Indigenous Services needs to better manage its PPE stockpile and nursing shortage, says auditor general

Indigenous Services Canada should review the management of its personal protective equipment (PPE) stockpile and work with remote and isolated First Nations to address a nursing shortage, says Canada's auditor general.

Karen Hogan found Indigenous Services Canada adjusted its approach to better respond to needs

A medical worker wears a surgical mask, face shield and gloves while conducting a COVID-19 test on an unidentified man in Montreal. (Ivanoh Demers/CBC)

Indigenous Services Canada should work with remote and isolated First Nations to address a nursing shortage and review the management of its personal protective equipment (PPE) stockpile, says Canada's auditor general.

In an audit tabled in Parliament today, Auditor General Karen Hogan looked at whether the federal department did enough to help First Nations, Inuit and Métis communities and organizations respond to the pandemic by supplying enough PPE and sufficient numbers of health care workers in a timely and coordinated matter.

Although the department expanded access to its contract nurses to all Indigenous communities, created new contracts for nurses and paramedics and streamlined its hiring processes, Hogan said it was unable to meet more than half of the 963 requests for extra nurses and paramedics that it received.

"The good news was they were able to provide personal protective equipment to many Indigenous communities in a rather quick way," Hogan told CBC's David Common on Power & Politics.

"The bad news is that, despite all of those efforts to increase the pipeline of health-care workers, the department was still unable to address more than half of the additional needs that Indigenous communities had because of the pandemic."

Hogan said the department lacked complete and accurate data on its PPE stock. It also didn't have enough of certain items, such as gloves and hand sanitizer, to meet demand at the beginning of the pandemic.

Still, the audit found the department secured additional PPE starting in April 2020 and quickly delivered it to communities and organizations when provinces and territories were unable to do so.

Hogan noted the department expanded access to its stockpile to include police officers, community members who tested positive for COVID-19 and those caring for ill family members.

From March 2020 to January 2021, the department responded to 1,622 requests for PPE in what the auditor found to be a timely manner — within an average of 10 calendar days, the audit said. Most of the time, the department also met its two-business-day service standard for approving and sending requests to the warehouse for shipping.

Vaccinate rate 75 per cent among Indigenous adults

Hogan said several factors contributed to an ongoing nursing shortages in many communities, including the challenging nature of the work, the diverse skill set required to work in remote and isolated communities, and inadequate housing.

Hogan said Indigenous Services Canada should work with the 51 remote and isolated First Nations it supplies nurses to so it can address shortages.

The department said it agreed with Hogan's findings. It promised to work with its Nursing Leadership Council to find new approaches.

It also said it is reviewing its PPE inventory and will maintain its stockpile. 

"They've done a decent job in terms of providing supports for our member nations as well as ensuring that there are adequate supplies of PPE, and also making us a priority when it comes to the vaccines," said Vice-Chief David Pratt of the Federation of Sovereign Indigenous Nations, which represents 74 First Nations in Saskatchewan. 

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Indigenous Services Minister Marc Miller and deputy minister Valerie Gideon provide an update on the government's response to the COVID-19 pandemic. 2:56

The vaccination effort in Indigenous communities reached a milestone this week: 75 per cent of Indigenous adults have received their first dose, Indigenous Services Minister Marc Miller told a press conference in Ottawa.

Since January, case counts have dropped by over 85 per cent on reserves and the number of Indigenous communities with significant outbreaks has seen a similar reduction, said Dr. Tom Wong, chief medical officer of public health at Indigenous Services.

As of Tuesday, there were 741 cases and 333 deaths on reserves. The Indigenous COVID-19 mortality rate is less than two thirds that of the non-Indigenous population, Miller said.

"I'm encouraged to see the overall number of cases dropping as the vaccination rates increase," Miller said.

"However, the pandemic is not yet behind us."

Some Indigenous communities say the government came through for them on PPE supplies — while others turned to alternative sources.

VIO Volunteers, a not-for-profit corporation, was created in the spring of 2020 to respond to the needs of Canada's northern, remote Indigenous communities.

Since then, it's delivered just over 1.7 million surgical masks, 9,450 face shields and 7,662 litres of hand sanitizer to 206 Indigenous communities and organizations that support the urban Indigenous population in seven provinces. 

In a written question tabled in the House of Commons last fall, Conservative Indigenous Services critic Gary Vidal asked for details on the amount of PPE delivered by the department.

