National Presentation Template Workshop: The State of National Governance Relative to the International Health Regulations (2005) Ottawa, Canada, September 2006.

Background: Political Structure & Public Health Governance the governance structure: Parliamentary Confederation of Provinces and Territories. All clinical and public health activities are the responsibility of the provinces and territories (exception: Quarantine Act which is federal)

Background: Flowchart major public health institutions involved in complying with the requirements of the IHR 2005: –Federal: Public Health Agency of Canada (National Focal Point) Pan Canadian Public Health Network (PHN) - integration mechanism between Federal and P/T –Provincial/Territorial: Ministries of Health –Local/Municipal: Departments of Health/Public Health

Background: National Core Capacities Levels Where Activities Are Performed ActivityNationalRegionalLocal Detection and notification of cases xxx Collection and consolidation of case data xxxxxxxxx Analysis and interpretation xxxxxxxxx Investigation of cases & confirmation of diagnosis: Epidemiologist xxxxxxxxx Clinician xxx Laboratory xxxxxxxxx Feedback Dissemination xxxxxxxxx Response/Interventionxxxxxxxxx

IHR negotiation & approval Agreements under development –Information sharing key changes to existing statutory law, and/or implementation regulations, at national or regional levels required to effectively comply with the IHR 2005 –under discussion

Development of surveillance systems Does the federal/national government have the authority to mandate the development of surveillance capacities to those required by the IHR 2005? –No If not, what mechanisms will the federal/national government utilize to ensure meeting surveillance requirements of the IHR 2005? –Long standing precedence for information sharing –Information sharing agreement under discussion –Could use spending power

Response to a PHEIC Does the federal/national government have clear jurisdictional authority to act on a public health emergency of international concern (PHEIC), as defined by the IHR 2005? –All PHEIC are local events –Long standing collaborative environment –Federal jurisdiction responsible for international notification

Coordination of reporting and response requirements How does your country plan to organize compliance with the IHR 2005 among the different levels of affected government? –Consensus processes already underway What agreements (formal or de facto) currently exist between levels of government concerning key IHR related issues? –Long standing collaborative environment What interfaces (e.g. administrative mechanisms) exist now or are being planned for communication between orders of government? –Well established reporting/communications systems in place

Financing and/or Cost Sharing describe how costs will be shared across levels of government –Each jurisdiction responsible for own costs

Comparing Strategies What potential challenges to communication and collaboration between orders of government do you anticipate? –No major challenges anticipated What strategies would you utilize to overcome these obstacles? What are the pros and cons of the strategies identified? –PHN is the mechanism to enhance communication/collaboration What mechanisms exist for dispute avoidance and resolution? Are new administrative institutions or mechanisms needed? –See above Do the IHR 2005 serve as a useful framework for public health legal renewal/reform? Pros & Cons? –Work is underway to harmonize public health law across Canada and the IHRs will facilitate those discussions

Summary & conclusions Please list 3 key governance challenges to implementing the IHR 2005 –Surveillance capacity at all levels. –Capacity at ports of entry. –F/P/T cooperation and collaboration What expectations do you have of the WHO/donors/other agencies for implementation assistance in overcoming these obstacles? –None How important is external (technical/legal/financial) assistance for your successful implementation of the IHR 2005? –Not important

Optional topics to consider Are there human rights challenges that may create obstacles to implementation of the IHR in your country? None Could any of the governance obstacles to IHR implementation require your country to issue a reservation? No Will your country’s implementation strategy be formally or informally linked with those of other countries? Yes e.g. USA