Health

Addressing Anti-Indigenous Racism in Health Systems

The Government of Canada is committed to ending anti-Indigenous racism in our health systems in a way that is informed by the lived experiences of Indigenous Peoples, driven by Joyce's Principle, and based on the recognition of the rights of Indigenous Peoples. With the support of Health Canada and Crown-Indigenous Relations and Northern Affairs Canada, Indigenous Services Canada led the planning and coordination of 4 national dialogues on addressing racism experienced by Indigenous Peoples in Canada's health systems from October 2020 to January 2023. The Government of Canada has publicly acknowledged the impact of colonization on Indigenous health at multiple forums including the third national dialogue on anti-Indigenous racism in health care held in June 2021.

Discussions at the national dialogues helped identify many of the root causes and critical gaps that need to be addressed, which have guided the implementation of the Addressing Anti-Indigenous Racism in Health Systems initiativeto ensure Indigenous Peoples have access to high quality, culturally-informed health services, and to ensure health care systems are free of racism and systemic discrimination against Indigenous Peoples. Current activities are focused on supporting Indigenous health system navigators, patient advocates, midwives and birth support workers, as well as initiatives to increase Indigenous representation in health professions.

Health Transformation

The Health Transformation initiative supports tripartite processes between First Nations-led health organizations (representing a number of communities), the Government of Canada, and provincial governments. The Health Transformation initiative transfers federally funded health services to the control of First Nations so that they can design and deliver health programs that respect distinct cultural practices and respond to the needs of their communities.

This initiative acknowledges that in order to make significant improvements in health service delivery and outcomes, the role of the federal government in health must change by establishing new partnerships that are based on reciprocal accountability, so that decisions over health for First Nations can be made by First Nations. Health Transformation aims to increase First Nations' control in the design, delivery, and management of health services, to enable improved coordination with provincial/territorial health systems, and to create the conditions needed to address health inequities faced by First Nations people.

Distinctions-based Indigenous Health Legislation

Indigenous Services Canada (ISC) supported over 200 engagement activities with Indigenous partners, in addition to those led by partners themselves. A total of 42 Indigenous-led engagement reports and position papers were submitted. The engagement process wrapped up in fall 2022, and a national summary report, What We Heard: Visions for Distinctions-based Indigenous Health Legislation is publicly available. From fall 2022 to June 2023, ISC supported distinctions-based+ co-development processes, which focused on translating what was heard through engagement into proposed legislative options. In total, 14 co-development tables were launched with First Nations, Inuit, Métis partners, and Indigenous partners who provided an intersectional lens.

Jordan's Principle and Inuit Child First Initiative

Jordan's Principle is a legal obligation, described by the Canadian Human Rights Commission to ensure that First Nations children do not experience gaps or delays in accessing government-funded health, social and education services, and that they are not denied these services due to their identity as First Nations children.

The Inuit Child First Initiative ensures Inuit children have access to the essential government funded health, social and educational products, services and supports they need, when they need them. Work is ongoing to co-develop a Shared Responsibility Model to guide the long-term approach for the initiative which will include a National framework and approaches specific to each of the four Inuit Treaty Organizations.

Indigenous Health Equity Fund

The Indigenous Health Equity Fund, administered by Indigenous Services Canada, is being directed to First Nations, Inuit and Métis communities in support of distinctions-based, Indigenous-led approaches to quality and culturally safe health.

Recent budget investments

To build on the progress made through the Budget 2021 investment to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe, Budget 2024 provided $167.6 million over 5 years to continue supporting patient advocates, health system navigators, midwives, and birth support workers, as well as initiatives to increase Indigenous representation in the health professions.

Through Budget 2021, Health Canada launched the Addressing Racism and Discrimination (ARD) Program, providing $14.9 million over 3 years to fund projects that address anti-Indigenous racism through cultural safety, accountability, and partnership across Canada's health system.

Budget 2023 provided $2 billion over 10 years through a new Indigenous Health Equity Fund to address the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding is provided to First Nations, Inuit, and Métis on a distinctions basis and to support Indigenous health priorities.

Building upon Budget 2018 and Budget 2021 investments, Budget 2024 provided $104.9 million over 5 years, starting in 2024 to 2025, for health transformation initiatives to support First Nations self-determination in the design and delivery of health services in their communities.

In early 2025, an additional $121.7 million was allocated through March 31, 2026 to support ongoing service delivery in the interim while Canada and Inuit Partners move forward on the co-development of a long-term approach for Inuit children.

