2013-14 Supplementary Information Tables - Departmental Performance Report

Table of Contents

• Departmental Sustainable Development Strategy;
• Details on Transfer Payment Programs;
  • Contributions for First Nations and Inuit Primary Health Care (Voted)
  • Contributions for First Nations and Inuit Supplementary Health Benefits (Voted)
  • Contributions for First Nations and Inuit Health Infrastructure Support (Voted)
  • Grant for Territorial Health System Sustainability Initiative (THSSI)
  • Contribution to the Canadian Patient Safety Institute (Voted)
  • Grant to the Health Council of Canada (Voted)
  • Grant to the Canadian Institute for Health Information (Voted)
  • Grant to support the Mental Health Commission of Canada (Voted)
  • Canada Brain Research Fund to Advance Knowledge for the Treatment of Brain Disorders (Voted)
  • Contribution to the Canadian Agency for Drugs and Technologies in Health (Voted)
  • Drug Treatment Funding Program (Voted)
  • Drug Strategy Community Initiatives Fund (Voted)
  • Canadian Blood Services: Blood Research and Development Program (Voted)
  • Official Languages Health Contribution Program (Voted)
  • Health Care Policy Contribution Program (Voted)
  • Contribution to the Canadian Partnership Against Cancer (Voted)
• Horizontal Initiatives
  • Federal Strategy on Early Childhood Development for First Nations and Other Aboriginal Children
  • Chemicals Management Plan
  • Food and Consumer Safety Action Plan
  • Federal Tobacco Control Strategy);
• Internal Audits and Evaluations;
• Response to Parliamentary Committees and External Audits;
• Up-Front Multi-Year Funding
  • Canadian Foundation for Healthcare Improvement
  • Canada Health Infoway
  • Mental Health Commission of Canada
• Sources of Respendable and Non-Respendable Revenue;
• User Fees Reporting
  • User Fees and Regulatory Charges (User Fee Act)
    • Fees Rights to Sell Drugs
    • Drug Establishment Licensing Fees
    • Drug Submission Evaluation Fees (Pharmaceuticals & Biologic Products)
    • Medical Device License Application Fees
    • Fees for Right to sell a Licensed Medical Device
    • Medical Device Establishment Licensing Fees
    • Veterinary Drug Evaluation Fees
    • Pest Control Product Application Examination Service
    • Right or Privilege to manufacture or sell a Pest Control Product in Canada and for Establishing a Maximum Residue Limit in relation to a Pest Control Product
    • Processing of access request filed under the Access to Information Act
    • Fees charged for filing a claim for exemption under the Hazardous Materials Information Review Act
  • User Fee Totals
  • External Fees (Policy on Service Standards for External Fees)

Departmental Sustainable Development Strategy

1. Overview of the Federal Government's Approach to Sustainable Development

The  2013-2016 Federal Sustainable Development Strategy (FSDS), tabled in Parliament on November 4, 2013, guides the Government of Canada's sustainable development activities. This second FSDS articulates Canada's federal sustainable development priorities for a period of three years, as required by the  Federal Sustainable Development Act (FSDA). The FSDA provides the legal framework for developing and implementing a FSDS that makes environmental decision-making more transparent and accountable to Parliament. Health Canada supports the implementation of the FSDS through the activities found in this departmental strategy.

This Supplementary Information Table presents the results on commitments related to all four themes of the FSDS:

• Theme 1: Addressing Climate Change and Air Quality;
• Theme 2: Maintaining Water Quality and Availability;
• Theme 3: Protecting Nature and Canadians; and,
• Theme 4: Shrinking the Environmental Footprint - Beginning with Government (also known as Greening Government Operations).

3(a). Themes I-III: Implementation Strategies

Theme 1. Addressing Climate Change and Air Quality

Goal 1: Climate Change

In order to mitigate the effects of climate change, reduce greenhouse gas emission levels and adapt to unavoidable impacts.

Target 1.2: Climate Change Adaptation

Facilitate reduced vulnerability of individuals, communities, regions and economic sectors to the impacts of climate change through the development and provision of information and tools.

Health Canada's Program Alignment Architecture

Strategic Outcome 2: Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

• Program 2.3: Environmental Risks to Health
• Sub-Program 2.3.1: Climate Change and Health

Strategic Outcome 3: First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status.

• Program 3.1: First Nations and Inuit Primary Health Care
• Sub-Program 3.1.2: First Nations and Inuit Public Health Protection
• Sub-Sub-Program 3.1.2.2: Environmental Public Health

Descriptions of Implementation Strategies

1.2.6. Work with Canadian communities to implement heat alert and response systems and provide information/education about the health impacts of extreme heat to public health professionals and the public. (Health Canada)

CAA Theme and Program Link

This implementation strategy supports the Heat Alert and Response System (HARS) program associated with the Climate Change Adaptation theme of the Clean Air Agenda (CAA).

Background

Climate change is expected to increase the risks to human health in a number of areas including air and water quality, extreme weather events, and infectious diseases. Extreme heat poses a growing risk to the health and well-being of Canadians as climate change is expected to produce a greater intensity, frequency and duration of extreme heat events. Communities and individuals are seeking information about the most effective ways to protect themselves, their families and those most at risk. Public health and emergency management officials in several Canadian communities are already taking actions to reduce their communities' vulnerability to heat-health risks.

Health Canada is enabling individuals and communities to increase their resiliency to extreme heat events by providing guidance, expert advice and science-based information about developing HARS to health professionals, public health and emergency management institutions. Health Canada has also developed training tools for health professionals working to reduce the vulnerabilities of their communities to extreme heat.

HARS centre on efforts to alert health authorities and the public when hazardous conditions arise, provide advice on how health risks can be minimized, and offer assistance to those in need during emergency situations.

Achievements supporting FSDS Implementation Strategy

The climate change and health program provided guidance and expert advice to public health and emergency management professionals in the development of HARS, as well as training tools for health professionals to reduce the vulnerability of communities to extreme heat.

Building on the successful completion of the pilot HARS in four Canadian communities in 2011 and the release of a Best Practices Guide in Developing HARS in 2012, Health Canada continued to support the expansion of HARS to at-risk regions.

In 2013-14, Health Canada shifted efforts from supporting the development of community-based HARS in at-risk communities to the development of provincial -level systems, such as the system in Manitoba.

Existing community-level partnerships in Ontario have been merged under a new initiative to establish a province-wide consistent approach to HARS. Establishing a provincial system in Alberta is also underway, with a pilot project being launched during summer 2014, and expected to be operational by 2016. The shift to provincially-based HARS has resulted in the development of HARS in 12 communities in 2013-14, ahead of schedule in relation to the target of 12 communities by 2015-16. Using the new provincial level system, Health Canada will work with regional health authorities to deliver the HARS program.

Health Canada also continues to provide education credits for health professionals who have completed the accredited extreme heat and health e-learning course that was launched in 2012.

1.2.7. Address the health effects of climate change by funding community-based research and assessment projects that enable northern First Nations and Inuit communities to develop climate change adaptation strategies and action plans. (Health Canada)

CAA Theme and Program Link

This implementation strategy supports the Climate Change and Health Adaptation for Northern First Nations and Inuit Communities program associated with the Climate Change Adaptation theme of the CAA.

Background

The Climate Change and Health Adaptation Program (CCHAP) for Northern First Nations and Inuit Communities is unique among global adaptation programs in that it directly supports projects by northern communities to strengthen climate change adaptation for improved community health outcomes. To help address the challenges of climate change, the program stresses the critical importance of enabling communities to take control of monitoring, researching, discussing, advocating and participating in the process of adaptation. Through community-based research projects, communities develop culturally appropriate adaptation strategies or action plans and communication materials. Increased research capacity in turn facilitates informed decision-making at the community, regional, national and international levels with respect to human health of Indigenous communities and a changing environment.

Achievements supporting FSDS Implementation Strategy

In 2013-14, the CCHAP funded 12 successful community-driven projects (seven projects led by First Nations communities and five projects led by Inuit communities) across the Canadian Arctic. These projects examined the impacts of climate change on food security, housing, and mental health. CCHAP also funded three capacity building workshops which were held in Ottawa, Whitehorse and Fort Simpson. These workshops were attended by Inuit and First Nations community members, non-governmental organizations and government representatives.

The Program contributed insight and expertise to the United Nations Framework Convention on Climate Change Secretariat (UNFCCC), on approaches for integrating Indigenous traditional knowledge into the global discussion on climate change adaptation   Program representatives also took part in a Task Group to share ideas on taking action on recommendations from the UNFCCC meeting.

Goal 2: Air Pollution

Minimize the threats to air quality so that the air Canadians breathe is clean and supports healthy ecosystems.

Target 2.1: Outdoor Air Pollutants

Improve outdoor air quality by ensuring compliance with new or amended regulated emission limits by 2020 and thus reducing emissions of air pollutants in support of Air Quality Management System objectives.

Health Canada's Program Alignment Architecture

Strategic Outcome 2: Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

• Program 2.3: Environmental Risks to Health
• Sub-Program 2.3.2: Air Quality

Descriptions of Implementation Strategies

2.1.11. Communicate outdoor air pollution health risks to Canadians through the Air Quality Health Index, which provides current and forecast air-quality information and advice on health risks in order to assist Canadians in making decisions on how to reduce their level of exposure. Continue development of the Air Quality Health Index and continue implementation in all provinces and major communities in the North to achieve access for 80% of the Canadian population. (Environment Canada (EC), Health Canada)

CAA Theme and Program Link

This implementation strategy supports the Data Collection and Reporting for Atmospheric Pollutants program associated with the Clean Air Regulatory Agenda (CARA) theme of the CAA.

Background

The Air Quality Health Index (AQHI) is a tool designed to help Canadians make decisions in real time on a daily basis to protect their health by limiting short-term exposure to air pollution and adjusting their activity levels during increased levels of air pollution. It also provides advice on how Canadians can improve the quality of the air they breathe. This Index pays particular attention to people who are sensitive to air pollution and provides them with advice on how to protect their health during air quality levels associated with low, moderate, high and very high health risks. This tool has been developed by Health Canada and EC, in collaboration with the provinces and key health and environment stakeholders.

Achievements supporting FSDS Implementation Strategy

In 2013-14, the AQHI was expanded from 74 locations in 2012-13 to 79 locations. The AQHI is available in all 10 provinces and one territory and provides 63% of Canadians with access to daily and forecasted air quality information. While expansion of coverage was slower than anticipated because the new communities that were added this year were small, significant progress was made to initiate new AQHI pilot programs in five communities in southern Ontario that will host the 2015 PanAm Summer Games.

2.1.13. Undertake and deliver scientific research, monitoring, modelling, testing, data analysis and science advice to inform regulations, policies, programs, science assessments, and services as well as to evaluate effectiveness of actions. (EC, Health Canada)

CAA Theme and Program Link

This implementation strategy supports the Atmospheric Research, Monitoring and Modelling program and the Health and Environmental Impacts of Air Pollutants program associated with the CARA theme of the CAA.

Background

This activity supports improvements to air quality and associated human health risks through research and assessment of the health risks posed by substances Canadians may be exposed to from ambient air and by supporting the development of ambient air quality standards.

Under the CARA and supporting implementation of the Air Quality Management System (AQMS), Health Canada plays an important role in improving ambient air quality and protecting the health of Canadians through a broad range of activities. Research studies are conducted to determine what substances Canadians may be exposed to from ambient air. Health risk assessments on these and other substances are carried out in order to develop ambient air quality standards that are used by public health professionals and regulators to better manage air quality. Conventional fuels and their alternatives, as well as fuel emission management technologies, are assessed for any potential adverse health impacts from their use or introduction into the Canadian marketplace.

Achievements supporting FSDS Implementation Strategy

Following a multi-year, multi-stakeholder process, which included participation from provincial and territorial partners; industry; and health and environment non-government organizations, the Canadian Council of Ministers of the Environment, in 2012, endorsed the implementation of the new, national AQMS.

Building on the multi-stakeholder consultation in 2012-13 on several key elements of the AQMS, in 2013-14, the Ministers of the Environment and of Health established new, more stringent health-based Canadian Ambient Air Quality Standards (CAAQS) for particulate matter (PM) and ozone under the Canadian Environmental Protection Act, 1999. Development of these new standards was guided by the findings of the Canadian Smog Science Assessment completed by Health Canada and EC in 2011.

A health risk assessment for sulphur dioxide was finalized in 2013-14, and another for nitrogen dioxide was initiated in 2013-14 and is near completion.  These will be used as the health science basis for developing additional CAAQS in 2015 through the AQMS multi-stakeholder consultation process. Health risk assessments for additional criteria air contaminants, coarse PM and carbon monoxide, were also completed. Work on a number of multi-pollutant sector analyses was re-aligned to focus on developing a model methodology which was then applied to assess the fertilizer sector. Once the latter is completed in 2014-15, additional industrial sector assessments will be finalized using the model. Completion of the risk assessment of emissions from the combustion of diesel fuel was behind schedule due to delays in data modeling while the assessment of conventional gasoline emissions progressed as planned.

Significant new research studies were also initiated in 2013-14 including: (1) assessing potential air quality issues in relation to shale gas development including baseline, production and deactivation of a well site; and, (2) health risks associated with wood smoke levels. Field work for a number of studies was also completed in 2013-14 including: (1) data collection to evaluate the potential impact of traffic pollution during exercise (e.g. bicycling) in high and low-traffic areas on acute cardiovascular health in women; and, (2) sampling air quality for a number of modes of urban transportation including bus, private vehicle and commuter trains.

The Air Health Indicators (AHIs) also advanced. For example, in 2013-14, the baseline for air quality and health benefit improvements was set to inform the AHI.  Updated measurements for ozone and PM were used, and there was further refinement of the cardiopulmonary mortality risk ratings. The AHI tracks the percentage of all cardiopulmonary mortality risks that can be attributed to exposure of ground-level ozone and fine PM. The AHI data shows an upward trend in cardiopulmonary mortality attributable to ozone exposure between 1990 and 2010 and no upward or downward trend attributable to fine PM between 2001 and 2010.

2.1.19. Continue to work collaboratively with provinces, territories and stakeholders to implement the Air Quality Management System, which includes new ambient air quality standards, a framework for managing air quality through local air zones and regional airsheds, and emissions requirements for major industrial sectors and equipment types. (EC, Health Canada)

CAA Theme and Program Link

This implementation strategy supports the Science Integration, Accountability and Benefits of Action program and the Atmospheric Pollutants Policy program associated with the CARA theme of the CAA.

Background

This activity ensures a coherent approach to managing air quality through Health Canada's provision of research, assessments and guidelines to provinces and territories. Health Canada's assessment of the potential adverse impacts of conventional fuels and their alternatives and fuel emission management technologies, as well as the cost-benefit analyses for proposed government options to control air pollution sources support the development of national industrial and transportation emissions requirements for key pollutants.

Health Canada, along with EC, work with the provinces and territories and other key stakeholders, to implement a national framework to manage air quality (the AQMS) including new health-driven CAAQS, local air zone management and emissions requirements for major industrial sectors. Health Canada research and assessments provide the health basis and guidance for developing actions to reduce the health risks from outdoor air pollutants.

Achievements supporting FSDS Implementation Strategy

Health Canada continued to work collaboratively with EC, and with provinces and territories through the Air Management Committee of the Canadian Council of Ministers of the Environment to develop a joint workplan. The workplan is to address air pollutants from mobile sources, which are a significant source of regional air pollution being addressed under the AQMS. The scientific research and monitoring activities, including health risk assessments, undertaken by Health Canada under CARA provided information to risk managers on how to better target any required control measures under the implementation of the AQMS.

2.1.20. Work with other jurisdictions, including the United States under the Canada-United States Air Quality Agreement to undertake regional and international efforts to manage transboundary air pollution of concern for Canadians and their environment. This includes work towards the completion of the necessary scientific, technical and regulatory foundations required for the consideration of a Particulate Matter Annex under the Air Quality Agreement. (EC, Health Canada)

Background

A significant level of air pollution in certain areas of Canada can be directly attributed to United States (U.S.) industrial sources. Additionally, some Canadian industrial facilities contribute to air pollution in the U.S.

Under the CARA, Health Canada is involved in research and assessments supporting implementation of a comprehensive air management quality system which will lead to reductions in industrial air emissions and provide the basis for negotiating a PM Annex to the Canada-U.S. Air Quality Agreement (AQA).

In addition, Health Canada conducts health science assessments in support of regulations to reduce air pollutant emissions from industrial sectors; and coordinated science activities as part of the Canada-U.S. AQA.

As part of this implementation strategy, Health Canada provides health science to support regional and international efforts with the U.S. under the Canada-U.S. AQA to promote strategies to reduce transboundary air pollution.

Achievements supporting FSDS Implementation Strategy

Health Canada peer reviewed  the joint U.S.-Canada PM Science Assessment, which will be used as the basis for future discussions with U.S. counterparts on the management of transboundary air pollution. Health Canada also is engaged in support of EC in international discussions with partners in the Climate and Clean Air Coalition and the World Health Organization to consider the impacts on air quality and health of short-lived climate pollutants such as black carbon. The establishment of new CAAQS for PM and ozone will provide a basis for ongoing Canada-U.S. discussions around the impacts and management of transboundary sources of air pollution.

Target 2.2: Indoor Air Quality

Help protect the health of Canadians by providing health-based guidance and tools to support actions to better manage indoor air quality.

Health Canada's Program Alignment Architecture

Strategic Outcome 2: Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

• Program 2.3: Environmental Risks to Health
• Sub-Program 2.3.2: Air Quality
  
• Program 2.6: Radiation Protection
• Sub-Program 2.6.1: Environmental Radiation Monitoring and Protection

Strategic Outcome 3: First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status.

• Program 3.1: First Nations and Inuit Primary Health Care
• Sub-Program 3.1.2: First Nations and Inuit Public Health Protection
• Sub-Sub-Program 3.1.2.2: Environmental Public Health

Descriptions of Implementation Strategies

2.2.1. Conduct research, assessments and communication activities in order to provide health-based guidance on reducing exposure to indoor air pollutants. (Health Canada)

CAA Theme and Program Link

This implementation strategy supports the Indoor Air Quality Management - Biological and Chemical Contaminants program associated with the CARA theme of the CAA.

Background

This activity develops guidelines and standards to better manage indoor air quality and provides advice for public health professionals and Canadians on how exposure to air pollutants can be reduced.

Health Canada plays an important role in improving indoor air quality and protecting the health of Canadians through a broad range of activities. Research studies are conducted to determine what substances Canadians may be exposed to in their homes or other indoor environments, and how to reduce this exposure. Health risk assessments on these and other substances are carried out in order to develop indoor air quality guidelines that are used by public health professionals and regulators to better manage air quality.

Achievements supporting FSDS Implementation Strategy

In 2013-14, field work for two significant studies was completed: a residential attached garage study to investigate the effectiveness of fan ventilation in reducing the flow of pollutants in attached garages into homes, and an Ottawa school study undertaken to assess the effectiveness of adjusting ventilation patterns to reduce the inflow of traffic pollutants into schools.

Using the rapid screening methodology developed in 2011-12, indoor air reference levels for four additional volatile organic compounds (VOCs) were determined. In 2013-14, the risk assessment for nitrogen dioxide in indoor air was also completed, elements of which will be used to support the current assessment of the health impacts of nitrogen dioxide in outdoor air. Completion of the draft guidelines for short- and long-term exposure to nitrogen dioxide for consultation was delayed due to the complexity of the risk assessment.

In 2013-14, Health Canada published two final Residential Indoor Air Quality Guidelines, for benzene and naphthalene, to go along with previously published guidelines on toluene, fine PM, carbon monoxide, ozone, formaldehyde and mould. Following a review of risk assessment priorities, the risk assessment for acetaldehyde and the rapid screening of nine additional VOCs were initiated. In the future, the rapid screening methodology and the development of indoor air reference levels will become the more common approach to managing indoor air issues.

Health Canada also continued to increase awareness about the health risks of indoor air pollutants, and to provide science-based guidance for actions to reduce them through a variety of outreach strategies, which included the launch of the first annual National Radon Action Month and the distribution of a radon health risk fact sheet for smokers to doctors' offices across Canada in combination with cessation information. Other activities included: distributing materials to public health professionals, publishing articles in stakeholder newsletters, giving media interviews, and communicating to the public through social media and through Health Canada's website, as well as responding to direct enquiries.

2.2.2. Maintain a database of indoor radon levels in Canadian homes and buildings. Assess new methods and technologies for measuring and reducing radon gas levels in homes and buildings. Maintain a radon awareness program to give information to Canadians on ways to reduce their exposure to radon. (Health Canada, Statistics Canada)

CAA Theme and Program Link

This implementation strategy supports the Indoor Air Quality Management - Radioactive Contaminants program associated with the CARA theme of the CAA.

Background

Raising public awareness of risks and health impacts, disseminating information to mitigate the risk of indoor radon exposure, and conducting testing and research projects are activities undertaken by Health Canada that support improved indoor air quality.

Health Canada develops new standards and updates existing guidance documents, codes of practice and protocols for measurement and mitigation of radon in homes and workplaces based on research and evidence. This includes working with private industry and key partners (e.g., other government departments such as the National Research Council and Canadian standards development bodies such as the Canadian General Standards Board) to investigate and validate methods for radon measurement and improved technologies to reduce intrusion of radon soil gas into residential homes and buildings. This helps to ensure homeowners, industry partners and stakeholders have tools and resources needed to protect themselves from exposure to indoor radon.

Health Canada continues to raise public awareness of health risks from exposure to elevated levels of radon and inform Canadians of strategies to reduce their risk by supporting the annual collaborative outreach campaign and National Radon Action Month and by partnering with provinces and territories, as well as stakeholders in the delivery of targeted outreach communications and programs to homeowners, health professionals and the building industry.

In addition, a database of indoor radon concentrations is maintained and updated as new information is acquired from radon surveys, residential radon measurement service providers and members of the public.

Achievements supporting FSDS Implementation Strategy

The Department continues to increase awareness on the risks, health impacts and mitigation strategies related to indoor radon exposure. In November 2013, Health Canada supported the New Brunswick Lung Association in launching National Radon Action Month to encourage all Canadians to test the levels of radon gas in their homes and to reduce radon levels if necessary.

In addition, as part of the annual collaborative radon outreach campaign, more than 30 stakeholders participated in education and awareness activities that included the distribution of radon awareness materials at home shows, conferences, community and health centres. The campaign also targeted children and young families by focusing on promoting radon testing alongside the more familiar home safety messages of smoke detector and carbon monoxide detector installation.

Since the start of the campaign in 2011, there has been an increase in national media interest each year. Visits to Health Canada's radon web pages increased by 50% in 2011, 100% in 2012-13 and 16% in 2013-14.

As part of the radon federal building testing program, 3,000 federal buildings were tested in 2013-14. Since the start of the program in 2007, roughly 15,000 federal buildings have been tested for radon.

Health Canada's Radiation Protection Bureau, in partnership with the National Research Council, hosted a workshop on the application of radon protective measures in Canada and worldwide, and has partnered with the Canadian General Standards Board  to create two national standards by 2015 for radon mitigation, one for new construction and one for existing construction.

Information from Health Canada's Cross-Canada Survey of Radon Concentrations in Homes, a two-year survey of radon concentrations in 14,000 homes distributed across Canada, informed the development of regional outreach tools with targeted information on radon risks. In particular, it was used to create radon risk maps for province-specific factsheets on radon.

Health Canada posted a Canadian mitigation guide entitled: Reducing Radon Levels in Existing Homes: A Canadian Guide for Professional Contractors. The guide provides detailed information about methods for reducing radon in existing and new homes and emphasizes the importance of seeking professionals with certification from the Canadian National Radon Proficiency Program.

2.2.3 - Implement the health promotion campaign on mould as part of the National Strategy to Address Mould in First Nations Communities. (Health Canada)*

*This implementation strategy supports the 2010-2013 FSDS and is complete as of March 31, 2014.

Background

Health Canada considers mould growth in residential buildings to be a potential health hazard. People living in buildings where mould grows are more likely to suffer from health problems, especially symptoms such as coughing, wheezing, and headaches. Asthmatics are especially at risk as mould may trigger asthma attacks. People respond to mould in different ways depending on the amount of exposure and the person's overall health. While this issue can impact the health of all Canadians, Health Canada has a specific role with respect to First Nations communities.

First Nations residents who are better informed about mould are able to take appropriate actions to prevent mould growth, remediate as needed, and minimize the potential risks to their health and that of their family members.

Health Canada develops and distributes mould communication products to First Nations residents as part of the health promotion campaign on mould. The campaign aims to enhance awareness and knowledge of mould and how to take action to prevent and/or remediate mould in homes.

Achievements supporting FSDS Implementation Strategy

Health Canada completed the assessment of the effectiveness of the health promotion campaign under the National Strategy to Address Mould in First Nations communities in March 2014.

The assessment found that since 2007, there have been significant improvements in understanding of mould (30% identify moisture as the cause, versus 20% in 2007) among First Nations people on-reserve, particularly in terms of causes, prevention and clean-up. There is reasonably good recall of the health promotion campaign (15% recall the campaign after 5 years, comparable to immediately after a print advertising campaign) and this has likely contributed to better knowledge about mould.

Theme 2. Maintaining Water Quality and Availability

Goal 3: Water Quality and Water Quantity

Protect and enhance water so that it is clean, safe and secure for all Canadians and supports healthy ecosystems.

Target 3.1: On-Reserve First Nations Water and Wastewater Systems

Increase the percent of on-reserve First Nations water systems with low risk ratings from 27% to 50% by 2015. Increase the percent of on-reserve First Nations wastewater systems with low risk ratings from 35% to 70% by 2015.

Health Canada's Program Alignment Architecture

Strategic Outcome 3: First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status.

• Program 3.1: First Nations and Inuit Primary Health Care
• Sub-Program 3.1.2: First Nations and Inuit Public Health Protection
• Sub-Sub-Program 3.1.2.2: Environmental Public Health

Descriptions of Implementation Strategies

3.1.4. Support all First Nations communities in ensuring ongoing access to a trained Community-Based Water Monitor or Environmental Health Officer. (Health Canada)

Background

In First Nations communities, Environmental Health Officers (EHOs) and Community-Based Water Monitors (CBWMs) share responsibility for drinking water quality monitoring at tap as per the Guidelines for Canadian Drinking Water Quality (GCDWQ). EHOs assist communities in monitoring drinking water quality for bacteriological, chemical, physical and radiological parameters, interpret drinking water quality results, disseminate results to First Nations authorities and maintain quality assurance. CBWMs are First Nations community members trained by an EHO. They are responsible for monitoring bacteriological water quality and disseminating results.

Capacity to monitor drinking water quality as per the GCDWQ in First Nations communities is supported by Health Canada through the provision of funding to Chief and Council for drinking water monitoring through the CBWM program, and training of CBWMs to monitor the drinking water for potential bacteriological contamination as a final check on the overall safety of the drinking water at tap. EHOs and CBWMs are the primary service providers with respect to drinking water quality monitoring, and it is therefore important to provide them with the support necessary to perform their duties effectively to better protect the public health of First Nations residents.

Achievements supporting FSDS Implementation Strategy

Consistent with the results achieved in 2012-13, Health Canada secured access to monitoring personnel (CWBMs or EHOs) for all First Nations communities in 2013-14.

3.1.5. Support all First Nations communities in ongoing monitoring of drinking water quality as per the GCDWQ. (Health Canada)

Background

Over time, by working with First Nations communities to identify challenges with meeting recommended testing frequencies, Health Canada aims to increase the percent of on-reserve public distribution systems that meet weekly national testing guidelines for bacteriological parameters. Regular testing of drinking water quality offers timely identification of potential problems with drinking water quality, minimizing potential risks to public health and therefore contributes to increasing the percentage of First Nations communities with acceptable water and wastewater facility ratings.

Health Canada assists First Nations communities in establishing drinking water quality monitoring programs. This includes verification monitoring of the overall quality of drinking water at tap, and reviewing, interpreting and disseminating results to First Nations and providing advice, guidance and recommendations for First Nations communities about drinking water safety and safe disposal of onsite domestic sewage.

Health Canada aims to assure that drinking water quality in First Nations communities is tested on a weekly basis as per the GCDWQ. The GCDWQ set out the basic parameters all drinking water systems should strive to achieve in order to deliver clean, safe and reliable drinking water at tap.

Achievements supporting FSDS Implementation Strategy

In 2013-14, 58% of on-reserve distribution systems (Public Water Systems [PWSs]) were monitored as recommended by the GCDWQ and achieved 100% of the recommended sampling frequency for that year. This monitoring compliance percentage excludes communities where the environmental public health services have been transferred to a First Nations community.

Target 3.2: Drinking Water Quality

Help protect the health of Canadians by developing up to 15 water quality guidelines/guidance documents by 2016.

Health Canada's Program Alignment Architecture

Strategic Outcome 2: Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

• Program 2.3: Environmental Risks to Health
• Sub-Program 2.3.3: Water Quality

Descriptions of Implementation Strategies

3.2.1. Develop on average five drinking water quality guidelines/guidance documents per year in collaboration with provinces/territories, which are used as a basis for their regulatory requirements. (Health Canada)

Background

Health Canada works in collaboration with provinces/territories to develop an average of five drinking water quality guidelines/guidance documents per year. These GCDWQ are used by all jurisdictions (provinces, territories and the federal government) as the basis for establishing their regulatory requirements for drinking water quality. The water quality program also provides direction and support on drinking water related research. Work is done in close collaboration with partners and stakeholders, as required to address key challenges to drinking water safety, including small community drinking water supplies.

Work is also undertaken with standards-setting organizations to develop harmonized North American health-based performance standards for drinking water materials. These standards are directly referenced in the GCDWQ.

Achievements supporting FSDS Implementation Strategy

From 2011-2014, Health Canada developed and/or updated fourteen water quality guidelines/guidance documents. In order to achieve this commitment on an ongoing basis, the program works on 20 to 30 risk assessments simultaneously at any one time.
The Department, in collaboration with the Public Health Agency of Canada, also continued to expand the Canadian Network of Public Health Intelligence's drinking water application to more locations. The drinking water application tracks boil water advisories and the reasons for which they were issued. This will allow the Department to identify trends over time, including reasons for advisories.

In addition, a  Canadian Environmental Sustainability Indicator was developed. This indicator, which is being used as part of the FSDS 2013-2016, focuses on the root causes (e.g. line breaks, cross connections, equipment failure) of advisories from a water quality perspective.

Theme 3. Protecting Nature and Canadians

Goal 4: Conserving and Restoring Ecosystems, Wildlife and Habitat, and Protecting Canadians

Resilient ecosystems with healthy wildlife populations so Canadians can enjoy benefits from natural spaces, resources and ecological services for generations to come.

Target 4.8: Chemicals Management

Reduce risks to Canadians and impacts on the environment and human health posed by releases of harmful substances.

Health Canada's Program Alignment Architecture

Strategic Outcome 2: Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

• Program 2.3: Environmental Risks to Health
• Sub-Program 2.3.4: Health Impacts of Chemicals
• Program 2.7: Pesticides

Descriptions of Implementation Strategies

4.8.5. Assess 100% of 1,500 targeted existing commercial substances as identified under the Chemicals Management Plan for risks to human health and/or the environment by 2016. (EC, Health Canada)

Background

Health Canada activities include risk assessments of existing (post-market) substances and developing risk management strategies, policies and regulations for substances determined as harmful to human health, as a complement to EC's review of environmental impacts. These activities reduce the health risks to Canadians posed by substances by identifying those that may be harmful and taking appropriate steps to reduce this risk.

Health Canada is in the process of assessing existing substances as priorities identified under the Chemicals Management Plan (CMP), both to determine whether they are harmful to human health due to their inherent properties, and the level of exposure to the Canadian public. Health Canada's research on the nature of existing substances and Canadians exposure to them support the scientifically grounded, risk-based approach used to assess the impact of chemical substances on Canadians health and to guide risk management or regulatory actions for substances determined to be harmful to human health.

Within the targeted assessment of 4,300 substances by 2020, 1,500 substances are planned for assessment by March 2016.

Achievements supporting FSDS Implementation Strategy

Building on the achievements in 2011-12 and 2012-13, the planned 2013-14 chemicals assessment and management activities under the CMP were largely on track. In 2013-14, through the substance groupings initiative and rapid screening, Health Canada reached 24% (362) of its target to assess 33% (500) substances by March 31, 2014.  The target was not met due to complex scientific and policy issues. Draft assessments for these 362 substances were published, as well as 117 final assessments. In addition, the program completed draft risk assessments for 48 substances and final risk assessments for 653 substances categorized as Challenge, Legacy, Petroleum, Rapid Screening 1, High Hazard or Food and Drugs Act products. The program also concluded on 249 substances which were determined to already have been assessed or managed.

Other important achievements include the release of the Second Report on Human Biomonitoring of Environmental Chemicals: Results of the Canadian Health Measures Survey (CHMS) Cycle 2 (2009-11). This report presents national biomonitoring data on the Canadian population's exposure to chemicals. The national data will be used for future monitoring and research and to track trends in levels of chemicals in Canadians over time.

