the Committee’s report are directed at the F/P/T Advisory Committee on Health Delivery and Human Resources (ACHDHR) and one recommendation is directed at the Association of Faculties of Medicine of Canada. Neither of these entities is included within the scope of this Response. The federal Government will, however, discuss these recommendations with the respective groups.
1. Effective HHR Planning
With respect to supporting effective HHR planning in Canada, the GoC focuses its efforts on sustaining collaboration while targeting funding at initiatives where potential impact has been assessed as having national significance.
The GoC acknowledges the Committee's desire for enhanced leadership at the pan-Canadian level and recognizes the challenges posed by the federated nature of health care delivery in Canada. Since health care education, management and delivery, including HHR planning, are primarily a P/T responsibility (with the exception of federal client groups), each jurisdiction, with its respective stakeholders, continues to be responsible for developing its own HHR policies, plans and service models. Consequently, no government has a singular leadership role with respect to national HHR planning. In light of this, F/P/T collaboration to support largely jurisdictionally-based planning efforts is the preferred approach.
The main vehicles for collaboration are the F/P/T Conference of Deputy Ministers’ Advisory Committee on Health Delivery and Human Resources (ACHDHR) and the Public Health Human Resources (PHHR) Task Group. The ACHDHR’s Framework for Collaborative Pan-Canadian Health Human Resources Planning identifies priority areas and sets out tangible actions that all jurisdictions can take, both collectively and on their own initiative, to achieve a more stable, effective health workforce. The GoC targets funding at initiatives that correspond to this Framework. The PHHR Task Group’s mandate is to advance the implementation of public health human resources strategies based on the Pan-Canadian Framework for Public Health Human Resource Planning; and to make recommendations to the Public Health Network Council.
To better meet the health needs of Aboriginal communities, the Aboriginal Health Human Resources Initiative (AHHRI) has been designed to lay the foundation for longer-term systemic change. The AHHRI has funded national and P/T First Nation and Inuit organizations to support their capacity for HHR planning. To augment HHR planning with respect to other federal client groups, the Federal Healthcare Partnership-Office of Health Human Resources (FHP-OHHR) is conducting an analysis of licensed health care professionals working in the federal public service with employment data provided directly by the Treasury Board Secretariat.
The GoC also targets funding at initiatives that are complementary to the extensive investments made by the P/Ts and key stakeholders in the area of HHR planning. For example, Health Canada’s Health Human Resources Strategy (HHRS) is providing over $700,000 (2010-2011) to the Western and Northern Health Forum, a collaborative venture of the Ministries of Health and the Ministries of Advanced Education from the four western provinces and three northern territories, to improve health workforce efficiency while examining appropriate measurement indicators to track system improvements and inform planning. The HHRS is also providing over $925,000 (2008-2013) for a Canadian Institutes of Health Research (CIHR) Applied Health Services Research Chair in HHR to support research and knowledge exchange in HHR.
With respect to the needs of official language minority communities (OLMCs), $174.3M over 5 years (2008-2013) has been committed to support increased access to health services for these communities. For example, through the Roadmap for Canada’s Linguistic Duality, the Consortium national de formation en santé, Société Santé en français and McGill University are funded to provide cultural and linguistic training to health professionals to improve their ability to provide health services to OLMCs. Additionally, through the HHRS, funding has been provided (2007-2013) to the Consortium national de formation en santé to plan for and better meet the needs of Francophone communities.
GoC investments continue to support organizations with mandates to conduct or facilitate data collection, research and knowledge exchange in areas that encompass HHR, to support more effective jurisdictional planning. Specifically, the Canadian Institute for Health Information (CIHI) HHR Databases Development Project, which developed national, supply-based databases for the professions of Pharmacy, Physiotherapy, Occupational Therapy, Medical Laboratory Technology and Medical Radiation Technology, evolved from a pilot project funded by Health Canada’s HHRS to a fully operational program funded by CIHI. Also, Budget 2010 increased CIHR’s annual budget by $16M to support research and knowledge exchange activities that include HHR. The Health Council of Canada, which has a mandate to monitor and publicly report on progress made in the implementation of the 2003/2004 First Ministers’ Accords, including in the area of HHR, is also funded by the GoC via an ongoing grant. A new five-year funding agreement was put in place April 1, 2010.
The GoC continues to investigate opportunities to improve the timeliness and comprehensiveness of HHR data collection and research, in an effort to further advance the effectiveness of planning within its jurisdiction as well as support P/T and stakeholder capacity in this area, where need is identified and interest in collaboration is forthcoming.