Jordan's Principle continues to be funded through 2025 to 2026.

Recent progress

Next steps

Indigenous Services Canada will continue to work with partners on the Addressing Anti-Indigenous Racism in Health Systems initiative, co-developing health policy and legislative options, the Indigenous Health Equity Fund, Jordan's Principle, and the long-term approach to the Inuit Child First Initiative.

Health Transformation projects continue to work towards changing the Government of Canada's role of a funder and service provider to that of a governance partner and funder, respecting First Nations intention to exercise self-determination over how services are delivered in their communities. Currently, 4 of the current 6 Indigenous partners will be advancing to full Health Transformation over the next 2 to 3 years.

Health Canada will continue integrating lessons from the ARD Program into ongoing operations and advancing long term Indigenous-led reforms toward health systems free of racism and discrimination.

Recent budget investments

To build on the progress made through the Budget 2021 investment to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe, Budget 2024 provided $167.6 million over 5 years, to continue supporting patient advocates, health system navigators, midwives, and birth support workers, as well as initiatives to increase Indigenous representation in the health professions.

Budget 2024 also provided $630.2 million over 2 years to support Indigenous people's access to mental health services, including through distinctions-based approaches to mental wellness.

Budget 2024 also provided $562.5 million in 2024 to 2025 for the Non-Insured Health Benefits Program to maintain supplementary health benefits for eligible First Nations and Inuit, including coverage for prescription drugs and over-the-counter (OTC) medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access medically required health services that are not available on reserve or in the community of residence.

Budget 2023 provided $2 billion over 10 years through a new Indigenous Health Equity Fund to address the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding is provided to First Nations, Inuit, and Métis on a distinctions basis and to support Indigenous health priorities.

PHAC has provided $200,000 to the First Nations Information Governance Centre (FNIGC) to support work until the end of 2025 on the development of a new report on mental wellness inequalities experienced by First Nations Peoples living on reserve and in northern communities.

In addition $27.5 million is being provided over 4 years (fiscal years 2023 to 2024 to 2026 to 27) for First Nations, Inuit and Métis partners for health and human resources in data capacity. This funding is to support partners in hiring epidemiologists or data analysts and to continue building health data capacity and continue building distinctions-based data strategies.

The Government of Canada has also invested in Health Transformation projects, most recently through Budget 2024, which provided $104.9 million over 5 years for initiatives to support First Nations self-determination in the design and delivery of health services in their communities.

The First Nations Regional Health Survey (RHS) continues to be supported over 10 years with $49 million from Budget 2019, and Qanuippitaa? National Inuit Health Survey (QNIHS) with $80 million from Budget 2018.

Recent progress

There are currently more than 150 Indigenous-led initiatives supported by Budget 2021 and Budget 2024 Addressing Anti-Indigenous Racism investments, many of which are aimed at closing the gaps in health outcomes between Indigenous and non-Indigenous communities, with a focus on services for Indigenous women, 2SLGBTQI+ people, people with disabilities and other groups who may experience intersecting forms of discrimination.

Investments in Indigenous midwifery are supporting the growth of a profession which not only provides culturally safe care to pregnant individuals, but can also shield them from anti-Indigenous racism in the healthcare system. Indigenous midwives contribute to healthier pregnancies and improved social and physical outcomes for mothers and children, including a reduction in infant morbidity, mortality, and apprehension rates. This builds stronger families, communities, and Nations. Some Indigenous midwives also provide sexual healthcare across the life course.

To close the gap in health outcomes and to ensure availability of appropriate health services for Indigenous peoples, funding was provided to urban Indigenous service delivery organizations, Indigenous health centres and Indigenous communities to employ Indigenous Health System Navigators. These Health System Navigators support Indigenous patients in navigating the federal, provincial and territorial health system. Funding was also provided to Indigenous health service delivery organizations employ Indigenous Patient Advocates to help Indigenous patients access provincial, territorial and professional regulatory processes, and work to resolve complaint issues within existing provincial and territorial ombudsperson or complaint resolution frameworks.

In partnership with Federation of Sovereign Indigenous Nations in Saskatchewan, the first ever First Nations Health Ombudsperson's Office was established. The office ensures First Nations have a point of contact where they feel safe to be able to report incidents of discrimination when accessing health care service in the province. The office also assists in determining options to resolve conflicts or concerns for overall system change improvements.

