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First Nations & Inuit Health

Contribution Agreements

Through contribution agreements, the Government of Canada provides funding that must be spent according to agreed upon conditions. Spending is monitored and reviewed to ensure that these conditions are met.

For many years Health Canada has provided direct health care services to First Nations and Inuit people of Canada. Beginning in the 1970s, government policies advocated more direct control by First Nations and Inuit communities of their own health services delivery. As a result, new health programs called for mechanisms to enable First Nations and Inuit communities to manage and control the delivery of health services to their members. First Nations and Inuit health programs, approved by Treasury Board, began to include contribution agreement authorities for First Nations and Inuit communities to administer the health programs themselves. Over the years, Treasury Board has approved various types of contribution arrangements based on the nature of the programs and the administrative capacity of the First Nations organizations to deliver the service.

The following are three broad categories that programs and services supported by Health Canada grants and contributions fall into:

  1. In lieu of services the Department would deliver itself (First Nations and Inuit Control);
  2. Inter-departmental partnerships; and
  3. Research projects.

For additional information, see Related Resources.

1. In lieu of services the Department would deliver itself.

The First Nations and Inuit Health Branch (FNIHB) has a variety of contribution agreements which serve as vehicles for the administration and management of First Nations and Inuit community health programs and services. This is part of FNIHB's strategic direction to transfer autonomy and control of programs to First Nations and Inuit within a time-frame to be determined in consultation with them.

The Department has a variety of Contribution Agreements which serve as vehicles for the administration and management of First Nations and Inuit community health programs and services. These agreements vary in terms of level of control, flexibility, authority, reporting requirements and accountability and are categorized by funding model. First Nations and Inuit communities interested in having more control of their health services can decide among the different funding models based on their eligibility, interests, needs and capacity. The funding models are outlined as follows:

  • Set Funding Model
    • FNIHB designs the programs. Recipients are able to redirect resources within the same sub-sub activity (with the written approval of the Minister). Interim and year-end reports are required. Duration of the agreements is up to three (3) years.
  • Flexible Funding Model
    • Recipients must establish a Multi-Year Work Plan, including a health management structure. Recipents have the flexibility to reallocate funds within the same Program Authority and are allowed to carry forward program funding (with written approval from the Minister) for reinvestment in the following fiscal year within the same Program Authority. Annual reports, including year-end audit reports, are mandatory. Duration of the agreements is two (2) to five (5) years.
  • Block Funding Model
    • Recipients determine their health priorities, prepare a Health Plan (HP) accordingly, and establish their health management structure. Recipients are able to reallocate funds across all authorities and are allowed to retain surpluses for reinvestment in priorities (listed in the approved HP). Annual reports and year-end audit reports are mandatory as well as an evaluation report every five (5) years. Duration of agreements is five (5) to ten (10) years.
  • Multi-Departmental Funding Arrangements
    • National Funding Model - Health Canada (First Nations and Inuit Health Branch) and Aborignal Affairs and Northern Development Canada collaborate on an ongoing basis to explore what actions could be taken to streamline funding mechanisms and instruments. As a result, in 1999/2000 the Canada First Nations Funding Agreement was was jointly developed by Health Canada (First Nations and Inuit Health Branch), Aborignal Affairs and Northern Development Canada and the Department of Justice for implementation. This has since been replaced by the National Funding Model. The National Funding Model is a funding mechanism which may be used by First Nations who wish to have one agreement that includes several federal departments' programs, resulting in a reduced number of agreements and less administrative burden for both bands and federal departments.

2. Inter-departmental Partnerships

To enable partners to address major national health priorities or health problems and for which there is no one departmental infrastructure, expertise or resources (for example: the National AIDS Strategy, the National Breast Cancer Strategy and, the Alcohol and Drug Treatment Strategy).

3. Research Projects

Research projects that stimulate the development of knowledge (for example: contribution programs that help the Canadian Institute for Health Information coordinate the development and maintenance of a comprehensive and integrated health information system). See Health Policy Research Contribution Audits for information on audited First Nations and Inuit research projects.

Related Resources

  • Templates - Contribution Agreements 2016 - 2017
  • The First Nations and Inuit Program Compendium provides information about health-related programs and services available to First Nations people and Inuit. The compendium includes an inventory of program information sheets that describe each program, their elements, goals and objectives, as well as the different types of service providers and their qualifications. First Nations and Inuit communities can use the compendium to better understand the objectives of the various programs and services being delivered to them either directly by Health Canada staff or through contribution agreements.
  • The status of First Nations and Inuit control activity section shows the number of communities/agreements currently under First Nations and Inuit control.
  • The Ten Years of Health Transfer - First Nations and Inuit Control report traces the history of health transfer in Canada.
  • Health Canada seeks an integrated approach to funding arrangements whereby federal and provincial funds for health services are combined into one envelope. For more information, see the financing a First Nations and Inuit integrated health system report.
  • To learn about the accountability measures taken, please see the Consolidated Contribution Agreement Audits section.