2. Innovations in HHR
The GoC acknowledges the Committee’s extensive exploration of various forms of innovation in HHR, particularly the promise held by interprofessional collaborative practice. Indeed, the GoC recognizes that, beyond addressing supply and distribution challenges, exploring how HHR can be optimized to more effectively and efficiently meet population health needs is an emerging and important area of focus.
With this goal in mind, to date over $24M has been invested through the HHRS in a series of interprofessional education and collaborative practice projects. These investments have resulted in: the training of 1060 educators to teach from an interprofessional approach; 8120 health science students working interprofessionally; 2500 health care providers, across eighteen disciplines, practicing interprofessionally; and thirteen post-secondary institutions adopting interprofessional education as a part of their curriculum. Through the Nursing Innovation Strategy ($34.5M from 2008-2013), funding has been provided to investigate and pilot new models of health care delivery involving collaborative health care teams comprised of Nurse Practitioners, Licensed Practical Nurses, Midwives, Lab, Xray and Pharmacy Technicians, to improve primary care delivery in remote and isolated First Nation communities.
With respect to other avenues for attaining the appropriate skill mix, AHHRI funding has supported educational initiatives targeted at First Nations and Inuit community-based health workers in the areas of mental health, addictions, diabetes prevention, early childhood development, and personal care to ensure that they are trained at a level equivalent to established standards of practice. The GoC has also supported a series of initiatives to build public health human resources capacity, including the launch of a set of 36 core competencies, the Public Health Scholarship and Capacity Building Initiative and the Skills Online Continuing Education Program.
In addition, the HHRS has supported a number of profession-specific innovations in HHR, such as the Canadian Medical Association’s project to enhance the quality of clinical care delivered by physicians and potentially other practitioners by providing improved access to quality online continuing education. Additionally, the Canadian Pharmacists Association has been funded to identify emerging research priorities related to pharmacy workforce roles and responsibilities in the context of interprofessional, patient-centred practice models, in support of the Blueprint for Pharmacy Implementation Plan.
With respect to recruitment and retention and the quality of worklife, funding has been provided through the HHRS for more than 20 projects to support the development and implementation of programs and tools to assist healthcare organizations to improve working conditions to attract and retain health care professionals. The HHRS has also funded the Canadian Federation of Nurses Unions (2008/09 - 2010/11) to implement 10 projects designed to improve retention, recruitment and the quality of worklife for nurses.
Finally, with respect to innovations in technology, as the Committee is aware, Budget 2007 allocated $400 million, and Budget 2009 committed an additional $500M, for Canada Health Infoway, a not-for-profit organization that works with P/Ts to encourage and accelerate the adoption of Electronic Health Records (EHRs). Investments in EHRs have the potential to improve the quality, safety and accessibility of health care provided by health professionals.
The GoC continues to respond to the evolving policy environment via existing programs that support HHR serving federal client groups as well as P/T and stakeholder efforts to optimize the health care workforce.
3. Supply and Distribution of Health Care Professionals
The GoC is pleased to report that, between 2004 and 2008, the total number of physicians and regulated nurses increased by about eight percent (CIHI). Since the mid- to late 1990s the number of physicians moving abroad has decreased and, between 2004 and 2008, has been less than the number of physicians returning from abroad, resulting in a net gain of physicians (CIHI).
These promising trends notwithstanding, the GoC acknowledges the challenges highlighted by the Committee with respect to ensuring all Canadians have access to appropriate, timely and effective care. Notably, shortages in rural and remote communities continue: nearly 19% of the Canadian population lives in rural Canada, but it is served by less than 8.7% of all physicians and 14.9% of general practitioners (CIHI). The situation is most acute in remote and Northern locations. In Canada, there is an average of 195 physicians for every 100,000 people, whereas the Northwest Territories has 112 physicians per 100,000 people and Nunavut has 35 physicians per 100,000 (CIHI).
The GoC recognizes that increasing the number of needed health care professionals entering the health workforce and encouraging them to practice in underserved areas and communities, such as rural and remote areas, is a complementary effort to supporting innovation in HHR.
To this end, the GoC is working with P/Ts to encourage the training of physicians for areas of high need. Specifically, Health Canada, through the HHRS, is working with the Province of Manitoba and the University of Manitoba on a pilot project (2009/10-2013/14) to introduce 15 additional residency seats in family medicine to support the delivery of medical services in remote and rural areas of Manitoba, Nunavut and the Northwest Territories. In addition, beginning in 2011/2012, Health Canada, through the HHRS, is committing an additional $33M over four years to support residency training, with a particular focus on family medicine residencies in underserved communities, including rural and remote communities. Residency positions will be open to all qualified Canadian residents, including international medical graduates (IMGs).