As of March 2024, 2900 Indigenous patients across the country have accessed Indigenous Health System Navigator services, assisting Indigenous patients with accessing and navigating health systems in a culturally safe manner. Further, Indigenous Patient Advocates have supported approximately 100 patients in accessing provincial and territorial complaints resolution processes. Initiatives like these are important steps to address gaps and immediate concerns identified by Indigenous partners during the national dialogues.

The Government of Canada has made significant recent investments to improve mental wellness in Indigenous communities. These investments are made to meet the immediate mental wellness needs of communities by supporting Indigenous-led suicide prevention, life promotion and crisis response, including through crisis line intervention services, and enhancing the delivery of culturally-appropriate substance use treatment and prevention services in Indigenous communities.

ISC invests in Indigenous mental wellness through a suite of services which includes, flexible funding for community-based mental wellness services, trauma-informed mental health, emotional, and cultural support for Survivors and Intergenerational Survivors of Indian Residential Schools and Federal Indian Day Schools, as well as for those impacted by the issue of Missing and Murdered Indigenous Women and Girls.

In addition, ISC funds a national network of community-based health and cultural support workers through funding agreements as well as mobile multidisciplinary Mental Wellness Teams providing services to communities across the nation. Mental wellness funding provides communities with flexibility to tailor programming to their unique cultural and linguistic priorities and needs.

Indigenous Services Canada works closely with First Nations, Inuit, and Métis communities to implement the Indigenous Health Equity Fund, distributing $190 million in annual funding to support Indigenous-led approaches to quality and culturally safe health services. In addition to the funding provided directly to partners, funding was distributed to 31 projects in 2024 to 2025 under the Targeted Initiatives Program, which provides $10 million on an annual basis towards short-term, activity-driven health projects. These projects are intended to support cross-cutting Indigenous health priorities, including Indigenous women's health and 2SLGBTQI+.

Indigenous Services Canada has also worked with Health Canada to support a series of trilateral discussions with regional Indigenous leadership and their respective provincial and territorial governments, which have provided opportunities for all involved to discuss Indigenous health priorities and ways to address them.

To help measure and track health gaps, Indigenous Services Canada continues to support 2 major health surveys, the First Nations Regional Health Survey (RHS) and the Qanuippitaa? National Inuit Health Survey (QNIHS). The RHS is a national survey of First Nations on-reserve and in northern communities, designed, managed, and conducted by the FNIGC. The QNIHS is an Inuit-owned and Inuit-led national population health survey of Inuit in Canada that is informed by Inuit knowledge, values, and worldview, as well as stakeholder engagement and the latest health sciences research.

A health inequalities data tool was created using data from a joint initiative between the Public Health Agency of Canada, the Pan-Canadian Public Health Network, Statistics Canada and the Canadian Institute for Health Information.

The first major refresh of the health inequalities data tool was completed in 2022. The tool now includes inequalities results sorted by First Nations living off reserve, Inuit or Métis identity for 81 new and updated indicators of health outcomes and determinants of health. New indicators focus on priority public health areas such as safe and stable housing, mental health, and access to care. Feedback on this update was sought through an ongoing partnership with FNIGC, MNC, ITK, AFN, the First Peoples Wellness Circle and other members of HIRI's Pan-Canadian Health Inequalities Working Group.

PHAC continues to work with FNIGC to improve our understanding of the drivers of health inequalities in Canada and how they have changed over time. To highlight the various approaches to mental health and wellness, including Indigenous perspectives, the most recent HIRI report, Inequalities in Mental Health, well-being and wellness in Canada (2024), examined both qualitative and quantitative evidence.

The report analyzes the social determinants of mental health inequalities in Canada, including:

• socio-economic conditions
• stigma and discrimination
• access, quality, and use of services
• social isolation and community belonging

Relevant analyses were co-developed with Indigenous partners, ensuring that Indigenous perspectives, knowledge, and priorities were meaningfully reflected. The analysis highlights how these determinants intersect across population groups, with particular attention to the impacts of systemic and structural factors such as racism, colonialism, and other forms of discrimination.

An accompanying data tool has been released, which includes a focus on trends in mental health and wellness outcomes. These outcomes are categorized by Indigenous identity where sample sizes allow and provide actionable insights at the program and policy levels.

More broadly, PHAC integrates Sex- and Gender-Based Analysis Plus to embed equity considerations throughout its policies and programs. This approach includes critically examining the impacts of colonialism and systemic racism as fundamental drivers of health inequities. By understanding how these structural factors intersect with gender, age, socioeconomic status, and other dimensions, PHAC ensures its initiatives are better positioned to address the unique needs of Indigenous communities, thereby supporting efforts to close the health gaps identified in Call to Action 19.

