We call upon all levels of government to:
- Increase the number of Aboriginal professionals working in the health care field.
- Ensure the retention of Aboriginal health-care providers in Aboriginal communities
- Provide cultural competency training for all health-care professionals
Indigenous Watchdog Status Update
|Current Status||March 31, 2021||IN PROGRESS|
|Previous Status||Dec. 31, 2020||IN PROGRESS|
Why “In Progress?”
Nov. 2020 – The Canadian Association of Schools of Nursing (CASN) in partnership with the Canadian Indigenous Nurses Association developed a framework of foundational strategies, recruitment and retention strategies, and curricular strategies for nursing education to advance responses to the TRC
Oct. 5, 2020 – The Canadian Indigenous Nurses Association (CINA) and Canadian Nurses Association have emphasized the need for a “mandatory” cultural competency and humility training program for health-care professions after the dearth of Joyce Echaquan, a 37-year-old woman from the Atikamekw community of Manawan, Que.
Indigenous Services Canada (ISC) through the Indigenous Health Human Resources Task Force develops strategies for increasing the recruitment and retention of Indigenous health care professionals, and supporting cultural competence training for all health care professionals. In addition, the Association of Faculties of Medicine, Royal College of Physicians and Surgeons and The Canadian Nurses Association have all made recommendations to address this Call to Action.
Commitment to Aboriginal Health Care Workers & Cultural Competency Training
Jan. 28, 2021 – Health Minister Patty Hajdu announced $4 million in support for a national consortium, led by Indigenous physicians, to implement projects to educate doctors on the provision of “culturally safe” health care that is “free from discrimination.”
Feb. 26, 2019 – Territorial Health Investment Fund provides $1 million annually for 4 years (2017-18 to 2020-21) for the development of cultural competency training.
June 28, 2017 – $8M to Canadian Health Research Network for an Indigenous Mentorship Network Program whose aim is to support the next generation of Indigenous health researchers by providing distinctive learning opportunities and specially tailored mentoring activities to Indigenous students at the undergraduate, master’s, doctoral and post-doctoral levels, as well as Indigenous researchers in the beginning phase of their careers
Mar. 1, 2017 – Declaration of Commitment to Cultural Safety and Humility signed by BC Health Regulators opens the door to formally encouraging all health professionals to complete cultural safety training, such as the San’yas Indigenous Cultural Safety
Oct. 18, 2017 – Training offered by the Provincial Health Services Authority (PHSA) – The UBC 23-24 Indigenous Cultural Safety interdisciplinary learning experience was launched this month as a required component for students in dental hygiene, dentistry, dietetics, genetic counselling, medicine, nursing, midwifery, occupational therapy, pharmacy, physical therapy, and social work. Next year, students in audiology and speech language pathology will also take part. The students will then be better prepared to work in B.C., where embedding cultural safety in the health-care system has long been a goal of the First Nations Health Authority (FNHA). In 2015, The Ministry of Health and six other health authorities joined the FNHA to declare their commitments to it. Earlier this year, 23 colleges that regulate B.C.’s health-care professions did the same. (UBC News)
June 3, 2015 – Aboriginal Recruitment and Retention initiative, new Northern/Remote Family Doctor Residency Program and a cost-covering tuition program for nurse practitioner students who agree to work in northern communities are already in place (CBC)
May 15, 2016 – One of the four focus areas is “Primary Care” that includes delivery of Indigenous cultural competency training to front-line health care workers who work with First Nation communities.
2016 – The Province of Ontario made San’yas training mandatory for every employee in the Ontario Public Service
June 1, 2018 – Over the last two years, the NE LHIN has provided Indigenous Cultural Safety on-line training to more than 400 people working in health care across Northeastern Ontario. These efforts are in keeping with the NE LHIN’s Aboriginal Health Care Reconciliation Action Plan, published in 2016, which identifies cultural competency as a core value. The Action plan recognizes the importance for all health service providers to develop cultural competency to better understand the history of Indigenous peoples in Canada, the legacy of residential schools, and to learn approaches that deliver health services in a culturally safe manner.
