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2006 May Status Report of the Auditor General of Canada

May 2006 Status Report—Chapter 5

Exhibit 5.1—Assessment of progress in implementing our recommendations

This list identifies each of our recommendations in chronological and numeric order, beginning with our 2000 Report, Chapter 15, Health Canada—First Nations Health: Follow-up, through to our 2003 Report, Chapter 10, Indian and Northern Affairs—Third-Party Intervention. Each recommendation is associated with a specific paragraph number in the relevant report; this number is shown in the left column for reference.

Paragraph number

Recommendation

Our assessment of progress

Progress

2000 Report, Chapter 15, Health Canada—First Nations Health: Follow-Up

15.29

Health Canada should ensure that its program structure reflects the manner in which community health programs are actually delivered.

Health Canada realigned its program structure in 2002 to deliver three clusters of community health programs. The Department renewed its program authorities for community health programs in 2005, identifying specific objectives for each program.

Satisfactory

15.31

Health Canada should continue to work with First Nations to ensure that the contribution agreements are clear about specific objectives and activities that First Nations will undertake. It should continue its efforts to encourage First Nations to define measures of success.

Contribution agreements we reviewed described the objectives of programs and activities that First Nations are to undertake. Measures of success are not well defined, although Health Canada is working with First Nations to improve them.

Satisfactory

15.33

Health Canada should ensure that it receives all the activity reports required under contribution agreements. It should work closely with First Nations to improve the activity reports so that they provide information on results achieved.

Health Canada monitors and follows up to ensure that it receives activity reports as required by contribution agreements. More efforts are needed to develop outcome-focussed measures of success.

Satisfactory

15.41

Health Canada should work more closely with First Nations to ensure that updated community health plans that meet the basic requirements are prepared, and that they form the basis of both initial and renewed transfer agreements.

Health Canada now requires that community health plans are prepared as required in health transfer agreements. In the sample we reviewed, Health Canada engaged First Nations and affiliated Aboriginal agencies in the development of plans.

Satisfactory

15.43

Health Canada should ensure that the audit requirements under transfer agreements are met.

In the sample we reviewed, Health Canada required that the audit requirements of the transfer agreements be met.

Satisfactory

15.45

Health Canada should continue to work with First Nations to improve the measurement of the services provided and of expected changes to health. These measures should be included in the annual reports, and the Department should ensure that these reports are provided.

Health Canada is working with First Nations but, in the files we reviewed, had not ensured that annual reports include measures of the services provided to First Nations communities or expected changes to health.

Unsatisfactory

15.50

Health Canada should ensure that First Nations conduct the required evaluations of the achievement of program objectives and that future evaluations will determine the extent to which the transfer initiative contributes to improving the health of First Nations.

In the files reviewed, transfer agreements contained requirements to have evaluations of the achievement of program objectives. Health Canada receives evaluations from First Nations, but these evaluations vary in their reporting of the achievement of measurable health outcomes.

Satisfactory

15.64

Health Canada should more closely monitor pharmacists' overrides of drug utilization warning messages and undertake rigorous analysis on an ongoing basis to assess the effectiveness of the messages.

Health Canada monitors pharmacists' overrides of drug utilization warning messages based on a risk profiling process. This monitoring leads to various queries, audits, and, in some cases, Health Canada's refusals of payment.

Satisfactory

15.69

In cases where it identifies a significant pattern of inappropriate use of prescription drugs, Health Canada should continue to perform a rigorous follow-up with Non-Insured Health Benefits clients, physicians, pharmacists, and professional bodies. Health Canada should ensure that it has the means to implement this action.

For five-and-a-half years (May 1999 to November 2004), Health Canada did not conduct drug use evaluation (DUE) analysis to identify significant patterns of inappropriate use of prescription drugs and was therefore not in a position to follow up with clients, physicians, pharmacists, and professional bodies. More recently, Health Canada resumed certain types of DUE analysis, but it is not yet able to identify reduction of inappropriate use of prescription drugs due to its interventions. It also began to follow up with community and health care professionals. The Department established a Drug Utilization Advisory Committee to develop and recommend a comprehensive program to promote safe, effective, and efficient use of drugs.

Unsatisfactory

15.71

Health Canada should systematically gather data on prescription drug-related deaths of First Nations individuals in all regions.