PHAC has partnered with ISC and FNIGC to support the development of complementary assessments that measure, monitor, and report on mental wellness inequalities experienced by First Nations Peoples living on reserve and in northern communities. This report is expected by early 2026.

Indigenous Service Canada also works with the PHAC in supporting the implementation of the 9-8-8 helpline network to First Nations, Inuit and Métis clients across Canada through the Hope for Wellness Helpline.

The Centre for Addiction and Mental Health (CAMH) leads the coordination of the 9-8-8 Suicide Crisis Helpline, and PHAC as part of the federal health portfolio funds, manages, and oversees the contribution agreement with CAMH.

ISC offers centralized tele-health services to First Nations, Inuit and Métis clients through the Hope for Wellness Health Line as a shared commitment and collective vision for the support and the implementation of 9-8-8 to First Nations, Inuit and Métis clients across Canada through the Hope for Wellness Helpline.

The Hope for Wellness Helpline provides crisis intervention to all Indigenous people in Canada, and the accessibility of this support is paramount in the context of Indigenous mental health care. ISC is also responsible for the implementation of the Missing and Murdered Indigenous Women and Girls Crisis Line, and the National Indian Residential Schools Crisis Line. Anonymous crisis support in English and French is available 24/7 on all three crisis lines. The Hope for Wellness Helpline also provides services, upon request, in three Indigenous languages - Cree, Ojibway and Inuktitut.

Health Transformation is currently supporting 6 Health Transformation tables who represent more than 150 First Nations across Canada and include:

• Keewatinohk Inniniw Minoayawin Inc. in Manitoba
• Southern Chiefs Organization in Manitoba
• Nishnawbe Aski Nation in Ontario
• La Commission de la santé et des services sociaux des Premières Nations du Québec et du Labrador
• Tajikeimɨk in Nova Scotia
• Battleford Agency Tribal Council in Saskatchewan

These partners are working to establish tripartite partnerships with the eventual goal of delivering health services to their communities that meet their health needs and priorities. These partners are also working with provinces and the federal government to collect data and information on the current state of health services and conditions in their communities so they develop approaches that directly address communities' priorities. For example:

• Tajikeimɨk has expanded their health surveillance functions through the Mi'kmaw Client Linkage Registry and plans to implement new indicators to inform health planning and surveillance
• Keewatinohk Inniniw Minoayawin Inc. (KIM) has established a relationship with The Virtual Emergency Care and Transfer Resource Service (VECTRS), Manitoba's centralized and coordinated source for clinical guidance and patient transport support. As of 2025, KIM also works with Manitoba's Shared Health - Emergency Response Services to ensure that patients from northern First Nation nursing stations transported via VECTRS are placed in line for hospital emergency room care, thus reducing their wait time

In response to the National Council for Reconciliation Act, which received Royal Assent on April 30, 2024, Indigenous Services Canada has provided a set of indicators and baseline data, in alignment with what is specified in Call to Action 19, to support the annual report.

Next steps

Planned activities for 2026 include:

• expanding HIRI's data tool with new and updated data points
• monitoring changes over time in health inequalities in Canada

These activities will help capture updated health indicators for First Nations (on- and off-reserve), Inuit (inside and outside Inuit Nunangat), and Métis (in rural and urban environments).

Work will continue to support tripartite partnerships through the Health Transformation process and to support on service transfer with Health Transformation partners. It is expected that 4 partners will be implementing full service transfer in 2 to 3 years.

Indigenous Services Canada will continue to work with Indigenous partners on their implementation of the Indigenous Health Equity Fund and reporting on progress.

Indigenous Services Canada will continue to support the annual report in response to the National Council for Reconciliation Act.

Emergency Treatment Fund

Health Canada's Emergency Treatment Fund (ETF) provides urgent support to municipalities and First Nations, Inuit, and Métis communities and organizations to help provide rapid responses to emergent, critical needs related to the substance use and overdose crisis.

ETF funding supports a range of activities, including culturally relevant, trauma-informed, community programming and on-the-land healing, building retrofits, increased access to Knowledge Keepers, Elders and other Indigenous professionals, support services and navigation for individuals about to enter treatment, recovery and wraparound services, and expanded mobile outreach services to underserved or remote communities.

