Canada-Nunavut agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26)

Tables of contents

Funding agreement
Annex 1 - Common statement of principles on shared health priorities
Annex 2 - Shared pan-Canadian interoperability roadmap
Annex 3 - Headline common indicators
Annex 4 - Action plan

Funding agreement

(the "Agreement")

BETWEEN:

HIS MAJESTY THE KING IN RIGHT OF CANADA  (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health and the Minister of Mental Health and Addictions and Associate Minister of Health (herein referred to as "the federal Ministers")

- and -

THE GOVERNMENT OF NUNAVUT (hereinafter referred to as "Nunavut" or "Government of Nunavut") as represented by the Minister of Health (herein referred to as "the territorial Minister")

REFERRED to collectively as the "Parties", and individually as a "Party"

PREAMBLE

WHEREAS, on July 6, 2023 Canada and Nunavut announced an overarching agreement in principle on Working Together to Improve Health Care for Canadians, supported by almost $200 billion over ten years in federal funding, including $46.2 billion in new funding to provinces and territories;

WHEREAS, Canada has also announced a 5 per cent Canada Health Transfer (CHT) guarantee for the next five years, starting in 2023-24, which will be provided through annual top-up payments as required. This is projected to provide approximately an additional $17 billion over 10 years in new support. The last top-up payment will be rolled into the CHT base at the end of the five years to ensure a permanent funding increase, providing certainty and sustainability to provinces and territories;

WHEREAS, Working Together to Improve Health Care for Canadians includes a federal commitment of $25 billion in bilateral funding to provinces and territories over ten years focused on four shared health priorities:

expanding access to family health services, including in rural and remote areas;
supporting our health workers and reducing backlogs;
improving access to quality mental health, substance use, and addictions services; and
modernizing health systems with health data and digital tools.

WHEREAS, in the area of mental health, substance use, and addictions services, Working Together to Improve Health Care for Canadians also includes a commitment by Canada and Nunavut to continue to work to support collaboration on the Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the "Common Statement", attached hereto as Annex 1), supported by the federal Budget 2017 investment of $5 billion over ten years;

WHEREAS, Nunavut has the primary responsibility for delivering health care services to its residents and supports diversity, equity, and the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+;

WHEREAS, Canada authorized the federal Ministers to enter into agreements with the provinces and territories, for the purpose of identifying activities that provinces and territories will undertake in respect of the four shared health priorities, and for funding in this Agreement associated with the federal investment for mental health, substance use, and addictions services consistent with the Common Statement (and menu of actions outlined in Annex 1);

WHEREAS, the Government of Nunavut authorized the territorial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Nunavut associated with the federal investment for four shared health priorities, and mental health, substance use and addictions services consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms betweenCanada and Nunavut as follows:

1.0 Key principles and collaboration

The key principles and commitment to collaboration agreed to in Working Together to Improve Health Care for Canadians are outlined below.

1.1 Canada and Nunavut acknowledge that this Agreement will mutually respect each government's jurisdiction, and be underpinned by key principles, including:

A shared responsibility to uphold the Canada Health Act that strengthens our public health care system;
Principles agreed to in the Common Statement (outlined in Annex 1);
Reconciliation with Indigenous Peoples, recognizing their right to fair and equal access to quality and culturally safe health services free from racism and discrimination anywhere in Canada, including through seamless service delivery across jurisdictions and meaningful engagement and work with Indigenous organizations and governments; and
Equity of access for under-served groups and individuals, including those in official language minority communities.

1.2 Canada and Nunavut acknowledge the importance of supporting health data infrastructure, data collection and public reporting, and will work together to improve the collection, sharing and use of de-identified health information, respecting federal/provincial/territorial privacy legislation, to improve transparency on results and to help manage public health emergencies, and to ensure Canadians can access their own health information and benefit from it being shared between health workers across health settings. This includes:

collecting and securely sharing high-quality, comparable information needed to improve services to Canadians, including disaggregated data on key common health indicators with the Canadian Institute for Health Information (CIHI);
adopting common interoperability standards (both technical exchange and content of data), including the Shared pan-Canadian Interoperability Roadmap (outlined in Annex 2), to improve Canadians' access to their health information in a usable digital format and support the exchange and analysis of health data within and across Canada's health systems in a way that protects Canadians' privacy and ensures the ethical use of data to improve the health and lives of people;
work to align provincial and territorial policies and legislative frameworks where necessary and appropriate to support secure patient access to health information, and stewardship of health information to support the public good, including improving care quality, patient safety, privacy protection, system governance and oversight, planning and research;
promoting health information as a public good by working with federal-provincial-territorial Ministers of Health to review and confirm overarching principles, which would affirm Canadians' ability to access their health information and have it follow them across all points of care. The existing Health Data Charter, as outlined in the Pan-Canadian Health Data Strategy would serve as the starting point for the discussion of these principles; and
collecting and sharing available public health data (e.g., vaccination data, testing data) with the Public Health Agency of Canada to support Canada's preparedness and response to public health events, building on commitments made as part of the Safe Restart Agreements.

1.3 Canada and Nunavut acknowledge they will work with other provinces and territories to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional recognition of health professional licences.

1.4 Canada and Nunavut acknowledge a mutual intent to engage in a two-phased formal review process:

Phase 1: This review will be done in 2026 by a joint committee of Federal, Provincial, and Territorial health and finance officials to assess results and determine next steps for bilateral agreements related to improvements to home and community care, mental health, substance use, and addiction services associated with the Common Statement and long-term care; and
Phase 2: A formal five-year review of the healthcare plan outlined on February 7, 2023, recognizing the importance of long-term sustainability for provincial-territorial health systems. This review would consist of an assessment of both the bilateral agreements (herein) and the CHT investments (not included as part of this bilateral agreement). The review will be done by a joint committee of Federal, Provincial, and Territorial health and finance officials, commencing by March 31, 2027, and concluded by December 31, 2027, to consider results achieved thus far in the four shared health priority areas and will include:
1. an assessment of progress-to-date on public reporting to Canadians using the common indicators;
2. sharing of de-identified health information, and other health data commitments; and
3. current and forward-looking Federal, Provincial, and Territorial investments to support this plan.