Although Health Canada committed to liaise with provinces and territories on prescription drug-related deaths, we found no evidence that it has done so. Health Canada told us that this measure to assess prescription drug misuse was not feasible and could not be implemented.

Unsatisfactory

15.74

Health Canada should continue to build on its existing strategies to address the combined problem of prescription drug abuse and solvent and alcohol abuse, and increase efforts in community health programs relating to prevention, community education, and treatment of prescription drug addiction.

Health Canada has continued to focus on the combined problems of drug, alcohol, and solvent abuse through community health programs. These include producing and promoting educational programs and developing new tools to combat emerging drug abuse problems such as crystal methamphetamine.

Satisfactory

15.89

Health Canada should enforce the contract requirements for audit of pharmacy and dental care providers and reporting by the contractor. The Department should continue to take steps to strengthen verification of claims and audits of providers.

Health Canada now enforces the contract requirements for audits of pharmacies and dental care providers. Audits of pharmacies have increased significantly.

Satisfactory

15.97

Health Canada should establish clear program criteria and minimum standards for medical transportation benefits without delay. It should also undertake audits of medical transportation expenditures based on an assessment of risks.

Fully implemented. In 2003, Health Canada developed and implemented a Medical Transportation Policy Framework to clarify key program criteria and revised it in 2005. The Department has also conducted risk-based audits on medical transportation expenditures.

Satisfactory

15.100

Health Canada should ensure that it completes an evaluation of each of the Non-Insured Health Benefits transfer pilot projects, as well as an overall evaluation of the pilot exercise.

Health Canada has conducted evaluations on each of the Non-Insured Health Benefits pilot projects established between 1996 and 2003. It has produced a draft overall evaluation of the pilot exercise, which it plans to finalize in 2006.

Satisfactory

2001 Report, Chapter 12, Follow-Up—Indian and Northern Affairs Canada—Comprehensive Land Claims (1998 Report, Chapter 14)

12.121

Indian and Northern Affairs Canada should enhance the achievement of certainty by addressing differing expectations relating to rights, capacity, and implementation of claim settlements.

There are still fundamental disagreements between the parties involved on the meaning of "certainty." There are also differing interpretations on the implementation of settlements. Indian and Northern Affairs Canada has made an effort to build capacity within First Nations, but more is required.

Unsatisfactory

12.121

Indian and Northern Affairs Canada, together with other settlement parties, as applicable, should expedite the treaty process and ensure adequate rigour in determining the nature and amount of assets to be included in the settlement.

Six agreements have been signed since our last audit of 2001. These have averaged 29 years to finalize. Four of these agreements are from the Yukon, where 11 of 14 outstanding claims have been signed. There are more than 50 claims outstanding elsewhere in Canada. The Department has told us that it has established guidelines and procedures that it says will ensure rigour in determining the nature and amount of assets to be included in settlements.

Unsatisfactory

12.121

Indian and Northern Affairs Canada should strengthen implementation plans, improve reporting, and conduct evaluations of settlement impact.

Indian and Northern Affairs Canada developed guidelines for implementing land claim agreements in 2004. They refer to the need for government to track obligations and activities, but do not propose that implementation plans focus on objectives and measurement of results. We also reviewed the implementation plans for three agreements signed in 2005. We found they do not set objectives, but rather commit the federal government to specified activities supporting obligations. The Department maintains that the focus on objectives can be achieved outside the medium of implementation plans. It has promoted results-based management in the annual reports produced by implementation committees through conducting results-based planning and reporting workshops during 2005. As well, in response to our 1998 chapter, the Department completed a Comprehensive Claims Evaluation Framework in 2002. It now has a draft plan for the evaluation of the impacts of comprehensive land claim agreements. The plan indicates that a pilot evaluation of a land claim agreement will be completed by February 2007.

Unsatisfactory

12.121

Indian and Northern Affairs Canada should report the complete costs of reaching and implementing settlements and compare them with relevant budgets.

Indian and Northern Affairs Canada stands by its previous assertions that it tracks costs sufficiently, although it does not track departmental administration costs or the costs to other departments. It states that the small amount of additional information gained from changing its systems would not be worth the investment needed.

