The Canadian Pandemic Influenza Plan for the Health
Sector
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Annex B
Pandemic Influenza Planning Considerations in On-reserve First
Nations Communities
Date of Latest Version: June
2005
This Annex is currently under review.
Summary of Significant Changes:
The revised version will reflect the following:
- clarification from the F/P/T Health Ministers meeting on
roles and responsibilities;
- progress made by First Nations communities with regards to
pandemic influenza planning;
- First Nations and Inuit Health Branch involvement in various
new fora related to pandemic influenza planning;
- National and Provincial Aboriginal Organizations' involvement
in pandemic influenza planning.
Note: The First Nations and Inuit Health
Branch will undertake the necessary consultations for the
revision of this annex. |
1. Introduction
The national pandemic influenza plan provides a framework that
will guide planning in all jurisdictions in Canada including
on-reserve First Nations (FNs) communities1. Annex B of the plan
has been developed based on a request to Health Canada's First
Nations and Inuit Health Branch (FNIHB) from the Pandemic
Influenza Committee (PIC) to describe some of the unique issues
related to pandemic planning in FNs communities.
Annex B outlines some of the key activities needed to have
sufficient pandemic influenza planning for on-reserve FNs
communities and proposes the respective roles and
responsibilities of various jurisdictions.
On-reserve FNs pandemic influenza planning needs to be
integrated into a seamless system of planning across all Canadian
jurisdictions.
This Annex B document is the result of extensive consultation
with key stakeholders. Input on the draft document was sought
from FNIHB regional public health staff (including medical
officers and nurses), members of the
federal/provincial/territorial Pandemic Influenza Committee, the
Centre for Emergency Preparedness and Response at the Public
Health Agency of Canada, the Assembly of First Nations, and the
National Aboriginal Health Organization. The document was refined
based on comments received from all of these groups.
2. Current Status
Health Canada's First Nations and Inuit Health Branch (FNIHB)
delivers public health services to the First Nations who live on
non-transferred federal reserves. In transferred communities that
have accepted funding and responsibility for public health
services, FNIHB provides the funding, but FNs communities are
responsible for providing the services. In order to do this,
transferred FNs communities can hire their own public health
professionals or enter into agreements with provincial or
regional health authorities for the provision of these services.
It is important to note that FNIHB requires transferred
communities to have an emergency preparedness plan as a condition
of receiving federal transferred funding for public health.
However, those emergency preparedness plans do not address
specific public health emergencies, such as pandemic influenza.
FNIHB, through its regional offices, will assume an intermediary
role between provinces and transferred communities.
Provision of public health services, including pandemic
influenza planning, to Inuit populations and to FNs communities
living in the Territories is primarily the responsibility of the
territorial governments2. Territorial governments provide public
health services in an integrated fashion to all residents
regardless of ethnicity.
Currently, the federal, provincial and territorial governments
also share the delivery of other health services to the First
Nations and Inuit population. Provinces provide universal insured
health services (including physician and hospital services) to
all citizens, including Aboriginal peoples on/off-reserve, except
in remote isolated, isolated and some semi-isolated on-reserve
communities where the primary health care is delivered by
FNIHB-employed registered nurses.
While most of the FNIHB regions have been participating in the
provincial committees for pandemic influenza planning, there are
very few formal agreements between Health Canada FNIHB regional
offices and the provincial governments on the management of
outbreaks of pandemic influenza in FNs communities. Nevertheless,
progress has been made in this area.
All FNIHB regions have developed draft or final regional
pandemic influenza plans or guiding frameworks to assist FNs
communities in developing their community pandemic influenza
plans. Other FNIHB regions are in the process of negotiating
roles and responsibilities with their respective provinces for
dealing with pandemic influenza.
In some regions, meetings between FNIHB and FNs to raise
awareness of the need for community-level planning on pandemic
influenza have occurred and, as a result, some communities have
developed their community plans. In other regions, health
directors from FNs communities are engaged directly with their
respective provincial/district/regional health authorities on
pandemic influenza planning to clarify the issues of acute care
and client management in the event of pandemic influenza
outbreaks.
In practice, there have always been informal collaborations
between provincial governments and FNIHB for management of public
health emergencies and disease outbreaks in on-reserve FNs
communities. It is important to emphasize, however, that there
are some gaps in these collaborations. For example, there have
been occasions when FNIHB medical officers have not been notified
by provincial/regional counterparts of cases of communicable
disease (e.g. meningitis) occurring on a reserve and where FNIHB
regional medical officers are the identified lead for the public
health response to such cases. Furthermore, this informal
collaboration with provinces and FNIHB regions has not been
tested during a massive national public health emergency, such as
pandemic influenza.