2.0 Objectives

2.1 Canada and Nunavut agree that, with financial support from Canada, Nunavut will continue to build and enhance health care systems towards achieving some or all of the objectives of:

timely access to high-quality family health services, including in rural and remote areas;
a sustainable, efficient and resilient health workforce that provides Canadians timely access to high-quality, effective, and safe health services;
access to timely, equitable, and quality mental health, substance use, and addictions services to support Canadians' well-being; and
access to a patient's own electronic health information that is shared between the health professionals they consult to improve safety and quality of care, and which informs Canadians on how the system is working.

2.2 Canada and Nunavut agree that, with Budget 2017 financial support from Canada outlined in 5.2.2, Nunavut will continue to work to improve access to mental health, substance use, and addictions services consistent with the Common Statement (and menu of actions outlined in Annex 1).

3.0 Action plan

3.1 Nunavut set out in their Action Plan (attached as Annex 4) how the federal investment under this Agreement will be used, as well as details on targets and timeframes based on common headline indicators in priority areas where federal funds will be invested, as well as jurisdiction-specific indicators, for each of the initiatives.

3.2 Nunavut will invest federal funding as part of the 2017 commitment for mental health, substance use, and addictions services provided through this Agreement in alignment with the menu of actions listed in the Common Statement.

3.3 Nunavut will invest federal funding in some or all of the four shared health priority areas, without displacing existing planned spending in those areas.

3.4 In developing initiatives under this Agreement, Nunavut agrees to implement measures that also respond to the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

3.5 Nunavut's approach to achieving objectives is set out in their three-year Action Plan (2023-24 to 2025-26), as set out in Annex 4.

4.0 Term of agreement

4.1 This Agreement comes into effect upon the date of the last signature of the Parties and will remain in effect until March 31, 2026 ("the Term"), unless terminated in accordance with section 11 of this Agreement. Funding provided under this Agreement will cover the period April 1, 2023 to March 31, 2026.

4.2 Renewal of Bilateral Agreements

4.2.1 Upon signing renewed bilateral agreements, Nunavut will have access to the remainder of its share of the federal funding, subject to appropriation by Parliament, for:

2026-27, the allocation based on the federal commitment in Budget 2017 of $5 billion over ten years for mental health, substance use and addiction services; and
2026-27 to 2032-33, the allocation based on the federal commitment in Budget 2023 of $25 billion over ten years to support the Working Together to Improve Health Care for Canadians plan.

5.0 Financial provisions

5.1 The funding provided under this Agreement is in addition to and not in lieu of those that Canada currently provides under the CHT to support delivering health care services within the territory.

5.2 Allocation to Nunavut

5.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

5.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative based on the allocation method outlined in subsection 5.2.3 for the Term of this Agreement.

Working Together to Improve Health Care for Canadians

$2.5 billion for the Fiscal Year beginning on April 1, 2023
$2.5 billion for the Fiscal Year beginning on April 1, 2024
$2.5 billion for the Fiscal Year beginning on April 1, 2025

Budget 2017 Mental Health, Substance Use, and Addictions Services

$600 million for the Fiscal Year beginning on April 1, 2022
$600 million for the Fiscal Year beginning on April 1, 2023
$600 million for the Fiscal Year beginning on April 1, 2024
$600 million for the Fiscal Year beginning on April 1, 2025

5.2.3 Allocation Method

For the funding associated with Working Together to Improve Health Care for Canadians, annual funding will be allocated to provinces and territories on base ($5,000,000 if population is less than 100,000; $20,000,000 if population is between 100,000 and 500,000; and $50,000,000 if population is greater than 500,000) plus per capita basis. The final total amount to be paid to each jurisdiction will be calculated using the following formula: B + (F - ((N * 5,000,000) + (O * 20,000,000) + (S * 50,000,000)) x (K / L), where:

B is the base amount allocated to each province or territory based on population ($5,000,000 if population is less than 100,000; $20,000,000 if population is between 100,000 and 500,000; and $50,000,000 if population is greater than 500,000), as determined using annual population estimates on July 1^st from Statistics Canada;

Fis the total annual funding amount available outlined under this program;

N is the number of provinces and territories with a population less than 100,000, as determined using annual population estimates on July 1^st from Statistics Canada;

O is the number of provinces and territories with a population between 100,000 and 500,000, as determined using annual population estimates on July 1^st from Statistics Canada;

Sis the number of provinces and territories with a population greater than 500,000, as determined using annual population estimates on July 1^st from Statistics Canada;

K is the total population of Nunavut, as determined using annual population estimates on July 1^st from Statistics Canada; and

Lis the total population of Canada, as determined using annual population estimates on July 1^st from Statistics Canada.
For funds associated with Budget 2017 Mental Health, Substance Use, and Addictions Services, annual funding will be allocated to provinces and territories on a per capita basis. The per capita funding for each Fiscal Year, is calculated using the following formula: F x K/L, where:

F is the annual total funding amount available under this program;

K is the total population of Nunavut, as determined using the annual population estimates on July 1^st from Statistics Canada; and

L is the total population of Canada, as determined using the annual population estimates on July 1^st from Statistics Canada.
For funds associated with Budget 2017 Mental Health, Substance Use, and Addictions Services, three fourths of Nunavut's share of the per capita annual funding allocation for Fiscal Year 2022-23 will be provided to Nunavut in the Term of this Agreement starting in 2023-24, with the final fourth to become available in accordance with section 4.2.1. This funding is calculated using the following formula: (F x K/L) / 4, where:

F is the annual total funding amount available under this program;

K is the total population of Nunavut, as determined using the annual population estimates on July 1^st, 2022 from Statistics Canada; and

L is the total population of Canada, as determined using the annual population estimates on July 1^st, 2022 from Statistics Canada.