As highlighted in this Response, several initiatives already undertaken by the GoC have focused on supporting innovation in areas identified in the WHO’s recommendations for addressing shortages in rural and remote areas, namely, education (e.g., funding residencies, a review of medical education), financial incentives (e.g., via scholarships and bursaries), and personal and professional support (e.g., healthy workplace initiatives, and the development of management competencies).
With respect to the profession of nursing, a range of targeted initiatives have been funded through the HHRS to address nursing shortages in rural and remote areas. For example, NurseOne is a portal that disseminates nursing best practices in rural and remote communities. The Atlantic Collaborative Learning Environment intends to establish collaborative learning environments in rural and urban communities including a francophone site. Furthermore, the Inuit Nursing Access Program in Labrador, co-funded by the AHHRI and the Nunatsiavut Government, consists of a bridging opportunity for Inuit students to acquire the basics required for admission into nursing and a nursing program in a culturally relevant setting (including a culturally adapted curriculum).
The integration of internationally educated health professionals is another ongoing strategy undertaken by the GoC to increase the availability of health professionals. To date, GoC investment in the Internationally Educated Health Professionals Initiative (IEHPI) has funded over 90 projects to facilitate greater access to assessment, training and licensure. For example, funding has been provided to jurisdictions to develop and deliver bridging programs across the professions of nursing, pharmacy, physiotherapy, occupational therapy, medical laboratory technology, midwifery and medical radiation technology; and, mentorship, orientation, and adaptation programs for the professions of nursing, pharmacy, physiotherapy, occupational therapy, and medicine.
The results of these investments include: a greater harmonization of assessment outcomes and bridging referrals; greater capacity of IEHPs to meet the demands of professional practice and patient-centre care; greater capacity of mentors to provide IEHPs with the knowledge, skills, enculturation, and professional socialization needed to accelerate their integration into the healthcare workforce; and greater capacity of IMGs to attain the necessary standards to gain access to entry to residency.
The GoC also has an interest in integrating qualified immigrants into the health care workforce to achieve labour market efficiencies, in accordance with the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications (Budget 2009 commitment of $50M over 2 years) developed by a F/P/T working group composed of immigration and labour market ministries and overseen by the Forum of Labour Market Ministers. This Foreign Qualifications Recognition (FQR) Framework is a public commitment by governments across Canada to work together to eliminate barriers to credential recognition and articulates a new, joint vision, which is to support a fair and competitive labour market environment where immigrants have the opportunity to fully use their education, skills and work experience. Of the fourteen occupations prioritized under the FQR, nine are health-related.
In considering the way forward, the GoC will continue to explore new opportunities to improve and encourage the adaptation of bridging programs and assessment tools for other professions and across jurisdictions. For example, a new IEHPI Call For Proposals for P/Ts was announced in August 2010. Projects funded as a result of the Call will build on previous IEHPI outcomes and support the FQR Framework.
Finally, the GoC also recognizes its responsibilities to both these skilled immigrants and to the international community, and supports the intent of the WHO Code of Practice on the International Recruitment of Health Personnel.
4. Meeting the Population Health Needs of Specific Communities
In addition to the GoC’s comprehensive approach to HHR aimed at meeting overall population health needs, the needs of specific communities are addressed by targeted programming and initiatives. As noted previously, $174.3M over 5 years (2008-2013) has been committed to support increased access to health services for official language minority communities. Targeted action is also being taken to address the needs of federal clients and Northern communities.
4.1 Meeting the Needs of Federal Client Groups
The federal Government provides some direct health care services to certain First Nations and Inuit people. The federal Government also provides certain health services to eligible veterans, refugee protection claimants and inmates of federal penitentiaries, and has responsibilities for health care for serving members of the Canadian Forces (CF) and the RCMP.
The AHHRI, renewed for 2 years in Budget 2010, is the key HHR initiative targeted at addressing the needs of First Nation and Inuit communities. It has focused on: increasing numbers of Aboriginal health care providers; improving retention of health care providers in Aboriginal communities; and increasing numbers of culturally competent healthcare providers serving Aboriginal communities.
The AHHRI has made significant inroads in facilitating the conditions for increased Aboriginal participation in the health care system in Canada. Awareness about available health care careers, educational prerequisites, and the attractiveness of these careers has increased among the Aboriginal population. Furthermore, innovative pilot bridging programs are expected to increase the number of Aboriginal people who qualify for entry into health professions.