3. Outstanding Issues
Linkages with Provincial/Territorial (P/T) Public Health
Authorities
- Formal agreements between provincial public health and FNIHB
regional offices on co-ordination of roles and responsibilities
during public health emergencies, including pandemic
influenza.
- Formal agreements between provincial public health and FNIHB
regional offices to include on-reserve FNs numbers into the
provincial/regional plans for purchase of antivirals, vaccines
(when developed), and other relevant emergency supplies, and to
clarify who would be the gatekeeper for these limited
supplies/products.
- Clear protocols for on-reserve FNs communities to access the
anti-virals, vaccines and other emergency supplies in a
coordinated fashion with the provinces.
- Communication protocols between FNIHB regional offices,
transferred bands and provinces on issues related to communicable
diseases and other public health concerns.
Legal Authority
- Clarity among the provinces, regional health authorities, the
First Nations, and FNIHB regional offices on the legally
recognized medical officer of health for each on-reserve FNs
community.
Resources
- Capacity at the FNIHB regional level and at the FNs community
levels to deal with outbreaks of pandemic influenza due to
limited public health infrastructure for FNs communities and
shortage of public health human resources.
- Surveillance, epidemiology and influenza vaccination program
data of on-reserve population for proper pandemic planning.
4. Next Steps
While FNIHB is working on assessing and addressing the issue
of public health infrastructure and the deficiency of public
health human resources in FNs communities and at FNIHB regional
levels, it is crucial that planning for management of pandemic
influenza in FNs communities be a coordinated effort involving
all jurisdictions. The on-reserve FNs communities, with the
support of FNIHB and provincial/regional health authorities, are
responsible for developing their community pandemic influenza
plans. However, the successful implementation of these plans
requires a coordinated effort involving all key stakeholders
(i.e. the FNs communities, FNIHB and provincial/regional health
authorities). FNIHB regional offices would lead in facilitating
the process among stakeholders.
Table 1 illustrates some of the key activities required for
adequate pandemic planning for on-reserve populations. It
includes proposed roles and responsibilities of the various
jurisdictions who will be facilitating the planning or be
involved in the planning. This table was developed because for
public health issues of on-reserve populations, the multiple
jurisdictional involvement has often created confusion over roles
and responsibilities. To effectively deal with pandemic influenza
outbreaks in on-reserve FNs communities, the roles and
responsibilities of the various jurisdictions must be clear to
all in advance.
Table 1: The Key Activities and Proposed Roles and
Responsibilities of Partners on Management of Pandemic Influenza
in On-reserve First Nations Communities
1. FNs Communities |
1.1 |
Develop community pandemic influenza plans in
collaboration with the respective FNIHB region and/or the
local/regional health authority, specifically:
- identify provincial/regional Medical Officer of Health (MOH)
for the community and establish formal arrangements for ongoing
MOH services;
- identify partners and clarify their roles and
responsibilities;
- enhance community awareness;
- train front line staff3;
- enhance community surveillance activities for early detection
of influenza-like illness (ILI);
- enhance triage/screening capacity;
- develop capacity for patient isolation in health care
facilities in FNs communities;
- implement infection control guidelines and public health
measures at the time of pandemic, in consultation with FNIHB
regional medical officers, regional health authorities, and in
accordance with the national pandemic plan;
- develop and regularly update communication plan;
- maintain ongoing stock and inventory of emergency supplies
(e.g. masks, gloves, etc.);
- calculate and regularly update the number of individuals
(within FNs communities) in each priority group for vaccines and
antivirals;
- plan for mass immunization, in collaboration with FNIHB
regional medical officers, and/or provincially recognized medical
officers of health;
- communicate and discuss with health authorities in
neighbouring municipalities the transfer of severe pandemic
influenza cases to hospitals and ensure equitable access for such
cases;
- assess the current means of patient transportation to
provincial/regional health care system (when required) and
examine their appropriateness during pandemic influenza (i.e.
identify the gaps and develop strategies to address them);
- plan ahead of time to ensure maintenance of essential
services4 in
the community;
- develop a contingency plan to enhance the knowledge of FNs
people on how to deal with situations when there are severe
shortages of health care workers and health care
services5 as
a result of pandemic influenza;
- develop formal partnership agreements between FNs communities
to allow for mutual aid;
- institute emergency response team;
- participate in simulation exercises with the respective
neighbouring municipalities for testing of preparedness and
response plan for pandemic influenza at the community level;
and
- actively participate in local pandemic influenza planning (in
neighbouring municipalities) to facilitate coordination of
efforts and integration with provincial/regional systems in
dealing with pandemic influenza.