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Nunavut estimated share of the amounts will be:

Fiscal Year	Working Together to Improve Health Care for Canadians Estimated amount to be paid to Nunavut^{Table 1 Footnote *}  (subject to annual adjustment)	Budget 2017 Mental Health, Substance Use, and Addictions Services Estimated amount to be paid to Nunavut^{Table 1 Footnote *}  (subject to annual adjustment)	Budget 2017 Mental Health, Substance Use, and Addictions Services Amount to be paid to Nunavut for share of 2022-23 allocation
2023-2024	$7,100,000	$625,000	$156,150
2024-2025	$7,100,000	$625,000	$156,150
2025-2026	$7,100,000	$625,000	$156,150
Table 1 Footnote * Amount represent annual estimates based on Statistics Canada's July 1^st, 2022, population estimates. Table 1 Return to footnote * referrer

5.3 Payment

5.3.1 Funding provided by Canada will be paid in semi-annual installments as follows:

In 2023-2024, the first installment will be paid within approximately 30 business days of execution of this Agreement by the Parties. The second installment will also be paid within approximately 30 business days of execution of this Agreement by the Parties, subject to 5.3.1.g.
Starting in 2024-2025, the first installment will be paid on or about April 15 of each Fiscal Year and the second installment will be paid on or about November 15 of each Fiscal Year.
The first installment will be equal to 50% of the notional amount set out in section 5.2.4 as adjusted by section 5.2.3.
The second installment will be equal to the balance of funding provided by Canada for the Fiscal Year as determined under sections 5.2.3 and 5.2.4.
Canada will notify Nunavut prior to the first payment of each Fiscal Year, of their notional amount. The notional amount will be based on the Statistics Canada quarterly preliminary population estimates on July 1 of the preceding Fiscal Year. Prior to the second payment, Canada will notify Nunavut of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
Canada shall withhold payments if Nunavut has failed to provide reporting in accordance with 7.1.
Canada shall withhold the second payment in 2023-24 if Nunavut has failed to satisfy all reporting requirements associated with the preceding Canada - Nunavut Home and Community Care and Mental Health and Addictions Services Funding Agreement, specifically to:
1. continue to participate in a Federal-Provincial-Territorial process to improve reporting on and provide data to CIHI for the 6 common indicators to measure pan-Canadian progress on improving access to mental health, substance use, and addictions services; and
2. submit an annual financial statement, with attestation from Nunavut's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada for mental health and addiction services under the Canada - Nunavut Home and Community Care and Mental Health and Addictions Services Funding Agreement compared against the Expenditure Plan, and noting any variances, between actual expenditures and the Expenditure Plan.
The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

5.4 Retaining funds

5.4.1 For Fiscal Years 2023-24 through 2024-25, upon request, Nunavut may retain and carry forward to the next Fiscal Year up to 10 percent of funding that is in excess of the amount of the eligible costs actually incurred in a Fiscal Year and use the amount carried forward for expenditures on eligible areas of investment. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their designated officials, at the Assistant Deputy Minister level (herein referred to as "Designated Officials"), and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.4.2 Any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Nunavut under subsection 5.2.4 of this Agreement in the next Fiscal Year.

5.4.3 Upon request, Nunavut may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible areas of investment, to be noted in the new agreement and subject to the terms and conditions of that new agreement. The new Action Plan will provide details on how any retained funds carried forward will be expended. Any request by Nunavut to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their Designated Officials, and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.5 Repayment of overpayment

5.5.1. In the event payments made exceed the amount to which Nunavut is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Nunavut shall repay the amount within sixty (60) calendar days of written notice from Canada.

5.6 Use of Funds

5.6.1. The Parties agree that funds provided under this Agreement will only be used by Nunavut in accordance with the initiatives outlined in Annex 4.

5.7 Eligible Expenditures

5.7.1. Eligible expenditures under this Agreement are the following:

data development and collection to support reporting;
information technology and health information infrastructure;
capital and operating funding;
salaries and benefits;
training, professional development; and
information and communications material related to programs.

6.0 Performance measurement

6.1 Nunavut agrees to designate an official or official(s), for the duration of this Agreement to participate in a CIHI led Federal-Provincial-Territorial indicator process to:

Refine the eight common headline indicators (outlined in Annex 3);
Work to identify additional common indicators that are mutually agreed upon, including indicators focused on the health of Indigenous populations with acknowledgement of the role for Indigenous partners in this work;
Improve reporting on common indicators to measure pan-Canadian progress on improving access to mental health, substance use, and addictions services, associated with the commitment in the Common Statement; and
Share available disaggregated data with CIHI and work with CIHI to improve availability of disaggregated data for existing and new common indicators to enable reporting on progress for underserved and/or disadvantaged populations including, but not limited to, Indigenous peoples, First Nations, Inuit, Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

7.0 Reporting to Canadians

7.1 Funding conditions and reporting

7.1.1 By no later than October 1, in each fiscal year, with respect of the previous Fiscal Year, Nunavut agrees to:

Provide data and information annually to CIHI related to the new headline indicators, additional common indicators, and the mental health, substance use, and addictions services indicators identified as part of commitment made in the Common Statement.
Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Nunavut on progress made on targets outlined in Annex 4 (Action Plan) for headline indicators in the priority area(s) where federal funds are to be invested, and on jurisdiction-specific indicators for each of the initiatives tailored to their jurisdiction's needs and circumstances.
Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from Nunavut's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement compared against the Action Plan, and noting any variances, between actual expenditures and the Action Plan:
1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
2. The total amount of funding used for each of the shared health priority areas that are supported by the federal funds;
3. If applicable, the amount of any funding carried forward under section 5.4; and
4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5.

7.1.2 Nunavut will provide quarterly reporting to Canada on the management and spending of the funds retained to the next Fiscal Year.