4.8.8. Address 100% of new substances, for which EC has been notified by industry of their intended manufacture or import, to determine if they may pose risks to human health and/or the environment within the timelines in the regulation or established services standards. (EC, Health Canada)

Background

Health Canada activities include assessing and managing potential health risks associated with new (pre-market) substances, including products of biotechnology. For new substances in products regulated under the Food and Drugs Act, the Department also assesses potential harm to the environment. These activities seek to reduce the health risks to Canadians posed by substances, including the identification of those that may be harmful and taking appropriate steps to reduce this risk.

Health Canada also assesses substances and products of biotechnology that are new to the Canadian market both to determine whether they are harmful to human health due to their inherent properties and the level of exposure to the Canadian public. Health Canada's research on the nature of new commercial substances and the products of biotechnology as well as Canadians' exposure to them supports a scientifically grounded, risk-based approach used to assess the impact of chemical substances on the health of Canadians and to guide risk management or regulatory actions for substances determined to be harmful to human health.

Achievements supporting FSDS Implementation Strategy

All 463 new substance notifications received in 2013-14 have been assessed. Of the 463 substances, 373 were chemicals and polymers, 20 were products of biotechnology, 5 were nanomaterials, and 65 were substances regulated as Food and Drugs Act products. The Revised "In Commerce List" (substances in products regulated under the Food and Drugs Act that were in Canadian commerce between January 1, 1987 and September 13, 2001), containing approximately 3,400 substances, was published on Health Canada's web site in May 2013. A total of 1,373 substances on the Revised "In Commerce List" have undergone prioritization.

4.8.9. Ensure at least one risk management measure is in place for 100% of substances deemed to be harmful to human health and/or the environment. (EC, Health Canada)

Background

Under the Canadian Environmental Protection Act, 1999 (CEPA), Health Canada in cooperation with EC, develops and implements risk management strategies, policies and regulations to manage the potential risks posed by substances that are assessed to be harmful to human health. This implementation strategy relates to the FSDS targets by ensuring that timely risk management instruments are put in place to mitigate human exposure and reduce the risk to Canadians posed by harmful substances.

It is directly through risk management actions that Health Canada contributes to decreases in environmental concentrations and human exposure to harmful substances. The mandated timeframe for publishing the proposed risk management instruments is within 24 months of publication of the final risk assessments. Publication of the final risk management instruments is mandated within 18 months following publication of a proposed risk management instrument.

Achievements supporting FSDS Implementation Strategy

Targeted risk management activities were published in 2013-14 for substances that were deemed harmful to human health and/or the environment.

Of the nine new substances that were assessed to be harmful to human health, nine had risk management instruments developed within mandated timeframes. Of the Challenge and Legacy substances assessed to be harmful to human health, 12 out of 13 (92%) met the mandated timeframe of publication of proposed risk management instruments within 24 months following publication of the final risk assessments and publication of final risk management instruments, and within 18 months following publication of proposed risk management instrument.

4.8.11. Prevent unacceptable risk to people and the environment through the regulation of pesticides by initiating 100% of the re-assessments of registered pesticide products identified in the Re-evaluation Initiation Schedule. (Health Canada)

Background

In the delivery of the pesticide program, Health Canada conducts activities that span the lifecycle of a pesticide, including: pre and post market product assessments for health and environmental risks and product values; risk management; post market surveillance; compliance and enforcement; changes in use; cancellation, or phase out of products that do not meet current standards; and, consultations and public awareness building.

Health Canada leverages its international efforts to align regulatory approaches to provide access to the best science available in meeting its mandate with respect to pesticides.

The objective of this program is to protect the health and safety of Canadians and the environment relating to the use of pesticides.

Achievements supporting FSDS Implementation Strategy

The Pesticide Re-evaluation program continued with the initiation and re-assessment of scheduled re-evaluations, according to the workplan, while managing an increased number of additional special review requests.

Explanation of Variance:

The surplus is mainly due to lower than anticipated laboratory maintenance costs, as well as delays in the initiation of a number of large projects due to complex contract development and staffing processes.

4. Theme IV: Implementation Strategies

Green Building Targets

As of April 1, 2012, and pursuant to departmental strategic frameworks, new construction and build-to-lease projects, and major renovation projects, will achieve an industry-recognized level of high environmental performance.^{Footnote 1} (Target 8.1 from 2010-13 FSDS)

Strategies and/or Comments

1. Minimum level of environmental performance: New construction and build-to-lease projects - Leadership in Energy and Environmental Design (LEED) New Construction Gold. Major renovation projects valued over $1 million - Green Globes Design 3 Globes or LEED Core Shell/Commercial Interiors (CS/CI) Silver.
2. Appropriate threshold (dollar value or floor area): Project floor space greater or equal to 1,000m2. Major renovation - project budget equals or exceeds 50% of the replacement cost of the subject building and significantly affects the building envelope and heating ventilation and air conditioning systems.
3. Applicable building types: temperature controlled office and lab space where benchmark data is available.
4. Rationale for target status: No projects were completed during the timeframe that met the appropriate threshold for this target.

As of April 1, 2012, and pursuant to departmental strategic frameworks, existing crown buildings over 1,000 m2 will be assessed for environmental performance using an industry-recognized assessment tool.^{Footnote 2} (Target 8.2 from 2010-13 FSDS)

Strategies and/or Comments

1. Minimum level of assessment: Building Owners and Managers Association (BOMA) Building Environmental Standards (BESt).
2. Appropriate threshold (floor area): Buildings with floor area greater than 1,000m2.
3. Applicable building types: All temperature controlled buildings where Health Canada has full access and control over utilities monitoring and usage.
4. Industry recognized assessment and verification tool used: BOMA BESt
5. Assessment level achieved: BOMA BESt Level 1 certification achieved at one site and BOMA BESt Level 2 at another site. Remaining four buildings were assessed using BOMA BESt tool and may later seek certification at the Department's discretion.
6. Rationale for target status: Health Canada has assessed 100% of its facilities (6 of 6) as per the departmental strategic framework.

As of April 1, 2012, and pursuant to departmental strategic frameworks, new lease or lease renewal projects over 1,000 m2, where the Crown is the major lessee, will be assessed for environmental performance using an industry-recognized assessment tool.^{Footnote 3} (Target 8.3 from 2010-13 FSDS)

Strategies and/or Comments

1. This target is not directly applicable to Health Canada since Public Works and Government Services Canada (PWGSC) negotiates leases on behalf of the Health Canada.
2. Rationale for target status: As the client, Health Canada can only request inclusion of this target in its lease requirements and adherence to FSDS green building targets pursuant to PWGSC's Strategic Framework and Departmental Sustainable Development Strategy.

As of April 1, 2012, and pursuant to departmental strategic frameworks, fit-up and refit projects will achieve an industry-recognized level of high environmental performance.^{Footnote 4} (Target 8.4 from 2010-13 FSDS)

Strategies and/or Comments

1. Minimum level of environmental performance: Green Globes Design 3 Globes or LEED CI Silver.
2. Appropriate threshold (dollar value or floor area): $1 million and 1,000m2.
3. Applicable building types: Temperature controlled facilities where Health Canada has full access and control over utilities monitoring and usage.
4. Rationale for target status: Two projects completed by Health Canada under its National Accommodation Strategy achieved a rating equivalent to 4 Globes under the Green Globes Design criteria using the online assessment tool. The third project was unable to score high enough points to achieve a Green Globe rating of high environmental performance. The project was too limited in scope to result in sufficient greening upgrades to the building as a whole. In the future, projects that do not include building systems upgrades will not be targeted for assessment.

Greenhouse Gas Emissions Target

The federal government will take action now to reduce levels of greenhouse gas (GHG) emissions from its operations to match the national target of 17% below 2005 by 2020.
(Target 8.5 from 2010-13 FSDS)

Strategies and/or Comments

1. Scope: Targeted GHG emissions sources include only on-road fleet operations.
2. Tools and Resources: The Fleet GHG Inventory Accounting Template provided by Public Works and Government Services Canada (PWGSC), the Automotive Resources International (ARI) database and the Health Canada Fleet Standard are used to monitor and manage fleet operations.
3. Interim target: Health Canada's annual interim target has been adjusted to reflect that as of 2012-13, Health Canada had decreased its on-road fleet related GHG emissions by 20% from the 2005-06 baseline year, surpassing the original commitment of an overall 10% reduction target by 2020-21. As a result of this reduction, Health Canada committed to maintain the 20% reduction for FSDS 2013-16.
4. Key component of departmental implementation plan: The implementation plan to reduce GHG emissions remains unchanged from 2011-12 and includes the following key activities:
   • Ensuring that the replacement of old vehicles are right sized for operational needs and are the most fuel efficient vehicle in its class, as per the Health Canada Fleet Standard and/or are an alternative fuel vehicle;
   • Encouraging policy adherence; and,
   • Building employee awareness through communication and oversight.
5. Rationale for target status: By 2013-14, Health Canada had achieved a cumulative decrease in its GHG emissions of 27% from the baseline year (2005-06) which is in line with our 2020-21 target of 20%. The variance in results from last year is due to an adherence to the Fleet Standard (66 of 68 new vehicle purchases for 2013-14 complied with the Fleet Standard directives).
6. Roles and responsibilities: Director of the Materiel and Assets Management Division (MAMD) is overseeing this target. Input and support comes from the Assets Management team and Cost Centre Managers.

Surplus Electronic and Electrical Equipment Target

By March 31, 2014, each department will reuse or recycle all surplus electronic and electrical equipment (EEE) in an environmentally sound and secure manner. (Target 8.6 from 2010-13 FSDS)

Strategies and/or Comments

1. Definition of location: Health Canada has defined location as a region, of which there are nine (9): National Capital Region (NCR), Atlantic, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Colombia, and, the Northern region.
2. EEE Implementation Plan: Standard Operating Procedures for the Management of Surplus EEE have been put into place to meet the needs of both Health Canada and the Public Health Agency of Canada (PHAC) at all locations across the country.
3. Roles and Responsibilities: Corporate Services Branch is the Office of Primary Interest in collaboration with PHAC's Sustainable Development Office (SDO) supports the management of surplus EEE at Health Canada and the Agency.
4. Key Activities of the EEE Disposal Process: Health Canada has developed and implemented Standard Operating Procedures for the Management of Surplus Electronic and Electrical Equipment to address key activities of the EEE disposal process.
5. Reporting Requirements:  The total weights of e-waste disposed of, per disposal stream are collected for both Health Canada and the Agency. During 2013-14, a cumulative total for both organizations of approximately 91 tonnes of EEE was disposed: 35 tonnes diverted to provincial recycling programs and 56 tonnes to the Computers for Schools Program.
6. Mechanisms to Evaluate Progress: Volumes of EEE disposed are tracked on an ongoing basis by the Corporate Services Branch.
7. Rationale for target status: Health Canada has put into action an implementation strategy at 100% of locations and is able to track and report on volumes (total weights and key equipment types) of EEE disposed.

Printing Unit Reduction Target

By March 31, 2013, each department will achieve an 8:1 average ratio of office employees to printing units. Departments will apply the target where building occupancy levels, security considerations, and space configuration allow. (Target 8.7 from 2010-13 FSDS)

Strategies and/or Comments 

1. Definition: desktop printers, network printers and multi-functional devices.
2. Scope: all employees and devices with the exception of those exempted under the Health Canada Printing Unit Policy for confidentiality, isolated locations, duty to accommodate or connection to specialized equipment.
3. Method used for determining the number of printing units: Network and personal printing units were initially determined utilizing asset management databases, tools, and by a walk-thorough exercise. Branch managers are required to validate the data on an as requested basis throughout each year.
4. Method used for determining number of employees: Number of occupied workstations taken from the Computer Automated Facilities Management (CAFM) accommodations management database.
5. Number of employees subject to this target: 9,375
6. Roles and responsibilities: Assistant Deputy Minister (ADM) of Corporate Services is the target lead. Branch ADMs are responsible for meeting the 8:1 ratio within their respective work units.
7. Rationale for target status: Through the Health Canada Printer Reduction Strategy, the department was able to reduce its printer ratio from 3:1 in 2010-11 to 8:1 in 2013-14.

Paper Consumption Target

By March 31, 2014, each department will reduce internal paper consumption per office employee by 20%. Each department will establish a baseline between 2005-06 and 2011-12, and an applicable scope. (Target 8.8 from 2010-13 FSDS)

Strategies and/or Comments

1. Scope: 100% of employees.
2. Method used for determining paper consumption: PWGSC standing offer data usage.
3. Method used for determining number of employees: Number of occupied workstations taken from the CAFM accommodations management database.
4. Number of employees subject to this target: 9,375.
5. Rationale for target status: Health Canada has already reduced paper consumption by 36%, and exceeded the 2013-14 target of 20%. Health Canada's approach will sustain efforts to maintain a high level of reduced paper consumption.
6. Roles and responsibilities: ADM of Corporate Services Branch is the target lead.

Green Meetings Target

By March 31, 2012, each department will adopt a guide for greening meetings.
(Target 8.9 from 2010-13 FSDS)

Strategies and/or Comments

1. Definition of "adoption": Health Canada adopted a Green Meeting Guide (GMG) through senior executive approval of the guide, along with it being posted to the Department's intranet site for employee use.
2. Rationale for target status: Health Canada adopted a Green Meeting Guide in 2010-11.

Green Procurement Targets

As of April 1, 2011, each department will establish at least three SMART green procurement targets to reduce environmental impacts. (Target 8.10 from 2010-13 FSDS)

1. By March 31, 2014, 60% of IT hardware purchases will be identified as environmentally preferred models up from 29% in 2009-10.

Strategies and/or Comments

1. Scope: (as selected through PWGSC recommendations):
   • N7010 Automatic Data Processing (ADP) equipment;
   • N7020 ADP CPU;
   • N7021 ADP CPU;
   • N7022 ADP CPU;
   • N7025 ADP Input-Output;
   • N7035 ADP Support Equipment; and.
   • N7042 Mini and Micro Computer Control Devices.
2. Exclusions: laboratory or field equipment and purchases using acquisition cards.
3. Tools and Resources: Departmental policy mandates the use of PWGSC standing offers (which include IT hardware purchases).
4. Rationale for target status: A review of contracting data was undertaken to confirm that 60% of the target was achieved through Standing Offer Agreements with Environmental Attributes of the Supplier. The results indicated that 64% of IT Hardware contracts had been conducted through Standing Offer Agreements.

2. By March 31, 2014, 60% of specified purchases of office supplies will be identified as having environmental features up from 30% in 2009-10.

Strategies and/or Comments

• Health Canada exceeded the March 31, 2014 target.
• Scope: (as selected through PWGSC recommendations):
  • N7045 Computer supplies and accessories;
  • N7510 Office supplies;
  • N7520 Office devices and accessories;
  • N7530 Stationery and record forms;
  • N7540 Standard forms; and,
  • N9905 Signs and identification plates.
• Exclusions: Purchases using acquisition cards
• Rationale for target status: In 2013-14, Health Canada exceeded the baseline of 30% set in 2009-10 by 35% and has exceeded the self-selected target of 60% by 5%.
• Plans for departmental engagement: Health Canada continues to use its green procurement field in the financial management system (SAP) to identify office supplies with environmental features.

3. By March 31, 2014, 90% of vehicles purchased annually are right sized for operational needs and are the most fuel efficient vehicle in its class, as per the Health Canada Fleet Standard and/or are an alternative fuel vehicle.

Strategies and/or Comments

1. Rationale for target status: Health Canada exceeded the set target by March 31, 2014 of 90%. A total of 97% of vehicles purchased by Health Canada during 2013-14 were compliant with the Health Canada Fleet Standard and/or were an alternative fuel vehicle.
2. Tools and Resources: Annual reports were obtained through PWGSC and Automotive Resources International to identify new fleet acquisitions. The results were individually assessed against the Health Canada Fleet Standard and the PWGSC Departmental Individual Standing Offer listing for fleet vehicles to determine compliance.
3. Roles and Responsibilities: Heath Canada's Asset Management team provides policy support and oversight which contributed to the increased compliance with the Health Canada Fleet Standard.

As of April 1, 2011, each department will establish SMART targets for training, employee performance evaluations, and management processes and controls, as they pertain to procurement decision making. (Target 8.11 from 2010-13 FSDS)

Training for select employees

As of March 31, 2014, 100% of materiel management staff (including director/manager and staff levels identified as having procurement functions and responsibilities in their respective work plans), will receive green procurement training through the Canada School of Public Service (CSPC) course C215 or in-house equivalent.

Strategies and/or Comments

1. Tools and Resources: The Green Procurement Policy supports all designated employees (PG group) to take green procurement training.
2. Mandatory green procurement training is provided to new material management staff on an ongoing basis.
3. Rational for target status: As of March 31, 2014, 20 of 22 (91%) of designated employees had completed green procurement training. The 2 new employees still requiring formal green procurement training have included it in their Learning Plans for 2014-15.

Employee performance evaluations for managers and functional heads of procurement and materiel management.

As of March 31, 2014, 100% of managers and functional heads of procurement and materiel management will have greening of government operations included in their employee performance evaluations.

Phase 1a: As of April 1, 2011, employee performance evaluations for PG group directors and managers as it relates to GGO (including adherence to greening initiatives/directions/frameworks and standards by subordinates) will be incorporated into their employee performance evaluations.

Phase 1b: As of April 1, 2012 employee performance evaluations related to GGO will be included as part of the Corporate Commitments for Executives.

Phase 2: By April 1, 2013, employee performance evaluations for program and regional managers with procurement responsibilities/authorities related to GGO (including adherence to greening initiatives/directions/frameworks and standards by subordinates) will be included as part of their performance evaluations.

Strategies and/or Comments

1. Rationale for target status: In 2013-14 Greening of Government Operations discussions will be included in employee performance evaluations for managers and functional heads of procurement and materiel management. The exception would be any EX positions that are subject to a different contracting process and any vacant position.
2. Health Canada had included an environmental consideration measure in the executive performance agreements, however, as of April 1, 2013, Health Canada had adopted a more strategic approach to the EX performance management agreements by linking performance expectations to departmental plans and priorities, as a result the environmental consideration clause was removed.
3. During 2013-14, MAMD completed the majority of the transformation initiative that began in 2012-13, including the consolidation of 10 procurement offices from across Canada. The consolidated positions have migrated to Phase 1a of the strategy.

Management processes and controls.

By 2014, Health Canada will ensure that 100% of management processes and controls accommodate green procurement, as appropriate.

Strategies and/or Comments

1. As part of the Shared Services and transformation initiative (consolidation of 10 procurement offices from across Canada) governance, policies, processes, procedures, as well as, tools and templates were reviewed during FY 2013-14 to ensure that green procurement is accommodated. Health Canada has achieved the self-selected target in all completed programs.
2. Rationale for target status: Relevant management processes and control documents that accommodate green procurement are currently going through the approval process for inclusion on Health Canada's updated intranet site.

3. Sustainable Development Management System

Health Canada is committed to sustainable development and contributes to the FSDS by delivering on its vision:

Health Canada is committed to improving the lives of all of Canada's people and to making this country's population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system.

Implicit in this vision is the recognition that integrating environmental, economic and social factors into Health Canada's policy development and decision making processes plays an important role in minimizing or mitigating risks to human health for present and future generations.

Health Canada is managing and aligning sustainable development with its internal policy and operational processes through:

• its internal management structure;
• the application of analytical techniques; and,
• communication and outreach.

Internal management structure - Health Canada's Assistant Deputy Minister Champion of Sustainable Development leads processes and mechanisms, as required, to develop Health Canada's DSDS and to report on its implementation. Decisions about sustainable development and how such decisions are applied in the context of Health Canada's mandate are brought to Health Canada's senior executive committees for consideration and approval.

Health Canada contributes to the federal approach to sustainable development by participating in standing and ad hoc interdepartmental working groups and committees.

Application of analytical techniques - Successful integration of sustainable development into policies, plans and programs is supported by the use of analytical techniques and management practices that consider and incorporate environmental, social and economic objectives with the aim of preserving similar benefits for future generations.

The analytical techniques most commonly identified and used to inform decision-making and to manage risk include: cost-benefit analysis; public surveys; workshops; risk assessment; advisory committees; and literature and case analysis. Risk management is embedded into Health Canada's evidence-based decision-making processes and provides reasonable assurance that policy objectives and desired outcomes will be achieved. Health Canada's approach to risk management is informed by the 2010 Treasury Board Secretariat's Framework for the Management of Risks and by the precautionary principle.

Communication and outreach - Health Canada's Assistant Deputy Minister Champion of Sustainable Development plays an important role in communicating the Department's sustainable development and Strategic Environmental Assessment (SEA) objectives to departmental employees and other senior managers. Information about Health Canada's role in sustainable development is available on the Department's Intranet as well as in the Onboarding Guide, which is available to new Health Canada employees and provides general information about the Department, as well as federal employee rights and obligations.

4. Strategic Environmental Assessment

The  Cabinet Directive on the Environmental Assessment of Policy, Plan and Program Proposals outlines the obligations of departments and agencies to conduct  Strategic Environmental Assessment for policies, plans and programs destined for Cabinet approval that may have important environmental effects. The Guidelines for Implementing the Cabinet Directive on the Environmental Assessment of Policy, Plan and Program Proposals were revised in October 2010 and reflect the requirement to apply FSDS goals and targets when undertaking SEAs.

In 2013, Health Canada undertook a review of its 2011 SEA Policy in order to continue to strengthen the application of SEA by reinforcing the link to the Governments FSDS goals and targets when developing policies, plans and programs. The Department also provides annual training to departmental employees that focus on their roles and responsibilities regarding SEA as well as on the processes and requirements that are specific to the Department. To support the principle of making environmental decision-making more transparent, Health Canada continues to publicly report SEA results linked to the FSDS goals and targets by releasing a public statement of environmental effects when an assessment of environmental effects results in a Detailed Analysis.

The Health Canada SEA process was applied to 100% of proposals going to Cabinet for approval to determine if there were positive or negative environmental effects. This resulted in the completion of nine Preliminary Scans. Health Canada did not have any Detailed Analysis' in 2013-14.

Details on Transfer Payment Programs

Name of transfer payment program: Contributions for First Nations and Inuit Primary Health Care (Voted)

Start date: April 1, 2011

End date: Ongoing

Description:

The Primary Health Care Authority funds a suite of programs, services and strategies provided primarily to First Nations and Inuit individuals, families, and communities living on-reserve or in Inuit communities. It encompasses health promotion and disease prevention programs to improve health outcomes and reduce health risks; public health protection, including surveillance, to prevent and/or mitigate human health risks associated with communicable diseases and exposure to environmental hazards; and, primary care where individuals are provided diagnostic, curative, rehabilitative, supportive, palliative/end-of-life care, and referral services.

Strategic outcome(s):

First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status.

Results achieved:

• Improved ongoing access to health promotion/disease prevention programs and services;
• Increased community capacity to deliver community-based health promotion and disease prevention programs and services;
• Increased community capacity to manage and administer communicable disease control programs;
• Increased program and community capacity to address and mitigate environmental public health risks;
• Increased appropriate primary care services based on assessed need; and,
• Improved coordinated and seamless responses to primary care needs.

Comments on variances:

The planned spending of $719.0 million was increased by $12.2 million mainly to support First Nations and Inuit Health Programs and Services in approved authorities through Supplementary Estimates and decreased by $55.1 million mainly to support the implementation of the British Columbia (B.C.) Tripartite Framework Agreement. The actual spending was slightly less than anticipated. The variance between the actual spending and the total authorities is due to a lapse in the Indian Residential Schools Resolution Health Support special purpose allotment.

Audits completed or planned:

• Portfolio Audit and Accountability Bureau (PAAB) Audit of Transfer Payment for Public Health Protection: 2013-14;
• Office of the Auditor General (OAG) Audit of Federal Programs for Diabetes: 2012-13;
• OAG Audit of Emergency Management on Reserves: 2013-14;
• PAAB Audit of the Transfer Payments for First Nation and Inuit (FNI) Health Promotion & Disease Prevention: 2015-16; and,
• PAAB Audit of Transfer Payments for Home and Community Care: 2014-15.

Evaluations completed or planned:

• Healthy Child Development: 2009-10;
• Healthy Child Development: 2014-15;

• Mental Wellness: 2012-13;
• Mental Wellness: 2015-16;

• Healthy Living: 2011-12;
• Healthy Living: 2014-15;

• Communicable Disease Control and Management: 2010-11;
• Communicable Disease Control and Management: 2014-15;

• Environmental Health: 2010-11;
• Environmental Health: 2016-17;

• Clinical and Client Care: 2013-14;
• Clinical and Client Care: 2017-18;

• Home and Community Care: 2013-14; and,
• Home and Community Care: 2017-18.

Engagement of applicants and recipients:

Health Canada's First Nations and Inuit Health Strategic Plan provides overall guidance on where efforts need to be focused in the short, medium, and long term to improve First Nations and Inuit health outcomes over time. This Plan was developed collaboratively with First Nations and Inuit, provinces and territories (PT), other federal departments and health and social organizations to outline how Health Canada plans to move forward in fulfilling its core mandate of providing quality health services while strengthening its focus with key partners to advance mutual priorities for improved health. More specifically, the Strategic Goal 2: Collaborative Planning and Relationships will include better mechanisms for First Nations and Inuit to feed into Branch's planning and decision-making including contribution programs management and delivery. The Goal 2 includes two key elements:

2.1 Identify and advance shared priorities with First Nations, Inuit, other federal departments, PT, and other partners through culturally-appropriate collaborative planning and coordinated initiatives to improve health outcomes; and,

2.2 Support First Nations and Inuit in their aim to influence, manage and/or control health programs and services that affect them.

The Primary Health Care funding is provided mainly to First Nations and Inuit organizations through multi-year funding agreements. The level of flexibility in the management of health funding is determined by the interest and capacity of the funding recipient in assuming greater control over their health programming and planning.

As part of the Strategic Plan, Regional Transition Plans (initiated in 2012-13) will be implemented, which specifically set out how regions will organize themselves to better respond to local health needs/priorities. In addition, Regional Transition Plans will set out mechanisms to engage with local First Nations and Inuit and provincial and territorial partners (e. g., regional advisory bodies).

In order to streamline and reduce reporting and administrative burden associated with grants and contributions, the Branch will continue efforts to standardize recipient reporting, multi-departmental contribution agreements, processes, procedures requirements, and tools for transfer payment programs such as the joint Grants and Contributions Information Management System (GCIMS) project initiative between Health Canada, the Public Health Agency of Canada (PHAC) and Aboriginal Affairs and Northern Development Canada (AANDC).

Name of transfer payment program: Contributions for First Nations and Inuit Supplementary Health Benefits (Voted)

Start date: April 1, 2011

End date: Ongoing

Description:

The Non-Insured Health Benefits (NIHB) program provides coverage for a specified range of medically necessary health-related goods and services to registered Indians (according to the Indian Act) and Inuit (recognized by one of the Inuit Land Claim Organizations) regardless of residency in Canada where not otherwise covered under a separate agreement (e.g. a self-government agreement) with federal, provincial or territorial governments. The benefits under the NIHB Program include the following, where not otherwise provided to eligible clients through other private or provincial/territorial programs: pharmacy benefits (prescription drugs and some over-the-counter medication), medical supplies and equipment, dental care, vision care, short term crisis intervention, mental health counselling, and medical transportation benefits to access medically required health services not available on-reserve or in the community of residence.

Strategic outcome(s):

First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status.

Results achieved:

• Improved access to non-insured health benefits appropriate to the unique health needs of First Nations people and Inuit; and
• Efficiently managed access to non-insured health benefits.

Comments on variances:

The planned spending of $169.1 million was increased to a total authority of $204.0 million mainly due to approved authorities through Supplementary Estimates to support First Nations and Inuit Health Programs and Services. Actual spending was slightly less than anticipated as Supplementary Health Benefits expenditures is a demand driven program. The variance between actual spending and total authorities is due to a lapse in the Non-Insured Health Benefits special purpose allotment and in the Non-Insured Health Benefits-Qalipu special purpose allotment.

Audits completed or planned:

• PAAB Audit of NIHB Pharmacy: 2011-12;
• PAAB Follow-up Audit of NIHB Medical Transportation: 2012-13; and,
• PAAB Audit of FNIHB - Vision Care, Medical Supplies, Mental Health: 2013-14.

Evaluations completed or planned:

• Supplementary Health Benefits for First Nations and Inuit: 2010-11; and,
• Supplementary Health Benefits for First Nations and Inuit: 2015-16.

Engagement of applicants and recipients:

Health Canada's First Nations and Inuit Health Strategic Plan provides overall guidance on where efforts need to be focused in the short-, medium-, and long-term to improve First Nations and Inuit health outcomes over time. This Plan was developed collaboratively with First Nations and Inuit, PT, other federal departments and health and social organizations to outline how Health Canada plans to move forward in fulfilling its core mandate of providing quality health services while strengthening its focus with key partners to advance mutual priorities for improved health. More specifically, the Strategic Goal 1: High Quality Health Services will emphasize quality improvement, strengthen access to services and adapt programs to ensure access to health services. Of the four key elements outlined in Goal 1, the following is directly related to Supplementary Health Benefits:

1.2 Support access to a comprehensive range of quality services and medically necessary health products and benefits.

Additionally, the Strategic Goal 3: Effective and Efficient Performance will improve availability of, and access to, high quality data, manage cost-effective and evidence-based supplementary health benefits, streamline and harmonize administrative processes and leverage work with other government departments. Of the four key elements outlined in Goal 3, the following is directly related to Supplementary Health Benefits:

3.2 Efficient management of cost-effective and evidence-based supplementary health benefits that contribute to improving the health status of First Nations and Inuit in Canada.

As part of the Strategic Plan, Regional Transition Plans (initiated in 2012-13) will be implemented, which specifically set out how regions will organize themselves to better respond to local health needs/priorities. In addition, Regional Transition Plans will set out mechanisms to engage with local First Nations and Inuit and provincial and territorial partners (e. g., regional advisory bodies).

Name of transfer payment program: Contributions for First Nations and Inuit Health Infrastructure Support (Voted)

Start date: April 1, 2011

End date: Ongoing

Description:

The Health Infrastructure Support Authority underpins the long-term vision of an integrated health system with greater First Nations and Inuit control by enhancing their capacity to design, manage, deliver and evaluate quality health programs and services. It provides the foundation to support the delivery of programs and services in First Nations communities and for individuals, and to promote innovation and partnerships in health care delivery to better meet the unique health needs of First Nations and Inuit.

The funds are used for: planning and management for the delivery of quality health services; construction and maintenance of health facilities; research activities; encouraging Aboriginal people to pursue health careers; investments in technologies to modernize health services; and integrate and realign the governance of existing health services.

Strategic outcome(s):

First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status.

Results achieved:

• Improved quality in the delivery of programs and services;
• Provided safe health facilities that supported health program delivery;
• Promoted engagement of key stakeholders in Aboriginal health in the integration of health services; and,
• Improved access to health information.

Comments on variances:

The planned spending of $212.9 million was increased by $187.1 million in approved authorities through Supplementary Estimates to support the implementation of the British Columbia (B.C.) Tripartite Framework Agreement and increased by $82.9 million in transferred authorities from other programs to support B.C. Tripartite, arriving at a total authority of $482.9 million.

Audits completed or planned:

• PAAB Audit of FNI Health System Capacity: 2016-17.

Evaluations completed or planned:

• Health Planning and Quality Management: 2011-12;
• Health Planning and Quality Management: 2016-17;

• B.C. Tripartite Initiative 2017-18;

• Health Human Resources: 2013-14;

• Health Facilities: 2011-12;
• Health Facilities: 2016-17;

• Health Services Integration Fund: 2015-16;

• e-Health Infostructure: 2011-12;
• e-Health Infostructure: 2016-17; and,

• Nursing Innovation: 2013-14.

Engagement of applicants and recipients:

Health Canada's First Nations and Inuit Health Strategic Plan provides overall guidance on where efforts need to be focused in the short-, medium-, and long-term to improve First Nations and Inuit health outcomes over time. This Plan was developed collaboratively with First Nations and Inuit, PT, other federal departments and health and social organizations to outline how Health Canada plans to move forward in fulfilling its core mandate of providing quality health services while strengthening its focus with key partners to advance mutual priorities for improved health. More specifically, the Strategic Goal 2: Collaborative Planning and Relationships will include better mechanisms for First Nations and Inuit to feed into Branch's planning and decision-making including contribution programs management and delivery. The Goal 2 includes two key elements:

2.1 Identify and advance shared priorities with First Nations, Inuit, other federal departments, PT, and other partners through culturally-appropriate collaborative planning and coordinated initiatives to improve health outcomes; and

2.2 Support First Nations and Inuit in their aim to influence, manage and/or control health programs and services that affect them.

The First Nations and Inuit Health Infrastructure funding is provided mainly to First Nations and Inuit organizations through multi-year funding agreements. The level of flexibility in the management of health funding is determined by the interest and capacity of the funding recipient in assuming greater control over their health programming and planning.

As part of the Strategic Plan, Regional Transition Plans (initiated in 2012-13) will be implemented, which specifically set out how regions will organize themselves to better respond to local health needs/priorities. In addition, Regional Transition Plans will set out mechanisms to engage with local First Nations and Inuit and provincial and territorial partners (e. g., regional advisory bodies).

In order to streamline and reduce reporting and administrative burden associated with grants and contributions, the Branch will continue efforts to standardize recipient reporting, multi-departmental contribution agreements, and standardization of processes, procedures requirements, and tools for transfer payment programs such as the joint GCIMS project initiative between Health Canada, the PHAC and AANDC.