Examples of AHHRI projects include a partnership with the National Aboriginal Achievement Foundation (NAAF) and Indian and Northern Affairs Canada (INAC) to host national career fairs for Aboriginal high school students that are designed to increase awareness about career opportunities. The First Nations and Inuit Skills Link Program supports annual National Science Camps and is designed to foster interest in science and technology and to encourage Aboriginal youth to consider a career in the health fields. Furthermore, $12.5M has been provided over 5 years for scholarships and bursaries for 1600 Aboriginal students pursuing health careers, through the NAAF and $7M has been provided over 5 years for 60 post-secondary health education programs to support Aboriginal students in successfully completing degrees. Additionally, over $1.3 million in bursaries and scholarships was awarded to Aboriginal health care students in 2007-2008 under the First Nations and Inuit Health Careers Program.
The AHHRI has also facilitated partnerships between the Indigenous Physicians Association of Canada (IPAC) and the Association of Faculties of Medicine of Canada; between the IPAC and the Royal College of Physicians of Canada; and among the Aboriginal Nurses Association of Canada, the Canadian Association of Schools of Nursing and the Canadian Nurses Association to develop the foundational work for improving the cultural competency of all medical and nursing students and professionals.
Finally, the AHHRI supported the establishment of the First Nations Health Managers National Association and the development of the First Nations Health Managers Competency Framework, in partnership with the Assembly of First Nations, to improve First Nation communities’ ability to recruit and retain qualified First Nations health managers and foster a supportive working environment.
Moving forward, the AHHRI is refocusing on the following areas: continuing to increase the numbers of Aboriginal providers; and assisting community-based workers to acquire the skills and certification comparable to P/T workers, including training First Nations Health Managers to run effective health systems.
In addition to AHHRI, Health Canada has invested in 275 tele-health facilities in First Nation communities, many of which connect to provincial and territorial tele-health infrastructure established in partnership with Infoway using federal funding. These investments will increase the capacity for continuous education of health staff and contribute to addressing recruitment and retention by providing access to medical consultation. Health Canada’s HHRS funding to University of Manitoba’s Northern and Remote Family Medicine Residency Program (2008/09) is designed to meet the needs of remote communities, as well as those with First Nations and Inuit populations. The project’s anticipated outcomes include an enhanced focus on northern and Aboriginal health issues to provide more equitable health care to patients. Of the 2008 investments in innovative models of nursing care for remote and isolated First Nation communities, $5.1 Million will be spent over 4 years to support nursing education to improve the skills of Health Canada and Band employed nurses. This is an example of an HHR initiative undertaken by Health Canada to support its role as the direct employer of health professionals serving Aboriginal communities.
As noted by the Committee, the GoC has also experienced challenges with respect to filling HHR vacancies to meet the health needs of other federal clients. To address these challenges on behalf of its member organizations, including Correctional Service Canada, the RCMP, Citizenship and Immigration Canada, Department of National Defence, Health Canada, Public Health Agency of Canada, and Veterans Affairs Canada, the federal Government established the Federal Healthcare Partnership’s (FHP) Office of Health Human Resources in 2008. This Office has a mandate to: initiate and coordinate collective recruitment and retention activities; provide leadership and assistance to FHP member Organizations when addressing common HHR issues and challenges; and, serve as a coordination point where federal health care professionals can come together to network, share best practices and strengthen their community through training and collaboration.
In relation to the Committee’s recommendations on the mental health needs of federal clients, the GoC supports a range of initiatives through the FHP and its partner organizations. For example, FHP’s Mental Health Working Group provides FHP partners with a forum for dialogue, information-sharing and collaboration concerning mental health services, programs and policies. FHP’s Office of Health Human Resources has also established a partnership with the Mental Health Table which is made up of 13 national health care associations whose membership practice in the mental health domain. This forum provides FHP partners the opportunity to introduce new assessment tools, establish networks for education and service provision purposes, as well as host and promote conferences and events.
Furthermore, Veterans Affairs Canada (VAC) provides, in addition to a range of other health services, mental health services to eligible CF and RCMP personnel through their Operational Stress Injuries Clinics, disseminates information and supports skill development with regard to the assessment and treatment of operational stress injuries in the community of professionals who cares for VAC clients. The RCMP’s mental health professionals work to ensure the safety of the public by addressing any psychological disorder that could affect a member's ability to perform police work satisfactorily, and to provide preventive services (including workshops on stress management, the prevention of alcohol abuse or misuse, and critical incident stress intervention).