7.2 Audit

7.2.1 Nunavut will ensure that expenditure information presented in the annual financial statement is, in accordance with Nunavut's standard accounting practices, complete and accurate.

7.3 Evaluation

7.3.1 Responsibility for evaluation of programs rests with Nunavut in accordance with its own evaluation policies and practices.

8.0 Communications

8.1 The Parties agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

8.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

8.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

8.4 Nunavut will make publicly available, clearly identified on a Government of Nunavut website, this Agreement, including any amendments.

8.5 Canada, with prior notice to Nunavut, may incorporate all or any part of the data and information in 7.1, or any part of evaluation and audit reports made public by Nunavut into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

8.6 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Canada agrees to give Nunavut 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.7 Nunavut reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Nunavut agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.8 Canada and Nunavut agree to participate in a joint announcement upon signing of this Agreement.

8.9 Canada and Nunavut agree to work together to identify mutually agreeable opportunities for joint announcements relating to programs funded under this Agreement.

9.0 Dispute resolution

9.1 The Parties are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

9.2 If at any time a Party is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their Designated Officials.

9.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Nunavut responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the territorial Minister(s) shall endeavour to resolve the dispute.

10.0 Amendments to the agreement

10.1 The main text of this Agreement may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the federal Minister(s), and in the case of Nunavut, by the territorial Minister(s).

10.2 Annex 4 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 4 shall be in writing and signed by each Party's Designated Official.

11.0 Termination

11.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least 6 months written notice of intention to terminate.

11.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.

11.3 Sections 1.0, and 8.0 of this Agreement survive for the period of the 10-year Working Together to Improve Health Care for Canadians plan.

11.4 Sections 5.4 and 7.0 of this Agreement survive the termination or expiration of this Agreement until reporting obligations are completed.

12.0 Notice

12.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter, email, postage or other charges prepaid. Any communication that is delivered will be deemed to have been received in delivery; and, except in periods of postal disruption, any communication mailed by post will be deemed to have been received eight calendar days after being mailed.

The address of the Designated Official for Canada shall be:

Assistant Deputy Minister, Strategic Policy Branch
Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Email:  jocelyne.voisin@hc-sc.gc.ca

The address of the Designated Official for Nunavut shall be:

Government of Nunavut
P.O. Box 1000 Stn 1000
Iqaluit, Nunavut
X0A 0H0
Email:  CNolan@GOV.NU.CA and VMadsen@GOV.NU.CA

13.0 General

13.1 This Agreement, including Annexes, comprises the entire Agreement entered into by the Parties.

13.2 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Nunavut.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Nunavut shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

13.4 If for any reason a provision of this Agreement, that is not a fundamental term, is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

13.5 This Agreement may be executed in counterparts, in which case (i) the Parties have caused this Agreement to be duly signed by the undersigned authorized representatives in separate signature pages in accordance with the following signature process, which together shall constitute one agreement, and (ii) the Parties agree that facsimile signature(s) and signature(s) transmitted by PDF shall be treated as original signature(s). Electronic signature(s) may be accepted as originals so long as the source of the transmission can be reasonably connected to the signatory.

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Health
The Honourable Mark Holland, Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Mental Health and Addictions and Associate Minister of Health
The Honourable Ya'ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Nunavut by the Minister of Health
The Honourable John Main, Minister of Health

Annex 1 - Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 - Shared pan-Canadian interoperability roadmap

**Figure 1. 5-Year shared pan-Canadian interoperability roadmap**

Annex 3 - Headline common indicators

Shared health priority area	Indicator
Family health services	Percentage of Canadians who report having access to a regular family health team, a family doctor or nurse practitioner, including in rural and remote areas
Health workers and backlogs	Size of COVID-19 surgery backlog
Health workers and backlogs	Net new family physicians, nurses, and nurse practitioners
Mental health and substance use	Median wait times for community mental health and substance use services
	Percentage of youth aged 12 to 25 with access to integrated youth services (IYS) for mental health and substance use
	Percentage of Canadians with a mental disorder who have an unmet mental health care need
Modern health data system	Percentage of Canadians who can access their own comprehensive health record electronically
Modern health data system	Percentage of family health service providers and other health professionals (e.g., pharmacists, specialists, etc.) who can share patient health information electronically

Annex 4 - Action plan

I. Context/current status

Nunavut's health care system provides care to approximately 40,000 residents across 25 communities. These communities are divided into three regions and three time zones: the Qikiqtaaluk, which consists of 13 communities; the Kivalliq, which consists of seven communities; and the Kitikmeot, which consists of five communities.

The territory spans two million square kilometers and covers one-fifth of Canada's total landmass. Communities are small and spread out over hundreds of kilometers accessible only by plane and sea in the warmer months. The geography means it is not feasible to offer all types of health care in-territory and with no roads connecting communities, every community relies heavily on medical travel within Nunavut or to southern jurisdictions.

Health care is delivered through the territory's 35-bed hospital in Iqaluit. Nunavut's entire population could be served by a small hospital, like the one in Iqaluit. However, given the distance between communities, and inability to drive between communities, each community has a health centre where out-patient and 24-hour emergency nursing services are provided by community health nurses. Operating health centres in remote areas poses significant challenges, notably the necessity for separate IT and HR systems, as well as respective staffing complements. Staffing teams in such locations presents difficulties, which can lead to disruptions in services at health centres including closures and emergency services only. Demonstrably, expenses associated with maintaining community health centres are high.

Unlike other jurisdictions, Nunavut does not have the economies of scale to offset these health expenditures. Because of this, Health expenditures in Nunavut are considerably higher on a per capita basis than the Canadian average. According to forecasts by the Canadian Institute for Health Information (CIHI), Nunavut has the highest level of spending per capita on health care services ($21,978 per person compared to a national average of $8,563).¹

Another significant driver of the high health care costs in Nunavut is medical travel. In FY 2022/23, Health arranged over 24,000 scheduled airline tickets and over 3,600 medical evacuations for Nunavummiut at a cost exceeding $87M. While the Government of Nunavut continues to work towards bringing care closer to home, the territory relies heavily on federal investments and agreements to work towards health equity across the territory.