When VIO Volunteers president Claudine Santos compared the list to her records, she said, she realized her volunteer organization was outpacing the government in providing masks to communities — in some cases doubling the federal contribution.

'We didn't ask to see the math'

Santos, who works as director of parliamentary affairs in Conservative Sen. Dennis Patterson's office in Nunavut, said she believes it's because VIO Volunteers took an approach to requests from Indigenous communities that differed from the one used by the bureaucracy.

"We didn't ask to see the math," Santos said. "They came to us and they said, 'This is what we need.' We said, 'If it is within our power to give it to you, we will give it to you.'"

In some instances, Santos said, the organization stockpiled enough masks to supply communities for six months to a year. 

"It isn't fair that we impose our own algorithms and our own standards onto these communities," Santos said.

This isn't about being perfect. It's about ...  trying to outpace a virus that moves faster than government and that's what we did.- Marc Miller

"We need to really embrace the fact that they are led by strong, capable people who really know and understand intimately the kind of needs that their communities have."

Santos said there needs to be a shift in the relationship between Indigenous communities and the federal government to empower them to make their own decisions.

She said VIO Volunteers is winding down operations and making space for Indigenous-led initiatives, such as those funded by the Indigenous Peoples Resilience Fund, to take over.

Santos also said the government needs to take responsibility to ensure communities are protected from predatory practices employed by some companies seeking to take advantage. 

"This is what happens when there isn't enough conversation and there isn't enough support," Santos said.

Indigenous Services Minister Marc Miller's department is the subject of the auditor general's performance review. (Sean Kilpatrick/Canadian Press)

Valerie Gideon, senior assistant deputy minister at the First Nations and Inuit Health Branch at Health Canada, defended the government's efforts to secure PPE.

Gideon said the department had to navigate global shortages to respond to urgent requests. She said the department responded to requests without worrying about whether they fell under another government's jurisdiction.

Gideon said the department used what she called a hybrid model to supply PPE from its own stockpile, from the Public Health Agency of Canada's national emergency stockpile and through funding for Indigenous partners and organizations.

"That hybrid model was very successful in ensuring that there were multiple strategies for acquiring and maintaining an ongoing supply of PPE," Gideon said.

Gideon said the department has put in place an online system to manage PPE requests. 

In a statement to CBC News, Miller's office said its top priority has been the health, safety and well-being of First Nations, Inuit and Métis people since the onset of the pandemic.

Watch: Federal procurement minister accepts the auditor general's findings:

Federal procurement minister accepts the auditor general's findings

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Anita Anand also thanked the public servants in her ministry for their work during the pandemic. 2:11

Federal procurement minister accepts the auditor general's findings

It's set aside more than $4.2 billion to help Indigenous communities prevent and fight COVID-19, and promised an additional $1.2 billion in the spring federal budget.

The government also pledged $354 million over five years in the budget to increase the number of nurses and other medical professionals in remote and isolated First Nations.

The department acknowledged that it has "learned lessons that will inform the Department's continued response efforts and better prepare in case of a future pandemic.

"Indigenous Services Canada is committed to continuing and improving on our work, in full partnership with our Indigenous partners."

Later Wednesday, Miller told reporters that he only became minister of Indigenous Services in November — a few months before the pandemic kicked off — and that his department "adapted and overcame" when confronted by challenges that existed across government in procurement.

"This isn't about being perfect. It's about realizing ... the cards that have been dealt to us and working with providers in record time, trying to outpace a virus that moves faster than government. And that's what we did," Miller said.

Miller also addressed one of the report's findings — that people living on-reserve were less likely to be hospitalized (4.5 per cent compared to 7.5 per cent) or die (1.2 per cent compared to 2.2 per cent) because of COVID‑19 compared to the general Canadian population.

He said that statistics coming in from the U.S. Centers for Disease Control suggested Indigenous populations faced a greater risk of hospitalization than the general U.S. population, so his department and Indigenous communities took steps to ensure Canada's First Nations were better prepared.

"Communities reacted well with the resources they had and implemented their pandemic plans with some success," Miller said. 

"The on-reserve portrait is positive but its a testament to the work that's been done and the extra precautions that Indigenous leadership took and the seriousness with which they approached both the first, second and now the third wave."


Olivia Stefanovich

Senior reporter

Olivia Stefanovich is a senior reporter for CBC's Parliamentary Bureau based in Ottawa. She previously worked in Toronto, Saskatchewan and northern Ontario. Connect with her on Twitter at @CBCOlivia. Story tips welcome: olivia.stefanovich@cbc.ca.

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