Name of transfer payment program: Grant for Territorial Health System Sustainability Initiative (THSSI)

Start date: April 1, 2010

End date: 2014

Description:

In 2011 the Government announced that the Territorial Health System Sustainability Initiative funding was being further extended by $60 million over a period of two years (2012-14). Funds being allocated for this period will support time-limited initiatives in key health system reform areas:

• Developing mental health and chronic disease management strategies;
• Addressing human resource gaps in the health field;
• Strengthening system performance measurements, monitoring and reporting; and,
• Implementing strategies to realize further efficiencies in medical transportation system.

The Territorial Health System Sustainability Initiative is divided into the following three funds:

• Territorial Health Access Fund intended to: reduce reliance over time on the health care system; strengthen community level services; and build self-reliant capacity to provide services in-territory;
• Operational Secretariat Fund intended to support the functioning of a Federal/Territorial Assistant Deputy Ministers Working Group to guide the implementation of the initiative; fund several Pan-Territorial projects; and provide Territorial governments with capacity to manage THSSI commitments; and,
• Medical Travel Fund - to offset or help pay for expenses related to or incurred in the course of providing or paying for medical transportation.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

The THSSI assisted the three territories to consolidate progress made under the THSSI in reducing the reliance on outside health care systems and medical travel. For territories, this included consolidating projects that have achieved their goals and integrating projects with an ongoing mandate into territorial core business.

Comments on variances: N/A

Audits completed or planned: N/A

Evaluations completed or planned:

• Medical Travel Fund - 2009; and,
• Territorial Health Access Fund and Operation Secretariat Fund Summative Evaluation - 2010.

Engagement of applicants and recipients:

Health Canada officials worked collaboratively with Territorial Governments via the Federal/Territorial Assistant Deputy Ministers' Working Group (F/T ADM WG) to ensure the successful completion of the current THSSI. The F/T ADM WG provided a forum to discuss strategic opportunities, share best practices, and discuss issues of mutual interest. This included the engagement of Territorial Governments in the development of pan-Territorial projects aimed at ensuring the long-term sustainability of the health system in the North.

Name of transfer payment program: Contribution to the Canadian Patient Safety Institute (Voted)

Start date: December 10, 2003

End date: Ongoing

Description:

The Canadian Patient Safety Institute (CPSI) is an independent not-for-profit corporation mandated to provide leadership and coordinate the work necessary to build a culture of patient safety and quality improvement throughout the Canadian health system. CPSI promotes leading ideas and best practices, raises awareness and provides advice on effective strategies to improve patient safety.

CPSI's first two grant agreements provided financial assistance to help it support implementation of the commitments governments made under the 2003 First Ministers' Accord on Health Care Renewal related to improving health care quality by strengthening system co-ordination and improving national collaboration related to patient safety. Funding is now delivered through a five-year contribution agreement, covering April 1, 2013 to March 31, 2018. For 2013-2018, CPSI will focus and align its activities with a new emphasis on the strategic goals that are most likely to drive further system-level transformation over the five-year period, and beyond.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

To continue to fulfill its mandate, CPSI focused on its strategic goals of: inspiring and sustaining patient safety knowledge within the system, and through innovation, enabling transformational change; building and influencing patient safety capability at organizational and systems levels; engaging all audiences across the health system in the national patient safety agenda; and providing leadership on the establishment of a National Integrated Patient Safety Strategy. In 2013-14, key results achieved included:

• The Safer Healthcare Now! campaign now has over 950 organizations throughout the country implementing evidence-based interventions known to reduce risk for patient harm in areas such as medication reconciliation, infection prevention and control, and surgical safety;
• Over 2,000 participants registered for Canadian Patient Safety Week 2013, a national annual campaign started in 2005 to inspire improvement in patient safety and quality by highlighting patient safety issues, sharing information about best practices, and expanding patient safety and quality initiatives;
• Training was delivered to increase capacity in local organizations through programs such as the Effective Governance for Quality and Patient Safety educational program for health care leaders, the Patient Safety Education Program-Canada, the Advancing Safety for Patients in Residency Education (ASPIRE) program and through the opportunities provided to the more than 1,900 sites and 5,800 viewers of Canada's Virtual Forum on Patient Safety and Quality Improvement;
• Targeted patient safety research was funded, including collaborations with partners to support research in the area of patient safety in the home care sector;
• Continued implementation of a Global Patient Safety Alerts system, which provides an ongoing resource of actionable information on specific patient safety incidents, and release of an App to allow mobile access to the system; and,
• Work began to develop a National Integrated Patient Safety Strategy, which will include a framework for identifying patient safety priorities and aligning CPSI's work with the activities of other organizations working to achieve patient safety improvement in Canada. The National Integrated Patient Safety Strategy will initially target the four clinical priority areas of surgical care safety, medication safety, infection prevention and control, and home care safety.

Comments on variances: N/A

Audits completed or planned:

CPSI's financial records are reviewed and audited annually by independent external accountants.

Evaluations completed or planned:

Health Canada conducted a synthesis evaluation involving this program that was completed in 2013-14.

Engagement of applicants and recipients:

To ensure the CPSI funding agreement is managed in an appropriate and efficient manner, Health Canada officials regularly engage with CPSI. In addition, the Department nominates one representative to CPSI's Board of Directors, and participates as a Voting Member of the corporation.

Name of transfer payment program: Grant to the Health Council of Canada (Voted)

Start date: September 1, 2004

End date: June 30, 2014

Description:

The Health Council of Canada (the Council) was established by First Ministers in the 2003 Accord on Health Care Renewal with the mandate to report on jurisdictional progress in meeting Accord commitments. The Council's mandate was expanded by First Ministers in the 2004 Health Accord to report on health outcomes and the health status of Canadians. In 2010, the Council's mandate was reconfirmed through Future Directions for the Health Council of Canada by participating federal, provincial and territorial Ministers of Health in their role as Corporate Members of the Council.

Note: Given that the Council's mandate was tied to the Accords and the 2004 Accord ending in 2014, the Government decided to wind down federal funding for the Council over two years (i.e., 2013-14 and 2014-15). Subsequently, the Council formally closed its operations on June 30, 2014.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

To continue to fulfill its mandate, the Council undertook a wide variety of projects, released associated public reports and undertook supporting promotional activities. For example, in 2013-14 the Council:

• Released Progress Report 2013: Health Care Renewal in Canada examining progress made in five Accord priority areas (access and wait times; primary health care reform and electronic health records; pharmaceuticals management; disease prevention, health promotion and public health; and, Aboriginal health) in consultation with experts, stakeholders and federal, provincial and territorial officials;
• Released the corporate annual report, Health Council of Canada Annual Report 2012-13: Shining a Light on Health Innovation;
• Developed and released a report concerning healthcare reform entitled, Better health, better care, better value for all: Refocusing health care reform in Canada;
• Developed and released a report on health of Aboriginal seniors entitled, Canada's most vulnerable: Improving health care for First Nations, Inuit, and Metis seniors;
• Conducted the National Symposium on quality improvement (Towards a High-Performing Health Care System: The Role of Canada's Quality Councils), and released a report of the symposium proceedings entitled Canada's Quality Improvement Conundrum: Should Canada achieve a whole that is greater than the sum of its parts?
• Developed and released a report on results of the 2013 Commonwealth Fund International Health Policy Survey of the General Public entitled, Where you live matters: Canadian views on health care quality;
• Developed and released a report on screening entitled, Better coordination of screening in Canada: What is the best way forward?; and,
• Developed and released a final progress report entitled, Progress timeline 2003-2013: Highlights of health care reform.

Comments on variance(s):

The Government decided to wind down the federal funding for the Council over two years. The Council was allocated a budget up to $6.5 million in 2013-14 versus the original planned spending of $8.0 million. Given that the Council had a surplus of $0.5 million in 2012-13, Health Canada provided the Council with $6.0 million for 2013-14.

Audits completed or planned:

The Council's financial records are reviewed and audited annually by independent external accountants.  Audited financial statements can be found on the following site: http://www.healthcouncilcanada.ca - which is hosted on the Carleton University Library.

Evaluations completed or planned:

As per the Funding Agreement, the Council conducted an independent evaluation and submitted its final report on September 24, 2013.

Also, Health Canada conducted a synthesis evaluation involving this program that was completed in 2013-14.

Engagement of applicants and recipients:

The Health Council of Canada engaged with participating federal, provincial and territorial (F/P/T) jurisdictions (all, with the exception of Québec), on a regular basis. As Council's Corporate Members, the Ministers of Health of the participating jurisdictions engaged throughout the planning and implementation of the Council's activities, including the review and approval of the annual work plan and budget. Further, the Council engaged with F/P/T officials and consulted with them, on an ongoing basis, in reviewing and providing comments on project charters, and other materials as appropriate.

Name of transfer payment program: Contribution to the Canadian Institute for Health Information (Voted)

Start date: April 1, 1999 (the current agreement expires on March 31, 2015. Negotiations for a new agreement are underway).

End date: Ongoing

Description:

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization supported by federal, provincial and territorial governments that provides essential data and analysis on Canada's health system and the health of Canadians. CIHI was created in 1991 by the Federal/Provincial/Territorial Ministers of Health to address significant gaps in health information. CIHI's data and its analyses respond to questions about Canada's health systems and assist a variety of stakeholders, including funders, policy makers, health system managers, analysts, clinicians and researchers, in making informed decisions.

Since 1999, the federal government has provided funding to CIHI through a series of grants and conditional grants, known as the Roadmap Initiatives. More recently CIHI's funding has been consolidated through the Health Information Initiative, and is currently delivered through a contribution agreement. This combined funding has allowed CIHI to produce quality and timely health information ranging from health care system capacity, wait times data to the development of pan-Canadian health indicators. The Health Information Initiative extended funding to CIHI for their 2012-15 Plan: Better data. Better decisions. Healthier Canadians. Under this funding agreement, up to $238.7 million is to be delivered to CIHI over three fiscal years (2012-13 to 2014-15).

Strategic outcome:

A Health System Responsive to the Needs of Canadians.

Results achieved:

In 2013-14, CIHI continued to make progress in producing more and better data, more relevant and actionable analysis, and improved client understanding and use of CIHI data and information products. The following are selected highlights from the President's Quarterly Reports, and are accurate as of June 30, 2014. More detailed information on results achieved for 2013-14 will be available once the CIHI Annual Report is released in mid-July 2014.

Improving the Comprehensiveness, Quality and Availability of Data

There has been solid progress in data collection, especially surrounding the comprehensiveness and availability of CIHI data holdings. Progress has been made most notably in:

• Canadian Multiple Sclerosis Monitoring System (CMSMS):
  • Participation in CMSMS increased in 2013-14; production data submissions from Saskatchewan and Alberta are being received. The Calgary MS Clinic submitted production data for 2009 and planned to submit data on an ongoing basis. In addition, two new resources were published for data providers -- Canadian Multiple Sclerosis Monitoring System Data Elements by Reporting Requirement and the booklet, Important information about the Canadian Multiple Sclerosis Monitoring System for people living with MS.
    
• Joint Replacement (CJRR):
  • CIHI received notification that starting May 1, 2014, Regina Qu'Appelle Health Region in Saskatchewan will be submitting CJRR data on behalf of facilities in the region; and,
  • The 2014 CJRR annual report, containing the latest two fiscal years of data on hip and knee replacements (up to 2012-13), was released in June 2014. CJRR coverage for 2012-13 was 74% nationally.
    
• Pharmaceutical:
  • CIHI purchased four years of aggregate data by drug class and payer (i.e. public, private, out of pocket) from IMS Brogan to support Pharmaceuticals and other analytic activities at CIHI and for work related to Organisation for Economic Cooperation and Development (OECD) drug indicators.
    
• Canadian Organ Replacement Registry (CORR):
  • New CORR centre-specific reports on clinical measures, based on 2010-12 data were released in January 2014; and,
  • The CORR annual report (2012 data), supporting infographic and data tables were released on February 25, 2014. Analyses based on 2012 CORR data were presented at the Canadian Society of Transplantation annual conference in February 2014. Additional analyses were presented at the Canadian Society of Nephrology Conference in April 2014.
    
• Home and Continuing Care:
  • The standards for Continuing Care Reporting System, Home Care Reporting System and Ontario Mental Health Reporting System (OMHRS), the interRAI Assessment Instruments, received Canadian Approved Standard (CAS) designation through the Standards Collaborative; and,
  • eTraining modules were developed to support transition to the new interRAI instruments in home care and long-term care.
    
• Mental Health and Rehabilitation:
  • The Mental Health and Addictions Data and Information Guide was released on March 18, 2014 to help individuals and health care organizations access mental health and addictions information available at CIHI through its data holdings and publicly available products.

In addition, CIHI has improved the timeliness of data holdings. With a few exceptions, the majority of their data is between one and two years old.

Support population health and health system decision-making

• Health System Performance (HSP) Measurement:
  • Data for the Collaborating for Excellence in Healthcare Quality (CEHQ) Mobile App was refreshed on January 9, 2014;
  • The Cardiac Care Quality Indicators usage survey was sent to cardiac centres, external advisory group and other stakeholders in February 2014;
  • The post-course web conference for the pilot HSP School was held on February 24, 2014. Toronto (rural participants) and Winnipeg were chosen for the two HSP schools to be held in 2014-15;
  • Indicators and supporting information, website wireframes and a communication plan were created for the HSP interactive facility/regional website project. The release date for the website is planned for September 2014; and,
  • The first phase of the Canadian Hospital Experiences Survey project was finalized in May 2014 and all documentation about the minimum dataset and the survey for the inpatient experiences survey is now available on our website. Funding to support this project was approved by the provinces of B.C., Alberta, Manitoba and Ontario and the project has entered into its second phase focusing on developing a database supporting data collection at a national level.
    
• Partnerships:
  • An agreement was signed with Statistics Canada for the collection of residential long-term care facilities data for 2012-13; and,
  • Initial meetings were held with the newly formed Mental Health Information Collaborative, which includes participation from CIHI, Mental Health Commission of Canada, PHAC and Statistics Canada.
    
• International Comparisons and Benchmarking:
  • The final Canadian diabetes and cardiovascular disease questionnaire was sent to the OECD Health Care Quality Indicator group on February 10, 2014;
  • Review and fact-checking were completed to support the OECD report from the OECD medical practice variations project;
  • CIHI has taken the lead to develop a comparable indicator of potentially avoidable hospitalizations for Ambulatory Care Sensitive Conditions for OECD countries. A one-page project description has been developed and approved by the Health Care Quality Indicators Expert Committee; and,
  • CIHI acquired responsibility for the Commonwealth Fund Survey data collection and reporting from the (former) Health Council of Canada. The Commonwealth Fund's 2014 International Health Policy Survey will examine perceptions and experience with health care of adults ages 55 and older in 11 countries. As the new national Canadian partner for the survey (together with Canadian Institutes of Health Research (CIHR) and Health Canada), CIHI worked with participating provincial partners to ensure samples would be large enough for reporting by province, and that questions would be adjusted or added to meet Canadian information needs. More than 5,000 Canadians were surveyed between March and May 2014.

Deliver organizational excellence

Some notable achievements from the last year include:

• The five modules of the LEADS learning series, (Lead self, Engage others, Achieve results, Develop coalitions and Transform systems), were delivered to the management team. Additional offerings of the Lead self-module were delivered to interested staff in Ottawa and Toronto;
• Lean projects were completed for pension statements; DAD operational processes; and, streamlining and standardization of the external data request process. A new policy for the release of preliminary and final data for custom data request program was developed and implemented. A number of new Lean initiatives are underway;
• CIHI's social media presence continued to grow and at the end of 2013-14, CIHI's Twitter site had registered over 7,600 followers; and,
• All applicable security controls were implemented for the International Organization for Standardization ISO 27001 implementation project and the information system management system (ISMS) was transitioned to operational mode.

Comments on variance(s): N/A

Audits completed or planned:

An independent performance audit of the Health Information Initiative (HII) is now underway with expected completion before March 31, 2015. The audit will assess CIHI's operations to determine the economy, efficiency and, effectiveness of HII programming.

Evaluations Completed or Planned:

The Office of Evaluation is currently evaluating the relevance and performance of the HII for the period of 2012-15, as required by the contribution agreement. The evaluation is scheduled to be completed by December 2014 in anticipation of a new funding agreement to come into effect on April 1, 2015.

The previous evaluation by the Office of Evaluation, released in June 2013, confirmed that HII objectives, mandate and activities were aligned and consistent with Health Canada objectives, federal government priorities and the federal role in the development of pan-Canadian health data.

Engagement of applicants and recipients:

None needed. CIHI is the sole recipient of HII funding as per the terms and conditions of the HII, which stipulates that CIHI is the only recipient of HII funding.

Name of transfer payment program: Grant to support the Mental Health Commission of Canada (Voted)

Start date: April 1, 2008

End date: March 31, 2017

Description:

As part of Budget 2007, the Government of Canada announced funding for the establishment of a Mental Health Commission of Canada (MHCC), an independent, arm's length organization, with a mandate to act as a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

The MHCC has made significant progress since 2007, and has become a valuable source of expertise, advice, programs and policies in the mental health field. In 2013-14, priority areas and achievements of the MHCC included:

Health system improvement

• Worked with all levels of government, health professionals and other stakeholders to support continued implementation of Changing Directions, Changing Lives, Canada's first national mental health strategy (released by the MHCC in May 2012).

Mental health education and mental illness anti-stigma

• Released an interim report outlining the research findings to date under Opening Minds, the MHCC's national mental illness anti-stigma initiative, as well as details on how research is being applied to programs across the country;
• Developed and launched a national youth anti-stigma campaign, including a national youth summit planned for November 2014; and,
• Developed a new anti-stigma/mental health education program in collaboration with the Department of National Defence (DND), based on DND's highly successful “Road to Mental Readiness (R2MR) program.” This new program was piloted tested in a variety of sectors across Canada.

Information sharing

• Launched the “Collaborative Spaces” section of the MHCC website to provide a space for the mental health community to discuss topics of interest, share resources and links, and highlight important events that are happening throughout Canada; and,
• Hosted, as part of the Knowledge Exchange Centre, the second Supporting the Promotion of Activated Research and Knowledge (SPARK) Training Workshop in July 2013. SPARK workshops are designed to help participants learn techniques for moving evidence-informed research and knowledge from the fields of mental health, substance use and addictions more quickly into practice.

Suicide prevention

• Continued to support the Government of Canada's Federal Framework for Suicide Prevention by providing guidance and advice on implementation.

Workplace mental health

• Implemented the National Standard for Psychological Health and Safety in the Workplace (“the Standard”). Since its launch in 2013, the Standard has been downloaded over 16,000 times and is being implemented in major organizations across Canada including Bell Canada and several federal departments; and,
• Continued to provide Mental Health First Aid training to staff in multiple sectors and across multiple private sector industries. As of March 31, 2014, approximately 100,000 people had been trained in Canada.

Mental health and homelessness

• Completed the At Home/Chez Soi research project on mental illness and homelessness, and published all findings. The project was highly successful in identifying effective health and social interventions for homeless persons with mental illness and its findings are being adopted by provincial and federal housing initiatives (e.g., the Government of Canada's Homelessness Partnering Strategy).

Further information on these initiatives can be found on the  MHCC's website at www.mentalhealthcommission.ca

Comments on variances: N/A

Audits completed or planned:

As specified in the funding agreement, the MHCC must submit independently audited financial statements to Health Canada each fiscal year. Also required is an Annual Report detailing activities conducted and outcomes achieved. These reports are due to Health Canada no later than 120 days after the end of the fiscal year (i.e., July 29).

Evaluations completed or planned:

An independent evaluation of the MHCC was completed in FY 2011-12.
A synthesis evaluation identifying common findings and recommendations from previous reviews of several Health Canada funding agreements, including the MHCC's 2011-12 evaluation, was completed in fiscal year 2013-14. This synthesis evaluation is being used to better align departmental funding practices, processes and strategies across the funding recipients examined.

A relevance and performance evaluation, conducted by Health Canada, is planned for fiscal year 2015-16.   

Engagement of applicants and recipients:

MHCC is the sole recipient of the grant. Health Canada monitors the recipient's compliance with the funding agreement through the analysis of corporate documents and has regular correspondence with senior management of the organization.

Name of transfer payment program: Canada Brain Research Fund to Advance Knowledge for the Treatment of Brain Disorders (Voted)

Start date: April 1, 2011 (actual funding received Supplementary Estimates C 2012)

End date: March 31, 2017

Description:

The Canada Brain Research Fund (CBRF) is managed by Brain Canada, an organization dedicated to advancing cutting-edge brain research. Announced in Budget 2011, the Government of Canada is providing up to $100 million in funding to match non-governmental donations over six years. The purpose of the Canada Brain Research Fund program is to bring together teams of scientists specializing in different disciplines to identify common mechanisms for repair, restructuring, remodeling and recovery of brain functions, and to translate this knowledge into brain repair and recovery that can apply to many different diseases and disorders of the brain and nervous system.

Specifically, the CBRF serves two functions:  it is a focal point for private investment in brain research, and attracts investment by matching private donations with Government of Canada funding through grants to researchers. The Fund will also support research that advances knowledge of the brain and that promises developments in diagnostics and therapies for Canadians who live with, or will develop, neurological disorders.

Through open competition and rigorous Canadian and international peer review, Brain Canada funds three types of grants aimed at collaboration and accelerating the pace of discovery: (a) transformative multi-investigator grants in brain research; (b) national neuroscience technology platforms; and (c) fellowships to train the next generation of researchers.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

Brain Canada continued to build on its activities and progress from the first year. Highlights include:

• Approved funding for 10 Multi-investigator Research Initiative (MIRI) grants;
• Launched an expression of interest for the first set of grants supporting enhanced technical and research capability for brain researchers;
• Launched a request for applications for the 2013-14 MIRI Sponsored Opportunity Program;
• Initiated and/or confirmed partnerships for co-funded MIRI projects with the following partners:
• Genome BC;
• Michael Smith for Health Research Foundation;
• Pacific Alzheimer's Research Foundation;
• Alberta Innovates;
• Hotchkiss Institute;
• Canadian Cancer Society;
• Alberta Prion Research Institute;
• Alzheimer's Society of Alberta and Northwest Territories; and,
• Campus Alberta Neuroscience to provide a total of $3 million to one MIRI.
• Increased outreach and visibility of Brain Canada to donors and partners, as well as media; and,
• Continued to ramp up fundraising.

Comments on variances:

As per the terms of the agreement, actual spending for 2013-14 represents the amount of private funds raised by Brain Canada in 2012-13 and matched by the Government of Canada.

Audits completed or planned:

As specified in the funding agreement, Brain Canada must submit independently audited financial statements to Health Canada each calendar year. Also required is an Annual Report detailing activities conducted and outcomes achieved. These reports are due to Health Canada no later than February 28 of the year following the calendar year being reported on.

Evaluations completed or planned:

As per the funding agreement Brain Canada will conduct an independent evaluation of the activities of the Canada Brain Research Fund that will measure relevance and performance (effectiveness, efficiency, economy) in achieving immediate-, intermediate-, and long-term outcomes identified in the evaluation framework. Brain Canada will make the evaluation report available to the Minister no later than September 30, 2016.

Engagement of applicants and recipients:

Brain Canada is the sole recipient of the contribution. Health Canada monitors the recipient's compliance with the contribution agreement through the analysis of corporate documents and has regular correspondence with senior management of the organization.

Name of transfer payment program: Contribution to the Canadian Agency for Drugs and Technologies in Health (Voted)

Start date: April 1, 2008

End date: Ongoing

Description:

The Canadian Agency for Drugs and Technologies in Health (CADTH) is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments to provide credible, impartial and evidence-based information about the cost-effectiveness and optimal use of drugs and other health technologies to Canadian health care decision makers.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

The purpose of the Named Grant is to provide financial assistance to support CADTH's core business activities, namely, the Common Drug Review (CDR), Health Technology Assessments (HTA) and Optimal Use Projects. Results include: creation and dissemination of evidence-based information that supports informed decisions on the adoption and appropriate utilization of drugs and non-drug technologies, in terms of both effectiveness and cost.

Comments on variances: N/A

Audits completed or planned:

Audit completed by the Portfolio Audit and Accountability Bureau in November 2012. The objectives of the audit were to determine whether the Strategic Policy Branch (SPB) has put in place an effective management control framework for the oversight and management of the funding agreement; and whether CADTH has complied with the terms and conditions of the funding agreement.

Evaluations completed or planned:

In 2011, CADTH underwent a two-phased independent evaluation to determine the performance to date of CADTH's three core activities and other program areas; the current state of CADTH's multi-phase organizational transformation; and the findings to make supporting recommendations to improve the impact of CADTH's customer offerings. Health Canada also conducted a synthesis evaluation involving this program that was completed in 2013-14.

Engagement of applicants and recipients:

CADTH has produced numerous products and services including health technology reports, optimal use projects, environmental scans, therapeutic reviews and formulary listing recommendations. These deliverables provide guidance and evidence-based information to health care decision-makers regarding the cost-effectiveness and optimal use of health technologies. In particular, the formulary listing recommendations increases transparency across jurisdictions and provides consistency to pharmaceutical reimbursement decisions made by the participating public drug plans.

Name of transfer payment program: Drug Treatment Funding Program (Voted)

Start date: April 2008 - Systems component

End date: Ongoing - Systems component

A one year extension of the terms and conditions was received, which expired March 31, 2014.

Description:

Drug Treatment Funding Program (DTFP), under the National Anti-Drug Strategy, provides $13.2 million in financial support annually to provincial and territorial governments and non-government organizations to strengthen drug treatment systems.

Strategic outcome(s):

Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

Results achieved:

In 2013-14 a comprehensive review and analysis of project evaluation reports was completed. This review confirmed program evaluation findings reported last fiscal year that the DTFP was successful in contributing to most of its outcomes.

Collaboration continues to be a key aspect and success of the DTFP program. All projects reported working collaboratively either within their own jurisdiction and/or with other DTFP projects. In many PT, collaboration helped lead to the development of provincial guidelines or standards which helped increase awareness of discrepancies and inconsistencies in practices as well as increase the use of common language amongst health sectors such as addictions and mental health. DTFP funding has resulted in the development of 34 evidence-informed standards/guidelines/best practices on a range of topics including addictions treatment, withdrawal management, concurrent disorders, costing, residential support services, brief and social detox programs and medication administration and management. These tools are beginning to be implemented in PT, thus resulting in uptake of evidence-informed treatment practices. For example, the needs-based planning model (NBP) utilized by the national project led by the Centre on Addiction and Mental Health (CAMH) found that the evidence-based model was being adopted into practice in areas such as Ontario, Québec and Prince Edward Island.

The review of project reports also showed that treatment systems on a whole were beginning to be strengthened by improving consistencies within the treatment system and making changes in policies/practices. These two themes were underlined with a culture shift beginning to happen in many projects towards valuing and using evidence to inform practices resulting in more systematic training of staff, increased awareness of staff and management of best practices and the need for performance measurement and more accessible data. Many of the system level improvements, such as improvements in collaboration, development and implementation of evidence-informed practices and improving performance measurement and evaluation capacity has led to improvements in actual treatment services. For example, in Prince Edward Island, the DTFP review of their treatment system and their participation in the national NBP project led by CAMH, helped lead the Government to invest $1.2 million in the creation of new programs and services for addictions, including increased residential support for early recovery and support for transitions between services and complex cases.

Comments on variance(s):

DTFP has an annual budget of $13.2 million. In 2013-14, the program spent $13.5 million. $0.3 million was reallocated to this program as the DSCIF had a surplus. The additional funding allowed for greater progress on project activities.

Audits completed or planned:

No audits conducted.

Evaluations completed or planned:

An evaluation assessing relevance and performance was conducted in 2012-13. The final report was approved in 2013-14. DTFP will participate in the next scheduled evaluation of the National Anti-Drug Strategy in 2016-17 and their next program evaluation is scheduled in 2017-18.

Engagement of applicants and recipients:

DTFP continued to engage recipients through various channels. Recipients participated in the Final DTFP Program Evaluation and provided valuable feedback regarding the need for and content of the program. Program consultants worked regularly with recipients to monitor contribution agreements and obtain required performance and evaluation reports. Teleconferences and email contact was used to engage and inform applicants about funding for 2013-14 and continuation of the program. PT were engaged in order to obtain their input on priorities for the new call for proposals and their option on what organizations should be included as part of the national call.

Name of transfer payment program: Drug Strategy Community Initiatives Fund (Voted)

Start date: April 2004

End date: Ongoing

Description:

The Drug Strategy Community Initiatives Fund (DSCIF) will contribute to reducing illicit drug use among Canadians, particularly among vulnerable populations such as youth, by focusing on health promotion and prevention approaches to address drug abuse before it happens. The objectives of the DSCIF are to facilitate the development of local, provincial, territorial, national and community-based solutions to drug use among youth and to promote public awareness of illicit drug use among youth. The Program is delivered nationally.

Strategic outcome(s):

Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

Results achieved:

Program-led performance measurement and evaluation activities continue to show that DSCIF projects are showing positive results and that the program is reaching their target population. Over 141,000 youth, 11,300 parents and 2,100 workers/schools have been reached through DSCIF to date. Results from the program cluster evaluation became available in 2013-14 and concluded that the program was successful in achieving three of its intended outcomes - increased awareness of illicit drugs, improved youth capacity to avoid illicit drugs and increased community engagement. Due to the timing of the standardized tools being ready and funding agreements, there were two different methodologies used in this evaluation. Data from cohort one projects (those funding through the 2007 call for proposals) was based on tools selected by each project whereas cohort two projects (those funding through the 2008-09 call for proposals) used standardized tools to assess outcomes across projects.

67% of cohort one projects reporting on awareness of illicit drugs and their negative consequences reported that their project resulted in an increase in participants' level of awareness and/or understanding of illicit drugs and their effects on individuals including health, family, peers, school and community. Youth from cohort two projects reported a small but statistically significant change in their overall awareness of illicit drugs, the effect drug use has on personal health, school performance, work performance, crime, relationships with friends, relationships with families and community, factors influencing decisions to use and not use illegal drugs and of the potential problems that can affect people who use illegal drugs has increased.  

83% of cohort one projects reported that their project resulted in an increase in participants' level of skills - coping, avoidance and resistance. Positive findings included increased coping skills, new skills in relationship building, development of supportive interactions, positive attitudinal shifts, increased skills in facilitation techniques, greater abilities to engage in prevention and educational discussions, improvement in family change variables, family functioning, parenting, communication and organization. Additionally, 91% (n=19) of projects reported that their project resulted in an increase in participants' level of resilience - self efficacy and access to supports.

Although there was no significant differences for cohort two projects related to self-esteem, leadership or communication skills, youth in cohort two projects did show statistically significant changes in their intention to try, or use regularly marijuana or other illicit drugs. There was also small but significant differences related to youth likelihood to use various strategies to avoid illicit drugs.

Nearly every DSCIF project was able to report on the outcome related to community engagement. In cohort one projects, 97% of projects reported positive findings with respect to engagement of existing community structures and 100% reported positive findings with respect to engaging new community structures. Cohort two projects found significant change for all 9 domains of the community capacity building tool (participation; leadership; community structures; role of external supports; asking why; resource mobilization; skills, knowledge and learning; links with others; and sense of community).

Comments on variance(s):

DSCIF has an annual budget of $9.6 million. In 2013-14, the program spent $4.5 million. The difference between planned and actual spending is due to a call for proposals being launched in February 2013 with new projects starting March/April 2014. The call for proposals process took longer than anticipated due to the volume of applications received and time needed for the review and approval processes.

Audits completed or planned:

One audit was completed on a DSCIF project in 2013-14.

Evaluations completed or planned:

The program-led cluster evaluation was completed in November 2013. An evaluation assessing relevance and performance was started in 2013-14. Results will be available in 2014-15.

Engagement of applicants and recipients:

DSCIF continued to engage recipients through various channels. Recipients participated in the collection of data related to the three core program outcomes and some projects participated in case studies to provide more in-depth information on their outcomes. Program consultants worked regularly with recipients to monitor contribution agreements and obtain required performance and evaluation reports.

Name of transfer payment program: Canadian Blood Services: Blood Research and Development Program (Voted)

Start date: April 2000

End date: Ongoing

Description:

To support basic, applied and clinical research on blood safety and effectiveness issues through the auspices of Canadian Blood Services (CBS).

Strategic outcome(s):

Health risks and benefits associated with food, products, substances, and environmental factors are appropriately managed and communicated to Canadians.

Results achieved:

An evaluation focusing on relevance and performance found that between 2008-09 and 2012-13, the CBS Research and Development (R&D) Program addressed a demonstrable need and remained responsive to the needs of Canadians. Although the Canadian blood system is now widely recognized as safe, there continues to be a need for scientific and evidence-based information to maintain and increase the safety, supply and efficiency of the Canadian blood system. This includes ongoing efforts to stay abreast of technological developments and to address the inherent risks associated with blood transfusions because of known and emerging pathogens. The R&D Program does so by advancing innovation and maintaining Canadian capacity in transfusion science and medicine. As such, the Program was generally found to be well aligned with related operational, regulatory, knowledge, and capacity needs.