It is imperative that these funding agreements are long-term and stable, that underpin the values of reconciliation, which means an acknowledgment of the distinct needs and challenges of delivering health care in the territory. Also, it is imperative funding agreements are founded in the principle of flexibility to allow the Department of Health (Health) to be responsive to local needs, which may require reallocation of funds under shared priorities. Further, Nunavut is the only jurisdiction in Canada where a department oversees and delivers health care directly to its constituents. As such, the health care staff responsible for reporting on initiatives are also responsible for the direct delivery of health care. Funding agreements with low administrative burden acknowledge this and respect limitations.

Health has already established initiatives to strengthen the health care system and respond to increasing health needs. Over the past several years, Health has developed programs intended to increase Inuit employment within health care, bring care closer to home through virtual care, and strengthen recruitment and retention efforts. However, additional investments are needed to work towards health equity in the north. Several key health indicators reflect the challenges impacting Nunavut Inuit, including lower life expectancy than the Canadian average, a higher infant mortality rate, high number of youth suicides, and a significantly higher tuberculosis rate.² Nunavut has also seen a continuous upward trend in the prevalence of chronic illnesses, most notably, diabetes, chronic obstructive pulmonary disease and hypertension. These lower health outcomes, combined with a significant growth in population, and subsequent increase in uptake in health services at both the hospital and community health centres reiterates the need for critical investments to achieve health equity in Nunavut.

Nunavut has identified several initiatives under the Agreement to Work Together to Improve Health Care for Canadians (Working Together Agreement) within three priority areas to support existing programs and establish new ones.

II. Shared health priorities and description of initiatives

Family Health Services

Shared Objective: Canadians have timely access to high quality family health services, including in rural and remote areas.

Initiatives to be supported by the Working Together bilateral agreement:

1. Increasing Inuit Employment

The Government of Nunavut's commitment to advancing health outcomes for Inuit is embedded in the Nunavut Agreement. One critical aspect to advancing health outcomes for Inuit means working towards a health workforce that is representative of the population it serves. Increasing the number of Inuit in health care positions will lead to a more sustainable health workforce, and means care is culturally relevant and can be delivered in Inuktitut.

Bilateral funding will help establish two initiatives to increase Inuit employment within health care positions:

A basic laboratory and electrocardiogram training program for Inuit for basic radiological technician graduates in community health centres (specific to Inuit).
- Over the three-year period, it is anticipated that 150 graduates will graduate from the new program.
An education and training pathway for Inuit midwifery.
- This work will include:
  - Engagement with Inuit and community stakeholders to review existing curriculum and previous education program.
  - Engagement with Inuit midwives and Inuit elders for feedback on current maternal child health care service delivery model.
  - Mapping modified curriculum and curriculum pathways.
  - Mapping Inuit midwifery skills training plan for communities.
- Anticipated outputs include:
  - New culturally informed maternal child health care service delivery model that promotes Inuit representation.
  - Translated Inuit maternal child standards of care and Inuit clinical practice guidelines for maternity care workers.
  - Three midwifery implementation plans: education pathways, new model of maternity care, community skills training.
  - Report with recommendations for regulatory legislative changes to align with changes to the program.

2. Community Health Needs and Workforce Assessment Tool

Over the past two years, Health has relied heavily on agencies and other contracted health workers to avoid severe service disruptions and complete closures of community health centres throughout the territory. These measures are short-term and limited in their overall effect on building a sustainable and representative health workforce.

The Nunavut health care system is complex, with health care delivered in 25 fly-in only communities spread across three time zones and medical referral pathways into three provinces and one other territory. Its complexity demands a unique set of tools to evaluate workforce needs and ensure a more sustainable health care system. The health workforce planning tools which currently exist globally are not adaptable to the remote northern community context, which deepens the inequities for Indigenous populations. Bilateral funding will facilitate a review of community health needs and establish assessment tools for remote and isolated communities. Understanding what communities require, based on population size and population health needs, will help drive the design of primary health care teams in remote settings. This will reduce disruptions in community health centres by:

Identifying strategies to address a community's health needs and identifying issues by ensuring a sufficient complement of staff and ensuring care is delivered by the right provider, in the right place, at the right time.
Diversifying the workforce beyond an almost exclusive nursing workforce and insulating the system from future workforce shortages.
Assisting Health in prioritizing staffing needs in communities.
Informing the scope and functions of existing and future health care roles for Nunavut Inuit with the intent to create a stable backbone for primary healthcare.

As part of this work, stakeholder and community engagement will be prioritized to ensure a collaborative approach and therefore increased willingness from staff to collectively improve health care delivery within communities. Also, workshops will be held in the communities on primary care collaboration to increase each team's success with new integrated care models.

Over the three-year period, work will be conducted in four main phases, including:

Phase one: hiring staff; identifying three pilot communities (small, medium and large); reviewing and revising draft Community Health Needs Assessment (CHNA) and workforce assessment tools and methodologies.
Phase two: piloting CHNA and workforce assessment tools in two communities; identifying data needs and data collection.
Phase three: completion of CHNA and health workforce assessment, including validating collected data from earlier phases, stakeholder interviews and focus groups, data analysis, draft reports for each community.
Phase four: application of the integrated needs-based health workforce planning approach (IHWA) for community health services including data collection, analysis, workshops, consultations, and health worker competency mapping.

Considering a blueprint for the design of these tools does not already exist globally, this project will ensure the final tool can be validated and replicated for use in all remote Indigenous communities, regardless of size. To note, throughout these phases, early lessons learned will be used contemporaneously to inform and improve other care areas and further develop existing and new health care roles throughout the system.

