Boards vote against merger of Northern Ontario health units

The boards of health for the Northwestern Health Unit (NWHU) and Thunder Bay District Health Unit (TBHDU) have announced a unanimous decision not to merge together.

As part of their plan to strengthen the public health sector, in August of 2023, the provincial government announced that they would give a one-time increase in funding for public health agencies that decide to voluntarily merge before Jan. 1, 2025.

Then, in Nov. 2023, the NWHU and TBDHU’s formed a voluntary merger assessment committee, and with the help of the third-party consultant, MNP LLP, worked to determine if a merger would be possible and beneficial for northern Ontario.

“At that time, the voluntary merger committee set specific criteria that we assigned a weighted score,” said NWHU CEO Marilyn Herbacz.

The criteria categories were geography, critical mass, organizational performance, human resources, system alignment and partnerships and other.

Information from the ministry outlines that the size of the population a health unit serves correlates with their success. One study found that increases in performance plateaued at a population of around 500,000 — the number the ministry is encouraging health units to reach by merging.

“Combined, our health units would not have that population,” said Herbacz. “Even with expansion and growth into the future, it didn't seem that that would be able to be achieved.”

The assessment committee held surveys and stakeholder engagement sessions, and at most of them, “everyone brought geography up as a huge part of the reason why it would be challenging for us to merge,” she said, noting the vast area to be covered and two different time zones. A merger with TBDHU would result in a catchment area over 400,000 km².

“It was thought that internally it would impact the way we work as a business, as well as it could impact service delivery,” said Herbacz. “We also found under the criteria that there would be no benefit.”

When it comes to human resources, for example, the challenges each unit faces in recruitment and retention are very different, she said, and a merger wouldn’t satisfy either’s needs.

“It's often very challenging here because our communities are small,” and many of the professionals who come to work in Northwestern Ontario don’t stick around long-term, said Herbacz.

Governance was another factor to consider, as a merged unit would cover 34 different municipalities. NWHU already serves 19 municipalities and a combined population of around 82,000 people across nearly 174,000 km² of land.

“We would cover such a vast area, it would be likely that small municipalities would have less say,” leading to them having less trust in the health unit and the role that they play, explained Herbacz.

Each unit’s existing partnerships with local schools, health care providers, social services and Indigenous communities were also a key factor, she said.

“While some of those would transfer to a new entity, there was a risk that these partnerships would not be able to be nurtured and maintained the way we currently do in such a large structure,” said Herbacz.

Although the two boards have decided not to merge their health units, the committee did find that more collaboration between them would be beneficial.

Now that the decision not to proceed with the merger has been made, the units will present the committee’s findings to the health ministry for their consideration. Herbacz said the NWHU is in contact regularly with Greg Rickford, the Member of Provincial Parliament for Kenora – Rainy River and the Minister of Northern Development.

“He has a strong understanding of the unique and distinct challenges, and the need to maintain both entities so that we can serve a vast area in Northwestern Ontario, and he supports our decision,” she said.

“Now that our board has made this decision, I hope it will create some relief for our staff so that we can move forward and do the important work of public health in our region.”

Moving forward, NWHU is working on a new strategy for staff recruitment and retention, Herbacz added.

“All healthcare is struggling to recruit within our region. We often find ourselves competing for the same people, so we have to look at the strategy going forward to see what next steps we can take," she concluded.

Serena Austin, Local Journalism Initiative Reporter, Kenora Miner and News