|
|
2. FNIHB Regions |
2.1 |
Develop FNIHB regional pandemic
influenza plans, in consultation with FNs communities and FNs
regional organizations, and integrate with provincial systems
where possible. More specifically: |
|
2.1.1 |
Develop formal agreements, through negotiation,
with provincial health authorities to clarify and co-ordinate
mutual roles and responsibilities for:
- procurement and distribution of vaccine/antivirals/emergency
supplies (e.g. supplies for diagnosis, treatment, infection
control, immunization);
- enhanced surveillance capacities, in conjunction with
provincial system, with the ability to separate out surveillance
data for on-reserve FNs;
- assistance with public health/medical care services in
overwhelming situations;
- clarity on the legally recognized medical officer of health
for each FNs reserve;
- two-way communication on case reporting;
- defined roles and responsibilities of provincial/regional vs
FNIHB public health authorities on needed activities for pandemic
influenza preparedness and response; and
- establishment of a means of transportation for respiratory
specimens to provincial public health laboratories, when
necessary.
|
|
2.1.2 |
develop partnership with INAC at the regional
level towards integration of health emergencies with the overall
emergency preparedness planning; |
|
2.1.3 |
develop communications plans; |
|
2.1.4 |
identify partners and clarify their roles and
responsibilities; |
|
2.1.5 |
participate in simulation exercises with
province(s) for testing of preparedness and response plan for
pandemic influenza at FNIHB regional level; |
|
2.1.6 |
partner with FNIHB Headquarters to develop
educational material; |
|
2.1.7 |
identify current means of distribution of
supplies to FNs communities and examine their appropriateness in
health emergencies, such as pandemic influenza (i.e. identify
gaps and develop strategies to address them) |
|
2.1.8 |
identify and address the financial, human
resource and legislative gaps in the current system; |
|
2.1.9 |
plan for mass immunization of priority groups
with pandemic influenza vaccine (when available); |
|
2.1.10 |
support training of front-line staff in
communities; |
|
2.1.11 |
inform community leaders about pandemic
influenza and its implications for their communities; |
|
2.1.12 |
support and facilitate community planning by
raising awareness, providing training sessions on planning, and
providing educational material to FNs community leaders and
regional FNs organizations; |
|
2.1.13 |
provide public health
services/recommendations/advice to FNs communities; |
|
2.1.14 |
plan for provision of rapid diagnostic tests to
health care facilities, if necessary; |
|
2.1.15 |
provide names and contact information of FNIHB
regional leads on pandemic influenza to other partners; |
|
2.1.16 |
keep track of number of individuals (within FNs
communities) in each priority group for vaccination; and |
|
2.1.17 |
develop regional surveillance capacities (to be
integrated with provincial system). |
|
3. FNIHB Headquarters |
3.1 |
Develop an overarching framework for Branch pandemic influenza
preparedness and response plan, specifically:
- combine regional and HQ plans into FNIHB organizational
pandemic influenza plan;
- based on the national pandemic influenza plan, develop
generic training modules for community front-line health care
workers and community leaders that are clear and culturally
appropriate;
- develop a cross-regional human resource mobilization plan
(from HQ to FNIHB Regions);
- develop communications plan; and
- develop capacity for central data compilation and analysis to
determine the overall burden of disease for FNIHB clientele.
|
3.2 |
Support and facilitate FNIHB regional pandemic
planning by providing coordination and resources. |
3.3 |
Work with provincial officials to clarify
federal and provincial legislation and authorities in the event
of pandemic influenza on reserves. |
3.4 |
Identify national partners and work with them to
define various roles and responsibilities. |
3.5 |
Link with national FNs leaders/organizations to
increase awareness of pandemic influenza and the necessity for
community planning. |
|
4. Provincial Public Health
Authorities |
4.1 |
Work with First Nations and FNIHB regional
offices during the development of provincial pandemic influenza
plans to define roles and responsibilities, coordinate efforts,
and prevent gaps in the management of pandemic influenza in FNs
communities. |
4.2 |
Develop formal agreements, through negotiation,
with FNIHB regional offices to incorporate on-reserve FNs people
into the provincial planning activities, where possible, and
specifically for:
- procurement and distribution of vaccine/antivirals/emergency
supplies (e.g. supplies for diagnosis, treatment, infection
control, immunization);
- enhanced surveillance capacities with the ability to separate
out surveillance data specific to on-reserve FNs;
- two-way communication on case reporting;
- facilitation of on-reserve FNs communities' access to federal
emergency services such as the National Emergency Stockpile
System (NESS) and the Health Emergency Response Team (when it is
established) when community and FNIHB resources are overwhelmed
and where available6;
- if PH capacity permits, assistance in the provision of PH
services to FN communities when community and FNIHB resources are
overwhelmed7; and
- clarity on the legally recognized medical officer of health
for each FNs reserve.