3. Paramedic Program

Although Health continues to work towards building a stable, sustainable, and representative health workforce, because of Nunavut's geography and the remoteness of communities, Health must rely on mechanisms, like the paramedic program, to fill short-term vacancies. The paramedic program was established in 2021 in response to critical staffing shortages and widespread projections of complete health centre closures.

Since the program was established, it has expanded beyond the initial intent of supporting primary care programs in community health centres. It has also assisted with tuberculosis outbreak responses and offsetting nursing vacancies in Nunavut's only hospital.

Currently, there are no models that incorporate the paramedic role into northern primary health care. Given the success, Health is exploring ways to build this function into the primary health care model to help maximize the use of paramedics, stabilize the health workforce, and improve access to care and health outcomes.

For the first year, bilateral funding will help cover program costs associated with the expansion of paramedic services in all 25 communities by the end of FY 2023/24. In the second and third year, Nunavut will invest funding for a new paramedic practice consultant, who will support the integration of paramedics into community health centres to enhance services offered and help maximize the use of paramedics. This will be accomplished through the development of a specific northern paramedic role, something that is not well defined in Canada.

4. Physician and Nurse Practitioner Services

Qikiqtani General Hospital (QGH), Nunavut's only hospital, offers a range of physician services in-territory including general surgery, anesthesia, obstetrics, emergency medicine, pediatrics, family medicine, obstetrics-gynecology, and various specialist clinics. These services provide essential care to Nunavummiut in-territory and reduce the need to travel to southern jurisdictions.

For the first year, bilateral funding will help cover program costs related to the newly established obstetrics-gynecology (OBGYN) program. Since the inception of Nunavut, most of the services at QGH have been provided by family physicians. In recent years, most of the physicians employed at QGH were recruited straight out of residency programs and therefore had less experience and exposure to obstetrics prior to their arrival in Nunavut. In response, there was a need to establish an OBGYN program with full-time coverage at QGH, to support the development of novice physicians and reduce the risk of patient safety incidents. The OBGYN program will allow Health to expand services at QGH that were not previously available, including colposcopy, endoscopic surgery (tubal ligation and endoscopic hysterectomies), and late-stage abortions. It also gives Health the ability to deliver more community care, which supports Nunavummiut by reducing travel and keeping patients within their communities and support structures.

In addition to the OBGYN program, in the first-year, bilateral funding will also fund other specialist clinics within QGH. Over the last five years there has been an increase in the number of surgery cases as well as surgery referrals. There has also been a need for more community surgery services to reflect a more patient-centric model of care and support Nunavummiut closer to home. Historically, QGH has employed one to two surgeons, which is not sustainable for the increased demands on the surgical program, including the expansion of the colorectal cancer screening and diagnostic program. Bilateral funding will fund three additional surgeons at QGH.

Further, funding in the first year will support the expansion of the cardiology services in Nunavut. This consists of a virtual clinic for every Baffin community, followed by in-person community clinics (including a traveling echocardiogram technician). This program was initially planned to be a temporary measure to address the wait list. However, due to its success, Health requires additional funding to sustain the expanded cardiology program.

In the second and third year, Nunavut will invest funds in piloting nurse practitioners in pediatric, home care and long-term care services, as well as continued expansion of physician services which could include increasing staff at QGH and/or increasing visits/specialty clinics done by staff from other jurisdictions.

Health workers and backlogs

Shared Objective: Canada has a sustainable, efficient and resilient health workforce that provides Canadians with timely access to high-quality, effective and safe health services.

Initiatives to be supported by the Working Together bilateral agreement:

1. Health Care Recruitment Campaign

The success of the Nunavut health care system is highly dependent on the availability and performance of approximately 300 nurses (registered nurses, licensed practical nurses, and registered psychiatric nurses), nurse practitioners and a wide range of other health care providers such as laboratory technologists, respiratory therapists, physicians, and community health representatives.

Currently, the vacancy rate for nurses in Nunavut is close to 50%.

Health's access to relief nurses has been severely impacted by the national health workforce shortage and given the geographic challenge of all fly-in communities in Nunavut and limited housing, it is not possible to rapidly deploy or re-locate nurses and other health professionals to communities in need.

In response to these shortages and vacancies, Health has undertaken significant research and consultation to gain an in-depth understanding of the health workforce issues in Nunavut and across Canada. This includes:

The Roadmap to Strengthen the Nunavut Nursing Workforce: a five-year nursing retention and recruitment strategy published in February 2022. This was the culmination of research and extensive consultation with stakeholders. A comprehensive evaluation framework has also been developed to monitor the success and impact of the strategy.
A nursing recruitment and retention survey, in collaboration with the College and Association of Nurses of the Northwest Territories and Nunavut (CANNN) and Nunavut Health and the Government of the Northwest Territories Department of Health and Social Services.

Bilateral funding will allow Health to develop and launch a comprehensive recruitment campaign to attract and engage highly skilled and motivated nurses and nurse practitioners to the territory. Over the three-year period, this work will include:

Stakeholder engagement sessions.
Environmental scan of factors affecting recruitment.
Developing a detailed campaign strategy intended to reach a national audience and Nunavummiut.
Developing campaign assets including on-site interviews, graphic design, illustration and multi-media content.
Campaign launch.

2. Nursing Student Pathway and Enhanced New Nursing Graduate Program

Making the decision to move away from family and friends to a remote community in Nunavut is daunting for a multitude of reasons. One strategy to promote a health career in Nunavut is early exposure through a supported clinical student placement. Currently, Health offers nursing students attending Nunavut's only college, Nunavut Arctic College, with financial support to travel to a community to fulfill their fourth-year practicum. No such opportunity exists for nursing students enrolled in southern institutions. The costs associated with travel to Nunavut act as a barrier for students wanting to complete their practicum in the north. Bilateral funding will allow Health to offer financial support to eligible nursing students out-of-territory (a maximum of five registered nursing students and five nurse practitioner students), creating a pathway for the recruitment of new nurses upon graduation. Financial support will remove the financial barriers by covering the costs associated with travel to Nunavut including flights and accommodations.