The CBS R&D Program has generated numerous outputs in the important areas of basic and applied research that support the mission of the CBS. The Program has shown a good level of achievement across most of its immediate and intermediate outcomes. In particular, the Program has played a key role in building and maintaining research capacity in transfusion science and medicine. Moreover, several examples of application and adoption of R&D results within and outside CBS were identified (e.g., optimization of buffy coat method, selective testing for pathogens) that contributed to a greater effectiveness and efficiency of the Canadian blood system. However, the findings suggest there is further room for improvement in knowledge exchange and collaboration with research users to facilitate greater adoption and application of knowledge or innovation results in policy and practice. CBS has already begun to focus its efforts on these areas, but it is too early to assess the success of these efforts.

Comments on variance(s): N/A

Audits completed or planned: None

Evaluations completed or planned:

An evaluation assessing relevance and performance was completed in 2013-14. The next planned evaluation will be 2017-18.

Engagement of applicants and recipients:

• The department gathered information/views from CBS during renewal of the program (i.e. validating program objectives; input on the performance measurement strategy); and,
• The Department convened a knowledge transfer event in January 2013 with CBS for Health Canada personnel with responsibility for federal oversight of blood safety.

Name of transfer payment program: Official Languages Health Contribution Program (Voted)

Start date:  April 1, 2009 (program renewal April 1, 2013)

End date:  Ongoing

A portion of funding ended on March 31, 2013, but was renewed on an ongoing basis on March 21, 2013 (Budget 2013).

Description:

The Official Languages Health Contribution Program (OLHCP) was renewed by the Treasury Board on November 28, 2013 with total funding of $174.3 million over five years (2013-14 to 2017-18 fiscal years) under the Government of Canada's Roadmap for Canada's Official Languages 2013-2018: Education, Immigration, Communities initiative.
The OLHCP Program has the following objectives:

• Increased access to bilingual health professionals and intake staff in English and French linguistic minority communities in Canada (EFLMCs); and,
• Increased active offer of health services for English and French linguistic minority communities within health institutions and communities.

These objectives are realized through the following three mutually reinforcing program components:

• Integrating health professionals within official language minority communities through French-language academic health programs in 11 colleges and universities outside of Québec, and language training for health professionals and health system intake personnel in all administrative regions of Québec;
• Strengthening local health networking capacity through the 38 existing community-based health networks across Canada by developing health strategies within health authorities and making improvements in health and health services access for English and French linguistic minority communities; and,
• Health Services Access and Retention Projects to encourage bilingual health professionals to practice in EFLMCs; engage front-line health service providers in providing services in the second official language; support EFLMC specific health human resource retention strategies within health services institutions, and addressing health needs that are specific to the demographics of EFLMCs.

To improve access to health services in EFLMCs it is essential to have health professionals who are proficient in the language of the patient. This initiative continues to fund 94 French-language academic health programs in 11 colleges and universities outside of Québec to generate additional health professionals in French minority language communities. Funding supports student/teacher recruitment, French-language training tools, teaching equipment purchases, and support to professors and students within each institution (e.g., bursaries and internships). The strategy in Québec provides funding to one coordinating organization (McGill University) for English and French-language training courses available to health professionals and intake personnel (such as medical secretaries) who are already working in the health system in all administrative regions of Québec.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

Under the OLHCP, 15 contribution agreements were extended in 2013-14 and 14 new contribution agreements were signed for 2013-14 to 2017-18 fiscal years.

Health Professionals:  In 2013-14, Health Canada funding administered under the Consortium national de formation en santé (CNFS) led to 693 additional French-speaking graduates from health-related disciplines in 11 French-language postsecondary institutions outside of Québec. These graduates became part of the health human resource pool available to provide health services to official language minority communities.

• Among these graduates were 18 doctors of family medicine from the Centre de formation médicale du Nouveau-Brunswick who are returning to practice in their home province of New Brunswick or Nova Scotia;
• Health Canada also funded continuing education courses in 2013-14 through CNFS institutions to 323 French-speaking health professionals outside of Québec; and,
• In Québec, 1,302 health professionals completed language training which was coordinated through McGill University and funded by Health Canada.

Health Networks:  The 38 health networks continued to collaborate with provincial and territorial health authorities and health systems partners to improve access to health care services in English and French linguistic minority communities. For instance:

• The Prince Edward Island health network signed an agreement with three professional associations to contact their members annually to regularly update the province's directory of bilingual health professionals. Similar agreements will be signed shortly with other professional associations;
• A new “Health Passport” was unveiled by the Yukon government in January 2014 in partnership with the health network of the territory (Partenariat communauté en santé). This booklet, which provides a translation of the main medical terms in French and English, will allow English-speaking health professionals and French-speaking patients to better communicate; and,
• A total of 39 partnerships (39 formal and 13 informal) were established or maintained by health networks with various stakeholders in Canada in order to improve access to health services for English and French-speaking minorities.

Health Projects:  An open call for proposals for projects integrating health human resources within EFLMCs, as well as projects responding to emerging needs (e.g., interpretation services in the health sector) was launched in December 2013 and closed on January 31, 2014. A total of 96 project proposals were received and reviewed. New health services access and retention projects will start in 2014-15.

Further information regarding these initiatives is available from the websites of Program recipients:

• Société Santé en français (http://santefrancais.ca)
• Community Health and Social Services Network
• Consortium national de formation en santé
• McGill University

Comments on variance(s):

The planned spending of $23.0 million was based on authorities as of April 1, 2013. The Roadmap for Canada’s Official Languages 2013-2018 was announced in March 2013. The program’s authorities increased by $4.0 million through Supplementary Estimates C. As a result, the program spent $24.9 million and $2.1 million was reallocated to other areas within the Department to address priorities.

Audits completed or planned:

One audit was under way as of March 31, 2014.

Evaluations completed or planned:

• Summative Evaluation of the Contribution Program to Improve Access to Health Services for Official Language Minority Communities (2003-2008): November 12, 2008;
• Evaluation of the Official Languages Health Contribution Program 2008-2012:  March 31, 2013; and,
• Evaluation of the Official Languages Health Contribution Program 2013-2017:  March 31, 2017.

Engagement of applicants and recipients:

Health Canada hosted a nationwide videoconference with designated funding recipients of the OLHCP in July 2013 to explain the funding structure for the contribution program and next steps in the program renewal process for the 2013-18 fiscal year periods.

During 2013-14, Health Canada's Deputy Minister and Associate Deputy Minister met with representatives of the Société Santé en français, the CNFS, the Community Health and Social Services Network and McGill University to discuss their support to official language minority communities.

Health Canada officials undertook numerous exchanges (meetings, phone calls, emails) with designated program recipients and with organizations that submitted “open call” proposals to discuss the terms of the renewed OLHP.

Name of transfer payment program: Health Care Policy Contribution Program (Voted)

Start date: September 24, 2002

End date: Ongoing

Description:

The Health Care Policy Contribution Program (HCPCP) provides contribution funding for projects that address the challenges facing Canada's health care system. The Program fosters strategic and evidence-based decision-making for quality health care, and promotes innovation through pilot projects, evaluation, research, and policy development on current and emerging health care system issues. The Program has continued to evolve in response to changing health care system priorities and currently consists of three components: the Health Care System Innovation Fund; the Health Human Resource Strategy; and, the Internationally Educated Health Professionals Initiative.

The Health Care System Innovation Fund (HCSIF) is designed to be flexible and support projects that address a wide range of health care policy issues to encourage innovation. The Canadian Medication Incident Reporting and Prevention System (CMIRPS) aims to reduce harm caused by preventable medication incidents through activities such as the collection and analysis of standardized incident data and the development and dissemination of information including best practices in support of safer medication use systems.

The goal of the Health Human Resource Strategy (HHRS) is to aid in the establishment and maintenance of a stable and optimal health workforce. Through the HHRS, Health Canada supports provincial and territorial governments, educational institutions and key health-related organizations, to address health human resource issues, such as the distribution of physicians, particularly in underserved locations; effective use of skills; provision of quality health care; and, effective planning and forecasting.

By working with the provinces, territories and stakeholder organizations, the Internationally Educated Health Professionals Initiative (IEHPI) is designed to facilitate the integration of internationally educated health professionals by assisting them in obtaining licensure and reducing barriers to practice within the Canadian health care workforce. The IEHPI complements the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications announced by the Forum of Labour Market Ministers in 2009.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

The HCSIF directed funding toward research and knowledge transfer activities to support innovation and implementation of best practices in key policy areas such as wait times, care for aging populations, and end-of-life care.

Canadian Medication Incident Reporting and Prevention System (CMIRPS) projects continued to contribute to system level changes to improve the safety of medication use in Canada. For example, through Institute for Safe Medication Practices (ISMP) Canada's individual practitioner incident report analyses, discussions continued with pharmaceutical manufacturers to inform enhancements to labeling and packaging. Over 30 improvements have been made by manufacturers since the inception of CMIRPS and more than 50 recommended system-based safeguards from medication incident analysis learning have been incorporated into Accreditation Canada standards. In addition, the results of CMIRPS analysis and system-based recommendations informed the development of regulatory proposals to modernise the Food and Drug Regulations.

The HHRS and the IEHP Initiative have supported projects which have contributed to: increasing the number of qualified providers entering the health workforce; increasing productivity of health care providers by making full and appropriate use of their skills; and improving access to health care services for all Canadians, particularly in underserved areas. Specific examples include:

• In 2012-13 under the HHRS, 21 innovative projects were funded, with activities such as: improving health human resources planning and forecasting; supporting more effective uses of health provider skills; and, developing learning opportunities to improve the quality of health care;
• In addition, the Family Medicine Residencies Initiative (FMRI), announced in 2011, provided $39.5 million to support the PT in providing family medicine residency positions and advanced training in rural and remote areas across the country. For example, the project with B.C. has supported the province in training 16 residents in the International Medical Graduate stream as of 2013-14;
• Notable accomplishments through the IEHPI include substantial gains in areas supporting improved integration of internationally educated health professionals, including the development of assessment, bridging, path-finding, orientation, workplace oriented language and communication programs for internationally educated health professionals. In 2013-14, IEHPI funding supported over 30 projects, representing all 13 PT and four pan-Canadian organizations; and,
• Progress has also been made toward pan-Canadian approaches to assessing internationally educated physicians and nurses. For example, IEHPI funding has supported the development and implementation of a common tool to assess an international medical graduate's preparedness for entry into post-graduate training. Partnerships with six assessment centers conducting entry to residency assessments have been developed. In 2013, more than 1,200 foreign-trained physicians completed this entry to residency assessment.

Comments on variance(s):

The variance between planned and actual spending is related to extended timelines required to establish contribution agreements with provinces and territories. These funds were reallocated to other areas within the Department to address priorities.

Audits completed or planned:

Under the Health Care Policy Contribution Program in 2013-14, an audit of two contribution agreements with the Consortium national de formation en santé (CNFS) was completed, as was an audit of three contribution agreements with Dalhousie University.

Evaluations completed or planned:

The evaluation report and Management Response and Action Plan for the Program were approved in October 2013. This evaluation covered fiscal years 2008-09 to 2012-13. The next evaluation is scheduled for fiscal year 2017-18.

Engagement of applicants and recipients:

Funding recipients continue to be engaged through site visits, and regular communication regarding the progress of funded projects.

Name of transfer payment program: Contribution to the Canadian Partnership Against Cancer (Voted)

Start date: April 1, 2007

End date: Ongoing

Description:

The Canadian Partnership Against Cancer (CPAC) is responsible for implementing the Canadian Strategy for Cancer Control with the following objectives: (1) to reduce the expected number of new cases of cancer among Canadians; (2) to enhance the quality of life of those living with cancer; and, (3) to lessen the likelihood of Canadians dying from cancer.

The mandate of CPAC is to provide a leadership role with respect to cancer control in Canada, through the management of knowledge and the coordination of efforts among PT, cancer experts, stakeholder groups and Aboriginal organizations to champion change and improve health outcomes related to cancer. The CPAC will act as a pan-Canadian resource to provide the most up-to-date knowledge across strategic priority areas including prevention, screening/early detection, patient-centered care, guidelines, standards, as well as supporting key research activities and facilitating the development of a pan-Canadian surveillance system.

Strategic outcome(s):

A Health System Responsive to the Needs of Canadians.

Results achieved:

Since it began operating in April 2007, the CPAC has:

• Armed cancer patients and physicians across Canada with state-of-the-art knowledge about what works best to prevent, diagnose and treat cancer;
• Improved the quality of our national cancer system by monitoring its performance and identifying gaps;
• Provided on-line cancer training for over 700 medical providers serving more than 215 First Nations communities and organizations with the @YourSide Colleague® Cancer Care Course;
• Improved the quality of life for cancer victims by providing information that addressed their social, emotional and financial needs;
• Implemented a large-scale effort to raise awareness of the common risk factors for cancer and other chronic diseases;
• Implemented the country's largest population health study of risk factors - the Canadian Partnership for Tomorrow Project - which has enrolled 300,000 Canadians to explore why some people develop cancer and others do not;
• Launched a First Nations, Inuit and Métis Action Plan on Cancer Control, in collaboration with First Peoples;
• Expanded cancer screening programs in all provinces and encouraged hard-to-reach populations, such as women living with cervical cancer, to undergo screening - which helps doctors catch cancer earlier; and,
• Developed programs to help survivors through the tremendous uncertainty following treatment.

Comments on variances: N/A

Audits completed or planned: N/A

Evaluations completed or planned:

An evaluation of CPAC was completed in 2010-11 and another one is planned for 2015-16. A performance measurement strategy and an evaluation framework were completed in 2012-13.

Engagement of applicants and recipients:

The Canadian Partnership Against Cancer works to engage stakeholders through communications activities that include media and on-line vehicles to both the broader public and the cancer and health communities, and targeted outreach and partnership building. In 2013-14, CPAC: finalized measurement indicators for public engagement; developed a patient volunteer program and related guidelines; launched a new public engagement and outreach strategy; explored collaborative opportunities with the organization's new pan-Canadian Cancer Communications Committee; increased collaboration with the Canadian Cancer Action Network to bring together patients and other key stakeholders; issued a series of joint media released with key partners; and, released publications addressing issues from cancer control for First Peoples to cancer system performance, including collaboration with the Canadian Institute of Health Information.

Horizontal Initiatives

Name of horizontal initiative: Federal Strategy on Early Childhood Development for First Nations and Other Aboriginal Children

Name of lead department: Health Canada

Lead department Program Alignment Architecture (PAA) Program: First Nations and Inuit Health Primary Health Care

Start date:

• Early Childhood Development (ECD) component - October 2002
• Early Learning and Child Care (ELCC) component - December 2004

End date: 

• ECD component - ongoing
• ELCC component - ongoing

 Total federal funding allocation (from start to end date):

• ECD: $770.95 million, 2002-03 to 2013-14. Ongoing: $62.975 million per year.
• ELCC: $129 million, 2005-06 to 2013-14. Ongoing: $14 million per year.

Description of the horizontal initiative (including funding agreement): The goal of the Federal Strategy on Early Childhood Development for First Nations and Other Aboriginal Children, announced in October 2002, is to address the gap in life chances between Aboriginal and non-Aboriginal children. This initiative allocated $320 million over the first five years with $65 million ongoing. These funds were shared by Health Canada, Employment and Social Development Canada (ESDC), Aboriginal Affairs and Northern Development Canada (AANDC), and the Public Health Agency of Canada (PHAC). AANDC's portion of the funding ended on March 31, 2012.

In December 2004, Cabinet approved an additional $45 million over three years (beginning fiscal year 2005-06) and $14 million ongoing for the ELCC component to improve integration and coordination of two ECD programs: Aboriginal Head Start On Reserve (AHSOR-Health Canada) and the First Nations and Inuit Child Care Initiative (FNICCI-ESDC).

Shared outcome(s): The ECD component complements the September 2000 First Ministers' Federal/Provincial/Territorial ECD Agreement. It seeks to address the gap in life chances between Aboriginal and non-Aboriginal children by improving the developmental opportunities to which Aboriginal children (and their families) are exposed at an early age (0-6 years).
The ELCC component complements funding released to provinces and territories under the March 2003 Multilateral Framework for Early Learning and Childcare (ELCC) to improve access to ELCC programs and services.

Governance structure(s):  Each federal department is responsible for their specific program activities.

Performance highlights: In collaboration with partners and stakeholders, federal departments will continue to build on evidence to inform programming, and enhance linkages between programs and services to better support Aboriginal children and families.

Federal Partner(s):

Federal Partner #1: Health Canada

Variance explanation: The variance between planned and actual spending is mainly due to reductions associated with the realignment of resources for the implementation of the British Columbia Tripartite initiative and a reallocation of funding between First Nation Inuit Health programs to address needs and priorities.

For more information, please visit Aboriginal Head Start on Reserve and Fetal Alcohol Syndrome/Fetal Alcohol Effects.

Aboriginal Head Start on Reserve (AHSOR):

• Ongoing program support and enhancement; and,
• Increase integration, coordination, access, and quality of programming (i.e., identify core competencies of workers/staff).

Fetal Alcohol Spectrum Disorder - First Nations and Inuit Component (FASD-FNIC):

• Strengthening program standards for the FASD Mentoring Projects; and,
• Improving data collection to better support First Nations and Inuit communities in achieving stronger health outcomes.

Aboriginal Head Start on Reserve (AHSOR)

Ongoing program support and enhancement were achieved by providing training to AHSOR community-based workers to become certified Early Childhood Educators (ECE). Approximately 519 staff attended post-secondary ECE education classes through partnerships with regional colleges and funding from Health Canada's Aboriginal Health Human Resources Initiative.

Continuing education for a total of 189 staff on priority areas such as parenting, nutrition, physical activity, and family literacy was provided through joint training sessions with other First Nations and Inuit Health Branch (FNIHB) programs. As a result, trained workers were better able to assist in supporting children with special needs.

Work continues to improve integration, coordination, access, and quality of early childhood education and child care programming through horizontal collaborations with the federal network of programs that directly address early learning and healthy development of First Nations children living on-reserve.

Menu Planning Guidelines, a nutritional resource to help in the planning of healthy meals for AHSOR children, were finalized and disseminated to over 450 First Nations communities to support delivery of quality programming.

Fetal Alcohol Spectrum Disorder - First Nations and Inuit Component (FASD-FNIC)

Continued program enhancement is achieved through increased support, capacity building and training of FASD community-based workers in areas such as mentoring, the Parent-Child Assistance Program (PCAP); the administration of the Addictions Severity Index; and motivational interviewing. The program continues to provide support to First Nations and Inuit organizations to bring together cultural speakers, experts and trainers. For example, the Health Canada FASD Program provided funding support to the Fourth Anishinabek G7 FASD Conference “Circle of Hope”, held in December 2013, which brought together over 200 First Nations communities, trainers, and experts in the field of FASD.

Through collaboration with First Nations communities and organizations, the Health Canada FASD Program has developed regional level culturally appropriate program guidelines in four regions. The new program guidelines aim to support improved program consistency and program effectiveness, while addressing the individual needs at the community level. The program continues to work closely with other maternal and child health programs and addictions services to improve supports and health outcomes for First Nations and Inuit women, children and families.

Federal Partner #2: PHAC

Variance explanation: The variance between planned and actual spending is due to historical government-wide reductions to departmental operating budgets.

For more information, please visit Aboriginal Head Start in Urban and Northern Communities (AHSUNC)

Expected results by program:

Aboriginal Head Start in Urban and Northern Communities (AHSUNC):

• Continue to support program expansion by serving 4,600 children on an ongoing basis. The program is also enhanced on an ongoing basis through an increased number of special needs and parental outreach workers and special needs training.

Capacity Building:

• The program will continue to enhance coordination, collaboration and information exchange with other federal departments, provincial/territorial (P/T) governments, national Aboriginal organizations and key stakeholders in Aboriginal early childhood education and to build further capacity in Aboriginal communities.

Contributing activity / program results:

Aboriginal Head Start in Urban and Northern Communities:

The Agency continued its expanded reach to approximately 4,600 children, as planned. The Agency also continued to support special needs and parental outreach workers and special needs training. Children with diagnosed or suspected special needs represent 19% of all children enrolled in the AHSUNC program. Most sites (89%) support children with special needs and refer children to health professionals (85%).

Capacity Building:

A Health Canada /The Agency Steering Committee on Aboriginal Maternal and Child Health was established to enhance horizontal collaboration and provide a forum for shared policy development, Knowledge Development and Exchange (KDE), and planning. In the last year, key stakeholders in Aboriginal early childhood education were identified to contribute to the development of a knowledge development and exchange plan for AHSUNC. Regional offices continue to work with P/T governments to enhance coordination on Aboriginal early childhood education.

Federal Partner #3: ESDC

Variance explanation: The variance between planned and actual spending is mainly due to the delay in implementation of a capital contribution project.

For more information please visit:  First Nations and Inuit Child Care Initiative (FNICCI)

Expected results by program:

First Nations and Inuit Child Care Initiative (FNICCI):

• Labour Market (Aboriginal Skills and Employment Training Strategy); and,
• Program support for parents participating in skills development and training.

Research and Knowledge:

• Information on the well-being of Aboriginal children; and
• Align collection of Aboriginal children information with Federal strategy on Aboriginal data.

Contributing activity / program results:

First Nations and Inuit Child Care Initiative (FNICCI):

FNICCI is a labour market support program that is currently administered under the Aboriginal Skills and Employment Training Strategy (ASETS). The FNICCI was designed to support parents participating in ASETS education and training programs.

Research and Knowledge:

Partnership in the Fourth generation of the Aboriginal Peoples Survey with respect to the collection of information on First Nations' early childhood development living on-reserve, the questionnaire on early childhood was developed and data collection initiated in 2013-14.

Results to be achieved by non-federal partners: Not Applicable.

Contact Information:

Halina Cyr
Director, Population Health and Wellness
First Nations and Inuit Health Branch
Health Canada
Tunney's Pasture
Ottawa, Ontario
K1A 0K9
Postal locator 1920A
Telephone: (613) 948-6412
E-mail:  halina.cyr@hc-sc.gc.ca

Name of horizontal initiative: Chemicals Management Plan

Name of lead department(s):

Health Canada/Environment Canada (EC)

Lead department Program Alignment Architecture (PAA) Program:

Environmental Risks to Health: Health Canada/Substances and Waste Management: EC

Start date: 2011-12 (second phase)

End date: 2015-16 (second phase)

Total federal funding allocation (start to end date): $516 million

Description of the horizontal initiative (including funding agreement):

Originally launched in 2006, the Chemicals Management Plan (CMP) enables the Government of Canada to protect human health and the environment by addressing substances of concern in Canada. It is a science-based approach that includes:

• setting priorities and government-imposed timelines for risk assessment and risk management (RM) of chemicals of concern;
• enhancing research, monitoring and surveillance;
• increasing industry stewardship and responsibilities for substances;
• collaborating internationally on chemicals assessment and management;
• communicating to Canadians the potential risks of chemical substances; and,
• engaging industry to inform risk assessment and RM action while also enhancing trust in the program.

Jointly managed by Health Canada and EC, the CMP brings all existing federal chemical programs together under a single strategy. This integrated approach allows the Government of Canada to address various routes of exposure to chronic and acute hazardous substances. It also enables use of the most appropriate management tools among a full suite of federal laws, which include the Canadian Environmental Protection Act (CEPA) 1999, the Canada Consumer Product Safety Act (CDPSA) (which replaced the Hazardous Products Act (HPA) in June 2011), the Food and Drugs Act (F&DA), and the Pest Control Products Act (PCPA).

Building on lessons learned in the first four years of the program, CMP priority setting was refined and, under the second phase of the CMP, the remaining substances were grouped to facilitate more efficient assessments, industry participation and RM. Integration across government programs remains critical since many remaining substances are found in consumer, health, drug and other products.

The same core functions continue in phase two of the CMP: risk assessment; RM, compliance promotion and enforcement; research; monitoring and surveillance; stakeholder engagement and risk communications; and, policy and program management.

The following program areas are involved in CMP activities:

In Health Canada:

• Health Products and Food Branch:
  • Biologics and Genetic Therapies Directorate;
  • Food Directorate;
  • Natural Health Products Directorate;
  • Policy, Planning and International Affairs Directorate;
  • Therapeutics Products Directorate; and,
  • Veterinary Drugs Directorate.

• Healthy Environments and Consumer Safety Branch:
  • Consumer Product Safety Directorate;
  • Safe Environments Directorate; and,
  • Environmental and Radiation Health Sciences Directorate.

• Regions and Programs Bureau;
• Pest Management Regulatory Agency.

In the Public Health Agency of Canada (PHAC):

• Office of Border Health Services:
  • Travelling Public Program.

In Environment Canada (EC):

• Environmental Stewardship Branch:
  • Chemicals Sector Directorate;
  • Legislative and Regulatory Affairs Directorate;
  • Industrial Sectors Directorate Energy and Transportation Directorate; and,
  • Environmental Protection Operations Directorate.

• Science and Technology Branch:
  • Science and Risk Assessment Directorate;
  • Wildlife and Landscape Sciences Directorate;
  • Atmospheric Science and Technology Directorate; and,
  • Water Science and Technology Directorate.

• Enforcement Branch;
• Strategic Policy Branch:
  • Economic Analysis Directorate.

For more information, see the Government of Canada  Chemical Substances Portal.

Shared outcome(s):

Immediate Outcomes:

• Knowledge, information and data on substances of concern is used by Health Canada and EC recipients to inform RM, risk communication and stakeholder engagement, research, risk assessment, and monitoring and surveillance activities;
• Canadians and stakeholder groups understand information on the risks and safe use of substances of concern;
• Targeted industry conforms or complies with requirements of RM measures;
• Targeted industry takes voluntary action to protect Canadians and the environment; and,
• Targeted industry understands its obligations to take action to protect Canadians and the Environment.

Intermediate Outcomes:

• Canadians use information on the risks and safe use of substances of concern to avoid or minimize risks posed by these substances; and,
• Risks associated with harmful substances in humans, the environment, food and consumer products are prevented, minimized or eliminated.

Final Outcome:

• Reduced threats to health and the environment from harmful substances.

Governance structure(s):

In meeting their obligations pursuant to the CMP, EC and Health Canada deliver their responsibilities through established internal departmental governance structures. CMP governance is assured through a joint Assistant Deputy Ministers Committee (CMP ADM Committee) and an Interdepartmental Chemicals Management Executive Committee (CMEC). These Committees were established to maximize the coordination of efforts, while minimizing duplication between the two departments.

The CMP ADM Committee provides strategic direction, coordination and a challenge function for the implementation and review of results and resource utilization of the CMP. The CMEC is the management committee at the Director General level to support the development of joint Health Canada/EC strategic directions. It is also a formal body for cooperation to ensure timely and concerted actions in implementing the CMP activities in an integrated fashion. The CMEC reports to the ADM Committee, providing recommendations on program implementation, results and resource utilization.

Performance Highlights:

In 2013-2014, Health Canada and EC continued to assess and manage the potential health and ecological risks from the remaining high priority existing substances. Screening Assessment Reports and Risk Management (RM) Strategies for most high priorities were completed, and RM measures continued to be developed, implemented, tracked and monitored. As of March 31, 2014, the majority of planned risk assessments of the remaining 1,500 priority existing substances (to be assessed between 2011-12 to 2015-16) have been addressed and, when necessary, RM actions initiated. As well, all new substance notifications received in 2013-14 were assessed and RM instruments developed within mandated timeframes as required.

Health Canada continued to conduct risk assessments and develop and implement RM measures to address risks posed by harmful chemicals in foods and food packaging materials, consumer products, cosmetics and drinking water while work continued on the re-evaluation of previously approved pesticides according to legislated timelines and requirements under the PCPA.

The program continued to conduct research and monitor programs to address existing and emerging chemicals of concern, and to inform risk assessment needs and RM activities.

Compliance strategies and enforcement plans were also developed and delivered for CMP substances. The focus in 2013-14 was on delivering compliance promotion activities for the highest priority instruments as determined by the compliance priority setting process.

A pan-regional public outreach strategy was developed and implemented to increase public awareness of CMP achievements. This included the targeted delivery, by regional staff, of chemical awareness sessions for frontline service providers - including First Nations and early childhood educators. These sessions inform opinion leaders and key stakeholders on ways to mitigate chemical-related health risks.

Totals may very slightly due to rounding of figures.

The variances in total allocation from previously reported amounts in the 2013-14 Report on Plans and Priorities is mainly due to the inclusion of funds related to the retrofit of the Sir Frederick Banting Research Centre. The Travelling Public Program, previously reported under Health Canada, was transferred to PHAC in 2013-14.

Notes:

17.1 Expected Results

Health Canada/PHAC/EC:

• Science-based information on the risks posed by substances informs risk assessment and RM processes, as well as monitoring and surveillance activities;
• Information on risks of substances to inform RM, monitoring and surveillance and research activities;
• Data on use, release, exposure and presence of substances of concern to inform risk assessment, RM, monitoring and surveillance and research activities;
• Engagement, consultation and communication products to inform the public and stakeholders;
• RM measures under CEPA, PCPA, HPA/CCSPA and F&DA;
• Information on obligations to conform or comply with RM control measures; and,
• Inspections, investigations and enforcement actions.

18.1 Program Results

A key component of the CMP has been to assess, and manage as appropriate, 4,300 priority existing substances by 2020. Some 1,100 chemicals were addressed in the first phase of the CMP, including the assessment of 200 of the highest priority substances in the Challenge to industry and, as required, RM actions were initiated. The second phase of the CMP involves the continued assessment and management of the potential health and ecological risks associated with approximately 1,500 substances by 2016 through the substance groupings initiative, rapid screening, and other approaches.

In 2013-14, Health Canada and EC continued to assess and manage the potential health and ecological risks from the remaining high priorities, which includes substances from the Challenge to industry, from the Petroleum Sector Stream Approach and the Groupings Initiative, as well as the assessment of other substances deemed to be a priority. Screening Assessment Reports and RM strategies for most high priorities were completed, and RM measures continued to be developed, implemented, tracked and monitored. Work with other jurisdictions bilaterally and in multinational fora to undertake regional and multilateral efforts to manage chemicals of concerns also continued.

Through the substance groupings initiative and rapid screening, the program is well on its way to reaching the overall CMP 2 goal of assessing and managing the potential health and ecological risks associated with approximately 1,500 substances. Draft risk assessments for 362 substances, and final risk assessments for 117 substances, were published as part of these initiatives. The program also addressed 249 substances which were determined to already have been assessed or managed. In addition, the program completed draft risk assessments for 48 substances and final risk assessments for 653 substances categorized as Challenge, legacy, petroleum, Rapid Screening 1, high hazard or F&DA.

Targeted RM activities were taken to address 13 Challenge substances and three legacy substances. Two proposed RM instruments were published for two substances and nine final RM instruments were published for 14 substances, including the Guidelines for the Reduction of Dyes and Released from Pulp and Paper Mills for MAPBAP acetate.

All 506 new substance notifications received in 2013-14 have been assessed. Of the 506 substances, 473 were chemicals and polymers and 33 were products of biotechnology. Of those five were nanomaterials, and 68 were substances regulated as F&DA products. All eight new substances assessed to be harmful to human health or the environment had at least one RM instrument developed within mandated timeframes. An additional 25 were subject to new or updated Significant New Activity provisions. The updated Revised "In Commerce List" (R-ICL), containing approximately 3,400 substances, was also published on Health Canada's web site in May 2013.  1,373 substances on the R-ICL have undergone prioritization.

In 2013-14, information gathering activities were initiated for 55 substances with the launch of two CEPA section 71 Notices for two substance groupings (Selenium and Phthalates), and completed for 10 substances in one substance grouping, as well as one legacy substance, resulting in approximately 430 submissions received. Analysis of the information collected from the CEPA section 71 Notices for the Cobalt-containing Substances, Methylenediphenyl diisocyanates and diamines, Internationally Classified Substances, Substituted Diphenylamines and Certain organic flame retardants issued in 2012-13 was completed.

Furthermore, analysis of the information collected from the second phase of the DSL IU (DSL IU2) (containing approximately 2,700 substances) was completed in  2013-14 , with approximately 630 submissions received. In support of information gathering for the substance groupings initiative and DSL IU2, webinars and WebEx's for CEPA section 71 Notices for DSL IU2, Triclosan, Organic Flame Retardants, Selenium, and Phthalates were conducted. In addition, four face-to-face stakeholder workshops on DSL IU2 were delivered across the country.

The program contributed to RM activities related to water quality. These activities are described in further detail elsewhere under Goal 3 Target 3.2 Drinking Water Quality in the 2013-14 DPR Sustainable Development Supplementary Table.

Highlights for consumer products and cosmetics included: completing method development and testing of CMP substances (incl. Benzene, Toluene, Ethyl-Benzene and Xylenes (BTEX), flame retardants and phthalates) to support RM actions and risk assessment activities. Consumer Product Safety (CPS) risk assessors reviewed assessment documents from Petroleum Stream 1-4, legacy substances and challenge substances. Risk assessors also completed product risk assessments, such as completing the draft risk assessment for diethyl phthalate, which will feed into the CMP 2 Phthalate grouping, and the review of the Cosmetic Hotlist restriction for boric acid in cosmetic products.

Cyclical enforcement projects were put in place to determine compliance levels for lead and cadmium in children's jewellery, cosmetics (labelling and notification requirements), surface coating materials (lead and mercury in artists' paints) and glazed ceramics (lead and cadmium), among others. Appropriate enforcement action was taken where non-compliance was identified resulting in 8 recalls in 2013-14 for CMP-related surveys. A 2013-14 regulatory highlight, was the preparation of the tris (2-chloroethyl) phosphate (TCEP) regulations for Canada Gazette II (published in April 2014). While work on two (2-methoxyethoxy) ethanol (DEGME) regulations advanced in 2013-14, work continues to advance a RM measure for DEGME in 2014-15.