Unsatisfactory

2002 December Report, Chapter 1, Streamlining First Nations Reporting to Federal Organizations

1.61

The federal government should consult with First Nations to review reporting requirements on a regular basis and to determine reporting needs when new programs are set up. Unnecessary or duplicative reporting requirements should be dropped.

Federal departments generally recognize the need to reduce the reporting burden, and there have been isolated efforts to consolidate reports. However, the overall reporting burden on First Nations has not been reduced.

Unsatisfactory

1.64

The federal government should use the most efficient procedures to submit and process reports required from First Nations, and should work with First Nations communities to file reports electronically where it is practical to do so.

The Treasury Board Secretariat is leading an effort to consolidate reporting requirements of First Nations, but improvements have yet to be realized. Indian and Northern Affairs Canada is leading an initiative to facilitate electronic reporting for many communities but has yet to implement it.

Unsatisfactory

1.87

The federal government should undertake a review of program authorities to streamline the programs and better allocate program responsibilities among departments and other federal organizations.

The Treasury Board Secretariat is currently leading a review of all federal government programs for First Nations communities. Through this review, the Secretariat has identified 360 programs and services targeted to Aboriginal peoples and delivered by 34 federal organizations. Work is in progress to consolidate program terms and conditions where appropriate.

Satisfactory

2002 December Report, Chapter 11, Other Audit Observations—Indian and Northern Affairs Canada—Food mail program

11.55

Indian and Northern Affairs Canada should undertake a review of the location of its major entry points.

Indian and Northern Affairs Canada has not undertaken a review of the major entry points for the food mail program, as previously recommended. Instead, it reviewed only one of the program's entry points. It has no immediate plans to review any others, but the Department indicates that based on the results of pilot projects under way in three communities, it is exploring the merits of program amendments, including a review of additional entry points.

Unsatisfactory

2003 April Report, Chapter 6, Federal Government Support to First Nations—Housing on Reserves

6.38

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation, in consultation with First Nations, should reach a broad agreement on their respective roles and responsibilities in addressing the housing shortage on reserves.

Fully implemented. Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation, in collaboration with the Assembly of First Nations and regional First Nations organizations, have jointly developed a management control framework that defines their respective roles and responsibilities for addressing housing shortages on reserves.

Satisfactory

6.44

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation should streamline their program structure and delivery.

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation, in consultation with First Nations representatives, jointly developed a new allocation methodology for the Budget 2005 housing initiative to streamline processes for clients and allow more efficient cash management and flexibility in planning.

Satisfactory

6.48

Indian and Northern Affairs Canada, Canada Mortgage and Housing Corporation, and Health Canada, in consultation with First Nations, should develop a comprehensive strategy and action plan to address the problem of mould on reserves.

Indian and Northern Affairs Canada, Canada Mortgage and Housing Corporation, and Health Canada have not developed a comprehensive strategy and action plan aimed at mitigating mould in houses on reserves. Instead, each federal organization is active with its own program, which collectively entails education, training, assessments, renovations, and research on mould and prevention techniques. Without a strategy and action plan, the scale of the problem has not been identified, priorities for action have not been established, and there is no comprehensive plan for co-ordinating departmental efforts or monitoring overall progress.

Unsatisfactory

6.53

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation, in consultation with First Nations, should provide reasonable assurance that all federally subsidized housing on reserves meets the National Building Code.

In the two regions we examined, the files of Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation indicate that the appropriate codes and standards were met, including those in the National Building Code.

Satisfactory

6.64

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation, in consultation with First Nations, should ensure that community housing plans are used as intended by the 1996 housing policy.

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation have made improvements in their use of community housing plans. Documentation indicates that these housing plans are being used to share information and co-ordinate funding between the two federal entities. These plans are also being considered in the allocation of funds from the Budget 2005 on-reserve housing program. Canada Mortgage and Housing Corporation has also developed training aids and has begun to deliver training to First Nations' housing providers.

Satisfactory

6.74

Canada Mortgage and Housing Corporation should strengthen its internal controls for subsidy payments and, in consultation with First Nations, ensure compliance with operating agreements.

Canada Mortgage and Housing Corporation has improved its monitoring and internal control mechanisms for housing subsidy agreements. This includes a review and sign off of financial statements, and enhanced site visits and physical inspections.

Satisfactory

6.79

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation, in consultation with First Nations, should define, collect, and use reliable information to manage on-reserve housing assistance.