Substance Use and Addictions Program

Health Canada's Substance Use and Addictions Program (SUAP) provides contribution funding to other levels of government and to community-led, Indigenous, and not-for-profit organizations for a wide range of innovative and evidence-informed projects across the continuum of care, from prevention, harm reduction, treatment, and recovery.

First Nations, Inuit and Métis peoples are disproportionately affected by overdose, so these communities were priority populations in the 2023 SUAP Call for Proposals (CFP).

Medical Assistance in Dying (MAID) and Palliative Care

Health Canada and Indigenous Services Canada partnered with First Nations, Inuit, Métis organizations and governments to explore Indigenous perspectives on palliative and end-of-life care, including medical assistance in dying (MAID). This collaboration respects the right to self-determination and supports culturally safe, community-led approaches to care at the end of life, approaches that reflect the cultural values, practices, and priorities of Indigenous Peoples.

Recent budget investments

To build on the progress made through the Budget 2021 investment to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe, Budget 2024 is providing $167.6 million over 5 years, to continue supporting patient advocates, health system navigators, midwives, and birth support workers, as well as initiatives to increase Indigenous representation in the health professions.

Indigenous Services Canada continues to support Jordan's Principle to ensure that First Nations children have access to the products, services, and supports they need. Most recently, on March 22, 2025, the Minister of Indigenous Services Canada announced the continued funding for Jordan's Principle through 2025 to 2026.

The Government of Canada also continues to address the immediate needs of Inuit children through the Inuit Child First Initiative. In early 2025, an additional $121.7 million was allocated through March 31, 2026 to support ongoing service delivery in the interim while Canada and Inuit partners move forward on the co-development of a long-term approach for Inuit children.

Budget 2023 provided $2 billion over 10 years through a new Indigenous Health Equity Fund to address the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding is provided to First Nations, Inuit, and Métis on a distinctions basis and to support Indigenous health priorities.

Recent progress

Through the Addressing Anti-Indigenous Racism in Canada's Health Systems initiative, the Government of Canada has invested in approximately 120 projects that primarily benefit First Nations individuals and communities. Some examples of projects supported include:

• the Federation of Sovereign Indigenous Nations
• First Nations Ombudspersons office in Saskatchewan
• health system navigators in First Nations communities across the Atlantic region
• the Council of Yukon First Nations Birthworker Program

Funding was also provided to support Métis priorities including restoring midwifery, health system navigators and patient advocates for the Otipemisiwak Métis Government or Métis Nation of Alberta, the Métis Nation of Ontario, and the Manitoba Métis Federation.

Further, Inuit partners have been funded to implement approximately 12 projects that primarily benefit Inuit and work to improve cultural safety, and increase access to Indigenous health system navigators and midwifery and birth support across Nunavut, Inuvialuit Settlement Region and Nunavik.

Additionally, funding for urban Indigenous service delivery organizations included the National Association of Friendship Centres, that was funded to hire health system navigators in 22 friendship centres across the country to assist urban Indigenous patients in navigating health systems.

Following significant engagement and feedback from Indigenous partners, in October 2024, Indigenous Services Canada received authorities to move forward on separate tracks with First Nations, Inuit, and Métis partners to co-develop health policy and legislative options, to provide more time and transparency to the process, and to move forward in a meaningful way, based on partners' readiness and ongoing engagement.

Indigenous Services Canada continues to work closely with First Nations, Inuit, and Métis communities to implement the Indigenous Health Equity Fund, distributing $190 million in annual funding to support Indigenous-led approaches to quality and culturally safe health services. In addition to the funding provided directly to partners, funding was distributed to 31 projects in 2024 to 2025 under the Targeted Initiatives Program, which provides $10 million on an annual basis towards short-term, activity-driven health projects. These projects are intended to support cross-cutting Indigenous health priorities, including Indigenous women's health and 2SLGBTQI+.

Indigenous Services Canada has also worked with Health Canada to support a series of trilateral discussions with regional Indigenous leadership, including Inuit and Métis partners, and their respective provincial and territorial governments, which have provided opportunities for all involved to discuss Indigenous health priorities and ways to address them.

Next steps

Indigenous Services Canada will continue to work with interested First Nations, Inuit, and Métis partners to discuss next steps on the co-development of health policy and legislative options, and on implementation of the Indigenous Health Equity Fund and reporting on progress.

The government continues to work with Inuit partners to co-develop an Inuit-specific long-term approach that ensures Inuit children have equal access to essential government funded health, social and educational products, services and supports.

Indigenous Services Canada will work with partners to develop options for a long-term sustainable approach to Jordan's Principle to ensure it is available for First Nations children who need it for years to come.