Health Canada and EC continued to conduct research and monitoring programs to address existing and emerging chemicals of concern, and to inform risk assessment needs and RM activities. In total, seven multi-year monitoring and surveillance studies under the themes targeted population, biomonitoring supportive research, and targeted environmental monitoring, were completed. In April 2013, Health Canada released The Second Report on Human Biomonitoring of Environmental Chemicals: Results of the Canadian Health Measures Survey (CHMS) Cycle Two (2009-11). In December 2013, the collection of samples for CHMS Cycle Three (2012-13) was completed with preparations for the release of the data in 2015. In January 2014, the sample collection for CHMS Cycle Four (2014-15) was initiated and planning also begun for Cycles Five and Six (including laboratory method development). Other monitoring activities included measurement of chemicals in household dust, volatile organic compounds in drinking water and a selection of chemicals in indoor air. The first Canadian study measuring levels of five flame retardants in human milk and serum was also completed. Health Canada also supported seven biomonitoring, health effects and risk communications projects related to heavy metals (e.g., mercury) and persistent organic pollutants (e.g., PCBs) in the Canadian Arctic. EC continued to conduct a broad range of chemical monitoring activities in ambient air, surface water, sediments, fish, bird eggs and municipal wastewater, in support of the CMP.

Data analysis is also underway for the Maternal Infant Research on Environmental Chemicals (MIREC) cohort study. The first in a series of research publications, a paper on phthalates and bisphenol A exposure in pregnant women, was published. In addition to focusing on the dissemination of the results of the MIREC study, work is also underway on the most recent extension of the cohort. This new study will include early childhood biomonitoring (age three) and an examination of neurodevelopment at the same age.

Research in support of CMP themes continued in order to better understand the exposure and effects of chemicals and to contribute to the development of better methods for chemical hazard and exposure assessment. Research continued on the exposure and toxicity of CMP priority chemicals such as endocrine-disrupting compounds, trace metals, flame retardants and nanomaterials. Health Canada nanomaterial research (six projects) addressed knowledge gaps on the chemical properties, health effects and methods for exposure assessment for manufactured nanomaterials. Five EC nanomaterials projects are also currently underway. Research is also focused on the development of novel methods to investigate toxicity and mechanisms of action of chemicals in order to support the use of new scientific approaches as lines of evidence in risk assessments.

Health Canada and EC managed a joint research program with 14 projects funded through a competitive research allocation process. Those projects were split between Health Canada (10 projects) and EC (four projects) and address priorities identified under the following themes: a) Effects, b) Exposure and c) Methods and Tools Development.   Additional CMP research is also underway at Health Canada and EC and is directed towards providing information on some of the remaining information gaps. Some examples of Health Canada research areas include: development of methods for measuring disinfection by-products in drinking water; in utero exposure to organic chemicals of emerging concern; computational toxicology modelling; new exposure data through phase two of the Canadian House Dust Study; and, validation of methods for detecting thyroid disrupting chemicals. The majority of these research projects are in their third and final year of funding and are concluding. Following the identification of new research priorities, Health Canada launched a competitive process to allocate funds to new CMP research projects for the final two years of the program.  

At EC, a number of research projects were completed in 2013-14. Many of these reports have been, or are in the process of being, published in peer-reviewed scientific journals. Research subjects include:

• flame retardants occurrence in avian species eggs and in St. Lawrence River fish, in ovo effects, presence in house dust, maternal transfer to eggs in avian species, avian cytotoxicity and mRNA expression, investigating non-brominated flame retardants to understand fate and global loadings from long-range transport, toxicity to a series of aquatic organisms of different taxanomic groups, use of Daphnia transcriptominic response for sublethal effects and long term exposure, and, fate and presence in remote aquatic environments;
• aromatic azo and benzidine substances: environmental fate in aquatic environments, bioaccumulation, bioavailability and toxicity of azo and benzidine compounds in aquatic organisms;
• persistent organic pollutants: impact on gene expression; levels of different persistent organic pollutants in humans; effects of dioxin-like compounds; atmospheric measurements including particles using improved tools and techniques; and,
• Inorganics: effects and bioaccumulation potential of inorganic substances on soil organisms and aquatic organisms in support of moiety assessments and effects and bioavailability of rare earth elements on plants and soil organisms.

Work continued on substances/products regulated under the F&DA, including the development of Environmental Assessment Regulations for new substances in F&DA products and research on non-regulatory initiatives to risk manage F&DA substances, re-evaluation of food additives and food packaging materials and assessment of food contaminants as indicated by CMP screening assessments and new scientific knowledge. Highlights for food included: performing exposure assessments and in some cases hazards characterizations for several substances of concern in food (e.g. amaranth, tartrazine Selenium  and Boron); completion of several sets of analyses for substances of interest in human milk under MIREC; publication of data from targeted surveys and Total Diet Study data for DEHA (a Challenge substance) and several phthalates; completion of the animal treatment phases for two targeted priority CMP flame retardants [1,2-dibromo-4-(1,2 dibromoethyl) cyclohexane (TBECH) and 1,2bis(2,4,6-tribromophenoxy) ethane (BTBPE)]; and significant stakeholder engagement in generating data for risk assessments for amaranth, tartrazine and ethyl carbamate.

Work also continued on the re-evaluation of previously approved pesticides according to legislated timelines and requirements under the PCPA, as well as on continuing to monitor health and environmental incidents related to pesticides, analyzing trends and sales data, and taking regulatory action as needed.

Public outreach, compliance promotion and stakeholder awareness activities were delivered. Activities were undertaken in order to target stakeholders to facilitate information sharing, including 59 cross-Canada general public outreach events, distribution of CMP communications tools such as Hazardcheck, Facebook and Twitter posts, and News Canada articles for web and print. In 2013-14 Regional Risk Communication and Public Involvement officers also provided 73 stakeholder engagement activities related to chemical effects on health. Regional Senior Risk Managers responded to 187 inquiries from industry in support of information gathering, compliance promotion and industry outreach.

EC continued to develop compliance strategies plans and deliver related activities, to promote regulatees' awareness and understanding of, and compliance with, regulatory requirements for CMP substances. Focus was on delivering compliance promotion activities for the highest priority instruments as determined by the compliance priority setting process. For example, in 2013-14, targeted compliance promotion activities were delivered on five RM instruments, focusing on small to medium sized enterprises and First Nations. About 17,815 regulatees were contacted through compliance promotion activities on RM instruments and Enforcement completed 73 investigations and 3,298 inspections related to the CMP regulations. As planned, Enforcement focused its efforts on the Tetrachloroethylene (Use in Dry Cleaning and Reporting Requirements) Regulations (PERC) by completing 1,081 inspections and 32 investigations in order to continue the efforts to increase the compliance rate amongst dry cleaners. The targeting of high risk sites and storage tanks was also accomplished as planned by completing a total of 637 inspections and 23 investigations under the Storage Tanks Systems for Petroleum Products and Allied Petroleum Products Regulations (STSR) and a total of 942 inspections and 12 investigations under the Polychlorinated biphenyls (PCB) Regulations. All the enforcement activities related to the CMP regulations resulted in a detection of 3,382 violations involving a total of 2,298 Written Warnings and 759 Environmental Protection Compliance Orders.

PHAC continued to work with passenger conveyance industry stakeholders including airlines, railways, cruise ships, ferries, buses and ancillary services such as flight kitchens and terminals in order to identify and address potential risks to travellers. Activities were targeted using a public health risk assessment tool, and PHAC completed 460 public health inspections, 12 outbreak investigations, 78 outreach and awareness activities, and took 1,220 water samples. When public health risks were identified, the Agency worked with operators to mitigate them. For example conveyance and facility operators successfully resolved 88% of critical public health violations that were identified.

Comments on variances:

Health Canada's variance is mainly due to less than anticipated spending related to the operation of laboratory facilities and activities conducted therein. Strategic departmental spending decisions were taken which resulted in contracting cancellations due to delays in risk assessment activities causing expenditures to spill over to FY 2014-15.

PHAC's variance is mainly due to delays in staffing actions.

EC's variance is mainly due to funds that have been allocated to other priorities within the Department.

Results achieved by non-federal partners (if applicable): Not Applicable.

Contact information:

Suzanne Leppinen
Director, Chemicals Policy Bureau
Safe Environments Directorate
Healthy Environments and Consumer Safety Branch
Health Canada
Tunney's Pasture
Ottawa, Ontario
K1A 0K9
Postal Locator:  4905B
Telephone: (613) 941-8071
E-mail:  suzanne.leppinen@hc-sc.gc.ca

Greg Carreau
Executive Director, Program Development and Engagement
Program Development and Engagement
Science and Risk Assessment Directorate
Environment Canada
Telephone: (819) 953-6072
E-mail:  greg.carreau@ec.gc.ca

Name of horizontal initiative: Food and Consumer Safety Action Plan

Name of lead department(s):

The lead is shared between Health Canada, the Canadian Food Inspection Agency (CFIA), the Public Health Agency of Canada (PHAC), and the Canadian Institutes of Health Research (CIHR).

Lead department Program Alignment Architecture (PAA) Program:

• Health Canada: Health Products, Consumer Products Safety, Pesticide Safety and Food Safety and Nutrition;
• CFIA: Food Safety Program;
• PHAC: Health Promotion and Disease Prevention and Public Health Infrastructure; and,
• CIHR: Health and Health Services Advances.

Start date:  Fiscal Year (FY) 2008-09.

End date:  Ongoing starting FY 2013-14.

Total federal funding allocation (start to end date): $488.6 million for 2008-09 to 2012-13 and $125.2 million ongoing.

Description of the horizontal initiative (including funding agreement):

The federal government is responsible for promoting the health and safety of Canadians. A key part of this role is to assess that the food, health and consumer products used by Canadians are safe. Adverse consequences associated with unsafe products impact not only the Canadian public, but also the Canadian economy. The Food and Consumer Safety Action Plan (FCSAP) is a horizontal initiative aimed at modernizing and strengthening Canada's safety system for food, health and consumer products. A number of high-profile incidents, such as lead and ingestible magnets in children's toys, food borne illness outbreaks, and the global withdrawal of some prescription medicines, have underscored the need for government action.

The FCSAP includes efforts to modernize Canada's regulatory system to enable it to better protect Canadians from unsafe food, health and consumer products in the face of current realities and future pressures. The FCSAP bolsters Canada's regulatory system by committing to amending or replacing outdated health and safety legislation with new legislative and regulatory regimes that respond to modern realities, and by enhancing safety programs in areas where modern legislative tools already exist. The FCSAP helps to ensure that Canadians have the information they need to assess the risks and benefits associated with the consumer and health products they choose to use, and to minimize risks associated with food safety.

The FCSAP is an integrated, risk-based plan which includes a series of initiatives that are premised on three key areas of action: active prevention, targeted oversight and rapid response. We focus on active prevention to avoid as many incidents as possible and work closely with industry to promote awareness, provide regulatory guidance, and help identify safety concerns at an early stage. Targeted oversight provides for early detection of safety problems and further safety verification at the appropriate stage in a product's life cycle. To improve rapid response capabilities and ensure the government has the ability to act quickly and effectively when needed, we work to enhance health and safety risk assessments, strengthen recall capacity, and increase the efficiency in responding and communicating clearly with consumers and stakeholders.

Shared outcome(s):

• Increased knowledge of food risks and product safety (scientific and surveillance/monitoring);
• Increased industry awareness and understanding of regulatory requirements;
• Increased industry compliance with safety standards;
• Increased consumer awareness and understanding of safety risks associated with health and consumer products and food;
• Strengthened oversight of, and response to, safety incidents;
• Increased consumer confidence in health and consumer products and food;
• Increased trade-partner confidence in Canadian controls, which meet international standards;
• Increased availability of safe and effective products; and,
• Level playing field where imports can be demonstrated to meet Canadian requirements.

Governance structure(s):

The Minister of Health has responsibility and accountability for results, and for providing information on progress achieved by the FCSAP.

Health Canada's Health Products and Food Branch (HPFB) has primary responsibility for implementing FCSAP activities related to health products along with the Regions and Programs Bureau (RAPB) with support from Health Canada's Strategic Policy Branch (SPB) and CIHR on one initiative (increased knowledge of post-market drug safety and effectiveness).

Health Canada's Healthy Environments and Consumer Safety Branch (HECSB) and the Pest Management Regulatory Agency (PMRA), along with RAPB and PHAC, work together to implement FCSAP activities related to consumer products.

The CFIA, HPFB and the PHAC work together to implement FCSAP activities related to food.

The Communications and Public Affairs Branch (CPAB) of Health Canada provides communications support for all of the above activities and coordinates or leads many of the horizontal Departmental activities.

Performance Highlights:

The FCSAP continued to reflect the need to modernize and sharpen the focus of Government action to protect Canadians and responds to the economic realities and new technologies of the 21st century, such as globalization and the introduction of more complex products. The FCSAP is an integrated, risk-based plan with the streams of initiatives (premised on the three key areas of action) aligned to meet these needs.

Funding ongoing starting 2013-14.

Health Canada 17.1 a - Expected results for 2013-14: (Active Prevention for Health Products)

In 2013-14, the Health Products program will continue to engage stakeholders in the modernization of Canada's regulatory system. Health Canada is taking a phased approach to implementation as described in the Regulatory Roadmap.

In an effort to improve the safety, quality and efficacy of health products, the Health Products program will implement regulatory change to include regulatory oversight of the manufacturing of Active Pharmaceutical Ingredients (API). An API Inspection Program is dependent on the final publication and coming into force of the proposed API regulations. As such, API inspections are not possible at this time and targets cannot be set until the regulatory amendments come into force. Planning and implementation work on inspection training, compliance and promotion, as well as on quality system documents continue while these regulations are pending.
 
Health Canada is committed to enhancing the transparency of regulatory decision making related to pharmaceutical and biological products and medical devices. The Summary Basis of Decision (SBD) project provides information about Health Canada's decision to authorise applicable products for sale in Canada. SBD documents have now been redesigned into a question and answer format that is more easily navigable and user-friendly. Information on post-authorisation activities will also be included, allowing Canadians to get up to date information on products which have SBDs. The SBDs will continue to include regulatory, safety and effectiveness considerations with an increased focus on Health Canada's risk/benefit analysis.

Health Canada also reviews Product Monographs (PM) produced by Market Authorization Holders (MAHs) that are factual, scientific documents on a drug product that describes the properties, claims, indications and conditions as well as information that may be required for the optimal, safe and effective use of the drug. The PM consists of three sections: Part 1 - Health Professional Information; Part 2 - Scientific Information; and Part 3 - Consumer Information. Health Canada has drafted plain language labelling improvements to PM Part 3 which are targeted to be released in 2013-14. Plans are also underway to make plain language labelling improvements to Parts 1 and 2 and consultations on these proposed improvements will take place in 2013.

As part of the lifecycle approach, Health Canada will continue reviewing Risk Management Plans (RMP) for therapeutic products. The RMPs provide information related to identified potential risks, strategies to characterize the risks in question, and a risk minimization plan. RMPs are submitted on a voluntary basis.

To increase awareness and compliance with regulatory requirements, Health Canada will continue to engage in pre-submission meetings with industry to ensure higher quality submissions and to provide valuable scientific and regulatory guidance to stakeholders. These meetings provide the opportunity to monitor and evaluate the exchange of information as well as obtain feedback regarding areas of concern prior to filing a submission.

The Government of Canada has made a number of commitments to involve the public in its decision-making processes. Health Canada is putting these commitments into effect through a variety of public involvement opportunities. External advisory bodies are one mechanism that Health Canada is using to receive public input and advice on scientific, technical, policy, and program matters. Currently, an initiative to incorporate observers in advisory body meetings has been undertaken in order to increase openness and transparency.

To improve and augment patient and consumer participation in consultations, Health Canada piloted a  Patient and Consumer Participation Pool (PCPP). This approach will increase access to a wider variety of patients and consumers who are able to make meaningful contributions to consultations, through tools and information designed to enhance their understanding of the regulatory process. The Pool was launched in 2012-13 and 87 pool participants were successfully recruited.

As technology adapts and Canadians look for their information in different ways, Health Canada continues to strive to offer information in a variety of new and traditional ways. CPAB will continue to focus on ensuring that Canadians have easy access to health and safety information so that they can make informed health and safety decisions.

Expected Results: Increase industry awareness and knowledge of regulatory requirements; enhance knowledge of post-market health products safety risks to inform decisions; increase oversight of the risk management and risk mitigation strategies for health products; increase safety of APIs through industry compliance with the Food and Drugs Act (F&DA) and its regulations; improve timeliness of pre-market reviews; increase awareness and understanding of the safe use of health products by consumers and health care professionals.

Performance Indicator: Number of engagement opportunities with industry, international collaborations; number of guidance/educational tools developed; number of standards, frameworks and policies developed or modified; and number of consultations/ engagement activities with Canadians and target populations; improved timeliness of pre-market reviews; number risk management and mitigation plans received, reviewed and implemented; % of API firms in compliance as determined through the inspection program (once established)^{Footnote 1i}

Health Canada 18.1 a - Results Achieved in 2013-14 (Active Prevention for Health Products):

Health Canada continues to be committed to enhancing the transparency of decision-making regarding the regulation of health products. SBD documents outline the regulatory, safety, effectiveness and quality (chemistry and manufacturing) considerations that led Health Canada to authorize certain drugs and medical devices for sale in Canada. Phase II of the SBD project was launched in June 2012. One of the most significant changes for Phase II involved the launch of a Post-Authorization Activity Table (PAAT, for drugs) or Post-Licensing Activity Table (PLAT, for devices). These tables provide important information beyond the product's authorization, allowing Canadians access to up to date information on products which have SBDs.   

With regard to performance results for SBDs, 43 (31 pharmaceutical drugs, one medical device, 11 biologic) SBDs were prepared and posted. 67% (29/43) of SBDs were completed and posted within established timeframes. With respect to performance results for PAAT, 45 (35 pharmaceutical drugs, 10 biologic) PAAT updates were prepared and posted, 82% which were completed within target.

Health Canada also produced PMs that are factual, scientific documents on a drug product that describe the properties, claims, indications and conditions as well as information that may be required for the optimal, safe and effective use of the drug. The PM consists of three sections: Part 1 - Health Professional Information, i.e., prescribing information; Part 2 - Scientific Information; and Part 3 - Consumer Information. In FY 2013-14, revisions were made to the Part III (Patient Medication Information) of the PM Guidance Document for Industry. A Question and Answer document was developed and internal training was delivered to help ensure a smooth transition. The revised PM guidance and templates were released on the Health Canada website, in April 2014. Plans are also underway to make plain language labelling improvements to Parts 1 and 2. Early consultations on these proposed improvements took place in 2013. Further external consultations are anticipated to take place in 2014. With regard to performance results for posting PMs, 3,797 (pharmaceutical drugs 3,345; Biologic 293; Veterinary 159) were posted within established timeframes. This is a slight increase from last year's 3,315 PMs.

To increase awareness and compliance with regulatory requirements, Health Canada continues to engage in pre-submission meetings (PSM) with industry. These meetings promote safety and efficiency by exchanging information on the product development plan to help ensure that submissions filed to Health Canada contain the required safety information needed to conduct a fulsome review of the product. Overall, in 2013-14 the Pharmaceutical Drugs Program received 105 requests from industry for pre-submission meetings and held 64 meetings. Specific to the PSM pilot, which focuses on a sub-set of oncology-related review submissions, 21 requests were received and 14 meetings were held. Not all requests resulted in a meeting, for example, some meetings were cancelled by the sponsor due to a change in their development plan, some were not held due to lack of adequate meeting materials and some are scheduled to take place later this year. In addition to the above, an internal survey with oncology reviewers and management was conducted. The findings, together with industry survey results from last year, formed the basis of an analysis report that was developed covering the five-year pilot project to assess the effectiveness of the pilot.

The Government of Canada has made a number of commitments to involve the public in its decision-making processes. These commitments were put into effect through a variety of public involvement opportunities, for example, External Advisory Bodies. Health Canada's Therapeutic Program uses three types of advisory bodies: 1) committees; 2) panels; and, 3) working groups each having a slightly different mechanism for obtaining advice. In 2013, an initiative to incorporate observers in advisory body meetings was implemented in order to increase openness and transparency. An observer protocol allows observers to listen to advisory committee meetings when confidential business information is not being discussed. In 2013-14, observers were present, either in person or by telephone, for meetings of the Scientific Advisory Committee on Medical Devices Used in the Cardiovascular System, as well as the Scientific Advisory Committee on Pharmaceutical Sciences and Clinical Pharmacology. Given the scientific nature of the discussions at these meetings, the observers were representatives of manufacturers or their associations. All expressed appreciation for the opportunity to participate.

As a result of the 2012 Federal Budget decisions, some activities performed by the Office of Consumer and Public Involvement, which included work on the PCPP, were reallocated within Health Canada and are now carried out in a streamlined approach using existing resources.

There has been an increase in industry submitted Risk Management Plans (RMP) and of RMP follow-up activities to Health Canada. In 2013-14, there were 184 RMPs and 40 RMP follow-up activities submitted by industry. Health Canada completed 150 RMPs and 40 RMP follow-ups in 2013-14. This represents an increase over the 125 RMPs and 51 RMP follow-ups completed in 2012-13. In the 2013-14 reporting year, 91% of the RMP reviews were completed within the nine-day performance standard.

During 2013-14, the Health Canada Biologics Program coordinated a total of 87 pre-submission meetings, including: 29 pre-New Drug Submission Meetings, 22 pre-Supplemental New Drug Submission Meetings, and 36 pre-Clinical Trial Application Meetings. Minutes were approved for 100% of these meetings, and the interactions resulted in increased industry awareness of submission filing expectations and industry understanding of new or proposed legislation and regulations. Furthermore, Health Canada allows sponsors to request meetings at any time during the year, and every effort is made to accommodate the meeting dates proposed. As a result, meetings usually occur within one to two months of receipt of the original meeting request.

The Active Pharmaceutical Inspection (API) Program

In FY 2013-14, work continued on amending the Food and Drug Regulations to include regulatory oversight of Active Pharmaceutical Ingredients (APIs). Amendments were published in Canada Gazette II (CG II) early in FY 2013-14. The amendments came into force on November 8, 2013 and include Establishment Licence (EL) requirements for fabricators, package/labellers, testers and importers of Active Ingredients. The regulatory amendments generally impose Good Manufacturing Practices (GMP) on the fabrication, packaging/labelling, testing, storage and transport of all APIs.

Efforts were focussed on preparing for the implementation of the regulatory amendments including a new licensing and inspection program. Activities in FY 2013-14 focussed on updating and developing guidance, industry education and program planning in preparation for new licensing and inspection activities.

Several guidance documents related to the regulatory amendments were developed or updated. The guidance document: “Good Manufacturing Practices for Active Pharmaceutical Ingredients Guidelines (GUI-0104)", which outlines the expectations for regulated industry to comply with new GMP requirements, was finalized and posted on the Health Canada website on February 3, 2014. Revisions of additional GMP-related quality system documentation continue. "Guidance on Evidence to Demonstrate Drug GMP Compliance of Foreign Sites (GUI-0080)" will be revised to incorporate requirements for foreign fabricators, packagers/labelers and testers of APIs. Guidance on Drug Establishment Licenses (DELs) and Drugs Establishments Licensing Fees (GUI-0002) is also being updated. These documents are expected to be published in the third quarter (Q3) of FY 2014-15 and will provide guidance to industry on how to comply with the regulatory amendments. Health Canada also conducted a number of Compliance Promotion Visits with industry to inform and educate them of the new regulations and guidelines. Webinars with external stakeholders were held in November and December 2013, and Questions and Answers as related to GMP for APIs were posted on the Health Canada website on January 21, 2014 to provide additional guidance regarding inspections and GMP that are specific to APIs.

In preparation for implementing the new licensing and inspection programs, Health Canada developed a phased-in approach to implement the new regulations to provide industry with a transition period. Industry already operating were given a three-month period (to February 8, 2014) to submit an establishment license application to Health Canada. During this time, Health Canada did not focus compliance efforts on these industries unless a risk to health was identified.   Industry that has not been previously operating will be required to obtain their Establishment Licence prior to conducting activities. Health Canada will implement the new inspection program prioritizing new establishments conducting fabrication, packaging/labeling, testing, and importation activities as well as using a risk-based approach.

Marketing

In 2013-14, the Healthy Canadians social media channels expanded and flourished. With the ongoing goal of providing Canadians with credible health and safety information when and where they need it, the social media team launched Twitter, YouTube and Pinterest channels for Healthy Canadians. The Facebook pages have more than doubled the number of followers from 2013, with more than 33,000 fans as of March 31, 2014. We also had 350 followers on our Twitter feed, 100 followers on Pinterest and almost 40 subscribers on YouTube. These channels have enabled us to reach almost 8 million Canadians in 2013-14.

We have also been able to include recalls among our daily and weekly posts, as they happen. Major recalls for consumer products, vehicles, food and health products that affect our target audience are posted on both our Facebook pages and Twitter feed shortly after they've been posted on the recalls and alerts website. In 2013-14 we posted 17 recalls on Facebook and Twitter.

Health Canada 17.1 b -Expected results for 2013-14 (Targeted Oversight for Health Products):

Through the National Border Integrity Program, Health Canada's ability to make and support admissibility decisions at the border as they relate to health products will be strengthened. The program will continue to advance its ability to monitor and control the importation of health products by addressing challenges involved in reducing the health and safety risk for products entering Canada through the following initiatives: a national standardized process for the handling of health products at the border; establishment of service standards between Canada Border Services Agency (CBSA) and Health Canada to improve the ability to respond when safety incidents occur; and, undertaking public education activities to inform Canadians of risk associated with the importation of non-compliant health products. The program intends to further expand its work on the Single Window Initiative (SWI).

In addition, Health Canada will continue to enhance the post-market surveillance elements of the program through increased efforts focused on review of Periodic Safety Update Reports (PSURs) which are documents that summarize the worldwide safety experience of a health product at pre-established post-authorization times. In 2013, a new reporting format, the Periodic Benefit-Risk Evaluation Report (PBRER), will expand the scope of the review to put an emphasis on the benefits of medicinal products, especially when risk estimates have changed the benefit-risk balance of a product. Furthermore, Health Canada will continue to seek opportunities to expand and enhance the Post Market Reporting Compliance (PMRC) inspection program, such as through a review of international best practices and the incorporation of additional elements to its inspections.

Health Canada will be exploring new ways to enhance the quality and reporting of adverse reaction (AR) reports. With this in mind, the Canada Vigilance eHealth Project will determine the feasibility of developing an eHealth-based AR reporting system to leverage the eHealth tools used by healthcare professionals, including electronic medical records, electronic health records and related data repositories such as provincial Drug Information Systems, for AR reporting to Health Canada.

The Department has worked with Accreditation Canada to develop AR reporting and monitoring standards as part of their accreditation program for hospitals. These standards will complement the Department's many efforts to encourage and facilitate AR reporting. Health Canada also promotes AR reporting through the Canada Vigilance Regional Offices, by way of outreach and promotional activities, as a way to increase health professional and consumer awareness of, and participation in, the Canada Vigilance Program.

In partnership with the CIHR, Health Canada has implemented the Drug Safety and Effectiveness Network (DSEN): a pan-Canadian network of centres of excellence in post-market pharmaceutical research. The evidence generated by DSEN funded studies is intended to inform pharmaceutical decision-making across the health care system. The CIHR and Health Canada will work collaboratively to streamline the DSEN processes and procedures (e.g., the framework to prioritize DSEN research queries, query submission, etc.) to make these tools as responsive as possible to the needs of the Federal Regulator, Federal/Provincial/Territorial (F/P/T) drug plans and organizations mandated to support F/P/T decision making.

In partnership with the CIHR, Health Canada continues to support the DSEN (a pan-Canadian virtual network of centres of excellence in post-market pharmaceutical research) in order to fund studies that will inform decision-making on the safety and effectiveness of drugs across the health care system. Please refer to Federal Partner # 4 CIHR for DSEN's Expected Results and Performance Indicators.

Expected Results: Enhance capacity of Health Canada and the pharmaceutical/biotech industries^{Footnote 2i} to identify and respond to risk issues; increase capacity to identify safety issues with health products on the market; increase knowledge of post-market drug safety and effectiveness to inform decisions and increase capacity to address priority research on post-market drug safety and effectiveness; improve ability to monitor and control importation of health products.

Performance Indicators: Year-over-year increase in PSUR submitted by industry; number new safety signals generated through PSUR reviews per year; % of safety issues identified by Market Authorization Holders (MAH) resulting in PM changes or regulatory action to mitigate risk; % of ARs addressed within service standards; number of import alerts resulting in detecting/stopping non-compliant products at the border; number/% of health product admissibility determinations that recommend refusal of entry into Canada^{Footnote 3i}. Regarding Health Canada's performance indicators for DSEN, HPFB tracked the Health Canada Team's submitted DSEN queries and evaluated the contribution of DSEN-generated data to the Department's decision-making.

Health Canada 18.1 b -Results Achieved in 2013-14 (Targeted Oversight for Health Products):

Two e-health pilot projects were implemented and are currently ongoing:

• Canadian Primary Care Sentinel and Surveillance Network (CPCSSN); and,
• B.C. PharmaNet (Partnership in Health System Improvement; province-wide network which links all B.C pharmacies to a central set of data systems)

The goal was to explore information within Electronic Medical Record/ Electronic Health Record (EMRs/EHRs) as a potential data source of AR information to support Health Canada surveillance activities.

Information gathered will also be used to inform future strategies for obtaining AR information from health institutions. Phase I of CPCSSN pilot was completed, and the data set from primary care physicians was analysed. B.C. PharmaNet, Phase I, first quarter (Q1), saw the implementation of the first set of proposed adverse drug event fields for reporting into PharmaNet, B.C.'s medication dispensing database.

The objective was to raise awareness to AR reporting and educate health professionals in order to increase the quality and quantity of AR reports submitted to Health Canada. In FY 2013-14, 118 outreach activities were conducted toward health professionals (including: primarily care staff in hospitals; nursing/medical students; and specialised conferences geared for health professionals).

Periodic Safety Update Reports

There has been an increase in industry submitted Periodic Safety Update Reports (PSUR) and Periodic Benefit Risk Evaluation Reports (PBRER) to Health Canada. In 2013-14, there were a total of 340 pharmaceutical and biologic PSURs/PBRERs submitted to Health Canada compared to 322 submitted in 2012-13. In 2013-14 Health Canada conducted 316 PSUR/PBRER initial reviews and 86 PSUR/PBRER follow-up reviews. Of those initial reviews, 93% of the PSUR/PBRER reviews were completed on target and 90% of the PSUR/PBRER follow-up reviews were completed on target.

Border Integrity Program

Health Canada worked closely with the CBSA to verify that imported health products met the regulatory requirements for the F&DA and associated Regulations. The CBSA referred health products suspected to be in violation of import requirements to Health Canada to undergo an admissibility determination for entry into Canada. Products deemed non-compliant with the legislative and/or regulatory requirements were recommended for refusal into Canada.   In FY 2013-14, over 59,000 admissibility recommendations with respect to imported health products were made by Health Canada. Health Canada also worked with the CBSA to develop an Annex to the Umbrella Memorandum of Understanding (MOU) that defines the roles and responsibilities of Health Canada and CBSA. The Annex was finalised on March 28, 2014. For FY 2014-15, efforts will be focussed on developing and monitoring service standards as well as finalizing the D-19-9-1 Memorandum and a Partnership Action Plan outlining priorities and activities to be undertaken jointly with respect to the Health Canada programs at the border.

Good Pharmacovigilance Practices (GVP) previously Post Market Reporting Compliance Inspection Program (PMRC)

In 2013-14, work continued on enhancing the efficiency and effectiveness of Good Pharmacovigilance Practices (GVP). In August 2013, the new guidance document Good Pharmacovigilance Practices (GVP) Guidelines (GUI-0102) was implemented. That document provided interpretive guidance to industry on the expectations of inspectors with respect to adverse drug reaction and post-approval reporting requirements when conducting GVP inspections. These expectations include systems related to the preparation of annual summary reports. In addition, there is a new expectation for market authorization holders and importers to have a self-inspection program in place. In 2013-14 over 80 GVP inspections were conducted.

Additionally, a webinar and presentation on the new and revised GVP documents published in February 2013 were provided to stakeholders during the second (Q2) and third quarter (Q3), respectively.

