Why does Health Canada take so long to approve new drugs and procedures

Health Canada is always very slow to approve new drugs and procedures, but in this case they have been almost criminally dilatory. 

Canada has just approved the OraQuick HIV self-test, a ground-breaking at-home oral HIV test, that doesn't require any blood and delivers results in as little as 20 minutes. It was approved in the United States way back in 2012, recommended by the World Health Organization in 2016, and is currently in use in 60 countries. It doesn't take the place of a physician-administered boood test, but it is an easy and non-invasive initial assessment that might encourage a person to seek more official help on a timely basis.

So, why is Canada so late to the game? After all, HIV is still rife in Canada, especially among the Indigenous populations of Saskatchewan and Manitoba, even if it doesn't make headlines any more.

According to a prominent urban health scientist, suppliers needed proof that there was a market for the test in Canada (why should that be a consideration for technical approval?), and Health Canada needed assurance that it "reached its standards" (60 other countries seem happy that it is safe and efficacious). Neither of these excuses seem convincing or compelling reasons for 14 years of delay and procrastination for a valuable andncost-effective health procedure.