Indigenous Wound, Ostomy, and Continence Health Core Program: A Change in Non-Insured Health Benefits Policy to Improve the Health of Indigenous Canadians : Journal of Wound Ostomy & Continence Nursing

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Indigenous Wound, Ostomy, and Continence Health Core Program

A Change in Non-Insured Health Benefits Policy to Improve the Health of Indigenous Canadians

Harley, Catherine; Smith, Beverly

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Journal of Wound, Ostomy and Continence Nursing 46(5):p 457-458, September/October 2019. | DOI: 10.1097/WON.0000000000000578
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In 1971, a policy for federal programs for Indigenous Canadians was developed, which is connected to constitutional and statutory provisions, treaties, and customary practice. This policy is rooted in the commitment of Indigenous Canadians to preserve and enhance their culture and traditions. There is a recognition in this policy of the intolerable conditions of poverty and community decline, which affect many Indigenous people, and as such it provides a framework in which Indigenous communities can address these conditions. Indigenous people have also been willing to identify themselves on the census as either First Nations, Metis, or Inuit. The Canadian Federal Government recognizes its legal and traditional responsibilities to the 1.7 million Indigenous Canadians.1 This population is growing four times faster than the non-Indigenous population due to natural growth, increased life expectancy, and a high fertility rate.

In order to support the health program of Indigenous Canadians, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched their own Core Program in June 2018 to address Indigenous wound, ostomy, and continence health. Core Program team members, working with Indigenous people from across Canada, came together to make a commitment to gain a better understanding of the patient care delivery of wound, ostomy, and continence care looking at the unique perspectives in First Nations Communities in both rural, remote, and urban areas.

In addition to Catherine Harley, Chief Executive Officer, NSWOCC, the initial team members consisted of representatives who work in the frontline with Indigenous, Metis, and Inuit people (Table 1). The team members conducted a Strengths, Opportunities, Aspirations and Results (SOAR) analysis, worked toward exploring possible solutions to challenges that were being faced by First Nations and Indigenous Groups, and then engaged these groups in order to discuss some of their key recommendations (Table 2).

TABLE 1. - Indigenous WOC Health Core Program Team Members
  1. Beverly Smith, RN, BScN, NSWOC—Alberta (Core Program Leader)

  2. Kathy Mutch, RN, BScN, NSWOC, WOCC(C)—Atlantic Provinces

  3. Heather Wright, RN, BScN, NSWOC, MCIScWH Student—Northern Ontario

  4. Karen Bruton, RN, BScN, MCIScWH, NSWOC, WOCC(C)—Northern Ontario

  5. Michelle Buffalo, RN, BScN, NSWOC Student—First Nations Community, Alberta

  6. Tracy Locke, RN, BScN, NSWOC—British Columbia

  7. Anna Tumchewics, RN, BScN, DipOPN, NSWOC, WOCC(C)—Northwest Territories

  8. Veronica Roberge, RN, BScN MCIScWH NSWOC Student—First Nations Community Nursing, British Columbia

  9. Benedict Leonard, RN, BSN Nurse Navigator—Nuu-chah-nulth Tribal Council, British Columbia

  10. Steven Fisher, Pharmacist—works with First Nations Community

TABLE 2. - Key Recommendations
  1. Develop a standardized, streamlined process for primary access to supplies through Non-Insured Health Benefits (NIHB; equal access to all Canadians).

  2. Improve access to Nurses Specialized in Wound, Ostomy and Continence (NSWOC) for assessment, development of care plans, and education delivery.

  3. Consider NSWOC to become NIHB authorizers for indigenous people experiencing a wound, ostomy, or continence issue.

  4. Improve knowledge of frontline care providers including delivery of wound, ostomy, and continence education to health care professionals working in First Nations communities to support the improvement of patient care.

  5. Provide patient education on proper product use and how best to manage wound, ostomy, and continence patients to improve lifestyle outcomes.

The team members then provided frontline feedback on challenges to the following stakeholder groups:

  • First Nations Groups including First Nations and Inuit Health Branch Indigenous Services Canada/Government of Canada
  • First Nations Health Managers Association
  • Canadian Indigenous Nurses Association (CINA)
  • The Assembly of First Nations

On October 29, 2018, a report was submitted to the Assembly of First Nations entitled “A Summary of Feedback from Front Line Healthcare Professionals Working with Indigenous People Across Canada Experiencing Wound, Ostomy and/or Continence Conditions—A Vision to Improve Wound, Ostomy and Continence Care for Indigenous People Living in Canada.” The 5 recommendations in this report were moved forward to the Non-Insured Health Benefit (NIHB) as recommendations for change.

In December, 2018, the Assembly of First Nations notified us that the NIHB had announced some updates. One of them was in regard to the Medical Supplies and Benefits prescribers. In addition to medical doctors (MD) and nurse practitioners (NP), NSWOC/WOCC(C) are added as prescribers/recommenders of wound, ostomy, and continence products—by designation and credential. This includes ostomy supplies and devices, urinary supplies and equipment, incontinent supplies, and wound care products. As per the new policy change, RNs can renew products after initial approval by an NSWOC/WOCC(C) and/or prescribe certain wound care products.2

In order to implement this new policy change, the team members developed a communication tool that highlighted the policy change and provided information on resources to assist NSWOC in navigating the wound, ostomy, and continence care of Indigenous Canadians. The Core Program also held a webinar in April 2019 in order to inform NSWOC from across Canada of the policy change and to increase knowledge of the NIHB. A second webinar will be held in October 2019 to further expand knowledge and an abstract is being written, which will be submitted for an oral presentation at the 2020 annual national NSWOCC conference taking place in Charlottetown, Prince Edward Island, Canada. This Indigenous WOC Health Core Program will continue to develop strategies, which will improve the care of Canadian Indigenous people experiencing a wound, ostomy, or continence issue.


1. Statistics Canada. Canadian Census 2016. Ottawa, Canada: Statistics Canada.
2. Government of Canada. Medical Supplies and Equipment Benefit Lists.
© 2019 by the Wound, Ostomy and Continence Nurses Society