The partner organizations (CIHR and Health Canada's SPB and HPFB) continued to collaborate on a number of DSEN processes:

• Finalization of the CIHR-led evaluation of DSEN's design and implementation. Results from this initial evaluation will form the foundation for future evaluations (including those which will be conducted on a five-year cycle, as per Treasury Board requirements) and help inform possible refinements to DSEN processes, programs, and strategic activities (HPFB and SPB);
• Collaboration to streamline processes and improve the responsiveness of the DSEN query process to better meet decision-makers' needs for pan-Canadian evidence on post-market safety and effectiveness (HPFB and SPB);
• Participation in the DSEN Science Advisory Committee (HPFB);
• Coordination of the DSEN Operational and DSEN Executive Working Group meetings, to maintain and strengthen the working partnership (SPB);
• Coordination of the Health Canada DSEN Implementation Project Team (HPFB) and participation and contribution to this team (SPB). The Team was established by HPFB in 2009, with representatives from HPFB and First Nations and Inuit Health Branch;
• As of 2013-14, the Team now includes representation from all Health Portfolio areas that make decisions based on the safety and effectiveness of drugs, including PHAC and HECSB;
• Liaising with the Canadian Agency for Drugs and Technologies in Health (CADTH) to enhance engagement of provincial drug plans in DSEN; and facilitation of communication with Provincial and Territorial government drug plan managers to identify opportunities for collaboration (SPB);
• HPFB's collation, review and forwarding of research queries from the Health Canada DSEN Team members to the DSEN Coordinating Office (within CIHR) for consideration as part of the Network's prioritized national research agenda. Health Canada continues to forward proposed research queries for the DSEN to investigate;
• Critical review of findings from DSEN-funded research studies in working towards contributing to Health Canada drug regulatory and/or policy development, decision-making activities (HPFB);
• Ongoing dialogues between Health Canada staff and DSEN researchers to refine queries and to discuss methodologies. This engagement fosters communication and understanding between both parties on DSEN capability and the needs of the regulator. Ultimately this will improve how Health Canada can leverage DSEN capacity (HPFB);
• Exchange of information on DSEN development and Health Canada research queries with the European Medicines Agency (HPFB);
• Engagement with international partners implementing related initiatives (e.g., ENCePP in EU; Sentinel in U.S.) to share best practices and explore opportunities for data sharing (HPFB);
• Support of DSEN Steering Committee representatives (e.g., preparation of briefing material, etc.) (SPB and HPFB);
• Active participant in CIHR-led DSEN activities (SPB and HPFB);
• Active contributor and participant in DSEN's annual Knowledge Translation meeting, to develop the guiding principles of transparency within DSEN, and for communicating DSEN findings (HPFB and SPB);
• Active participation in the semi-annual DSEN Network operational meetings, which bring together DSEN decision makers and researchers to advance their working relationships (SPB and HPFB);
• Coordinated a Health Canada DSEN Symposium (June 17, 2013) to increase awareness about the DSEN initiative and DSEN researchers' scientific capacity. Following ADM opening remarks, researchers from each of the 7 DSEN research teams gave presentations to an audience of over 120 attendees (HPFB); and,
• Coordination of the Drug Information Association (DIA) Canada 2013 Session on DSEN with presentations by Health Canada and CIHR senior management, and from a senior DSEN researcher (HPFB).

Health Canada 17.2 a - Expected results for 2013-14 (Active Prevention for Consumer Product Safety):

The Canada Consumer Product Safety Act (CCPSA) and the F&DA and its Cosmetics Regulations provide the authorities for Health Canada to support industry's responsibility for the safety of their products and consumers' responsibility to make informed decisions about product purchases and use.

The Department will work with industry, standard setting bodies and international counterparts to develop standards and guidelines and share best practices as appropriate. Health Canada will also promote consumer awareness of the safe use of consumer products and cosmetics to support informed decision-making.

Expected Results: Industry is informed / aware of regulatory requirements related to consumer products and cosmetics.

Performance Indicator:  % of Canadian industries informed/aware of regulatory requirements.

Health Canada 18.2 a - Results Achieved in 2013-14 (Active Prevention for Consumer Product Safety):

Health Canada continued the implementation of the CCPSA, which came into force on June 20, 2011. In 2013-14 work continued on the development and implementation of new strategic policy frameworks and operational procedures in accordance with the new Act. Highlights for Active Prevention include: the development and implementation of a Risk Communications Plan for Consumer Products following a pilot project conducted in 2012-13. New tools, including for social media, have been developed to ensure that consumers receive the most up-to-date and relevant information regarding the risks that may be posed by consumer products and cosmetics.

While extensive work was conducted to inform industry of their obligations under the Act, Health Canada recognized following a program evaluation of Consumer Product Activities, that there was still a portion of industry, in particular Small and Medium Enterprises, who were unaware of some of their obligations. In response, several industry outreach initiatives were delivered in 2013-14 to help industry improve their understanding of their obligations. Examples include:

• Small Retailer Campaign on the CCPSA - May 2013;
• Guide to Notices of Violation and Administrative Monetary Penalties under the CCPSA - June 2013 ;
• Industry Guides for Children's Jewellery - June 2013  Electrical Industry Outreach - Information Sessions/Webinar - June 2013;
• Direct Sellers Association Webinar - October 2013;
• Guidance regarding the flammability of consumer products made of, or containing, marabou or other feathers - November 2013;
• Risk Assessment Framework Consultation - November 2013
• Communication on the Exemption Regulations under the CCPSA, including publication in the CG Part I - November 2013; and,
• Industry Guidance - “Danger to Human Health or Safety" Posed by Consumer Products - December 2013.

According to performance feedback following information sessions, 90% of respondents somewhat agreed/strongly agreed they had an increased awareness of their obligations; and 100% somewhat agreed/strongly agreed they had an increased understanding of their obligations.

In order to promote compliance with the CCPSA, Health Canada actively engaged with the regulated consumer products industry to help them understand their obligations. Examples of regional activities in 2013-14 included:

• 37 audits of head offices completed;
• Participation in trade shows (26 domestic and 3 international) to educate industry about Canadian requirements;
• Participation in a Toy Safety Event in Ontario Region;
• Delivery of 273 outreach activities to consumers, parents, industry head offices, associations, Chambers of commerce, provincial health care organizations, and other special interest and multiplier groups; and,
• Completion of enforcement and compliance promotion activities in 158 remote areas and cities throughout Canada.

Finally, one of the key strategies of the FCSAP is to promote industry awareness and effective use of standards, protocols and codes of practice. To ensure Canadian interests are represented and needs are met, the Program focused its participation on domestic and international standards committees based on risk management priorities. For example, the Department is an active participant at various standards meetings related to improving existing requirements for corded window coverings. Health Canada is also investigating the further use of standards as the basis for identifying products that may pose a danger to human health or safety. Through an Memorandum of Understanding with the Standards Council of Canada, the Program funds consumer participation in standards development work and the development of a standards portal to help stakeholders find and use standards and conformity assessment approaches suitable to their products.

With respect to consumer and clinical radiation protection activities under the Radiation Emitting Devices Act (REDA), Health Canada responded to 234 requests for interpretation/technical advice to industry under REDA.

Health Canada announced proposed changes to the Radiation Emitting Devices Regulations that would strengthen the labelling requirements and the health warning messages for tanning equipment. The revised  Tanning Equipment Regulations were published in CG II in February 2014.

In addition Health Canada has completed the following Safety Codes and guidelines:

• Safety Code 36 "Radiation Protection and Quality Standards in Mammography" was published on the Health Canada website on November 27, 2013;
• Publication of Guidance Document for Cabinet X-Ray Equipment on Health Canada's website on September 25, 2013;
• Addendum to Safety Code 32: Portable, hand-held, x-ray tube based open-beam XRF devices; 
• Posting of two fact sheet in support of increasing Canadians' awareness and understanding of risks related to radiation emitting devices on the Government of Canada Healthy Canadians website on February 4, 2014: 
  • Hand held lasers and laser pointers;
  • The safety of compact fluorescent lamps; and,
• Provided an information update on Unlicensed laser hair removal products.

Health Canada responded to 840 public inquiries associated with radiation emitting devices. Many of the inquiries were related to the potential health effects of electric and magnetic fields, ultraviolet, infrared and visible light radiation and acoustics from consumer devices and manmade environmental sources.

Health Canada 17.2 b - Expected results for 2013-14 (Targeted Oversight for Consumer Product Safety):

Through Targeted Oversight, the Program undertakes regular cycles of compliance and enforcement in selected product categories as part of the Cyclical Enforcement Plan and responds to issues identified through mandatory incident reporting, market surveys, lab results and other means. Under the CCPSA, the Program has improved authorities to ensure investigative actions are being taken to determine the safety profile of products and to verify that preventative measures are being implemented.

Expected Results: Early detection of potentially unsafe consumer products and cosmetics.

Performance Indicator:  % of incident reports received and triaged within service standard

Health Canada 18.2 b - Results Achieved in 2013-14 (Targeted Oversight for Consumer Product Safety):

Health Canada continued the implementation of the CCPSA, which came into force on June 20, 2011. In 2013-14, work continued on the development of a Risk Assessment Framework in accordance with the new Act, including stakeholder consultation. Highlights for Targeted Oversight include: an increase in the Program's strategic monitoring and surveillance capability; a review and update of the incident triage tool to better reflect risks posed by consumer electrical products; and, implementation of a transparent and evidence-based approach to the prioritization of reported incidents and the assessment of risks related to product hazards.

In order to ensure potentially unsafe consumer products and cosmetics are detected at the earliest stage possible, incident reports are triaged to detect potentially unsafe consumer products and cosmetics at the earliest stage possible. Incident reports are then sent for appropriate risk assessment, risk management, compliance and enforcement, or placed under surveillance.

In 2013-14 Health Canada received 1,793 incident reports (59% from industry, 41% from consumers), and triaged 85% of these reports within the service standard. The service standard target was not met primarily because the on-line reporting and case management tools were not available due to computer server issues. However, all reports undergo an initial screening, where any serious incidents are immediately actioned on a priority basis. Health Canada will use the lessons learned from the development of the triage service standards, to finalize service standards for risk assessments in 2014-15.

Finally, in the spirit of international collaboration and alignment with the North American Cooperation and Engagement Framework, Health Canada engaged with the United States and Mexico during the Second North American Summit held in Ottawa in September 2013. The Framework supports greater cooperation and sharing of information on consumer products that could present a hazard to human health and safety. Following the Summit, the three countries agreed to work collaboratively to address issues of common concern such as consumer outreach, customs communications with regulators and enforcement information sharing.

Increased sharing of information with international regulators

Health Canada scientists provided ongoing scientific support and advice in the areas of EMF, Noise and Electro-optics, participated in meetings on international standards for non-ionizing radiation emitting devices (e.g., noisy machinery, ultraviolet, lasers, microwave, radiofrequency and ultrasound) and supported the development of international standards for medical imaging equipment. Some of the international organizations include:

1. World Health Organization International EMF project Advisory Committee and the WHO Noise Guidelines Working Group;
2.  American National Standards Institute (ANSI) S12 Noise Working Group;
3. International Commission on Illumination Division 6 Working Group (Photochemistry and Photobiology);
4. Canadian Standards Association Technical Standards Committee Z-386;
5. International Organization for Standardization; and,
6. International Electrotechnical Commission.

Health Canada 17.2 c - Expected results for 2013-14 (Rapid Response for Consumer Product Safety):

The Government is equipped to respond rapidly to remove unsafe consumer products from shelves, preventing them from reaching consumers. While the Department continues to operate with a step-wise approach to compliance and enforcement by working with industry to voluntarily take corrective actions, the CCPSA includes measures to protect Canadians from unsafe consumer products. Under Rapid Response, when an unacceptable risk from consumer products and cosmetics is identified, the program can act quickly to protect the public and take appropriate enforcement actions - including issuing consumer advisories, working with industry to negotiate recalls or other corrective measures.

Expected result: Risks associated with consumer products and cosmetics in the Canadian marketplace are appropriately managed

Performance Indicator: % of non-compliant products identified through the Cyclical Enforcement Plan and incident reporting, for which risk management action is taken in accordance with established operating procedures and timelines.

Health Canada 18.2 c - Results Achieved in 2013-14 (Rapid Response for Consumer Product Safety):

Health Canada continued the implementation of the CCPSA, which came into force on June 20, 2011. In 2013-14 work continued on the development and implementation of new strategic policy frameworks and operational procedures in accordance with the new Act. Highlights for Rapid Response included: re-focused compliance and enforcement activities at a facility level; establishment of a surveillance program for recalls; and, the introduction and implementation of the Administrative Monetary Penalties (Consumer Product Regulations) so that the Program has a flexible and responsive enforcement approach for dealing with specific incidences of non-compliance.

All projects identified in the risk-based Cyclical Enforcement Plan for consumer products and cosmetics were implemented in 2013-14. Examples of key projects included, BPA in baby bottles, mattresses, infant feeding bottle nipples, and textiles among others. Of the 283 samples collected by Health Canada, 144 were deemed to be non-compliant resulting in 45 product recalls and other enforcement actions.

A new initiative for 2013-14 was the implementation and review of a pilot project on Drawstrings on Children's Upper Outerwear using voluntary standards as the basis for identifying products that may pose a risk to human health or safety under the CCPSA. The final analysis and lessons learned will be completed in early 2014-15.

Health Canada takes action on non-compliant consumer products and cosmetics whenever a product may pose a danger to human health or safety. In 2013-14, Health Canada used the new provisions in the CCPSA to take action, including: a request for tests and studies to verify compliance; ordering mandatory recalls; implementing orders to compel companies to take appropriate measures ; and, an independent review of an order. In addition, Health Canada followed up on 626 consumer product incident reports, facilitated 154 voluntary recalls (not related to Cyclical Enforcement Projects), and monitored 1,187 recalls and stop sales.

In order to reduce the risk of importation of dangerous consumer products and cosmetics, Health Canada provided 1,024 recommendations to the CBSA, 20% of which were to refuse shipment entry into Canada. We also inspected 769 packages at the Mail Centres and participated in 19 blitzes at various ports of entry.

Following the evaluation of the Consumer Product Activities program, which took place in 2012-13, Health Canada developed new procedures and service standards for select risk management actions. In 2013-14, Health Canada took action on non-compliant consumer products and cosmetics approximately 97% of the time within the service standard.

Using the results of this performance evaluation, Health Canada continued to monitor the efficiency of its risk management operational procedures to ensure prompt action was taken to reduce the risks posed by dangerous consumer products and cosmetics in the Canadian marketplace.

Health Canada responded to 90 requests for assessments related to radiation emitting devices and to 15 requests for support under the Canada Labour Code. A cyclical enforcement plan for radiation emitting devices regulated under the REDA has been finalized and will be implemented in FY 2014-15.

Web Development:

The Healthy Canadians website and the Recalls and Safety Alerts web and mobile presences continued to be widely sought, visited and referenced information, with over 2.8 and 2.3 million visits respectively for the April 2013 to March 2014 time frame. Visitors to the site continued to browse for over two minutes, indicating that engagement levels are consistent with the previous years, where there was a giant leap in the time users spend on the site. The Recalls and Safety Alerts mobile application had over 9,400 downloads last year, allowing users to continue to access recall information on-the-go, and showcasing that mobile users are a growing audience.

The fall of 2013 saw the launch of the Government of Canada Web Renewal Action Plan, which has the objective to create a new, fully integrated and streamlined Government of Canada website at Canada.ca by December 2016. With information and content organized by themes and tasks, the goal of Canada.ca is to allow users to find information and complete tasks quickly and easily. Health Canada, as the lead for the health theme, was an "early-adopter" and participated in the inaugural launch of the Canada.ca site in December 2013.

For the December 2013 launch of Canada.ca/health, focus was put on the writing and editing of specific consumer-focussed content. In addition, the Canada.ca look and feel was applied to the Healthy Canadians website, and some changes to the navigation of the site were made, to allow for a seamless initial launch, as well as to prepare for further migration of all health-related content in upcoming and future releases.

Health Canada 17.3 a - Expected results for 2013-14 (Active Prevention for Pesticide Safety)

The Health Canada Pesticide Safety Program encouraged and facilitated industry development and adoption of quality assurance and stewardship programs for the safe manufacture and subsequent selection and use of pesticides and other consumer products containing pesticides. Retailers of pest control products often rely on their distributors for validation of access to registered products. Work under this strategy fostered an increased knowledge of the requirements under the Pest Controls Products Act (PCPA) and Regulations and an awareness of the tools available to validate the status of the pest control products and their label information.

PMRA will continue to provide information to consumers through outreach programs related to the responsible use of pesticides. This included dissemination of material through media, booths, the web, and PMRA's Information Service, which every year responds to a wide range of queries from the public on the safe and proper use of pesticides. The compliance strategies under active prevention aim to engage stakeholders in order to test assumptions about the ability and will to comply in a timely and effective manner with enforcement actions.

Expected Results: Increased industry (manufacturers, distributors, retailers and vendors) awareness of risks and related regulatory requirements.

Performance Indicators: Number of active prevention activities (e.g. booths, visits, presentations, surveys, workshops) conducted.

Health Canada 18.3 a -Results Achieved in 2013-14 (Active Prevention for Pesticides Safety):

The PMRA disseminated outreach material and information to various targeted populations as well as to the general public through PMRA's Information Service and in on-line and print publications throughout Canada.

Support was also provided to facilitate participation at fairs, exhibits, and consumer-oriented events, in order to promote pesticide safety and responsible pesticide use.

Health Canada 17.3 b -Expected results for 2013-14 (Rapid Response for Pesticides Safety):

Under rapid response, the pesticide safety program will enhance compliance monitoring of pest control products at the retail or marketplace level as a strategy for early detection of any pesticide safety issues.

Expected results: Improved monitoring of pest control products using a risk-based management approach.

Performance Indicators: Number of targeted inspections conducted (marketplace, manufacturers, retailers, distributors and vendors of consumer pesticides; number and type of enforcement responses initiated in situations of non-compliance.

Health Canada 18.3 b - Results Achieved in 2013-14 (Rapid Response for Pesticides Safety):

The PMRA undertook several initiatives to monitor and enforce industry compliance with the PCPA. The Agency delivered programs in the marketplace, as well as with pest control operators, to ensure that only registered products are sold and used. Furthermore, the PMRA continued to verify compliance with vendors and distributors when non-compliance was previously identified. Additionally, the PMRA verified product integrity through analysis of product samples. Finally, the PMRA formalized its working arrangements with the CBSA in order to provide adequate oversight of imported pesticides at the border.

Health Canada 17.4 a - Expected results for 2013-14 (Active Prevention for Food Safety and Nutrition):

Health Canada's Food Safety and Nutrition program will continue to enhance risk management measures for priority food safety hazards in foods, implement Food Allergy Incident Prevention Measures, consult with industry and stakeholders on key files, and engage with international standards bodies while developing standards, policies, regulations and processes.

Expected Results: Increased effective assessment and mitigation strategies of food safety risks.

Performance Indicators: Number of risk modelling activities conducted, number and type of involvement in International initiatives that support industry, number and type of involvement with international standard setting initiatives, % and range of new submissions addressed within time standards, research in policy and RIAS, as well as the considerations of consumer and stakeholder feedback documented in decision-making.

Health Canada 18.4 a - Results Achieved in 2013-14 (Active Prevention for Food Safety and Nutrition):

In 2013-14, Health Canada set maximum levels for vitamin, mineral and amino acid addition to foods in “non-caffeinated energy drinks” (non-CED), foods formerly regulated as natural health products, which were delivered as guidance to industry on Temporary Marketing Authorization requirements for the addition of vitamins and mineral nutrients to foods.

The prevalence and persistence of various foodborne pathogens on fresh produce, raw foods of animal origin, and seafood continues to be assessed. Health Canada established the National Vibrio Reference Service (VRS) of Canada, in collaboration with PHAC (National Microbial Lab, Winnipeg) and CFIA (Burnaby Laboratory), by documenting an epidemiological report of Canadian V. parahaemolyticus strains.

Health Canada focused on stakeholder engagement in 2013-14 through: the development of a guidance document on highly refined oils derived from food allergen sources; an amendment to the existing Diarrhetic Shellfish Poisoning standard, which is pending consultation through publication of the risk assessment and proposed risk management in the International Food Risk Analysis Journal; and,  the encouragement of multilateral participation in the regulatory process through soliciting calls for data on the adventitious presence of soya in grain-based foods to key industry stakeholders and federal partners.

Health Canada continued to better understand food safety risks and enhance risk management measures to address them. It also continued to lead and leverage national and international food standards development and risk management standards by effectively contributing to the international food standard setting process under the Codex Alimentarius Commission (Codex).

Canada led the international Codex Committee on Nutrition and Foods for Special Dietary Uses work to revise the Codex General Principles for the Addition of Essential Nutrients to Foods in order to reflect the latest scientific evidence and current global market trends while ensuring rational and safe addition of essential nutrients to foods.

Health Canada's Food Directorate actively contributes to several Codex committees, namely Contaminants in Food and Food Additives, and is leading the working group on acetylated Deoxynivalenol or Vomitoxin (DON) derivatives as well as the working group on the prioritization of food colours for re-evaluation by Joint Expert Committee on Food Additives.

Health Canada's risk assessment of DON is in progress (the exposure assessment is well advanced and the hazard characterisation is complete). Health Canada has developed and presented the Canadian position regarding DON in grain and grain based foods traded internationally. Progress was also made on a risk assessment of inorganic arsenic levels in food, including rice-based foods and the hazard characterisation has been completed. As well, the food program has continued to work with industry on tools to manage and measure Ochratoxin A (OTA) in grain-based foods.

In coordination with the CFIA Food Safety Action Plan program, a rapid multi-toxin bead based method has been reviewed, and Health Canada has provided informal safety opinions for OTA in finished foods collected by the CFIA. Health Canada has continued its ongoing work to update the dietary exposure assessment for OTA, and has completed a regulatory animal study to measure the health effects of OTA on juveniles to determine the health risks to children. This data will contribute to regulatory decisions about safe levels of OTA in foods.

As part of Canada's involvement in the Asia-Pacific Economic Cooperation's Food Safety Cooperation Forum, Health Canada advanced its priority of promoting greater alignment in regulatory approach for addressing presence of food allergens in food products. Health Canada was supported by several APEC economies to enable participation of a broader audience of food regulators from the Asia Pacific Region to the workshop.

The Food Safety Program also developed a multifaceted consultation plan to guide the Government's 2013 Speech from the Throne commitment to consult with Canadian parents on ways to improve nutritional information on food labels. The consultation was launched in 2013-14, with initial roundtable and on-line consultations with parents held between January and April 2014.

Health Canada 17.4 b - Expected results for 2013-14 (Targeted Oversight for Food Safety and Nutrition):

The Food Safety & Nutrition program has no targeted oversight funding under this stream.

Health Canada 17.4 c - Expected results for 2013-14 (Rapid Response for Food Safety and Nutrition):

Under the rapid response pillar Health Canada will continue its participation in the Partnership for Consumer Food Safety Education with the goal of promoting the "Be Food Safe" campaign and will continue to develop new education materials for consumers to promote food safety in an effort to reduce foodborne disease outbreaks in Canada.

Expected Results: Consumers make informed decisions about food.

Performance Indicators:  % of consumers aware and knowledgeable of their role in food safety, and how this is used in decision-making.

Health Canada 18.4 c - Results Achieved in 2013-14 (Rapid Response for Food Safety and Nutrition):

As a member of the Canadian Partnership for Food Safety Education, Health Canada contributed to the update of the Be Food Safe Website during 2013-14. Progress is being made with respect to social media engagement through Twitter, Facebook, Pinterest and Instagram in an effort to communicate focused risk communication messages.

A “Be Food Safe” hamburger insert was developed to be used by meat association members to educate consumers on the importance of cooking hamburgers to the appropriate internal temperature and encouraging the use of a digital food thermometer.

Health Canada continues to participate in consumer education activities such as the “Handle with Care” campaign and the “Science Funfest”.

Health Canada held workshops with a broad range of stakeholders (i.e., industry, health professionals, consumer groups, provinces and territories) on risks associated with the consumption of caffeinated energy drinks and potential activities and partnerships that could be undertaken to mitigate and manage such risks - with a focus on education and awareness.

Publication/Distribution

In FY 2013-14, CPAB Distribution Centre responded to 5,606 orders for Food Safety publications and 11,242 orders for consumer safety related publications. 196,784 copies of food safety publications were shipped to Canadians in every province and territory, as well as 1,014,730 consumer safety related publications. 5,387 telephone enquiries were received about Food Safety, representing 8% of the total volume of calls. As well, 4,503 e-mails related to consumer safety were received.

CPAB continued to manage the Service Level Agreement (SLA) put into place in May 2012 with Service Canada. This SLA has increased efficiencies with telephone inquiries by providing extended hours of service to Canadians, fielding a larger volume of calls and responding more efficiently to e-mail inquiries. This streamlined approach also provided a more consistent response to consumer-related inquiries.

Performance Indicators: % of targeted population aware, engaged in food safety risks, alert systems and safety systems; and number of web hits of consumer oriented web pages.

Funding ongoing starting 2013-14
Totals may vary slightly due to rounding of figures

CFIA - 17.1 a - Expected Results for 2013-14 (Active Prevention):

The CFIA food safety initiatives are aimed at ensuring active prevention and include measures to enable government to better understand and identify food safety risks and to work with industry to implement effective food safety risk mitigation strategies. The CFIA, along with its federal partners, will strive to strengthen food safety standards and regulations and will engage Canadians in making decisions with respect to food safety.

In 2013-14, the CFIA will work towards the implementation of the Safe Food for Canadians Act through the redesign of its food regulatory framework, and will move forward with its Imported Food Sector Product Regulations regulatory proposal under the Canada Agricultural Products Act. In light of these regulatory changes, the CFIA will continue to revise its food safety programming for verification of industry food safety systems in high-risk sectors and conclude establishment of the administrative infrastructure for importer licensing, including the implementation of an Information Management/Information Technology (IM/IT) business solution.

The CFIA will continue to work with Health Canada on data collection and risk mapping towards identification and characterization of areas of concern, including imported food ingredients, fresh produce, mycotoxins in cereals and undeclared allergens. Risk mapping will identify gaps in standard-setting and policy development and will assist in focusing operational efforts on areas of greatest risk. Data collected through baseline surveillance will serve to fill information gaps.

The CFIA will continue engagement with counterparts in foreign countries to enhance food safety information exchange and identify best practices to inform risk management approaches.

As well, the CFIA will also continue to inform consumers and industry on the Canadian Food Labelling Initiative and the use of Product of Canada and Made in Canada claims on food products.

Expected results: To better identify, assess, and prioritize potential food safety hazards through risk mapping, information gathering, and sampling and testing of foods on the Canadian marketplace and to inform the relevant Agency stakeholders on relative risk in order to influence decisions and priorities for different food/hazard combinations; improved industry compliance; industry implementation of preventive food safety systems; establishment of standards, regulations, and policies that contribute to the prevention of food safety issues through the product lifecycle.

Performance indicators: % of completion of regulatory approval process; number of planned and % completed commodity / hazard targeted surveys to address information gaps; number of risk profiles completed; number and % of high risk / priority areas for which CFIA has the requisite tools and processes to identify, assess and prioritize potential food safety risks, % completion of revised approaches to food safety system verification; number of industry awareness sessions delivered versus planned, ability to report on the number and nature of inquiries regarding the Product of Canada guidelines; % completion of the supporting IM/IT infrastructure and tool for importer licensing management; evidence of new/ongoing engagement on food safety with international regulatory counterparts.

CFIA - 18.1 a - Results Achieved in 2013-14 (Active Prevention):

The activities surrounding the targeted surveys are guided by the findings and recommendations of the Food Safety Science Committee (FSSC). The 2013 Food Hazards of Concern report, reviews the 2008 Food Safety Science Committee's rankings of food safety risks, identifies any changes in the level of risk, and proposes new food-hazard combinations for future rankings. In addition, progress on key recommendations made since 2008 is highlighted. Risk rankings of over 120 food-hazard combinations in seven different hazard areas have been updated to reflect the current science and expert opinion. The process was co-ordinated by the CFIA's Science Branch and input was sought from experts in Health Canada, PMRA, PHAC and other parts of CFIA.

The results of the report can be used to guide risk management, research and regulatory priorities. It is important to note that the methodology for conducting risk ranking is evolving and complex. Comparisons between hazard areas are difficult given the differences in health effects and the nature of the hazard (i.e. acute vs chronic effects). Moving forward, there are new tools available to conduct comparative risk assessments that could be helpful to future risk ranking. How best to integrate the output of risk modeling tools with expert opinion needs to be determined. This will be considered part of the future work of the Food Safety Science Committee which is being re-designed to ensure an integrated interdepartmental approach to food safety science including risk ranking.

Six risk profile reports, which are a compilation of scientific information on a specific food hazard combinations, were completed; E. coli in baby spinach, allergens in food, Ochratoxin A in cereals, Salmonella in cocoa, Norovirus in Leafy Greens, and Dioxins in Guar Gum  In addition to the risk profile reports, influence diagrams, and/or farm-to-fork food process flow charts have been developed to fully examine gaps along the farm-to-fork continuum to better explain the risk profiles, firmly establishing linkages between risk profiling and risk prioritization.

Risk prioritization was enhanced with the successful development of a multi-food chemical assessment feature in iRisk to allow single-hazard, multi-food chemical scenarios (i.e. Ochratoxin A in raisins, rice, and/or wheat). iRisk is an automated science-based risk ranking tool which comparatively ranks food/hazard combinations. This enhanced functionality is particularly important to the assessment of chemical hazards that appear in multiple food sources.

The CFIA conducted 47 targeted surveys for microbiological and chemical hazards: undeclared allergens, bacteriology, and chemistry.

The regulatory proposal for the Imported Food Sector Products Regulations (IFSPR) was modified to respond to stakeholder feedback and to better align with what is expected in regulations under the Safe Food for Canadians Act (SFCA). The revised draft regulation is proposed to provide a stepwise transition for importers of imported food sector products to planned regulations under the SFCA. A draft enhanced compliance promotion strategy was developed, which is designed to help small businesses in particular, adjust to proposed new requirements. Engagement activities continued with specific focus on small businesses.

The Food Safety Regulatory Forum, held in June 2013, provided the CFIA with an opportunity to consult with representatives of industry, industry associations, consumer groups, academia, and unions on the implications of the proposed regulatory and programmatic changes.

CFIA continued to work with CBSA to develop procedures to promote smooth implementation of the IFSPR at the border.

Significant progress was made on several policy and guidance documents (e.g. guide for importers on the IFSPR and a policy on the scope of products affected by the proposed IFSPR), and the program re-design for inspection in the non-registered sector was completed. Guidance was drafted for inspection staff to inform compliance verification activities, along with development of the associated training material.

Release 1 of the Licence Management System (LMS) was delivered according to the approved schedule, on October 30, 2013. This release included all components to support the implementation of the IFSPR. However, due to the delays experienced with publication of the regulation, the system was not deployed for external access by industry.

The CFIA completed Operations staff training in preparation for the 2014-15 initiation of a narrow scope inspection activity targeting facilities that pack, re-pack and minimally process fresh fruit and vegetables to assess their food safety practices and their implementation of GMP, good handling practices, and preventive food safety controls. This activity aims to verify industry compliance with applicable requirements of the Food and Drug Regulations and Fresh Fruit and Vegetables Regulations and to work with industry to resolve deficiencies that may prevent the industry to conform with requirements that will apply with the coming into force of the SFCA. Inspection tools, communication materials were developed and published to ensure transparency and industry's awareness of the CFIA's changes to the inspection oversight of fresh fruit and vegetables sector.

The CFIA continued to engage with regulatory counterparts on food safety to enhance regulatory cooperation and relationship building (i.e. United States, New Zealand, European Union, India). The CFIA also continued its participation in Codex Working Groups, including review and development of the Codex Annexes on melons and berries.

In furthering the Canadian Food Labelling Modernization, the Product of Canada guidelines provide consumers with information that help them make informed purchasing decisions, help industry comply with the requirements for making truthful and accurate claims, and provide the CFIA with the tools necessary to promote compliance in the market place. In this regard, the CFIA updated Product of Canada information on its website and has seen a year-over-year decline of about 85% for inquires, and close to 80% for investigations. In total, the CFIA responded to 13 requests in 2013-14, for ongoing program guidance and policy clarification, from internal, other government departments, industry, and media sources. During this period, the CFIA conducted 12 labelling investigations related to Product of Canada, while continuing to monitor compliance with the guidelines through its inspection and label verification activities and responding to complaints and referrals related to the interpretation and implementation of the revised policy. More specifically, the CFIA chaired three meetings of the Working Group on the “Product of Canada” Labelling for Live Animals to address gaps in the meat sector.

Other CFIA Food Labelling Modernization initiatives include the Understanding a Food Label web tools available on the CFIA website that provide easy-to-understand information on food labelling and explains the Government of Canada's role, specifically the CFIA. Because today's food labels contain extensive information, which can make them confusing, this tool was developed to explain the complexity of food labels and what federal regulations and requirements are mandatory. There are web tools for both industry and consumers.

CFIA - 17.1 b - Expected Results for 2013-14 (Targeted Oversight):

Targeted oversight initiatives include enhanced inspection of identified high-risk food sectors and targeted import control measures. In 2013-14, the CFIA will continue to adapt its food safety inspection practices for high-risk sectors, including the implementation of an importer licensing regime, and provide training to inspection staff on revised procedures. Evaluation and verification of industry's food safety control systems in both fresh fruit and vegetable and non-federally registered sectors will take place with a focus on imported products. Method development and testing in targeted areas will continue. Enhanced tracking of imported food products will continue and border blitzes will be conducted.

Expected results: Improved industry compliance with food safety standards; modern tools and new risk-based approaches contribute to improved safety of imported foods.

Performance indicators: Number and % of total required inspectors trained on revised procedures, number and % of planned high-risk food safety inspections and verifications completed; number of border blitzes conducted versus planned; number and % of new testing methodologies developed and implemented.