Nov. 6, 2020 – Training will be provided to management and workers in the health and social services network to familiarize them with the concept of cultural safety. Liaison officers will be added within institutions to provide relations with Indigenous communities and organizations, as one of the first steps in the process. Service navigators, preferably Indigenous people, will also be deployed in the field. The mandate of these people will be to guide and support Indigenous users within the care system, with a view to improving accessibility and continuity of the services provided.
Feb. 26, 2019 – As part of the Department of Health and Social Services’ official release of the “Caring for Our People: Cultural Safety Action Plan 2018-2020” today, a Declaration of Commitment was signed to embed cultural safety within the Northwest Territories’ health and social services system. Through the implementation of the Cultural Safety Action Plan, the Government of the Northwest Territories aims to improve the health outcomes Indigenous residents and all Northerners.
An engagement process with Indigenous and northern residents, including health and social services clients, the NTHSSA Leadership Council, Regional Wellness Councils, and non-government organizations, four objectives were identified for the Action Plan.
- Creating an organizational culture of cultural safety.
- Strengthening staff capacity for cultural safety.
- Honouring traditional knowledge and healing approaches in care.
- Improving client and community experience.
The federal government Health Services Integration Fund has disbursed $1,476,387 to support and embed cultural safety across the Northwest Territories’ health and social services system.
Mar. 17, 2017 – Canadian Foundation for Healthcare Improvement and the Government of Nunavut (Depts. of Health, Education, and Culture and Heritage) announced that the territory’s first cohort of trainers in Indigenous Cultural Competence has now been certified, paving the way for more culturally safe health and social services.
Aboriginal Nursing in Canada Fact Sheet: 2016
Aboriginal health professionals include physicians, dentists, veterinarians, pharmacists, occupational therapists, optometrists, chiropractors, speech pathologists, dieticians, nutritionists, physiotherapists, audiologists and registered nurses, etc.
- There are 13,010 health professionals identifying as Aboriginal of which 9,695 are nurses
- 1.2% of all Canadian health professionals are Aboriginal health professionals.
The Association of Faculties of Medicine and the Canadian Nurses Association have both made commitments to increase the number of aboriginal healthcare professionals.
Association of Faculties of Medicine
Founded in 1943, the Association of Faculties of Medicine of Canada (AFMC) represents Canada’s 17 faculties of medicine and is the voice of academic medicine in this country. Our member faculties graduate over 2,700 MDs per year; teach over 11,500 undergraduate medical students; train over 15,000 postgraduate trainees; employ nearly 48,000 full and part-time faculty members and undertake over 3 billion dollars of biomedical and health care research annually.
AFMC Joint Commitment to Action on Indigenous Health – May 23, 3019
First and foremost, we need to stop thinking of Indigenous health as an optional topic…We have an obligation to respond to the Calls to Action of the TRC… We must be training a medical workforce in Canada that can contribute meaningfully to closing the gaps in Indigenous health, through all of the CanMEDS roles and in each arena of physician work.
Top 10 Prioritized Statement and Related Themes include:
Infrastructure and Organizational Culture (Learning Environment) # 4 Medical schools invest in the development of a critical mass of Indigenous Faculty and Staff with the appropriate supportive infrastructure to lead all aspects of Indigenous medical education including admissions, student recruitment and retention, curriculum development and implementation, and with structured presence on key decision-making committees within the medical school
Social Accountability and Community Engagement # 6 Medical schools focus on the development of meaningful relationships with the Indigenous communities that they serve using rights-based approaches to the co-creation of the terms of the relationship. Indigenous communities are recognized as expert resources for the medical school and are provided with the opportunity and resources needed to participate in all aspects of the admissions process, teaching, hosting learners, research and scholarship, and faculty development.