Recent budget investments

In 2024-25, $10 million was allocated towards the construction of Aqqusariaq, in addition to the $47.5 million over 5 years and $9.7 million ongoing that was previously announced, to address the escalating costs associated with inflation and the unforeseen construction costs.

In November 2022, Prime Minister Trudeau announced a $42.5 million investment over 6 years and $4.5 million ongoing to construct a new wellness centre in James Smith Cree Nation, refurbish the existing treatment centre, fund wraparound services and transitional supports. This investment is supporting healing, mental health, and well-being of community members impacted by a mass stabbing in September 2022.

In May 2021, Tk'emlúps te Secwépemc First Nation announced that ground-penetrating radar had detected remains of 215 children who died at the former Kamloops Indian Residential School. The confirmations of unmarked burials at residential schools has accelerated the need for cultural and emotional supports for survivors, family members, and those affected by the intergenerational trauma of residential schools. In March 2023, the Government of Canada announced that Tk'emlúps te Secwépemc First Nation would receive $12.5 million in federal funding, directed through the First Nations Health Authority, towards the construction of a healing centre for the community. The healing centre is intended to deliver traditional healing activities and equine therapy, bringing much needed traditional healing to members of the community.

Budget 2024 is providing $630.2 million over 2 years to support Indigenous Peoples' access to mental health services, including through distinctions-based approaches to mental wellness strategies.

Budget 2024 is also providing $104.9 million over 5 years, starting in 2024 to 2025, for health transformation initiatives to support First Nations self-determination in the design and delivery of health services in their communities.

Recent progress

On October 2, 2020, Indigenous Services Canada signed a Memorandum of Progress has been made on the governance of Aqqusariaq. The Government of Nunavut, Indigenous Services Canada, and Nunavut Tunngavik Incorporated are finalizing the multi-year budget and work plan for the operations of the centre, working towards a phased approach for the opening and intake of patients.

The Isuarsivik Regional Recovery Center and Lac La Ronge Indian Band's Woodland Wellness Centre are open and continue to serve communities in Kuujjuaq, Nunavik and Northern Saskatchewan, respectively.

Next steps

Construction on Aqqusariaq began in 2023, and its substantial completion date is expected to be December 2025. Aqqusariaq is anticipated to be operational in early 2026. Indigenous Services Canada continues to meet regularly with the Government of Nunavut and Nunavut Tunngavik Incorporated through the Aqqusariaq Working Group and the Nunavut Partnership Table on Health.

Indigenous Services Canada is currently working with James Smith Cree Nation to initiate planning of the First Nation-led wellness centre and refurbished treatment centre that will enable the community to develop and design programs that best serve the needs of the community. The community-led design and implementation plan for these projects will help inform internal government processes required to access and deliver this important funding to the community.

The Health Transformation initiative is supporting partners with their multi-year health planning preparations as they work to assume responsibility over health services and supports, including treatment.

Recent budget investments

The Government of Canada is currently investing over $200 million per year to support Mental Wellness Programs. This includes $630.2 million over 2 years provided through Budget 2024 to support Indigenous people's access to mental health services, including through distinctions-based mental wellness strategies.

Budget 2024 is providing $167.6 million over 5 years, to combat anti-Indigenous racism in health care to help ensure Indigenous Peoples are treated with the respect and safety they deserve. These investments are continuing to support patient advocates, health system navigators, midwives and birth support workers, as well as initiatives to increase Indigenous representation in the health professions.

Budget 2024 is also providing $104.9 million over 5 years, for health transformation initiatives to support First Nations self-determination in the design and delivery of health services in their communities.

To continue to support the Non-Insured Health Benefits program, Budget 2024 provided $562.5 million in 2024 to 2025 to support medically necessary services and a range of benefits for First Nations and Inuit people, including mental health services, medical travel, medications and more.

Recent progress

Recognizing there is a shortage of Indigenous midwives and that culturally safe birthing services are predicated on a sufficient work force, Budget 2024 investments are supporting community-based Indigenous midwifery education and training programs in several regions including Labrador, Ontario, Quebec, Nova Scotia, Nunavik, and Saskatchewan.

Sturgeon Lake First Nation, one of the original Budget 2017 demonstration projects, celebrated its first midwife assisted birth in the community in over 50 years in 2022. The community has received additional investments for construction of a new standalone birthing centre, expected to open in late 2025.

