Boards of Health vote against voluntary merger of northwestern Ontario’s two health units

From the NWHU
Press release

Today, the Boards of Health for the Northwestern Health Unit (NWHU) and Thunder Bay District Health Unit (TBDHU) announced that they will not move forward with a business case for a voluntary merger of the two health units under the Province’s Strengthening Public Health Strategy.

In August 2023, the Ministry of Health announced plans to strengthen the public health sector by offering one-time funding, resources, and support to local public health agencies that decide to voluntarily merge by January 1, 2025.

In response to this announcement, the Boards of Health for NWHU and TBDHU decided to form a Voluntary Merger Assessment Committee, with representatives from both health units, who retained a third-party consultant, MNP LLP, to explore the viability of a merger for the two health units in the province’s northwest. “Mergers have been discussed by the Province for quite some time, so when the Ministry presented the opportunity to evaluate the viability of a merger in our region, we felt it was important to explore,” said Marilyn Herbacz, NWHU CEO.

Over a series of months, the Voluntary Merger Assessment Committee, along with MNP, completed stakeholder engagement and a significant review of documentation from each health unit to determine whether a merger between the two health units would meet the desired outcomes of this pillar of the Province’s Strengthening Public Health strategy. The final result indicates that for a number of reasons, a merger between NWHU and TBDHU would not be viable.

Geography was noted as a significant consideration for a merged entity. Currently, NWHU serves 19 municipalities across an area of 173,828 km2 with a population of approximately 82,000. A merger with TBDHU would result in a catchment area that spans over 400,000 km2, limiting the organization’s ability to nimbly adapt services to meet the diversity of local health needs. Lengthy travel times, particularly with unfavourable travel conditions, would be a challenge in providing centralized services or improving economies of scale or critical mass.

 “While there are similarities in programming, there are notable differences in type and the operational model of programming based on the unique context of each health unit. A merged entity would still need to have different programming to meet the needs of communities” Stated Dr. Young Hoon, NWHU Medical Officer of Health. “Additionally, the vast majority of partners did not align with the larger geography, and the formation of a new entity had the potential to weaken partnerships across the system.”

The merger assessment considered the benefits and risks of a merger with respect to programming, service delivery, financial integration, information technology, human resources and capital infrastructure. “Merging is a substantial undertaking and worth it if the benefits are clear. While the assessment project identified some benefits, it did not demonstrate a level of benefit over risks that could justify the significant disruption and cost of a merger,” emphasized Herbacz.

In addition, it would be a challenge in ensuring that the 34 municipalities within a merged entity had a voice and adequate representation within its governance structure. “Municipalities are a key partner in the success of public health initiatives; they understand the needs of their communities. It is important to ensure true local representation to enable our staff to provide relevant and effective public health services.” Stated NWHU Board of Health Chair, Doug Lawrance.

Although the Board of Health has voted not to pursue a voluntary merger, the process was not without benefit. “We heard a lot about the ways in which collaboration is already happening between our health units, and identified opportunities for additional collaboration, both for how we approach service delivery, and in sharing the burden of cost for resources,” said Lawrance. “There is a clear willingness from our senior leaders to work together where possible to support the health and well-being of the people of northwestern Ontario.”

“Voluntary Mergers are just one of the three pillars to the Strengthening Public Health Strategy put forward by the Ministry of Health. Northwestern Health Unit looks forward to continued participation in the review of the Ontario Public Health Standards and the public health funding methodology review to support a truly strengthened public health system in Ontario, and especially for our communities here in the northwest.” noted Herbacz. For information about Northwestern Health Unit’s Board of Health and local public health programs and services, please visit