Our Healthcare Model
Learn about Nunavut’s unique healthcare model.
About Nunavut’s Healthcare Model
Prior to the 1950s, formal governmental health care services were almost non-existent in northern Canada. Healthcare services were provided by the federal government until 1967 when they were devolved to the Northwest Territories and later to Nunavut when Canada’s 3rd territory was formed in 1999 (1, 2). The territorial government has a department of health which is responsible for administering a range of health and health care services, in particular, medically necessary hospital and primary care services that are defined as “insured services” under the Canada Health Act (3).
Primary care services in Nunavut are accessed through community-based health clinics. Primary care clinics are commonly known as community health centres and have been built on the nursing stations and outposts initially established by the federal government in the 1950s.
Community Health Centres Staff
The community health centres are staffed by community health nurses (CHNs), community health representatives (CHRs), and other important support staff, such as interpreter/translators, x-ray takers and telehealth technicians.
The community health centres are staffed by:
- community health nurses (CHNs)
- community health representatives (CHRs)
- interpreter/translators
- x-ray takers
- telehealth technicians
- and other important staff
The majority of nursing staff are registered nurses (RNs), very occasionally supplemented by nurse practitioners (NPs) who have advanced practice standing (Chatwood & Marchildon, 2012). The scope of practice for community health nurses is much more broad than their southern counterparts and they deliver a diverse range of health services in isolated conditions (RNANTNU, 2010; Roberts & Gerber, 2003). CHNs provide basic 24-hour, seven day a week emergency care, primary care services, as well as some public health services. Consultations with physicians, either in the regional centres, territorial capitals or in the south, are done through community visits by the physician or by telephone. The number of CHNs in any given community health centre is a function of the community’s population size and its overall health needs relative to surrounding communities.
Community health representatives are required to have received training through an approved program, one of which has been offered through the Nunavut Arctic College and other post-secondary schools throughout the country.
CHRs are often bilingual in English and Inuktitut and offer public health programming in both languages. There is a CHR position in every health centre. The role of the CHR is to work with a variety of health professionals in the prevention of disease and maintenance of health, and protection of individuals and communities from armful exposure to disease and disability (Finance, 2015). The responsibilities of the CHR include working with members of the health promotion team, other community program staff, such as nurses, social workers and other organizations for example shelters and elders’ centers in promoting health to all staff and general public.
In remote communities, patients access care through the nurses located in the health centres. However the larger communities of Iqaluit, Rankin Inlet, and Cambridge Bay are serviced by family physicians who play a major role in the delivery of primary care. In total there are 29.5 physician positions, which include a pediatrician, anesthetist, and surgeons. More than half of the physicians are located in Iqaluit at the Qikiqtani General Hospital. The physicians also provide week-long clinics in the more remote communities in their region on a regular schedule throughout the year.
Community health representatives are required to have received training through an approved program, one of which has been offered through the Nunavut Arctic College and other post-secondary schools throughout the country.
CHRs are often bilingual in English and Inuktitut and offer public health programming in both languages. There is a CHR position in every health centre. The role of the CHR is to work with a variety of health professionals in the prevention of disease and maintenance of health, and protection of individuals and communities from armful exposure to disease and disability (Finance, 2015). The responsibilities of the CHR include working with members of the health promotion team, other community program staff, such as nurses, social workers and other organizations for example shelters and elders’ centers in promoting health to all staff and general public.
In remote communities, patients access care through the nurses located in the health centres. However the larger communities of Iqaluit, Rankin Inlet, and Cambridge Bay are serviced by family physicians who play a major role in the delivery of primary care. In total there are 29.5 physician positions, which include a pediatrician, anesthetist, and surgeons. More than half of the physicians are located in Iqaluit at the Qikiqtani General Hospital. The physicians also provide week-long clinics in the more remote communities in their region on a regular schedule throughout the year.
Qikiqtani General Hospital’s Services
The Qikiqtani General Hospital provides a broad range of secondary services, including:
- birthing services
- emergency department
- day (ambulatory) surgery
- physicians
- pediatrics
- medical imaging
- laboratory services
Physiotherapy, occupational therapy and speech therapy are available through referral to a rehabilitation services clinic located in Iqaluit, NU. Mental health and wellness counseling is available through a referral process to the mental health division of the Dept. of Health, and advanced psychiatric supports and addictions treatment are referred out of the territory. A family practice clinic, serviced by nurse practitioners, also operates in Iqaluit.
Some tertiary services are available via visiting specialists from the provinces. There are considerably fewer specialized services available than those offered by a typical urban hospital in southern Canada. As a consequence, there are a large number of referrals and emergency medical evacuations to large urban hospitals in southern Canada in cities such as Edmonton, Winnipeg, Ottawa and Montreal. The referral patterns are a product of the agreements reached between the territorial department of health with hospitals, health regions and health ministries in the provinces.
References
1. Nunavut Act, (1993).
2. GNWT GoNT. Devolution: Of lands and resources in the Northwest Territories online: Government of Northwest Territories; 2015 [Available from: http://devolution.gov.nt.ca/about-devolution/faq/general-devolution-faq.
3. Marchildon G. Health Systems in Transition: European Observatory on Health Systems
and Policies; 2005.