1. Renewing Health Canada’s strategy against TB for First Nations on-reserve Provincial Primary Care Tuberculosis Education Day October 28, 2011 Presented by: Dr. Ibrahim Khan, FNIH Saskatchewan

2. Purpose 2 To provide an update on the renewal of Health Canada’s strategy against TB for First Nations on- reserve

3. History of TB in Canada 1900-1940s: Death rates from TB were extremely high in Canada's Aboriginal population. 1950s-1970s: TB incidence and death rates declined globally. 1980s: TB rates leveled off globally and in Canada. The emergence of TB drug resistance and HIV/AIDS created new challenges. Early 1990s: The National Tuberculosis Elimination Strategy was developed by Health Canada’s Medical Services Branch in 1992 to address these challenges and support a continued reduction in TB rates for Aboriginal populations in Canada. 2000-2008: While rates again leveled off, they remained high for First Nations on-reserve in Canada. This health inequity precipitated renewal of the 1992 Strategy. 3

4. Renewal of Health Canada’s Strategy Against TB 2008 – Planning for renewal of FNIHB 1992 Strategy begins. 2009-2010 – Review of evidence and development of strategic framework. 2011 – Review of drafts by partners and stakeholders. Provincial partners Communities Aboriginal partners TB experts Rates of TB in First Nations on- reserve remain unchanged since 2000; higher than general Canadian population. 4

5. Structure of the renewed Strategy Developing & Maintaining Partnerships Enhance partnerships with provinces, communities, First Nations and Inuit representatives as well as with other stakeholders Address the Social Determinants of Health through collaborations with relevant stakeholders Diagnosing, Managing & Preventing TB Populations at Greatest Risk for TB TARGET: High-Incidence Communities & Outbreaks Remote & Isolated Communities TB-HIV Co-Infection Chronic Medical Conditions Mental Health & Addictions Paediatric Population & BCG Apply Canadian TB Standards Decrease transmission of TB in & across communities Manage data Continuously evaluate programming Assure seamless access to care STRATEGIC THEMES The Strategy is a technical tool for TB prevention and control programming provided to First Nations on-reserve. 5

6. The 1992 Strategy was updated to…. Align with current best practices:  E.g.: the Canadian TB Standards, 6 th edition Emphasize targeted approaches and quality improvement:  For populations at greatest risk, especially high incidence communities;  With a focus on community-based initiatives. Develop and strengthen partnerships at all levels of the health system:  For seamless access to TB services;  To address underlying factors that influence the spread of TB, such as the social determinants of health. 6

7. Monitoring Progress Accountability is a key difference between the 1992 and 2011 Strategies and will be addressed through:  Application wherever FNIHB is accountable for TB programming, either through services provided or funding.  Standardized program performance measurement and evaluation.  Development of an evaluation framework that reflects the elements of the Strategy. 7

8. Implementation Implementation of Health Canada’s strategy against TB will occur through a phased approach, beginning in 2011. How elements are implemented will vary from region to region. Partner and stakeholder engagement will be a key part of the process. Early implementation is moving forward. 8

9. Next Steps Early implementation will include:  Gap analyses.  Developing action plans to address identified gaps and establish priorities. An evaluation framework will be developed with partners:  To outline indicators, targets and reporting requirements.  As a guidance document for Regions to develop evaluation plans.  To indicate how program monitoring will integrate into assessment and evaluation at the regional, HQ and Branch levels. 9

10. Questions, comments, reflections??