Stop Talking, Start Doing: The Social Accountability of Canadian Medical Schools and Indigenous Health
April 29, 2017 -. Since 2016, the AFMC Board has held open sessions to discuss areas of common concern and for pan- Canadian collaboration from the 17 medical schools and their partners. The 2017 session was held on the topic of the Social Accountability of Medical Schools in Addressing Indigenous Health.
The Objectives of the session were:
- To share knowledge and improve cultural sensitivity about indigenous health in Canada.
- To describe the progress that has been made and future directions in the contribution of medical schools to the health workforce in addressing indigenous health needs.
- To advance strategies in community engagement and community-based education.
- To share best practices and facilitate advocacy for indigenous peoples health in Canada.
In taking leadership in Indigenous Health, what are we trying to achieve?
- The emphasis, promotion, and integration of cultural safety in Canadian faculties of medicine
- Authentic and continued engagement between faculties of medicine and Indigenous communities and leaders
- The increased representation of First Nations, Métis, and Indigenous medical students and physicians
- The development of a core curriculum on Indigenous health as part of undergraduate medical education
Is there alignment between the health needs of Indigenous Persons in Canada and the Missions of our Medical Schools? Can we be more explicit about our Social Accountability?
1) Integrating the needs of FNMI communities explicitly into FoM mission statements/social accountability mandates is warranted
2) Resourcing, funding, advocacy, and research will be essential to embed FNMI needs as a priority area within Faculties
3) There may be existing alignment between FoM missions and FNMI needs, but engaging and collaborating with FNMI communities must take place in order to identify those areas of alignment
Royal College of Physicians and and Surgeons
We share our expertise and maintain close working relations with Canada’s 17 university medical schools, national professional associations, national specialty societies, voluntary health organizations and government agencies. Our voice is respected and influential in critical discussions on issues that affect medical education, medical research and the delivery of high-quality health care to Canadians.
On October 26, 2017, the Royal College’s Council endorsed a resolution proposed by the Indigenous Health Committee of the Royal College (IHC) to include Indigenous health across all residency training programs, a step towards fulfilling the Truth and Reconciliation Commission’s Calls to Action, including numbers 23 and 24.
The IHC, an independent body that comprises Indigenous physicians, scholars and other health care professionals, led the development of two flagship documents that underpin the Royal College’s actions to improve Indigenous health.
- The Indigenous Health Primer (2019) provides core information about Indigenous health through stories and case studies of Indigenous experiences and essential knowledge for Fellows, health care providers, learners and educators in caring for Indigenous Peoples.
Download the primer (pdf)
- The Indigenous Health Values and Principles Statement, Second Edition (2019) examines the values pertaining to Indigenous health and bridges these values to the CanMEDS framework with actionable principles that guide culturally safe health care.
Download the Indigenous Health Values and Principles Statement (pdf).
Additionally, the Royal College recommends the following resources to all on a journey to become a culturally safe provider to Indigenous patients: The San’yas Indigenous Cultural Safety online training:
- Increases knowledge of the history of Indigenous people in Canada
- Builds self-awareness of biases and assumptions
- Strengthens the skills of those who work both directly and indirectly with Indigenous people to ensure they have access to culturally safe care
The overall goal is to improve the health and well-being of Indigenous people and close the health gap between Indigenous and non-Indigenous British Columbians
Core Indigenous Cultural Safety Health training is designed for health authority and Ministry of Health employees as well as other professionals working in the health care field. This training was developed in British Columbia, but portions of the training are relevant across Nations.
This training is designated as an accredited self-assessment program by the Royal College for up to 8.0 section 3 credits as defined by the maintenance of certification (MOC) Program.
Enrollment in Faculties of Medicine
- 2003 1.0% out of a population of 3.8% (2006 census)
- 2016 2.7% out of a population of 4.3% (2011 census)
See the San’yas homepage for further detail: http://www.sanyas.ca/
Canadian Nurses Association
CNA is the national professional voice of over 139,000 registered nurses and nurse practitioners across Canada. CNA advances the practice and profession of nursing to improve health outcomes and strengthen Canada’s publicly funded, not-for-profit health system.