|
4.3 |
Ensure equitable access to hospital care for
transferred, severe pandemic influenza cases. |
4.4 |
Work with federal officials to clarify federal
and provincial legislation and authorities in the event of
pandemic influenza on reserves. |
4.5 |
Develop communication plan (with FNIHB regional
offices and other key players). |
|
5. Centre for Emergency Preparedness and
Response (CEPR) |
5.1 |
Communicate with FNIHB regularly and effectively
on matters related to emergency preparedness and response. |
5.2 |
Provide timely opportunities to FNIHB to input
into the federal/provincial/territorial (FPT) Networks on
Emergency Preparedness and Response and provide regular and
timely feedback to FNIHB on developments at the FPT Networks on
Emergency Preparedness and Response that affect FNIHB's progress
on emergency planning (including pandemic influenza
planning). |
5.3 |
Invite FNIHB to FPT Network on Emergency
Preparedness and Response when the focus of discussion has
implications for FNIHB HQ, FNIHB regions, and FNs communities
with regard to pandemic influenza planning. This will ensure that
FNIHB, CEPR and Provincial health/social services authorities
work together in an integrated/coordinated manner to prevent gaps
and duplications when managing outbreaks of pandemic influenza in
FNs communities. |
5.4 |
In situations where FNIHB's regional capacity
(including provincial aid) is exhausted, CEPR could deploy
available Health Emergency Response Team (HERT), when it is
established, to FNs communities (through provincial systems of
deployment) to assist FNIHB regional health professionals in
responding to public health emergencies, such as pandemic
influenza8. |
5.5 |
Through provincial system for access to the
National Emergency Stockpile System (NESS) within a province,
provide access to the federally-controlled pharmaceuticals and
other emergency supplies/services for FNs communities. |
5.6 |
Facilitate linkages between FNIHB and provincial
authorities to discuss and clarify the provincial roles and
responsibilities in FNs communities access to NESS and HERT, as
per letter of agreement between Centre for Emergency Preparedness
and Response, the Public Health Agency of Canada, and the First
Nations and Inuit Health Branch, Health Canada. |
5.7 |
Provide courses/training on pandemic planning
and setting up clinics for mass immunization. |
5.8 |
Provide technical consultations to FNIHB staff
on development of educational modules and courses on pandemic
influenza for community health care providers and other first
responders in FNs communities and facilitate on-line delivery of
courses through existing mechanisms. |
5.9 |
Provide technical assistance to FNIHB HQ for
development and testing of preparedness and response plan for
pandemic influenza (e.g. taking part in federal/national
simulation exercises). |
|
5. Conclusion
The management of a predictable pandemic influenza in FNs
communities will require a coordinated effort involving all
levels of government. Considerations of the unique needs of FNs
communities must be reflected in plans at the local, P/T and
federal levels. The goal of pandemic influenza preparedness and
response is: "First, to minimize serious illness and overall
deaths, and second to minimize societal disruption among
Canadians as a result of an influenza pandemic." These goals will
only be achieved if strategies and specific plans for FNs
communities are integrated within the pandemic plans of all
jurisdictions.
_____________________
1. This
document focusses on "on-reserve First Nations communities"
living in the provinces for which there are concerns over clarity
of roles and responsibilities for public health services
(including pandemic influenza planning) among the various
jurisdictions.
2. Seven
Inuit communities and two Innu communities in Labrador fall under
FNIHB's public health programming.
3. Should
include training of front-line health care workers on diagnosis
and care, infection control, public health measures, surveillance
and communication.
4. Such as
maintenance of fire-fighting/policing, maintenance of
water/energy/food availability, management of mass
fatalities.
5. Should
include monitoring of illness, provision of care at home and use
of infection control measures and communication.
6. FNIHB
regional offices must make such requests to the provincial public
health authorities, which would provide such services through
coordination with the Centre for Emergency Preparedness and
Response (CEPR).
7. For
provinces that do not have a public health service delivery
mandate at the provincial level, these responsibilities could be
relevant to regional health authorities.
8. It is
expected that federal assistance would be available to on-reserve
FNs communities and the rest of the province in an equitable
fashion.
Note: INAC (Indian and Northern Affairs
Canada) has responsibility for overall emergency preparedness. In
the event of a health emergency, including pandemic influenza,
INAC's role is to fcilitate communication with First Nations and
support Health Canada and the Public Health Agency of Canada when
required.
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