Moving forward, the RCMP is currently undertaking a series of initiatives, in conjunction with their Healthy Workplace Strategy, that include the development of a disability case management policy and program to expedite members’ recovery and return to work. Additionally, the RCMP is undergoing pilot sessions on resiliency training to address police-specific trauma in a preventative manner and developing a health and safety research program mandated to enhance the quality, quantity and diversity of health information and indicators collected and analyzed.
4.2 Meeting the Needs of Northern Populations
The GoC recognizes the unique challenges of First Nations and Inuit living in the North, as highlighted in the Committee’s report. The GoC supports territorial governments who are responsible for the delivery of health services to all residents, including Aboriginal populations, through major transfers and a range of targeted initiatives.
For example, territories receive significant, ongoing financial support from the GoC through Territorial Formula Financing (TFF) and the Canada Health Transfer (CHT). TFF is an annual unconditional transfer to enable the three territories to provide comparable programs and services, including health. The CHT is a conditional block transfer to all provincial and territorial governments in support of health care. In 2010-11, TFF transfers to the three territorial governments will total $2.7B, and CHT payments to the territories will total $80M.
The GoC also supports a range of targeted initiatives. The five year, $150 million Territorial Health System Sustainability Initiative facilitated the transformation of territorial health systems by providing territorial governments with the opportunity to continue to incorporate health reform activities as part of their ongoing business, to reduce reliance over time on the health care system and improve community-level access to health services. Budget 2010 further extended this supplementary funding by $60 million over two years in order to consolidate the progress made in reducing the reliance on the primary care system, strengthening community level services, and building self-reliant capacity to provide services “in-territory”, as well as offset medical travel costs in the territories.
In 2008, the federal Government invested $34.5 million over 5 years to establish the Nursing Strategy with the goal of improving access to and quality of primary care nursing services in remote and isolated First Nation communities. The Strategy is investigating new models of care through the piloting of collaborative teams involving nurses and other health care providers such as pharmacy clerks, midwives; integration of nursing and technology such as Nurse Practitioner-led virtual clinics; introduction of new hours of operation in targeted 24/7 nursing stations such as extended on-duty nursing services beyond regular business hours; and support for Nursing Education programs to enable nurses working in these communities to obtain the required advanced Primacy Care competencies to meet the new conditions under the Federal Controlled Drugs and Substances (CDSA) legislation in order to safely delivery quality primary care services.
The University of Manitoba’s Northern and Remote Family Medicine Residency Program, funded through the HHRS (starting in 2009), is also designed to meet the needs of remote communities. The anticipated pilot project outcomes include: increased access to telehealth and tele-education to northern and remote residents and physicians; improved access to physicians, health care delivery and services to northern and remote communities that augment existing primary care services available in these areas; enhanced focus on northern and Aboriginal health issues to provide more equitable health care to patients; and, increased retention of family physicians in northern and remote areas.
Additionally, INAC’s Nutrition North Canada supports access to healthy and nutritious food for many northern communities and funds community and retail-based nutrition education and awareness activities. The Government of Canada committed $45M over two years (starting in 2010) to fund a new food retail subsidy program and nutrition and health promotion initiatives. Including existing funding, this will bring the annual budget for Nutrition North Canada to $60M, providing stable ongoing funding.
Health Canada and PHAC support a number of community-based health promotion and disease prevention programs across the three territories. As well, through the Canadian Public Health Service and Canadian Field Epidemiology Program, PHAC places qualified public health officers, graduate-level students and field epidemiologists in jurisdictions across Canada, including the North, to gain field experience and respond to a variety of public health needs. Finally, through the AHHRI, Health Canada has supported the development of an Inuit-specific HHR strategy involving the Inuit Tapiriit Kanatami, Northwest Territories and Nunavut governments.
To fulfill the mandates of their respective departments, Health Canada, PHAC and INAC employ professionals with a broad range of expertise on health and its determinants, including food security, education, social development and recreation. The GoC continues to work closely with the territories, which deliver federal health programming in the North, to ensure that the programming supports health capacity development and ultimately is responsive to, and meets the needs of, Northern communities.
Concluding Remarks
The GoC wishes to note the substantial investments made, both federally and at the P/T level, to support capacity in HHR planning, innovation, supply and distribution, all in an effort to better meet broad population health needs, as well as the needs of specific communities. The GoC is committed to continued leadership, targeting its investments to well position Canada to meet emerging HHR needs and challenges, while acknowledging P/T jurisdiction in this area.
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