Opening Statement to the Standing Committee on Health

Streamlining First Nations Reporting to Federal Organizations
(Chapter 1 - December 2002 Report of the Auditor General)

Statistics Canada—Managing the Quality of Health Statistics
(Chapter 6 - December 2002 Report of the Auditor General)

Madam Chair, thank you for this opportunity to discuss two chapters of our December 2002 Report—Chapter 1 on First Nations' reporting to federal organizations, and Chapter 6 on the management of health statistics quality. With me today are Jerome Berthelette and Barry Leighton, the Principals responsible for these chapters.

Our health statistics audit examined the quality of the statistics that Statistics Canada, Health Canada, and the Canadian Institute for Health Information (CIHI) provide for the federal, provincial, and territorial reports on health indicators reports. These reports resulted from an agreement by First Ministers in September 2000 to have independent third-party verification of the accuracy of the health indicators data.

The Auditor General verified the accuracy of the health indicators reports for Canada, Nunavut, the Northwest Territories, and Yukon. The Health Canada report included measures of health status, health outcomes and quality of service of health care provided to the total Canadian population and to specific populations receiving federal health services, such as the First Nations.

We worked closely with our colleagues in the provincial audit offices who carried out the verification of their provinces' reports. In a joint team effort led by the Office of the Auditor General of British Columbia, we worked on statistics produced by the Canadian Institute for Health Information (CIHI) on seven of the health indicators.

We found that Statistics Canada databases met standards for quality assurance, with the exception of the Hospital Person-oriented Database, which relies on CIHI data. From our review of the two CIHI databases, we concluded that the quality assurance processes were not documented adequately to be able to form an opinion on the quality of the indicators.

We found that Health Canada's quality assurance systems and practices for its national surveillance systems were inadequate. They did not assure that the data were accurate and therefore we could not form an opinion on their accuracy.

These work initiatives were new for the preparers of the reports and the auditors alike. We worked closely together to produce these first verified reports. The 2003 agreement, which builds on the 2000 agreement, confirms the continuing commitment to produce reports on health indicators. We believe that legislative auditors can continue to play an important role.

Health Canada recognized in its report that the collection of health data for First Nations populations faces several challenges. We found that quality assurance processes for these indicators were inadequate to ensure the accuracy of the data.

As we noted in our chapter on First Nations' reporting, First Nations that sign multi-year contribution agreements with Health Canada are required to report annually on programs and services, including mandatory programs such as communicable disease control, environmental health and treatment services. First Nations are also required to prepare several reports on program activities, with detailed information on the numbers and types of health services provided in their communities.

Health Canada officials that we met in the Saskatchewan Region indicated that in many cases, they do not rely on non-financial reports, such as annual reports, when dealing with First Nations. Notable exceptions to this practice include some targeted programs, such as the Tuberculosis Elimination Strategy. That program centralizes control and measures how effective it is.

The First Nations we visited were concerned about the number and frequency of the reports required by Health Canada. They also told us they received no feedback on the reports from Health Canada officials in the Saskatchewan Region.

Health Canada's lack of attention to many of the non-financial reports it requires of First Nations calls into question the purpose of the reports.

That concludes my opening statement, Madam Chair, and we would be pleased to answer any questions the Committee may have.