CFIA - 18.1 b - Results achieved in 2013-14 (Targeted Oversight):

In the non-federally registered sector, a total of 478 inspections were conducted in the four identified priority areas of greatest risk (produce, mycotoxins in cereal, imported ingredients, undeclared allergens). In 2013-14, the CFIA completed the final phase of the Product Tracking Initiative for enhancements to the Automated Import Reference System database, which improves the availability of the information the CFIA uses to identify and track food products. This was complemented with the completion of IM/IT enhancements to the Import Control and Tracking System to improve the interchange of electronic data with the CBSA.

Fresh Fruit & Vegetable Establishment Inspection training was delivered to 28 inspection staff and 122 inspection staff were trained on Imported & Manufactured Food Program legislative responsibilities.

The CFIA continued monitoring of the requirements for importing Mexican cantaloupes into Canada, which are certified by the Mexican government (i.e. SENASICA) under the Cantaloupe Certification Program. Following the 2012 revision to the import requirements for fresh Guatemalan raspberries and blackberries, the CFIA developed and implemented a targeted plan for sampling and testing of Guatemalan blackberries for the presence of Cyclospora.

The CFIA conducted 97 Border Blitz inspections and 426 import surveillance activities in continuing targeted oversight of imported products.

In support of the Government of Canada Beyond the Border Initiative, the CFIA and the CBSA successfully completed the pilot study which explored the feasibility of allowing a client of the CBSA's Customs Self-Assessment (CSA) Program to clear import shipments of non-federally registered sector (NFRS) products originating from the USA though the CSA process. A summary report of the findings of this pilot study has been completed and made available for external posting. The pilot identified several issues relating to the requirements, administration and management of the Program that require further evaluation. The CFIA and CBSA are currently conducting an analysis to determine how access to the CSA program benefits could be provided to other food importers, while ensuring compliance with Government of Canada requirements.

 During 2013-14, the CFIA developed and enhanced a number of laboratory methods for analysis of chemical hazards including pesticide residues in wine; pesticides in fruit & vegetables; methyl eugenol in foods; furfural in foods; and low levels of phthalats in food as a result of leaching of plastics. Validation of an isolation and detection method for protozan oocysts in mushrooms; and validation of a multiplex qPCR assay for detection of Cryptosporidium and Giardia were also completed.

CFIA - 17.1 c - Expected Results for 2013-14 (Rapid Response):

Towards ensuring rapid response to food safety issues and emergencies, enhanced recall capacity will enable the Government of Canada to effectively respond to and conduct investigations for an anticipated increased number of food recalls resulting from targeted oversight activities. Targeted consumer risk communication activities and products will also improve Canadian's awareness of food safety issues and recalls and will help consumers better protect their health.

In 2013-14, the CFIA continued to enhance food safety recall and investigation methodology.

Expected results: Timely and efficient recall capacity in the face of increased identification of potential risks through targeted testing and other information; better public understanding of food safety risks; increased consumer use of various food safety alert systems; and increased public trust and confidence in the food safety system.

Performance indicators: number of personnel trained and available to support recall activities; number of recalls and % conducted in accordance with CFIA standards; number of and % of required investigations conducted in accordance with CFIA standards; number of communications initiatives aimed at increasing consumer awareness of food safety issues and recall; $ of consumers aware of food safety issues.

CFIA - 18.1 c - Results achieved in 2013-14 (Rapid Response):

By the end of 2013-14, the CFIA managed 236 primary recalls related to non-federally registered and fresh fruit and vegetable products, which resulted in a total of 358 recalls (primary and secondary combined). In continuing its efforts to enhance food safety recall and investigation methodology, the CFIA delivered sessions to 125 trainers across all five areas (Ontario, Québec, Atlantic, West, National Capital Region) on revised materials for Food Safety Investigation, Issues Management System, and Food Recall courses, making training readily available to inspection staff.

During this same time period the CFIA increased its use of social media as a communications tool and published 922 (625 Twitter and 297 Facebook) postings of food recalls and allergy alerts. The Agency also received and responded to enquiries via social media on recalls and allergy alerts and received 618 e-mail enquiries with questions about food recalls and allergy alerts. Based on feedback from focus group sessions, the CFIA revised food recall warnings to make them clearer and easier to understand. In addition, the Agency enhanced its web presence by developing a more user-friendly consumer centre and adding interactive tools on the food safety investigation and recall process, and the beef processing and inspection process.

Fourteen targeted surveys reports were posted to the CFIA's website. These reports, which summarize the findings of CFIA's targeted surveys, present information regarding the occurrence of contaminants in the food supply. Posting the results of these reports on the CFIA website is an important step in raising consumer awareness about food safety risks and issues.

Funding ongoing starting 2013-14.

PHAC - 17.1 a - Expected Results for 2013-14 (Active Prevention):

The PHAC will modernize and strengthen Canada's food safety systems by use of innovative laboratory tests (molecular typing), by expanding integrated surveillance systems (Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) and C-EnterNet), use of decision making models in priority areas and dissemination of outbreak investigation results to provincial and territorial partners through the web-based Outbreak Summaries system.

Expected results: Increased understanding of food-borne illness risks by Health Canada, CFIA and the PHAC.

Performance indicators:  % of reports tracked, number of peer-reviewed publications, number of issue papers provided to departmental colleagues and stakeholders, and number of provinces/territories using the Outbreak Summaries system.

PHAC - 18.1 a - Results Achieved in 2013-14 (Active Prevention):

In order to better identify and understand food safety risks, the PHAC was engaged in several activities, including surveillance, sharing of outbreak information, detection technologies, and development of risk assessment tools. Significant achievements to date include the following:

Surveillance

FCSAP funding has maintained and enhanced the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) and the National Integrated Pathogen Surveillance Program (FoodNet Canada, formerly C-EnterNet). These surveillance programs consistently contributed valuable population-based information not available from any other sources on antimicrobial resistance in the food chain and augmented data on food-borne and gastrointestinal pathogens from FoodNet Canada. CIPARS information supported the creation and evaluation of policies to contain antimicrobial resistance and to better manage antimicrobial use in human medicine, veterinary medicine, and agricultural sectors. FoodNet Canada provided information on source attribution to identify targets for food safety interventions and to determine effectiveness of interventions. Data from both these programs were accessed to look for potential sources in provincial and national food-borne illness outbreaks.

FoodNet Canada operated in two sentinel sites and expanded to a third site in 2013-2014. Key achievements included:

• Analysis of survey data on foodborne, waterborne and environmental exposures provided important information about potential sources of enteric pathogens;
• A review of consumer food safety knowledge and behaviour in Canada was published,  revealing current gaps in this area and which provided a baseline for future work;
• Further information on the occurrence of enteric pathogens on bagged leafy greens was generated, to determine if issues identified in 2010 were addressed;
• Sampling of sliced fruits was initiated in 2014, to determine the occurrence of viruses, parasites and Listeria on the products;
• Analysis of domestically acquired foodborne disease data was continued to provide information on sources related to gastrointestinal disease in Canada; and,
• Data from FoodNet Canada provided information on severity of illness and proportion of cases that are travel-related for generating the revised estimates of foodborne diseases in Canada published in 2013.

CIPARS achievements related to FCSAP funding in 2013-14 included the following:

• Retail sampling continued in seven provinces and targeted sampling in an eighth province. Sampling included beef, pork, chicken, turkey, imported seafood and, in collaboration with CFIA, produce;
• Through retail chicken meat testing, CIPARS continued to monitor and communicate the impact of partial reintroduction of ceftiofur use in chicken meat hatching eggs, now augmented by on-farm antimicrobial use and antimicrobial resistance data from the CIPARS on-farm component, and prepared to monitor the impact of a national voluntary ban on ceftiofur initiated by the broiler chicken sector in the Spring of 2014 in response to CIPARS data;
• CIPARS similarly continued monitoring and communicating changes in the prevalence of Campylobacter resistant to fluoroquinolones in retail chicken meat and this was communicated in a peer-reviewed publication, a surveillance bulletin, at a multi-commodity stakeholder meeting and in the CIPARS Annual Report;
• CIPARS retail meat data were used in a "Risk Profile of Ceftiofur-Resistant Salmonella Heidelberg of Poultry Origin", based on Codex Guidelines for Risk Analysis of Foodborne AMR. The Risk Profile showed the current state of knowledge and the risk management options for ceftiofur-resistant Salmonella Heidelberg of Poultry Origin, and was, in part, a pilot test of the implementation of the Codex Guidelines for Risk Analysis of Foodborne AMR in Canada. It is in the final stages of preparation;
• CIPARS retail data continued to be regularly used by Health Canada in conducting safety evaluations to authorize the sale of antimicrobials for animal use, including post-market safety assessments of certain antimicrobials. This has resulted in label changes and a 2012 claim withdrawal of a particular use of an antimicrobial in a class considered very important to human medicine; and,
• For the first time and using molecular methods, the occurrence of a particular gene in bacteria from animals and meat was examined using samples collected through CIPARS, including the CIPARS retail component. The gene, blaSHV-2, is common in bacteria from human patients with resistant infections but rare in bacteria from food animals and retail meat; however, it has a high potential for transfer between bacteria and is a public health concern.

There were four peer-related publications relating directly to CIPARS' FCSAP activities. In addition, in 2013-14, the Agency produced the CIPARS 2010 Annual Report, as well as the CIPARS 2012 fourth quarter (Q4) and 2013 Q1 and Q2 Quarterly Salmonella Reports. CIPARS also presented the 2012 retail data at a multi-commodity stakeholder meeting in October 2013, in addition to other surveillance findings.

There were four peer-reviewed publications from FoodNet Canada in 2013-2014. In addition, data from FoodNet Canada provided information on severity of illness and the proportion of cases that are travel-related for generating the revised estimates of food-borne diseases in Canada.

Outbreak Summaries Application

The PHAC is leading the development and implementation of a platform for summarizing outbreak information. The Outbreak Summaries Application is a secure, web-based application for documenting and disseminating outbreak data in a standardized manner, which can then be used for monitoring trends in sources and risk factors, evaluating public health interventions, and informing risk assessments. The application has been implemented in five provinces, as well as at the PHAC and discussions are ongoing to have additional provinces and territories implement the application. As of March 31, 2014, there were over 3,300 outbreak summaries in the system. The Agency is currently in the process of writing the first report of outbreak summaries data, covering outbreaks reported in the system from 2008 to 2012, which will be released to public health partners in June of 2014.

Detection

The PHAC had the capacity and continued to conduct molecular fingerprinting using Pulsed Field Gel Electrophoresis (PFGE) for Listeria, Salmonella spp., Shigella spp., E. coli O157:H7 and non-O157:H7 VTEC isolated by surveillance programs. As noted in previous years, the Agency also optimized and evaluated the effectiveness of next generation molecular typing methodology (Multilocus Variable Number Tandem Repeat Analysis (MLVA)). An additional Agency laboratory was certified in MLVA for Salmonella Enteritidis and E. Coli O157 in 2013-14.

In 2013-14, 92% of all E. coli O157:H7 isolates were characterized by MLVA, comprising virtually every case and food isolate captured in the PulseNet Canada surveillance system. Additionally, MLVA training and certification were made available to federal, provincial, and territorial partners in 2013-14:  NML provided on-site training to Health Canada's Bureau of Microbial Hazards, and personnel from the Laboratory for Foodborne Zoonoses became certified in the method. Internally, five additional NML staff became certified in MLVA. A thorough analysis and review of E. coli O157:H7 outbreak data from 2008-12 was completed; from this work, the PulseNet Canada Executive Steering Committee adopted interpretation criteria for E. coli O157:H7 MLVA results. The Agency detected and evaluated 100 separate clusters of cases spanning two or more provinces, based on real-time molecular testing (72 clusters of Salmonella, 13 clusters of E. coli O157:H7, nine clusters of Shigella, and six clusters of listeriosis), which enabled outbreak investigations to be initiated at the earliest possible stage. Genomics (DNA sequencing and genetic mapping) has been used to develop novel laboratory fingerprinting methods for Salmonella Enteritidis and Campylobacter. Testing for Campylobacter using these methods now occurs at two sentinel sites and is being integrated into the PulseNet network, which ultimately will lead to better support and more rapid identification of contaminated food sources. The Agency also continued to develop and implement whole genome sequencing as the next generation method to further improve surveillance and outbreak detection.

Risk Assessment

The PHAC conducted quantitative risk assessment modelling to identify and compare public health risks and evaluated potential mitigation measures to prevent foodborne illness. Key 2013-14 activities included:

• Collaborated with Health Canada to publish the E .coliO157/mechanically tenderized beef risk assessment which provided a quantitative analysis of the risks from tenderized beef cuts to inform labelling policies;
• Developed a model exploring bacteria cross-contamination during poultry processing, which can be used in risk assessment to evaluate impacts of processing practices on public health risks and identify means to prevent foodborne illness;
• Evaluated the effectiveness of chilling interventions against Campylobacter spp. in broiler chicken processing using systematic review and meta-analysis. Results will be incorporated into a risk assessment model to identify interventions to reduce public health impacts; and,
• Completed an analysis of Campylobacter/poultry risk assessments and used the analysis to identify approaches suitable for a Canadian model.

As part of the Agency's risk assessment activities under the FCSAP, there were two peer-reviewed publications and five papers issued to departmental colleagues and stakeholders.

PHAC - 17.1 b - Expected Results for 2013-14 (Targeted Oversight):

Through ongoing and expanded data collection, analysis and the PHAC will contribute to the evidence base for policies, practices and programs for injury prevention focusing on vulnerable populations including children and seniors.

Expected results:

1. More and better data on accidents, injuries, illnesses and deaths due to consumer products; and,
2. Engagement of risk assessment stakeholders.

PHAC - 18.1 b - Results Achieved in 2013-14 (Targeted Oversight):

1) The Agency improved injury data by launching a real-time secure surveillance system to identify emerging hazards, injury trends, illnesses and deaths related to consumer products and other risk factors. This system operates in 17 hospitals across the country and the data collected was made available to the public through the Government of Canada's Open Data Initiative.

In addition, the Agency enhanced surveillance in Nunavut to provide data on injury in the territory. It also collected, analyzed and disseminated data on select consumer products (e.g., magnets, small button batteries, trampolines, detergent pods and baby products, including strollers and carriages) in order to strengthen the evidence base for action.

The Agency and its partners and stakeholders have published peer-reviewed journal articles using Canadian Hospitals Injury Reporting and Prevention Program data for many injuries, including those related to consumer-products.

2) The Agency developed and offered training webinars for the new real-time surveillance system to support participating hospital staff in implementing the data collection system and to help improve the quality of the data collected.

 Funding ongoing starting 2013-14.

CIHR - 17.1 a - Expected Results for 2013-14 (Targeted Oversight):

CIHR will make investments and focus efforts in advancing the DSEN to increase the evidence on drug safety and effectiveness available to regulators, policy-makers, health care providers and patients and to increase capacity within Canada to undertake high-quality post-market research in this area.

Work will continue on refining the DSEN Query management process, engaging decision makers, delivering on peer reviewed funding opportunities for the initiative and responding to strategic direction received from the DSEN Steering Committee.

Expected results: Increased knowledge of post-market drug safety and effectiveness to inform decisions and increase capacity in Canada to address priority research on post-market drug safety and effectiveness.

Performance Indicators: Increased knowledge of post-market drug safety and effectiveness to inform decisions.

CIHR - 18.1 a - Results achieved in 2013-14 (Targeted Oversight):

Also see: DSEN, Health Canada, Health Products, Targeted Oversight

The DSEN Coordinating Office (CO) has continuously taken action to improve program efficiency. The establishment of the Science Advisory Committee (SAC) improved the development of the Queries by bringing together researchers and decision makers early in the Query process. This dialogue facilitates the development, formulation and submission of scientifically, methodologically, and technically feasible DSEN Queries, increases the efficiency of the Query management process and enhances the direct interaction and communication between DSEN researchers and decision-makers. The establishment of the SAC, along with new improvements in the Rapid Funding for DSEN Targeted Research grant, CIHR's mechanism to fund DSEN Queries, resulted in a reduction of 25% of the time between Query submission and onset of research in the last year.

DSEN provided funds through the Rapid Funding for DSEN Targeted Research funding tool, to cover the project costs of DSEN Research Teams (Teams) responding to specific decision makers' queries. In 2013-14, DSEN, funded six projects, via its Rapid Funding process, investing $1.3 million over three fiscal years. DSEN also launched an additional Rapid Funding opportunity to release an additional $0.2 million over two fiscal years which began in May 2014.

Following the DSEN Steering Committee recommendations, the DSEN CO launched a funding opportunity to maintain program continuity and renewal of six of the seven Teams, whose initial three years grants terminate August 31, 2014. Collectively the Teams form a tightly coordinated national network of over 150 researchers committed to the highest excellence in post-market drug safety and effectiveness research. Together, they create the research platform which enabled the DSEN program to respond in a timely manner to the Queries as proposed by decision makers.

The Teams continued working to respond to priorities on the DSEN research agenda and to disseminate their research results. At year end, 17 queries were completed (representing a 143% increase in activity in 2012-13) and results shared with the federal regulator or federal/provincial decision makers, 23 Queries were under research by the Teams, and six more in development. Extending the reach of these research findings, 13 peer reviewed articles were published or submitted to open-access journals, by the Teams who also presented their findings at a range of meetings and symposia throughout the year.

To further support the dissemination of DSEN funded research results, the DSEN CO held a Knowledge Translation (KT) workshop on February 21, 2014 to advance DSEN's KT strategy by the development of adaptive research reporting templates correspond to various stakeholders' information needs.

The DSEN CO continued striving to engage decision-makers at the provincial and territorial levels. A half-day workshop entitled “Put the Drug Safety and Effectiveness Network to Work for You!”, designed primarily to support provincial and territorial decision makers' engagement in DSEN, was presented in St-John's, Edmonton and Vancouver. The workshops provide provincial decision makers an in-depth and hands-on knowledge of DSEN through a full simulation of the query management process.

DSEN also provided funds to support a three year partnership agreement with the Canadian Agency for Drugs and Technologies in Health (CADTH) to enhance provincial drug plans' engagement with the DSEN. DSEN and CADTH have complementary mandates to support decision makers in the health care system by providing timely, relevant and credible information.   CADTH offers dedicated resources to provide a consolidated point of contact with provincial decision makers and a scientific interface between these parties and DSEN researchers. This partnership will facilitate identification and submission of Queries by the provinces, bring scientific support to the provincial drug plans and facilitate the dissemination of DSEN research outputs.

The DSEN CO held semi-annual network meetings to maintain and stimulate the collaboration necessary for optimal network operations and to discuss evidence needs with the research teams, Health Canada, provincial / territorial decision-makers and other organizations mandated to support federal/provincial decision-making with respect to drugs. The 5th semi-annual DSEN meeting, held on October 18th, 2013, focused on the specific needs of the provinces and territories under the theme “ The Canadian Mosaic of Drug Safety and Effectiveness Strategy”.  On March 21st, 2014, the 6th meeting, entitled “Modernization of the drug regulatory framework: Training for the future”, focused on the development of the next generation of researchers in post market drug safety and effectiveness. To support research capacity development in post-market drug safety and effectiveness, DSEN invested $400,000 over four fiscal years in the career development of two doctoral and two post-doctoral trainees, starting in 2014-15.

In 2013-14 CIHR conducted an evaluation of DSEN's implementation phase, from the inception of the program in 2008-09 to the end of FY 2012-13 and assesses the design, implementation and early performance of DSEN to provide recommendations for program improvements. The evaluation report should be available to the public in FY 2014-15.

Comments on Variances:

Health Canada
Health Products
The variance was mainly due to the delays in staffing actions.

Food Safety
The variance was mainly due to increased laboratory maintenance costs. An internal reallocation from existing reference level was made to support the required activities.

Consumer Product Safety

The variance was mainly due to over-spending in Targeted Oversight and Rapid Response activities. An internal reallocation from existing reference level was made to support the required activities.

CFIA

The variance was mainly due to a continued delay in the finalization of the proposed Imported Food Sector Product Regulations which impacted the timing of hiring and training of inspectors, most specifically in Targeted Oversight. As a result the CFIA will carry forward the associated funding into 2014-15, aligning funding to the updated expenditure requirements. The CFIA realigned funding to support the actual requirements of Rapid Response.

PHAC

The variance was mainly due to the delays in staffing actions and the contracting processes.

Results achieved by non-federal partners: N/A

Contact information:

Diana Dowthwaite,
Director General, Resource Management and Operations Directorate
Health Products and Food Branch
Health Canada
250 Lanark Ave
Ottawa, Ontario
K1A 0K9
Telephone: 613-952-8149
E-mail: Diana.Dowthwaite@hc-sc.gc.ca

Name of Horizontal Initiative:  Federal Tobacco Control Strategy

Name of lead department(s): Health Canada

Lead department Program Alignment Architecture (PAA) program:  Substance Use and Abuse

Start date: April 2012

End date: March 31, 2017

Total federal funding allocation (from start to end date):  $228.3 million

Description of the Horizontal Initiative (including funding agreement):

The Federal Tobacco Control Strategy (FTCS) was initiated in 2001. In 2012, the Strategy was renewed for five years to provide a focused federal presence to preserve the gains of the past decade and continue the downward trend in smoking prevalence. The renewed strategy focuses on the core areas of federal responsibility and invests in new priorities including populations with higher smoking rates. The objective of the Strategy is to reduce the use of tobacco and the resulting death and disease in Canada.

Shared outcome(s):  To preserve the gains made over the past decade, and to continue the downward trend in smoking prevalence.

Governance structure(s):  Health Canada remains the lead department with responsibility for the coordination and implementation of the FTCS. As part of the Health Portfolio, the Public Health Agency of Canada (PHAC) delivers a contribution program.

Federal partners manage the control of tobacco products through monitoring and assessing the illicit and licit tobacco markets.

• PS - monitors contraband tobacco activity and related crime;
• The Royal Canadian Mounted Police (RCMP) - works with federal partners to identify and investigate criminal activities and to coordinate information on national and international contraband tobacco issues;
• The Canada Border Services Agency (CBSA) - increases knowledge of contraband domestically and internationally by liaising with tobacco authorities at all levels and by monitoring and providing regular reports on both national and global contraband tobacco. The CBSA provides reports, information and guidance to the Department of Finance Canada (FIN) on matters that will impact the future tax structure of tobacco;
• The Canada Revenue Agency (CRA) - administers the Excise Act 2001, which governs federal taxation of tobacco products and regulates activities involving the manufacture, possession and sale of tobacco products in Canada; and,
• Public Prosecutions Service Canada (PPSC) - monitors federal fines imposed in relation to tobacco and other types of offences in order to enforce and recover outstanding fines.

Performance highlights: 

Few other countries have been as successful as Canada in lowering smoking rates and shifting public attitudes about tobacco. Smoking prevalence is now at its lowest-ever overall rate. As of 2012, 16% of Canadians were current smokers, down from 22% in 2001. Further, 7% of teens aged 15-17 were current smokers, down from 18% in 2001. Key commitments of the renewed Strategy were implemented in 2013-14 including the provision of funding to the provinces and territories to support the implementation of the Pan-Canadian Quitline number and web portal. In addition, a young adult tobacco cessation, awareness and marketing campaign called breakitoff.ca was launched in partnership with the Canadian Cancer Society.

Federal Partner(s):

Federal Partner #1: Health Portfolio

Reductions in total allocation and planned spending from the previously reported amounts in the Report on Plans and Priorities 2013-14 and the refocused FTCS for 2012-13 to 2016-17 is due to the savings achieved from simplifying and streamlining operations while maintaining services to Canadians.

Comments on Variances:

Health Canada

The variance between planned and actual spending is due to: lower than anticipated tobacco litigation costs due to success in Court; lower than anticipated provincial and territorial funding requirements for the pan-Canadian Quitline; procurement challenges that delayed the launch of new social media platforms; and funding for First Nations and Inuit Health programs received late in the fiscal year resulting in under spending. The balance of the FTCS budget was reallocated to priority departmental program pressures.

PHAC

The variance between the planned and actual spending is due to: delays to some FTCS contribution agreements due to longer than anticipated timelines regarding proposal and partnership development; and fluctuations in currency conversion rates between American and Canadian dollars affecting the Voluntary Assessed Contributions to the World Health Organization (WHO) Framework Convention on Tobacco Control (WHO FCTC) paid through the International Health Grants Program.

Expected results by program (Health Portfolio):

• Regulations and Compliance - Conducting compliance monitoring activities and undertake enforcement measures with respect to the Tobacco Act and its regulations;
• Research - Conducting research and surveillance to support decision making and the development of anti-tobacco policies and programs;
• Policy - Leading the development of policies supporting the renewal of the FTCS in 2017 and facilitating stakeholder engagement. This includes coordinating and supporting policies associated with Canada's membership in the WHO FCTC;
• Litigation - Providing base funding for ongoing or any new tobacco litigation and for the defense of the Tobacco Act and its regulations; and,
• Community interventions - Supporting interventions and programming that aim to reduce tobacco use, and supporting on-reserve First Nations and Inuit communities to implement evidence-based tobacco control strategies.

Contributing activity / program results for the Health Portfolio 

Canada has made substantial progress in tobacco control. Few countries have witnessed similar reductions in prevalence, or a similar shift in public attitudes towards tobacco use. Smoking prevalence is at an all-time low of 16% across all age groups, down from 22% in 2001, and youth smoking has declined to an all-time low of 7% (Canadian Tobacco Use Monitoring Survey 2012).

Health Portfolio achievements in 2013-14 include:

• In partnership with the Canadian Cancer Society, Health Canada launched breakitoff.ca a young adult tobacco cessation, awareness and marketing campaign which will run until 2017;
• Health Canada provided funding to the provinces and territories to support the implementation of the Pan-Canadian Quitline number and web portal;
• The First Nations and Inuit Component of the FTCS will support a targeted number of First Nations and Inuit communities and organizations to establish comprehensive tobacco control strategies aimed at reducing and preventing tobacco misuse. In 2013-14, Health Canada's efforts focused on engagement with Aboriginal organizations, the finalization of an implementation approach, and funding to support tobacco control strategy planning at the regional level;
• Health Canada continued to implement new labelling requirements for cigarettes and little cigars;
• Health Canada proposed amendments to tobacco regulations (Cigarette Ignition Propensity Regulations; Tobacco Products Information Regulations; and Tobacco Seizures and Restoration Regulations) that were pre-published in Canada Gazette Part 1 on March 8, 2014;
• Health Canada conducted compliance monitoring and enforcement activities pursuant to the Tobacco Act. Health Canada found that 8% of regulated parties were deemed to be non-compliant with the Tobacco Act and its regulations through the inspection program. Health Canada did not find any non-compliance with the cigarette ignition propensity standard or with the prohibition on flavouring additives from the samples that were analysed;
• Health Canada launched the new Canadian Tobacco Alcohol and Drugs Survey (CTADS) in partnership with Statistics Canada. This biennial survey replaces the Canadian Tobacco Use Monitoring Survey (CTUMS) and the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS);
• Health Canada supported the defense of Canada in high profile tobacco litigation cases. The Department met all court requirements relating to tobacco litigation and in the defense of the Tobacco Act and its regulations;
• Health Canada distributed over 148,000 tobacco publications and responded to over 580 public enquiries on tobacco issues;
• The Health Portfolio contributed to international efforts to reduce tobacco use through its engagement with the WHO FCTC, and has been implementing policies associated with Canada's obligations as a Party; and,
• The PHAC continued its work on two tobacco-related interventions established in 2012-13, which will enhance the capacity of health professionals who provide smoking cessation services. The Agency also began negotiating with not-for-profit groups, other levels of Government and the private sector to put in place 3-5 new projects focused primarily on cessation for select groups (e.g. skilled trade workers).

Federal Partner #2: PS Portfolio

Comments on Variances:

RCMP

As noted in Chapter 5 of the June 2011 Status Report of the Auditor General of Canada, the RCMP has had to reallocate funding internally from all programs in order to meet the increased demands for National Policing Services. Furthermore, various Federal and Protective policing priorities have created additional requirements to reallocate funding and resources.

CBSA

The spending variance for CBSA under the FTCS can be attributed to constraints in staffing during 2012-13 and 2013-14. The Regions in particular were affected due to a change in internal Agency approval processes.

Expected results by program (PS Portfolio):
 
PS

• Enhanced partnership arrangement with Akwesasne Mohawk Police through the administration of contribution funding for monitoring activities in connection with determining levels of contraband activity;

• Leading interdepartmental efforts to explore the implementation of the Protocol to Eliminate the Illicit Trade in Tobacco Products under the WHO Framework Convention on Tobacco Control; and,
• Provide policy leadership and development of strategies to support law enforcements efforts to combat organized crime in the trade of contraband tobacco.

RCMP

• RCMP Police Operations (Tech Ops): Improve border security through the use of sophisticated technology which permits detection and monitoring of illegal border intrusions, resulting in vital intelligence in support of criminal intelligence;

• RCMP Canadian Law Enforcement Services (CI): Provide regular reports on the illicit tobacco situation to Finance and Health Canada, including data on seizures, organized crime involvement and trends. Provide side bar reports and presentations to other partners and key Ministerial entities upon request;
• Attend regular meetings to brief the FIN and other agencies on the illicit tobacco market; and,
• Participate in information sharing sessions with various law enforcement partners, including American Law Enforcement. Give presentations at law enforcement courses/workshops in Canada and the United States on the subject of contraband tobacco.

CBSA

• Provide advice to FIN on matters that will impact the future tax structure on tobacco;
• Monitor and report on the contraband tobacco situation in Canada;
• Expand cooperation with international and national law enforcement partners; and,
• Collection of the tobacco duties imposed on personal importations of returning Canadians.

Contributing activity / program results for PS 

• Managed the Akwesasne Partnership Initiative (API) contribution agreement to support Akwesasne Mohawk Police Service in combating organized crime in and around Akwesasne Mohawk Territory;
• Led interdepartmental efforts to explore the implementation of the Protocol to Eliminate Illicit Trade in Tobacco Products; and,
• Continues to lead the development of domestic and international policy initiatives to further address the contraband tobacco market, including negotiations with First Nations Band Councils to build on existing law enforcement partnerships to address organized crime activities, including contraband tobacco.

Contributing activity / program results for RCMP

• Through the use of enhanced technology, RCMP Technical Operations was better able to detect illegal border intrusions by monitoring the movement of people, vehicles, shipping containers and other packages. The technology allows for the automatic registration of intrusions in electronic format, producing intelligence suitable for analysis to establish patterns and trends. This approach allows for targeted interception of smuggling and the seizure of contraband products, leading to the disruption and prosecution of organized crime groups involved in the smuggling of contraband tobacco products;
• The RCMP Federal Coordination Centre provided regular reports on the illicit tobacco situation to the FIN and Health Canada. Reports and presentations were provided to other key partners and key Ministerial entities upon request. The tobacco analysts also regularly briefed and attended meetings with the FIN;
• The FTCS-supported criminal intelligence analysts for tobacco have attended the the Interprovincial Investigations Conference (IIC). The focus of the Conference was to develop, increase and maintain cooperation among all those who are involved in combating the contraband tobacco market by providing current information and contacts in other jurisdictions;
• While there were no recorded disruptions of organized crime groups (OCG) during the 2013-14 fiscal year,  for that same time period, the RCMP seized approximately 94,800 cartons or unmarked bags of cigarettes and approximately 34,100 kg of fine-cut tobacco. This represents a decrease of approximately 74% for cartons or unmarked bags of cigarettes, and a decrease of 24% from seizures made in fiscal year 2012-13; and,
• Although there has been a steady decline in contraband tobacco seizures since 2009, the RCMP maintains that a thriving illicit tobacco manufacturing industry continues to exist based on the amount of seizures of equipment and raw materials (fine cut tobacco). A decline in seizures may be an indication of some success as a result of previous disruption efforts and a reflection of the RCMP's recent Federal Policing Re-Engineering whereby operational decisions have moved away from commodity-based investigation units (C&E) to a streamlined approach to police operations without commodity-based boundaries. This new structure has led to lengthier, long term project-based investigations which focus on higher levels/targets in the distribution chain, often resulting in fewer seizures.  

Contributing activity / program results for CBSA

• Provided status updates on the contraband tobacco market, as well as seizure statistics, at the FIN chaired Tobacco Enforcement meetings;
• Produced an annual assessment of Canada's contraband tobacco market detailing characteristics and trends encountered by CBSA that year;
• Collaborated with other agencies, such as the RCMP and the Akwesasne Mohawk Police, which has resulted in an increase in referrals for examination for both commercial and travelers;
• Identified indicators and modus operandi not previously known;  identified emerging trends and threats and shared this information with CBSA Regional Offices, and with domestic and international partners, including the World Customs Organization; and,
• Continued to collect duties and taxes at Ports of Entry on all personal importations of tobacco.

Federal Partner #3: CRA

Expected results by program (CRA):

Legislative and Policy and Regulatory Affairs Branch

• Verify export activity;
• Ensure compliance with legislative requirements imposed on the manufacture, possession and sale of tobacco products in Canada;
• Work with stakeholders to monitor and assess the effectiveness of measures used to reduce contraband tobacco; and,
• Support RCMP/CBSA enforcement activities.

Assessment and Benefit Services Branch

• Maintaining accounts provide services relative to account transactions (including refunds) and produce reports of tobacco-related activities.

