Canada's primary care system faces persistent challenges related to access, continuity, and coordination. These pressures are commonly framed in terms of health workforce shortages, long waits, and growing demand associated with population aging and immigration. But capacity constraints do not fully account for the problem. Many access failures also arise before and between clinical encounters: needs go unrecognized, entry points are unclear or culturally misaligned, referrals break down across handoffs, and follow-up is not sustained. These breakdowns disproportionately affect people facing structural barriers such as language, poverty and food insecurity, limited digital access, geographic isolation, and administrative complexity. This policy analysis argues that community health workers (CHWs) can address these failures by providing the relational infrastructure needed to strengthen prevention, navigation, follow-up, and linkage to community-based supports, while complementing regulated providers. Drawing on comparative experience (Brazil, Rwanda, and England) and Canadian precedents, the paper distills design requirements for routinizing CHW functions at scale: assigning responsibility for outreach and follow-up, embedding CHWs within team workflows and pathways with supervision, enabling CHWs to bring community knowledge and priorities into service planning and decision-making, and ensuring stable financing. The analysis further emphasizes that equity benefits depend on pathfway design, community-sector capacity, and measurement that prioritizes connection achieved and sustained rather than referral counts alone. The paper concludes with recommendations for a Canadian policy framework that enables provincial adaptation while establishing common standards for role definition, training, supervision, accountability, and equity-aligned evaluation.

Canada approved its first generic version of semaglutide on April 28, 2026, 114 days after market exclusivity on the brand-name product expired and 26 months after the first generic company filed. Neither Health Canada nor the manufacturers appear to have missed a regulatory deadline. The delay arose because Health Canada had never set out how a manufacturer should establish that a fully synthetic semaglutide is the same drug as a semisynthetic reference product, so the agency and the companies settled that evidentiary standard one round of review at a time. Canadians paying out-of-pocket spent more than $160 extra per month across roughly 4 months, while public payers lost discounts that confidential rebate agreements make impossible to quantify. We argue that Health Canada should publish up-front equivalence standards for complex generic products, starting with synthetic peptides, so the next manufacturer can build the required evidence into its first submission. Any regulator that has not defined an equivalence standard for complex generics before the relevant exclusivities lapse may face similar delays, and a growing number of high-income countries will confront that question as peptide products lose protection.