First Nations need co-ordinated health care

In November 2025, Garden Hill Anisininew Nation declared a state of emergency. The threat was not wildfire or flood. The reason was hepatitis A, a vaccine-preventable liver infection spread through contaminated water, food and close contact.

As of July 16, 2026, Manitoba had recorded 898 cases of hepatitis A across the province since September 2024, including 197 hospitalizations and seven deaths.

Manitoba Health says most cases spread from person to person, while inadequate sewage and water infrastructure in remote communities has contributed to ongoing transmission.

The outbreak has spread across all four Anisininew Nations of the Island Lake region — Garden Hill, St. Theresa Point, Wasagamack and Red Sucker Lake.

Anisininew Okimawin has asked Ottawa to address the infrastructure beneath the crisis — housing, safe drinking water and wastewater systems.

Primary care in remote Island Lake communities is delivered through nursing stations supported by Indigenous Services Canada and community health organizations.

The federal non-insured health benefits program funds eligible medical transportation, while Manitoba finances insured hospital care and leads the provincial vaccination program.

A transmission chain intensified by infrastructure financed through one jurisdiction can therefore end in a hospital bed financed through another.

Every one of those hospitalizations and deaths lands in a single ledger: Manitoba’s health statistics.

The Canadian Institute for Health Information forecasts total health spending of $10,868 per Manitoban in 2025, third-highest among the provinces.

Manitoba sits well above average on spending. Its life expectancy remains below the national average, while emergency crowding and surgical waits persist despite substantial investment.

An average summarizes a population but it does not explain the differences within it.

The assumption is that Manitoba’s system performs poorly. Some of that criticism is deserved, because the province owns wait times and emergency rooms. The averages do not explain everything.

Indigenous people comprised 18.1 per cent of Manitoba’s population in the 2021 census, the highest proportion among the provinces. First Nations people accounted for roughly one in 10 Manitobans, alongside substantial Métis and smaller Inuit populations. First Nations are distinct, rights-holding nations whose relationships with the Crown predate Manitoba itself.

Research using Manitoba Centre for Health Policy data found that during 2012-13 to 2016-17, registered First Nations people had a life expectancy more than 10 years shorter than other Manitobans. The rate of death before age 75 ran three times higher.

When Manitoba publishes one provincial average, those outcomes are included.

When Manitoba reports below-average results, is it measuring one health system, or is it averaging together several systems governed by different governments?

The math points somewhere provincial spending cannot reach. Some of the most meaningful interventions lie outside Manitoba’s direct control.

Additional provincial spending cannot substitute for adequate housing, household water service and wastewater infrastructure. At some point, provincial spending stops being the limiting factor.

Consider what each government has purchased.

Manitoba’s books are mostly transparent: hospitals, cancer centres, physician training, an outbreak vaccine program. We can debate the impacts but we cannot dispute the invoice.

Try finding the same invoice for Ottawa. It is remarkably difficult. No readily accessible public account consolidates all Indigenous Services Canada health spending in Manitoba and links it to communities, services, staffing and outcomes.

The non-insured health benefits (NIHB) program is one of the few major federal health expenditures that routinely reports by province. In 2023-24, NIHB spent $503.1 million in Manitoba, nearly a quarter of the national program. More than half of Manitoba’s reported NIHB spending paid to transport patients to care. Most other federal health spending appears in national or program totals rather than in one Manitoba account linking dollars to communities, staffing, services and outcomes.

Of the 50 remote and isolated communities in which Indigenous Services Canada directly delivers primary care, 21 are in Manitoba. No public community-by-community operating-cost breakdown is readily available, leaving a basic question unanswered — what does one station cost to run?

Indigenous Services Canada tracks the money. It still does not show each First Nation what that money bought or whether access improved.

The Auditor General’s October 2025 follow-up found that Indigenous Services Canada had made unsatisfactory progress on 18 of 34 recommendations drawn from a decade of audits.

Its remote nursing-station workforce had an average monthly vacancy rate of 21 per cent in 2023–24 and 2024–25, and the department had not assessed since 2016 whether remote First Nations communities had access to essential health services comparable with those available in other communities in similar locations.

A 2022 Parliamentary Budget Officer review found that Indigenous Services Canada repeatedly spent more than planned while its ability to set clear targets declined.

Imagine Manitoba Health conceding that it had not reassessed in nearly a decade whether remote communities had access comparable with similar communities, and could not demonstrate whether essential services were reaching patients equitably.

Manitobans would not consider that a funding debate. A provincial department that had perfected the reporting of inputs while abandoning the measurement of results would not survive public scrutiny.

In 1983, Keith Penner’s parliamentary committee recommended recognition of First Nations self-government and broad authority over matters affecting First Nations. British Columbia acted on related principles in 2013, when its First Nations Health Authority assumed responsibility for programs previously administered by Health Canada’s regional branch.

Manitoba does not need to copy B.C., but it does need co-ordinated care across governments — federal financing, First Nations governance and provincially insured hospital, physician and specialist care.

Island Lake’s outbreak will close eventually.

The impact will sit in Manitoba’s statistics forever.

» Dr. Rafiq Andani is a physician, assistant professor at the University of Manitoba, and holds an MSc in health economics, policy and management from the London School of Economics. He is the author of The Canadian Health Care Paradox, to be published this fall. This column first appeared in the Winnipeg Free Press.