Indian and Northern Affairs Canada and Canada Mortgage and Housing Corporation (CMHC), working in conjunction with the Assembly of First Nations, have adopted a revised allocation methodology to better define, collect, and use information for on-reserve housing. Although the Department and CMHC have improved their process for obtaining accurate information for on-reserve housing, more is needed to verify its accuracy.

Satisfactory

6.84

Indian and Northern Affairs Canada should seek approval from the Treasury Board for the terms and conditions of the 1996 housing policy. The Department should provide its regional offices with sufficient guidance and training to ensure that the policy is properly understood and applied consistently.

Fully implemented. Indian and Northern Affairs Canada obtained approval from the Treasury Board on the terms and conditions of the 1996 housing policy in March 2005. Regions were informed of the formal approval during national workshops.

Satisfactory

6.88

Indian and Northern Affairs Canada should evaluate its interim policy on shelter allowances and approve a final policy with necessary changes resulting from the evaluation, while taking into account approved funding levels.

Indian and Northern Affairs Canada completed an evaluation of its interim shelter allowance policy in April 2005. The Department is developing a national strategy on shelter allowances based on the outcome of this evaluation.

Satisfactory

6.94

Indian and Northern Affairs Canada, in co-operation with Canada Mortgage and Housing Corporation, should improve its reporting to Parliament. It should clearly articulate its expected results; report on costs, program performance, and results; and clarify how the reported outputs have an impact on the critical housing shortage.

Indian and Northern Affairs Canada has worked with Canada Mortgage and Housing Corporation to identify how many housing units it plans to build and improve, what has been built, and how much the program costs. However, it has not identified how well the program is working to alleviate the critical housing shortage on reserves.

Unsatisfactory

2003 November Report, Chapter 9, Economic Development of First Nations Communities—Institutional Arrangements

9.82

The federal government should support First Nations in identifying, planning, and implementing institutional arrangements that take advantage of economies of scale where possible, and that are appropriate to the First Nations' economic development circumstances and visions.

Indian and Northern Affairs Canada has an action plan for its economic development programs resulting from a new structure to increase community economic capacity. In addition, the Department has identified, planned, and begun to implement four new First Nations institutions to support economic development and capacity.

Satisfactory

9.90

Under the leadership of Indian and Northern Affairs Canada, federal organizations should develop horizontal performance information for economic development programming that is outcome-focussed and relevant to the performance information needs of First Nations.

Indian and Northern Affairs Canada has identified outcome-focussed performance information for its Community Economic Development program. However, the Department has yet to measure and report against these performance measures.

Unsatisfactory

2003 November Report, Chapter 10, Other Audit Observations—Indian and Northern Affairs Canada—Third-Party Intervention

10.46

Indian and Northern Affairs Canada should address the elements missing from its new Third Party Manager Policy, namely provision for First Nations input, chief and council capacity building, and dispute resolution.

Indian and Northern Affairs Canada has not addressed elements missing from its 2003 Third Party Manager Policy. The Department is developing a new policy, which may be in place by April 2006. This policy is expected to include provisions for First Nations input, chief and council capacity building, and dispute resolution. Until then, these provisions are not formally available to First Nations subject to this policy.

Unsatisfactory

10.47

Indian and Northern Affairs Canada should develop a strategy and action plan for implementing the new Third Party Manager Policy.

Indian and Northern Affairs Canada has developed an action plan to implement its 2003 policy. In September 2005, the Department also began to develop a new strategy to accompany the new policy expected in April 2006. The Department informs us that it plans to have an action plan in place by the time the new policy is approved.

Satisfactory

10.48

In consultation with First Nations, Indian and Northern Affairs Canada should conduct an evaluation of third-party manager intervention.

Indian and Northern Affairs Canada has not conducted an evaluation of the effectiveness of third-party manager intervention, although it has conducted compliance reviews. As such, the new policy being developed (planned for April 2006) does not benefit from a formal evaluation of third-party management process.

Unsatisfactory

Satisfactory Satisfactory—Progress is satisfactory, given the significance and complexity of the issue, and the time that has elapsed since the recommendation was made.

UnsatisfactoryUnsatisfactory—Progress is unsatisfactory, given the significance and complexity of the issue, and the time that has elapsed since the recommendation was made.