In addition, Health plans to enhance its new Graduate Nursing Residence Program (GNRP) with dedicated resources. The GNRP was first introduced to support new nursing graduates from the Nunavut Arctic College to successfully transition into Nunavut's health care workforce. Nursing in a remote community usually requires a minimum of two years of experience due to the complexity of the nursing roles and functions expected of each nurse's role. Taking on such a role can deter new graduates. As such, the GNRP is designed to support new graduates obtain the competencies and confidence needed to be successful in this role.

The global nursing shortage has prompted Health to plan for hiring more new nursing graduates to minimize operational disruptions in such a manner that will also minimize patient safety risks. As such, Health anticipates a higher volume of new graduates that will need to move through the GNRP. Through bilateral funding, this will be done with the onboarding of a dedicated nurse educator who will be responsible for both the nursing student program and the GNRP.

3. Orthopedic Surgeries

QGH offers specialist clinics to provide Nunavummiut with access to a broad range of specialist services in-territory including, orthopedics, neurology, rheumatology, cardiology, ENT, urology, internal medicine, respirology, allergy, and dermatology.

The orthopedic specialist clinics rely heavily on the one CT scanner at QGH. In FY 2022/23, there were 4,336 CT exams performed on 3,291 patients. With a CT scanner on-site, QGH sends very few clients out-of-territory for CT scans. This reduces the need for medical travel associated with diagnostic imaging. The original CT was purchased due to the misdiagnosis of a patient with a head injury and was a recommendation out of a quality review.

By Spring 2024, Health will require a replacement CT as the scanner has reached its end of life. As such, funding in FY 2023/24 will allow Health to purchase a new CT machine to replace the existing CT machine. In addition, Health is looking to purchase a portable MRI that will reduce the need for Nunavummiut to travel to Ottawa for this service. It will also be a replacement for emergency head CT scans, which reduces the radiation exposure and gives QGH the ability to scan trauma patients in the emergency department. On average, on an annual basis there are close to 1000 head CT scans done at the QGH emergency department, and 150 head MRIs done in Ottawa.

In the second year of this action plan, federal funding will allow Health to purchase a C-Arm to facilitate surgical procedures. Funding these capital costs means Health can increase the medical procedures done in-territory, reducing the number of Nunavummiut medevacked to Ottawa and overall reliance on medical travel.

Mental health and substance use

Shared Objective: Canadians have access to timely, equitable and quality mental health, substance use and addictions services to support their wellbeing.

Initiatives to be supported by the Working Together bilateral agreement:

With the remaining four years of funding for mental health services associated with the 2017 Common Statement of Principles on Shared Health Priorities (CSOP), Nunavut is continuing to invest federal funds to maintain the following mental health initiatives:

Paraprofessional Project: This project aims to increase the number of Inuit in the workplace by providing the opportunity for training, growth, and advanced employment through career laddering. Funding will support paraprofessional initiatives including Atii Angutiit men's programs, peer support, youth facilitators and outreach workers. Training paraprofessionals for these programs ensures Nunavut Inuit can access Inuit-specific, culturally, and linguistically relevant mental health services and programs. Additionally, developing paraprofessional programs increase consistency of services by employing Nunavummiut rather than relying on staff from out-of-territory.
Annual Trauma Symposiums: These symposiums provide northern frontline workers with the tools and skills needed to engage in trauma work with community members, particularly children and youth, and to protect themselves and staff from the challenges of engaging in trauma-related work. Since 2021, there have been three trauma symposiums, reaching over 300 participants from various fields including youth workers, frontline Health and Family Services staff, RCMP officers, traditional counsellors, and community justice workers.

Funding from the Working Together Agreement will also be dedicated towards securing infrastructure for mental health programming, which continues to be the largest barrier, especially when it comes to providing specialized youth-based services. There are significant challenges associated with infrastructure across the territory, including the limited number of adequate spaces, aging facilities, the high cost of construction, and the short sealift and building season. If a location is secured, funding will support the establishment of Nunavut's first integrated youth services (IYS) space.

Funding will also support the expansion of both virtual and in-person mental health services.

To date, for 2023, there have been close to 20,000 visits to a health centre by Nunavummiut, to access mental health services. Funding will establish new integrated mental health teams that include mental health social workers, license practical nurses, case managers and nurse practitioners. These integrated mental health teams will provide wrap-around mental health services to Nunavummiut, including increased early intervention support, access to suicide prevention, and increased specialized services closer to home, reducing the need to travel to regional centres and/or out-of-territory.

As well, funding will support enhanced virtual mental health services, which play a pivotal role in the provision of mental health services in Nunavut. Since the establishment of virtual mental health services in Nunavut in 2021, there has been continued uptake.

III. Measuring and reporting

Over the past few years, significant progress has been made in Nunavut to strengthen and streamline data collection. For instance, in Fall 2020 Health established the Health Information Unit (HIU). The HIU serves as the primary structure for the creation, management, protection, and utilization of health information resources and services within Health. Prior to the establishment of the HIU, Health did not have a single organizational unit dedicated to this. Rather, these functions were spread across different organizational units, such as eHealth, Population Health Information, the Office of the Chief Public Health Officer, Population Health, and Policy & Planning. This led to significant functional gaps in the overall health data management, affecting health program design, delivery, and management.

The initial establishment of the HIU saw the consolidation of the different units including eHealth and Population Health within a single unit under a single management team, which has played a critical role in advancing Health's capacities within data collection and reporting.

More recently, in 2023 Health secured funds to expand HIU's efforts in data collection and reporting.

However, there are ongoing challenges in Nunavut related to its capacity to collect and report on data for its health system, including those related to the maturity of data collection systems, privacy associated with small sample sizes, and health workforce supply and stability.