Inuit Land Claim organizations have begun projects, including the Ungava Tulattavik Health Center (UTHC) in Kuujjuaq, Nunavik, to recruit additional trainees for their Inuulitsivik Midwifery Education Program, and allow the students to work alongside the existing four person midwifery team on a 24/7 basis.

New Métis-specific midwifery and doula projects are underway, including work by the Métis Nation Saskatchewan towards the development of a Métis midwifery education and training program, and wrap-around supports for expectant Métis families in Alberta provided and coordinated by Aunties.

Indigenous Services Canada has funded the development and implementation of a network of Indigenous birth support workers in Saskatchewan to increase the accessibility of culturally appropriate services during hospital births. These birth workers have access to training and provide one-on-one advocacy and support to First Nations families. They also coordinate a network of referrals connecting families with community-based services to maximize the potential for a safe return home.

Meadow Lake Tribal Council has begun work toward a community-based midwifery program and birth lodge in Canoe Lake. program and birth lodge in Canoe Lake. They have developed an Elders' committee and will be holding community consultation to plan the path forward.

First Nations University of Canada has developed and is delivering a program in Indigenous birth support work. Training is available both in-person and online to maximize accessibility. Some of the courses may be used toward a degree in midwifery.

Indigenous Services Canada continues to fund First Nations and Inuit partner organizations to manage and deliver services by traditional healers to address mental health needs. The recipient organizations have the flexibility to determine appropriate providers of traditional healing services in support of mental wellness, to compensate them in a manner that is culturally appropriate and to define the types of activities that traditional healers may undertake.

Since 2018, significant progress and momentum has been made related to self-determination and service transfer as there are currently 6 sub-regional Health Transformation projects and tables (Keewatinohk Inniniw Minoayawin Inc. and Southern Chiefs Organization in Manitoba, Tajikeimɨk in Nova Scotia, Nishnawbe Aski Nation in Ontario, La Commission de la santé et des services sociaux des Premières Nations du Québec et du Labrador in Quebec, and Battleford Agency Tribal Council in Saskatchewan). Recent achievements include:

• southern Chiefs Organization signing an Agreement-in-Principle on Health Governance with Canada and working on a Tripartite Framework Agreement
• Keewatinohk Inniniw Minoayawin Inc. signing an Agreement in Principle
• Tajikeimik aiming to complete the Agreement in Principle by the end of March 2026
• Nishnawbe Aski Nation working to draft a Charter Implementation Protocol (e.g. Agreement in Principle)
• Battleford Agency Tribal Council initiating work on their health services model and initiating work on a Memorandum of Understanding in 2025
• la Commission de la santé et des services sociaux des Premières Nations du Québec et du Labrador in Quebec reaching a consensus on a new health and wellness governance model
• ongoing discussions with First Nations Health Authority and Province representatives to streamline health service approaches for First Nations in BC

Following significant engagement and feedback from Indigenous partners, in October 2024, Indigenous Services Canada received authorities to move forward on separate tracks with First Nations, Inuit, and Métis partners to co-develop health policy and legislative options, to provide more time and transparency to the process, and to move forward in a meaningful way, based on partners' readiness and ongoing engagement

Next steps

Indigenous Services Canada will continue to support Indigenous midwifery projects with funding from Budget 2024 and ongoing funding from Budget 2017, and work closely with partners, including the National Council of Indigenous Midwives and National Indigenous Women's Organizations, through the Indigenous Women's Wellbeing Advisory Committee, to improve and sustain access to culturally safe sexual and reproductive health services.

Indigenous Services Canada will also continue to support access to health and cultural support services for eligible individuals through the Trauma-Informed Health and Cultural Support Programs, and continue to work with interested First Nations, Inuit, and Métis partners to discuss next steps on the co-development of health policy and/or legislative options..

Work will continue to support tripartite partnerships through the Health Transformation process and to support on service transfer with Health Transformation partners. It is expected that 4 partners will be implementing full service transfer in 2 to 3 years.

Recent budget investments

Budget 2021 provided $354 million over 5 years, to increase the number of nurses and other medical professionals in remote and isolated First Nations communities. More recently, Budget 2024 provided $167.6 million over 5 years, to combat anti-Indigenous racism in health care to help ensure Indigenous Peoples are treated with the respect and safety they deserve. Part of this investment will continue to support initiatives aimed at increasing Indigenous representation in the health professions and supporting Indigenous midwifery.

Through the 2022 Fall Economic Statement, the Government of Canada provided $250 million over 5 years to further support the recruitment and retention of health professionals on reserve.