CNA works to advance Indigenous health and nursing through its partnership accord with the Canadian Indigenous Nurses Association (CINA) and through its Canadian Network of Nursing Specialties.
Canadian Association of Schools of Nursing – Framework of Strategies for Nursing Education to Respond to the Calls to Action of Canada’s Truth and Reconciliation Commission
Nov., 2020 – Created in partnership with the Canadian Indigenous Nurses Association and with cross-country input. It identifies two calls to action that schools of nursing can make a reality:
- increasing in the number of Indigenous professionals working in health care and
- creating a requirement for nursing and medical students to take a course on Indigenous health issues, including the legacy of residential schools, treaties, rights and Indigenous teachings and practices.
The document states that many universities and colleges in Canada have already begun to respond to the TRC’s calls to action and that nursing schools are “well positioned” to address and accomplish these goals. (University Affairs: – “Canada’s nursing programs address racial prejudice in the profession”: Jan. 15, 2021)
The purpose of this discussion paper is to provide national support for reconciliation by fostering reflection related to decolonization and Indigenization, and by offering direction to schools of nursing in responding to the TRC Calls to Action. The background context of decolonization, Indigenization, and reconciliation is presented first, followed by a review of responses to the TRC among post-secondary institutions in Canada. The paper concludes with a framework of strategies to address the TRC Calls to Action in nursing education.
Initiatives underway to respond to the TRC in nursing education can be grouped into the following:
- Foundational strategies supporting reconciliation
- Strategies focused on the recruitment and retention of Indigenous students
- Strategies targeting the curriculum and pedagogy of the program
Taken together they offer guidelines for schools of nursing to support reconciliation.
Foundational strategies being implemented provide a supportive base for both the recruitment and retention of Indigenous students and program changes that the TRC has called for. They include:
- faculty and staff training
- institutional respect, and
- a welcoming environment.
Recruitment and Retention Strategies
Social, cultural, and economic factors are often barriers to the successful recruitment and retention of Indigenous students. Strategies being implemented to facilitate admission into nursing programs and program completion include:
- designated seats
- pre-admission outreach
- transition support
- cultural support, and
- distributive program delivery.
Call to Action 24 of the TRC specifically highlights a need for curricular strategies in nursing education programs in order to address issues related to health care delivery to Indigenous Peoples. Initiatives to respond to this Call to Action have included:
- having Indigenous teachers in the program
- welcoming Indigenous pedagogy in the classroom;
- incorporating Indigenous community placements
- teaching students about Indigenous history, knowledge, and culture; and
- incorporating anti-racism and cultural safety in the curriculum.
Summary and Conclusion
CASN member schools unanimously supported a motion for nursing education to respond to the TRC’s Report. As a result, a task force was struck, chaired by the CEO of CINA, with the goal of supporting decolonization, Indigenization, and reconciliation in nursing education. To this end, a framework of foundational strategies, recruitment and retention strategies, and curricular strategies for nursing education has been developed to advance responses to the TRC.
Official Federal Government Response: Sept. 5, 2019
Indigenous Services Canada (ISC) participates in the Indigenous Health Human Resources Task Force under the Federal Provincial Territorial Committee on Health Workforce. The task force develops strategies for increasing the recruitment and retention of Indigenous health care professionals and supporting cultural competence training for all health care professionals. As a result of close collaboration with federal, provincial and territorial representatives, an environmental scan was conducted to take stock of current and notable past initiatives across Canada to increase the recruitment and retention of Indigenous health professionals and provide cultural safety training to health professionals working with Indigenous communities, patients and families within health care systems.
ISC included cultural competency training for new registered nurses and nurse practitioners employed by its First Nations and Inuit Health Branch. ISC also financially supports and works with the Canadian Indigenous Nurses Association and other Indigenous health organizations to explore ways to recruit and retain more Indigenous health professionals and to develop cultural competency training for all health professionals.