Many of the headline indicators that are shown below, are not currently applicable in Nunavut or must be understood with several caveats including the fact that Nunavut delivers its primary health care differently than other jurisdictions, as set out above.

Health is committed to developing performance measurement targets. As per the Canada-Nunavut Agreement to Work Together to Improve Health Care for Canadians, a dedicated staff is required to work with CIHI to refine the headline indicators and any additional indicators, refine Nunavut-specific indicators and support efforts to report on those indicators. As such, Health will work to hire additional staff who will be responsible for this work. Once staff are hired, Health will work with Health Canada to revisit the indicators; as such, some indicators and/or targets will be set and/or refined. It is anticipated that these targets will be updated by September 2024.

Targets and timeframes
Indicator	Baseline	Target and Timeframe
Indicator	Baseline	Target	Timeframe
Family Health Services
Headline Indicator
Percentage of Nunavummiut who report having access to a regular family health team including in rural and remote areas	24%³	To be determined⁴	To be determined
Nunavut-specific Indicator
Number of graduates in the basic laboratory and electrocardiogram training pilot program	0	150	March 2026
Number of Inuit enrolled in the midwifery education program	0	5	March 2026
Health Workers and Backlogs
Headline Indicator
Size of COVID-19 surgery backlog	Data unavailable in the territory⁵	Data unavailable in the territory	Data unavailable in the territory
Net new family physicians, nurses, and nurse practitioners as represented by health care providers per 10,000 population	Physicians: 5 per 10,000 population⁶ Registered Nurses: 175 per 10,000 population Nurse Practitioners: 11 per 10,000 population	Physicians: 7 per 10,000 population Registered Nurses: 180 per 10,000 population Nurse Practitioners: 13 per 10,000 population	March 2026
Nunavut-specific Indicator
Vacancy rate for nurses	49%	30%	March 2026
Number of nurses under the new nursing student pathway	0	10	March 2026
Number of MRI procedures being completed in-territory	0	300 (total procedures conducted with new portable MRI before March 2026)	March 2026
Mental Health and Substance Use
Headline Indicator
Median wait times for community mental health and substance use services	Data unavailable in the territory	Data unavailable in the territory	Data unavailable in the territory
Percentage of youth aged 12 to 25 with access to integrated youth services for mental health and substance use	Not applicable⁷	Not applicable	Not applicable
Percentage of Canadians with a mental disorder who have unmet health care needs	Data unavailable in the territory⁸	Data unavailable in the territory	Data unavailable in the territory
Nunavut-specific Indicator
Number of paraprofessionals	30	50	March 2026
Modernizing Health Systems
Headline Indicator
Percentage of Canadians who can access their own comprehensive health record electronically	Not applicable⁹
Percentage of family health service providers and other health professionals (e.g. pharmacists, specialist, etc.) who can share patient health information electronically	Not applicable¹⁰

IV. Funding allocation

Summary of the Working TogetherAction Plan
Initiative	Incremental Investments
Initiative	2023-24	2024-25	2025-26
Family health services Initiatives: Increasing Inuit Employment Community Health Needs and Workforce Assessment Tool Paramedic Program Physician and Nurse Practitioner Services	$4,918,500	$4,305,000	$4,366,000
Health workers and backlogs Initiatives: Health Care Recruitment Campaign Nursing Student Pathway and Enhanced New Nursing Graduate Program Orthopedic Surgeries	$1,895,100	$2,500,000	$1,692,000
Mental health and addiction Initiatives: Paraprofessional Program Training Capital Costs for Mental Health Programming Integrated Mental Health Teams Virtual Mental Health Services	$1,366,100	$1,075,000	$1,822,000
Total	$8,179,700	$7,880,000	$7,880,000
Funding available^{Table 4 Footnote *}	$8,179,700	$7,880,000	$7,880,000
Table 4 Footnote * The 2023-24 funding available includes $299,700 carried forward from 2022-23 Canada-Nunavut Home and Community Care and Mental Health and Addiction Services Funding Agreement. Table 4 Return to footnote * referrer

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Date modified:: 2024-03-22

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Canada-Nunavut agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26)

Tables of contents

Funding agreement

1.0 Key principles and collaboration

2.0 Objectives

3.0 Action plan

4.0 Term of agreement

5.0 Financial provisions

6.0 Performance measurement

7.0 Reporting to Canadians

8.0 Communications

9.0 Dispute resolution

10.0 Amendments to the agreement

11.0 Termination

12.0 Notice

13.0 General

Annex 1 - Common Statement of Principles on Shared Health Priorities

Annex 2 - Shared pan-Canadian interoperability roadmap

5-Year Shared Pan-Canadian Interoperability Roadmap

Patient Summary

Data Portability

Patient Access

eReferral & eConsult

Enablers

Data

Access & Exchange

Trusted Framework

Outcomes

Annex 3 - Headline common indicators

Annex 4 - Action plan

Family Health Services

Health workers and backlogs

Mental health and substance use

Page details

Canada-Nunavut agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26)

Tables of contents

Funding agreement

1.0 Key principles and collaboration

2.0 Objectives

3.0 Action plan

4.0 Term of agreement

5.0 Financial provisions

6.0 Performance measurement

7.0 Reporting to Canadians

8.0 Communications

9.0 Dispute resolution

10.0 Amendments to the agreement

11.0 Termination

12.0 Notice

13.0 General

Annex 1 - Common Statement of Principles on Shared Health Priorities

Annex 2 - Shared pan-Canadian interoperability roadmap

5-Year Shared Pan-Canadian Interoperability Roadmap

Patient Summary

Data Portability

Patient Access

eReferral & eConsult

Enablers

Data

Access & Exchange

Trusted Framework

Outcomes

Annex 3 - Headline common indicators

Annex 4 - Action plan

Family Health Services

Health workers and backlogs

Mental health and substance use

Page details

5.0 Financial provisions