Budget 2023 provided $2 billion over 10 years through a new Indigenous Health Equity Fund to address the unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. Funding is provided to First Nations, Inuit, and Métis on a distinctions basis and to support Indigenous health priorities.

Budget 2024 also provided $390.4 million over 4 years to build or renovate health facilities, including to support the Virtual Health Hub led by the Saskatchewan Indian Institute of Technologies of Whitecap Dakota First Nation, and the University of Saskatchewan. This funding will also improve the safety of primary care workers in remote and isolated on reserve First Nations communities.

Recent progress

Following significant engagement and feedback from Indigenous partners, in October 2024, Indigenous Services Canada received authorities to move forward on separate tracks with First Nations, Inuit, and Métis partners to co-develop health policy and legislative options, to provide more time and transparency to the process, and to move forward in a meaningful way, based on partners' readiness and ongoing engagement.

In addition to the cultural competency training requirement of all ISC staff, in 2023, a cultural competency training requirement was added to all nursing and paramedic agency contracts, requiring a minimum of 15 hours of culture competency training per year by any contractor providing services on behalf of ISC.

The 2023 Nursing Workforce Survey included an analysis of ISC employed nurses who self-identify as Indigenous to better understand the barriers and facilitators to retention of this subset of nurses in remote and isolated Indigenous communities.

Indigenous Services Canada also provides funding to Indigenous health organizations and Indigenous communities to build capacity and support the development of transformative measures that help eliminate anti-Indigenous racism in health systems:

• The Indigenous Physicians Association of Canada continues to work as a national leader on addressing anti-Indigenous racism in health systems specifically in medical education. The association will also be creating and implementing a framework for accreditation changes needed to reduce anti-Indigenous racism in medical education.
• The Indigenous Pharmacy Professionals of Canada assists with the recruitment and retention of Indigenous students in pharmacy assistant, pharmacy technician, and PharmD programs across Canada. They also strive to provide leadership in the continuing professional development of all pharmacy professionals, curricular and accreditation guidance, cultural safety education, and scholarships.
• The First Nations Health Managers Association is being supported to develop curriculum and pilot a training project for Indigenous patient navigators.
• To date, 70 Indigenous health system navigators and 20 Indigenous patients advocates have been hired across Indigenous communities. These roles help to support and increase Indigenous representation in health care spaces while ensuring the provision of culturally safe care.

Initial investments in Indigenous midwifery are helping to restore Indigenous birth practices, strengthen families, and build community capacity. Federal investments have supported the development or expansion of Indigenous midwifery education pathways. Community-based Indigenous midwifery education allows students to complete their education while living and working in their community or Nation, an approach that strengthens cultural continuity, supports family wellness, and advances Indigenous self-determination in health care. By training students within their community, families and communities can begin to experience many of the benefits of Indigenous midwifery support even before birth itself is returned.

Indigenous Services Canada works closely with First Nations, Inuit, and Métis communities to implement the Indigenous Health Equity Fund, distributing $190 million in annual funding to support Indigenous-led approaches to quality and culturally safe health services. In addition to the funding provided directly to partners, funding was distributed to 31 projects in 2024 to 2025 under the Targeted Initiatives Program, which provides $10 million on an annual basis towards short-term, activity-driven health projects. These projects are intended to support cross-cutting Indigenous health priorities, including Indigenous women's health and 2SLGBTQI+.

Next steps

Indigenous Services Canada will continue to work with interested First Nations, Inuit, and Métis partners to discuss next steps on the co-development of health policy and/or legislative options.

Indigenous Services Canada will also work with partners to develop a fulsome Indigenous Health Human Resources Framework to support the development, retention and recruitment of Indigenous health human resources across Canada.

Indigenous Services Canada will continue to work with Indigenous partners on implementation of the Indigenous Health Equity Fund including their reporting on progress, which may encompass monitoring on the types of activities being funded, such as health human resources.

Recent Budget Investments

Launched under Budget 2021 with $14.9 million over 3 years, the ARD Program funds projects that develop educational tools and culturally safe standards to help health-care professionals better serve Indigenous Peoples.

Funded projects include initiatives focused on promoting cultural safety and courses focused on Indigenous Health and wellness and allyship, which has reached thousands of learners nationwide. These initiatives are transforming training and practice across health disciplines.

Next Steps

Health Canada will continue integrating lessons from the ARD Program into ongoing operations and advancing long term Indigenous-led reforms toward health systems free of racism and discrimination.