Contributing activity / program results for CRA

Legislative Policy and Regulatory Affairs Branch

• Audits and regulatory reviews were performed to ensure compliance with legislative requirements imposed on the manufacture, possession and sale of tobacco products in Canada;
• Information about specific tobacco transactions as well as expert testimony and affidavits, as required, were provided to support RCMP/CBSA enforcement activity; and,
• Officials participated on a number of committees dealing with the monitoring and control of tobacco products, including those dealing with interprovincial issues.

Assessment and Benefits Services Branch

• Processed returns and refunds to ensure correctness and maintained systems and reporting capabilities to meet program requirements.

Federal Partner #4: Public Prosecution Service of Canada (PPSC)

The PPSC is no longer receiving funding under this Horizontal Initiative.

Results to be achieved by non-federal partners: N/A.

Contact information:

Suzy McDonald
Director General, Controlled Substances & Tobacco Directorate
Healthy Environments and Consumer Safety Branch
Health Canada
Tunney's Pasture
Ottawa, Ontario
K1A 0K9
Postal Locator:  0301
Telephone: (613) 941-1977
E-mail:  suzy.mcdonald@hc-sc.gc.ca

Internal Audits and Evaluations

Internal Audits (2013-14)

Evaluations (2013-14)

The following table lists all key evaluations conducted in 2013-14. Completed Evaluation Reports are available online.

Response to Parliamentary Committees and External Audits

Response to parliamentary committees

“Technological Innovation in Health Care” - Report by the Standing Committee on Health was released on June 6, 2013. The Government Response was tabled on October 16, 2013.

In its 14th Report, the Standing Committee on Health recommended that the Government of Canada continue to: fund research that promotes the development, implementation and evaluation of e-health tools; work with other levels of government to address jurisdictional challenges in the development and implementation of e-health and telehealth systems; and, ensure that remote and First Nations communities have sufficient access to broadband networks and telerobotic systems, where feasible. The Committee commended the government's ongoing efforts to find efficiencies and harmonize regulatory systems with other jurisdictions, as well as its continued support of developments in genomics, nanotechnology, personalized medicine and rare disease research. The Committee also recommended that the government facilitate the sharing of best practices and promote health literacy to empower patients in the prevention and management of chronic illness.

The Government Response (GR) to this Committee Report supported the study's findings and outlined the government's role and actions taken in health innovation. It highlighted government efforts and investments in advancing telehealth, e-health (and medical records), and telerobotics initiatives in First Nations communities. It also highlighted Health Canada's regulatory modernization efforts for pharmaceutical drugs and medical devices (as outlined in its Regulatory Roadmap), increased cooperation with other international regulatory agencies, and ongoing work to reduce administrative burdens on businesses. Regarding the treatment of rare diseases, the GR indicated collaborative efforts by Health Canada and Orphanet-Canada to facilitate exchanges between patients, clinicians and associations in the context of innovative clinical trials and the Orphan Drug Regulatory Framework. The GR noted that the Government of Canada is the country's largest single-investor in health research and innovation, amounting to approximately $1 billion disbursed annually to the Canadian Institutes for Health Research (CIHR). It reported on government support for the work carried out by the Canadian Agency for Drugs and Technologies in Health (CADTH), which provides decision-makers with data about the optimal use and effectiveness of drugs and other health technologies, as well as CIHR's Drug Safety and Effectiveness Network, which aims to increase the evidence on the post-market safety and effectiveness of drugs. While recognizing that provincial and territorial governments have primary responsibility for the design and delivery of healthcare, the GR emphasized the Government of Canada's support for innovation and innovative technologies to improve healthcare and healthcare delivery for all Canadians.

For further information, please visit:

 House of Commons Committees - HESA (41-1) - Technological Innovation in Health Care

Government Response -  14th Report of the Standing Committee on Health, "Technological Innovation in Health Care"

“Prescription Pharmaceuticals in Canada: Off-Label Use” - Report by the Standing Senate Committee on Social Affairs, Science and Technology was released on January 30, 2014. The Government Response was tabled on July 3, 2014.

In the third phase of its four-part study on pharmaceutical drugs in Canada, the Committee studied the off-label use of drugs, which is considered a “practice of medicine” and falls mainly outside of the federal mandate. Through its 18 recommendations, the Committee raised issues regarding the extent of off-label prescribing practices and drug use in Canada and the concerns this poses to vulnerable sub-populations such as children, pregnant/nursing women and the elderly. Issues related to access to medicines in general and drugs used in the treatment of rare diseases, the safety and effectiveness of data, and the promotion and awareness activities (including the question of informed consent) in off-label drug uses were also raised.

The Government Response (GR) highlighted some of Health Canada's recent efforts aimed at improving what is already recognized as one of the best drug safety regulatory systems in the world. The Government of Canada agreed that new legislative and regulatory post-market authorities are needed, and referred to some measures undertaken to modernize the Food and Drugs Act and achieve better patient protection.An example of this is the introduction of Bill C-17, Protecting Canadians from Unsafe Drugs Act (Vanessa's Law) in December 2013, which proposed strengthened post-market authorities for the safety of marketed drug products. The GR also highlighted government efforts to improve the monitoring, data collecting and information-sharing practices related to off-label use. It also emphasized ongoing government support for research studies on the safety and effectiveness of off-label use (including those focusing on vulnerable populations) and in enhancing openness and transparency measures by implementing practices such as the publicly available electronic posting of both positive (approved) and negative (rejected) Summary Basis of Decision documents for drugs and medical devices reviewed by Health Canada for possible sale in Canada.

For further information, please visit:

 Senate of Canada Committees - SOCI (41-2) - Prescription Pharmaceuticals in Canada: Off-Label Use

Government Response -  5th Report of the Senate Standing Committee on Social Affairs, Science and Technology, “Prescription Pharmaceuticals in Canada: Off-Label Use”.

Response to the Auditor General (including to the Commissioner of the Environment and Sustainable Development)

2013 Spring Report of the Auditor General of Canada

Chapter 4 - Official Development Assistance through Multilateral Organizations
The overall objective of the audit was to determine whether the responsible federal departments and agencies promote Canadian development priorities and assess, on an ongoing basis, the effectiveness of spending on Official Development Assistance delivered through multilateral organizations, and whether they have assurance that the government's spending is consistent with the Official Development Assistance Accountability Act.

There were no recommendations addressed to Health Canada.  More information on audit:
http://www.oag-bvg.gc.ca/internet/English/parl_oag_201304_04_e_38189.html

Chapter 5 - Promoting Diabetes Prevention and Control
The objective of the audit was to determine whether the Public Health Agency of Canada (PHAC), Health Canada, and the Canadian Institutes of Health Research have implemented and coordinated activities, with partners, for the prevention and control of diabetes.

Health Canada received three recommendations.  More information on audit: http://www.oag-bvg.gc.ca/internet/English/parl_oag_201304_05_e_38190.html

2013 Fall Report of the Auditor General of Canada

Chapter 4 - Canada's Food Recall System
The overall audit objective was to determine whether the Canadian Food Inspection Agency, with the support of Health Canada and the PHAC, adequately manages the food recall system.

There were no recommendations addressed to Health Canada.  More information on audit: http://www.oag-bvg.gc.ca/internet/English/parl_oag_201311_04_e_38798.html

Chapter 6 - Emergency Management on Reserves
The objective of the audit was to determine whether Aboriginal Affairs and Northern Development Canada's and Health Canada's emergency management support to First Nations on reserves is adequately managed.

Health Canada received four recommendations.  More information on audit: http://www.oag-bvg.gc.ca/internet/English/parl_oag_201311_06_e_38800.html

External audits conducted by the Public Service Commission of Canada or the Office of the Commissioner of Official Languages

September 2013 - Office of the Commissioner of Official Languages

Horizontal Audit of Accountability for Official Languages Transfer Payments to the Provinces (Part VII of the Official Languages Act)

The objectives of the audit were to:  ensure that senior management at the audited institutions are strongly committed to accountability mechanisms for official languages transfer payments to the provinces; verify whether the institutions have formal and effective procedures and mechanisms in place with regard to accountability for official languages transfer payments; and, verify whether federal institutions are effectively monitoring their performance in terms of accountability for official languages transfer payments.

More information on  the audit: http://www.ocol-clo.gc.ca/html/audit_verification_092013_e.php

Up-Front Multi-Year Funding

Name of recipient: Canadian Foundation for Healthcare Improvement (CFHI), formerly known as the Canadian Health Services Research Foundation (CHSRF)

Start date:  1996-97

End date:  N/A

Total funding: $151.5 million

Description:

The Canadian Foundation for Healthcare Improvement (CFHI), formerly known as the Canadian Health Services Research Foundation (CHSRF), is an independent, not-for-profit organization originally established in 1996 to support evidence-informed health services decision-making. Subsequent targeted federal grants in 1999 and 2003 were built on this mandate. In total, between 1996 and 2003, CFHI (then known as CHSRF) received $151.5 million, starting with an initial federal endowment of $66.5 million in 1996. This was followed in 1999 by a grant of $25 million to support a ten-year program to develop capacity for research on nursing issues, and a $35 million grant to support CHSRF's participation in the Canadian Institutes of Health Research. In 2003, the Government of Canada provided additional funding of $25 million to develop a program to equip health system managers and their organizations with the skills to use research to better manage the Canadian health care system over a thirteen-year period.

Building on this history, in 2012 CHSRF's mission and name were changed to the Canadian Foundation for Healthcare Improvement (CFHI) to reflect the evolution of this work away from research and toward assisting organizations to implement evidence-based health care improvements. It collaborates with governments, policy makers and health system leaders to convert evidence and innovative practices into actionable policies, programs, tools and leadership development.

Strategic outcome(s):  A Health System Responsive to the Needs of Canadians

Summary of results achieved by the recipient:

CFHI’s health care transformation and improvement work is guided by three strategic priorities: engaging citizens, patients and families; accelerating evidence-informed improvement in health care delivery; and promoting policy analysis and facilitating dialogue.  All three of CFHI’s strategic priorities are propelled by programs which are focused on realizing change and accelerating health care improvement, and enabling improved health care efficiency, coordinated care, and patient- and family-centred care.  For example, CFHI:

• Supported 45 improvement teams within seven collaborations across the country, representing 264 health care leaders, administrators and front-line providers to accelerate health care improvement.  This includes continuation of the Atlantic Health care Collaboration to improve health care for people living with chronic disease, the Northern, Rural or Remote pan-provincial collaboration to improve health outcomes in those regions, the collaboration with the North Shore Tribal Council to redesign their primary health care service delivery, and a collaboration with the Institute for Health care Improvement (IHI) to support nine Canadian health care organizations to participate in the IHI’s Triple Aim Improvement Community;
• Completed 17 patient engagement projects across the country that increased involvement of patients in improving health care;
• Supported 29 leaders through 9 improvement projects across Canada as part of the Executive Training for Research Application (EXTRA) program.  Examples of projects included:  adopting an integrated model for chronic illness management; development of integrated pathway for patients with schizophrenia; development of an educational framework to reduce antipsychotic drug use in long-term care; and, development of an organizational framework for building capability and capacity for health system improvements; and,
• Organized an annual CEO Forum which promoted dialogue among the 183 participating health care executives on implementation strategies for achieving efficiencies, improving disease management, and introducing new technologies, with an emphasis placed on being patient and family-centred.
• Connected with the health care community via a four-part Patient and Family Engagement webinar series to spread information about patient and family engagement initiatives.  The four sessions averaged more than 255 participants for each broadcast, across 87 organizations.

Comment on variances:
N/A

Significant evaluation findings by the recipient during the reporting year and future plan:

As per the requirements of the funding agreement with Health Canada, CFHI is undertaking an independent evaluation, which will be finalized in summer 2014.

Significant audit findings by the recipient during the reporting year and future plan:

CFHI's financial records are reviewed and audited annually by independent external accountants. The 2013 external financial and pension audits showed no major concerns, with the auditors reporting clean audits with no evidence of fraud or illegal acts.

Link to  recipient's website: http://www.cfhi-fcass.ca/Home.aspx

Name of recipient: Canada Health Infoway (Infoway)

Start date: March 31, 2001^(a)

^(a)Infoway's original allocation (2001) was governed by a Memorandum of Understanding. Infoway is presently accountable for the provisions of four active funding agreements, signed in: March 2003 (encompasses 2001 and 2003 allocations), March 2004, March 2007 and March 2010.

End date: March 31, 2015^(b)

^(b)As per the 2010 finding agreement, the duration of the agreement is until the later date of: the date upon which all Up-Front Multi-Year Funding provided has been expended, or March 31, 2015. The duration of the 2007 funding agreement is until the later of: the date upon which all Grant Funding has been expended, or March 31, 2012. The funding allocations under the 2003 and 2004 agreements were provided as lump sums.

Total funding:

$2.1 billion*

*Canada Health Infoway (Infoway) received $1.2 billion as lump-sum grants between 2001 and 2004. The $400 million allocated in 2007 was subject to new conditions - these funds flow to Infoway on an as-needed basis based on cash flow requests. An additional $500 million for Infoway was announced in Budget 2009 and confirmed in Budget 2010. In March 2010, Health Canada and Infoway signed a related funding agreement. The $500 million funds flow to Infoway on an as-needed basis based on cash flow requests.

Description:

Canada Health Infoway Inc. (Infoway) is an independent, not-for-profit corporation established in 2001 to accelerate the development of electronic health technologies such as electronic health records (EHRs) and telehealth on a pan-Canadian basis. Its Corporate Members are the 14 federal, provincial and territorial Deputy Ministers of Health.

To date, the Government of Canada has committed the following funding allocations to Infoway: $500 million in 2001 in support of the September 2000 First Ministers' Action Plan for Health System Renewal to strengthen a Canada-wide health infostructure, with the EHR as a priority; $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth; $100 million as part of Budget 2004 to support development of a pan-Canadian health surveillance system; and $400 million as part of Budget 2007 to support continued work on EHRs and wait times reductions. Also, as confirmed in Budget 2010, Canada's Economic Action Plan allocated an additional $500 million to Infoway, to support continued implementation of EHRs, implementation of electronic medical records (EMRs) in physician's offices, and integration of points of service with the EHR system. Infoway invests in electronic health projects in collaboration with a range of partners, in particular provincial and territorial governments, typically on a cost-shared basis. Project payments are made based on the completion of pre-determined milestones.

It is anticipated that Infoway's approach, where federal, provincial and territorial governments participate toward a goal of modernizing electronic health information systems, will reduce costs and improve the quality of health care and patient safety in Canada through coordination of effort, avoidance of duplication and errors, and improved access to patient data.

Strategic outcome: A Health System Responsive to the Needs of Canadians.

Summary of results achieved by the recipient:

Investment Strategy: Infoway is a strategic investor, with a funding formula covering up to 100% of territorial and 75% of provincial eligible project development and implementation costs. Infoway provides project oversight and monitoring, while provincial/territorial (P/T) partners are responsible for actual system development, implementation and funding of all other costs, including ongoing operational costs. In 2013-14, Infoway approved $2.5 million in new projects (6 projects), bringing its cumulative allocation of investments to $2.112 billion (393 projects since Infoways inception). Infoway estimates that investments in EMRs, diagnostic imaging, drug information systems and telehealth have produced an estimated $10.5 billion in benefits for Canadians and the health care system since 2007.

Electronic Health Records: Infoway's goal, endorsed by all jurisdictions is that by 2016, 100 per cent of Canadians will have an EHR available to their authorized health care professionals. Based on Infoway's historic measurement approach, which takes into account only the completion rate for the least advanced of six components of an EHR in each jurisdiction, EHR data is considered as being available for 57.4 % of Canadians. However, using a revised approach that considers progress for all components, EHR data is available for 89 % of Canadians as of March 2014.
Results achieved in 2013-14 include:

• EHR Systems - Clinicians across Canada are increasingly using EHR systems to support the care of their patients. In 2006, there were approximately 7,600 users of the electronic health record (based on access to two or more integrated jurisdictional data assets). By 2014, that number had increased significantly to over 62,000 users across Canada – an increase of more than 700 %;
• Diagnostic Imaging Systems - As of March 2014, an estimated 54,000 health care professionals are using diagnostic imaging system technology. Virtually 100% of exams performed in public hospitals in all thirteen provinces and territories are filmless, stored digitally and available to physicians. Researchers estimate that this has increased productivity by more than 25%, enabling as many as 11 million more exams each year;
• Drug Information Systems - Approximately 35,000 health care professionals are estimated to be using drug information systems that enable authorized care providers to securely view a patient's medication profile online, allow for enhanced medication reconciliation and perform drug interaction alert checking.  Over 45,000 users in eight jurisdictions can view electronic medication profiles for their patients;
• Registries - Registries needed to identify patients and health care providers have been established in every province and two of the territories. Some work is still required to complete the registries in Yukon;
• Laboratory Test Results - Systems to electronically capture and share laboratory tests are now available in most jurisdictions, while others are in various stages of implementation. It is estimated that there are currently nearly 65,000 users of lab information systems in Canada; and,
• Clinical reports/immunizations - All jurisdictions have made clinical reports or immunizations available in a shared repository.

Telehealth: Telehealth is the technology-enabled delivery of health care services when the clinician and patient are not in the same location. It is estimated that 98 % of hospitals in Canada are telehealth-enabled. Statistics from 2013 demonstrate continued strong growth, with use across Canada estimated at more than 400,000 clinical events. Clinical use of telehealth has demonstrated growth of more than 110 % since 2010. Approximately 5,000 Canadians are enrolled in remote patient monitoring (RPM) programs and pilots. These technologies allow for the electronic transmission of patient data (e.g., symptoms, vital signs) from a patient’s home to a health care provider for monitoring and support over a specified time period.  A review of Canadian RPM programs indicates a steady increase of activity across different jurisdictions.

Electronic Medical Records (EMR): Part of the 2010 federal funding has been allocated towards investment in EMR systems in community-based practices and outpatient settings. In March 2014, Infoway reported that it had supported the enrolment of more than 16,000 clinicians in EMR programs across nine jurisdictions with a physician office program, surpassing the target of 12,000.  As at March 31, 2014, more than 85 % of these 16,000 clinicians had also met specified clinical value targets that promote the effective use of EMRs. In addition to EMR deployment in physicians’ offices, 20 projects are complete or in progress to implement EMRs in ambulatory care (outpatient clinic) settings that will support approximately 25,000 users when fully implemented.  Seventy % of these ambulatory EMR systems had been deployed by March 31, 2014, providing more than 19,000 clinicians with the ability to better manage patient information and access to important clinical information through connections to hospital systems and the EHR.

Early benefits research on EMR investments shows positive demonstrable clinical value, particularly in the area of practice productivity and efficiencies. An independent pan-Canadian study commissioned by Infoway and published in April 2013 reports more than $1.3 billion in benefits of EMRs over a six year period (2006-12). The results of this study are tied to significant national progress in EMR adoption over the same period, which saw adoption by primary care physicians in Canada triple from 16% in 2004 to 64% in 2013, based on the National Physician Survey.

Consumer Health and Clinical Innovation/Adoption: To date, Infoway has invested in nine consumer health and 20 clinical innovation demonstration projects. As of March 31, 2014, these projects were reporting a combined total of more than 42,000 active clinical/consumer users. These demonstration projects are receiving local, national and international recognition for their innovative nature and the value that they are delivering to patients and care providers.

In 2013-14, the ImagineNation Outcomes Challenge encouraged the health care community to accelerate the use and growth of innovative digital health solutions for e-scheduling, patient access to health information, medication reconciliation and clinical synoptic reporting. The 43 teams involved achieved more than 3.6 million combined total uses of their solutions (against a target of 2 million uses), along with an almost 95 % increase in users during the course of the Challenge.

In 2013-14, Infoway continued its efforts to accelerate the use of electronic health information technologies by clinicians. Examples of recent initiatives include:

• Continued support for clinician peer leader networks, which have been established in 10 jurisdictions;
• Continuation of the "Knowing is Better for Clinicians" campaign, which offers a series of educational resources such as videos, presentations and articles for use by clinicians who want to share information about the clinical value and progress of electronic health information systems in clinical practice;
• Partnerships with physician, nursing and pharmacy educators on programs to prepare future clinicians to practice in a health information technology-enabled environment, including collaboration in 2013-14 on projects for an eHealth environmental scan in undergraduate medical education, a pharmacist e-learning online resource and a nursing faculty toolkit to strengthen learning in the digital age;
• Supporting the evolution of the Clinician Education Campaign by developing the “LEADing Practice” initiative to identify and showcase clinical leadership in using technology to advance professional practice and quality patient care; and,
• Holding on February 27-28, 2014 of a symposium ( “Advancing Care: Optimizing the Use and Value of Digital Health”), which brought together leaders from the clinician community and health professional associations, members of Infoway’s Clinical Council and Reference Groups, academia, regulators, and representatives from government and quality councils to discuss improvements to health and health care through digital health.

2018 Pan-Canadian Digital Health Strategic Plan: In June 2013, Infoway published “Opportunities for Action: A Pan-Canadian Digital Health Strategic Plan”. Based on consultations with over 500 stakeholders, this strategic plan identifies five areas of opportunities for advancement (bringing care closer to home, providing easier access, supporting new models of care, improving patient safety, and enabling a high-performing health system).  The plan identifies the corresponding technologies and considerations for the implementation. Infoway will be allocating $20 million from existing funding to projects that are in line with the “Opportunities for Action” strategic plan. Program criteria were developed in 2013-14 and Infoway will be considering proposals for consumer health demonstration projects as well as remote patient monitoring start-ups and deployment in 2014-15.

Expanded Outreach to Canadians on the Value of Digital Health: In September 2013, Infoway launched a public education campaign to create awareness of, and support for, digital health among Canadians. Every jurisdiction across Canada supported the campaign, as did a number of organizations representing clinicians, patients and disease-specific groups. The “Better Health Together” campaign featured Canadians sharing their stories of how digital health has improved their patient experience. It is estimated that through target media advertisements, social media, coverage on radio stations and television channels, and online presence, the campaign materials have been seen or heard by Canadians in excess of 100 million times.

National and International Recognition for Infoway’s Results and Commitment to Accountability:  In 2013-14 Infoway was twice recognized for its stewardship of public funds. In November 2013, Infoway was named the worldwide “Project Management Office of the Year”, an international distinction bestowed by the Project Management Institute, the leading membership organization for the project management profession. In February 2014, Infoway was also the recipient of a “Canadian Government Executive Leadership Award”, which recognizes improved public service at lower cost.

Comment on variances: N/A

Significant evaluation findings by the recipient during the reporting year and future plan:

No evaluation activity was undertaken in the 2013-2014 fiscal year.

An independent performance evaluation on actions achieved under the 2007 funding agreement will be commissioned for completion by March 2015.

Significant audit findings by the recipient during the reporting year and future plan:

No audit activity was undertaken in the 2013-2014 fiscal year.

Link to recipient’s website:  Canada Health Infoway

Name of recipient: Mental Health Commission of Canada (MHCC) - Conditional Grant to support Research Demonstration Projects in Mental Health and Homelessness

Start date: March 31, 2008

End date: March 31, 2014

Total funding: $110 million^{Footnote m1}

Description:

As part of Budget 2008, the federal government provided $110 million^{Footnote m1} in funding to the MHCC to support five research demonstration projects in mental health and homelessness over five years (2008 - 2013). This agreement was later extended by one year (to March 31, 2014) to allow time for project participants who received housing to be transitioned to provincial services.

Research took place in five urban centres: Moncton, Montreal, Toronto, Winnipeg, and Vancouver. The overall goal of this project was to provide evidence on what services and systems most effectively and efficiently help homeless people who are living with mental illness.

The main intervention tested was the “Housing First” approach.  Under this approach, homeless persons with serious mental illness receive stable housing as a first step toward recovery, rather than as a support provided only after certain conditions are met (e.g., employment secured, mental health and/or addictions counselling completed, etc.).

Strategic outcomes:

• The development of best practices and lessons learned that are applicable to future efforts with respect to mental health and homelessness across Canada, including innovative methodologies for providing targeted interventions to specific subpopulations; and,

• Data that reflects the impact and prevalence of mental health issues and substance abuse challenges.

Summary of results achieved by the recipient:

In 2013-14, the final year of the project, the MHCC:

• Successfully transitioned participants who received housing to provincial social services; and,
• Completed and publicly released detailed final reports for each of the project sites, as well as a national roll up report. All reports, including two “Early Findings” reports released in 2012, can be found at the following web link: www.mentalhealthcommission.ca/English/initiatives-and-projects/home?terminitial=38

The key findings from the final reports include:

• For all persons who received housing, on average every $1 invested resulted in savings of $0.65 through reduced use of health and social services;
• Specifically, every $1 invested in moderate needs and high needs persons saved $0.34 and $0.96, respectively. For the highest 10% of service users in the Housing First group, every $1 invested saved $2.17; and,
• The “Housing First” approach resulted in stable housing and improved quality of life and community engagement.

Overall, the reports identify best practices and lessons learned that are now being applied to ongoing efforts to address the complex issue of homelessness and mental illness. For example, based on the findings from At Home/Chez Soi, in 2013 the Government of Canada's renewed its Homelessness Partnering Strategy, in the amount of $595 million over five years, using a Housing First approach.

The reports also provide new information on the impact and prevalence of mental health and addictions within the homeless population for potential further study.

Comment on variances:

The full $110 million was provided to the recipient upon signing of the agreement in 2008; therefore, no yearly variances occurred.

Significant evaluation findings by the recipient during the reporting year and future plan:

No evaluation was completed during the reporting year. A Health Canada-led evaluation of the MHCC is scheduled for fiscal year 2015-16. An Independent Evaluation of the MHCC was completed in fiscal year 2011-12, which included the homelessness initiative. This  evaluation can be found at the following web link: https://www.mentalhealthcommission.ca/English/document/215/mental-health-commission-canada-formative-evaluation-final-technical-report.

Significant audit findings by the recipient during the reporting year and future plan:

As specified in the funding agreement, the MHCC must submit independently audited financial statements to Health Canada each fiscal year. Also required is an Annual Report detailing activities conducted and outcomes achieved. These reports are due to Health Canada no later than 120 days after the end of the fiscal year (i.e., July 29).

Upon completion of the audited financial statements and a final Annual Report for 2013-14, complementing the research reports already produced, all reporting obligations of the funding agreement will be met and the agreement will be closed.

Link to recipient's website:

 www.mentalhealthcommission.ca

Sources of Respendable and Non-Respendable Revenue

Reflected in this table are the collection of respendable revenues and of non-respendable revenues by program, sub-program and sub-sub program. Respendable revenues refers to funds collected for user fees or for the recovery of the cost of departmental services. These revenues include those both external and internal to the government, the majority being external.

A variety of respendable revenues are collected which include Medical Devices, Radiation Dosimetry, Drug Submission Evaluation, Veterinary Drugs, Pest Management Regulation, Product Safety, hospital revenues resulting from payments for services provided to First Nations and Inuit Health hospitals, which are covered under provincial or territorial plans, the sale of drugs and health services for First Nations communities, and revenues associated with the recovery of health benefits from the First Nations Health Authority (FNHA) in British Columbia.

User Fees Reporting

User Fees and Regulatory Charges (User Fee Act)

User fee: Fees Rights to Sell Drug Fees

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1, 2011

Performance standards:

120 Calendar days to update the Drug Product Database following notification

Performance results:

100% within 120 Calendar days

User fee:  Drug Establishment Licensing Fees

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1, 2011

Performance standards:

250 Calendar days to issue/renew licence

Performance results:

Average number of days: 153 days

User fee: Drug Submission Evaluation Fees (Pharmaceuticals & Biologic Products)

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1, 2011

Performance standards:

Review 1 (average time in calendar days)

Pharmaceuticals :

NAS: NDS = 300
CLIN C&M: NDS = 300
CLIN C&M: SNDS = 300
CLIN : NDS = 300
CLIN: SNDS = 300
CLIN: DIN A = 210
COMP C&M: ANDS = 180
COMP C&M: NDS = 180
COMP C&M: SANDS = 180
COMP C&M: SNDS = 180
COMP C&M: DIN A = 210
C&M: ANDS = 180
C&M: NDS = 180
C&M: SANDS = 180
C&M: SNDS = 180
C&M: DIN A = 210
PUBLISHED DATA: SNDS=300
PUBLISHED DATA: DIN A=210
Rx to OTC Switch: SNDS = 180
DISINFECTANT: NDS-D = 300
DISINFECTANT: SNDS-D = 300
DISINFECTANT: DIN D = 210
DISINFECTANT: DIN D = 180
LABELLING ONLY: NDS=60
LABELLING ONLY: SNDS=60
LABELLING ONLY: ANDS=60
LABELLING ONLY: SANDS=60
LABELLING ONLY: DIN A=180
LABEL STANDARD: DIN A=45
LABEL STANDARD: DIN D=45
LABEL STANDARD: DIN F=45
ADMINISTRATIVE: ANDS = 45
ADMINISTRATIVE: NDS = 45
ADMINISTRATIVE: SNDS = 45
ADMINISTRATIVE: SANDS = 45
ADMINISTRATIVE: DIN A = 45
ADMINISTRATIVE: DIN D = 45

Biologics:

NAS: NDS = 300
CLIN C&M: NDS = 300
CLIN C&M: SNDS = 300
CLIN C&M: DIN B = 210
CLIN: NDS = 300
CLIN: SNDS = 300
C&M: ANDS = 180
C&M: SNDS = 180
C&M: DINB = 210
COMP C&M: SNDS = 180
LABELLING ONLY: SNDS = 60
PUBLISHED DATA: SNDS = 300
ADMINISTRATIVE: NDS = 45
ADMINISTRATIVE: DINB = 45

Performance results:

Review 1 (average time in calendar days)

Pharmaceuticals :

NAS: NDS = 268
CLIN C&M: NDS = 291
CLIN C&M: SNDS = 293
CLIN : NDS = 297
CLIN: SNDS = 276
CLIN: DIN A = 205
COMP C&M: ANDS = 196
COMP C&M: NDS = N/A
COMP C&M: SANDS = 191
COMP C&M: SNDS = 174
COMP C&M: DIN A = 193
C&M: ANDS = 288
C&M: NDS = 178
C&M: SANDS = 149
C&M: SNDS = 157
C&M: DIN A = 177
PUBLISHED DATA: SNDS=262
PUBLISHED DATA: DIN A= 159
Rx to OTC Switch: SNDS = 172
DISINFECTANT: NDS-D = 327
DISINFECTANT: SNDS-D = 290
DISINFECTANT: DIN D = 210
DISINFECTANT: DIN D = N/A
LABELLING ONLY: NDS= 50
LABELLING ONLY: SNDS= 52
LABELLING ONLY: ANDS= 48
LABELLING ONLY: SANDS= 29
LABELLING ONLY: DIN A= 127
LABEL STANDARD: DIN A= 37
LABEL STANDARD: DIN D= 42
LABEL STANDARD: DIN F= 34
ADMINISTRATIVE: ANDS = 28
ADMINISTRATIVE: NDS = 29
ADMINISTRATIVE: SNDS =  31
ADMINISTRATIVE: SANDS = 30
ADMINISTRATIVE: DIN A = 20
ADMINISTRATIVE: DIN D = 32

Biologics:

NAS: NDS = 239
CLIN C&M: NDS = 280
CLIN C&M: SNDS = 264
CLIN C&M: DIN B = 209
CLIN: NDS = N/A
CLIN: SNDS = 286
C&M ANDS = 180
C&M: SNDS = 168
C&M: DINB = 206
COMP C&M: SNDS =179
LABELLING ONLY: SNDS = 50
PUBLISHED DATA: SNDS = 291
ADMINISTRATIVE: NDS = 28
ADMINISTRATIVE: DINB = N/A

User fee: Medical Device License Application Fees

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1, 2011

Performance standards:

Review 1 (average time in calendar days):

Class II New = 15
Class III New = 60
Class III Near Patient =60
Class III Manufacturing Amendment = 60
Class III Significant Amendment = 60
Class IV New = 75
Class IV Human-Animal Tissue =75
Class IV Manufacturing Amendment = 75
Class IV Significant Amendment = 75

Performance results:

Review 1 (average time in calendar days):

Class II New = 11
Class III New = 53
Class III Near Patient = 49
Class III Manufacturing Amendment = 44
Class III Significant Amendment = 53
Class IV New = 78
Class IV Human-Animal Tissue= 62
Class IV Manufacturing Amendment = 59
Class IV Significant Amendment= 67

User fee: Fees for Right to sell a Licensed Medical Device

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1, 2011

Performance standards:

20 calendar days from deadline for receipt of annual notification to update the Medical Devices Active License Listing (MDALL) database

Performance results:

99.9% within 20 calendar days

User fee: Medical Device Establishment Licensing Fees

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1, 2011

Performance standards:

120 calendar days to issue / renew licence

Performance results:

Average number of days: 90 Days

User fee: Veterinary Drug Evaluation Fees

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

March, 1996

Performance standards:

Review 1 (average time in calendar days):

NDS (including Priority Review) = 300
ANDS = 300
SNDS = 240
SANDS = 240
Admin = 90
DIN (including changes to DINs) = 120
NC = 90
ESC = 60
Labels = 45
Emergency Drug Release = 2

Performance results:

Review 1 (average time in calendar days):

NDS (including Priority Review) = 331
ANDS = 310
SNDS = 235
SANDS = 140
Admin = 25
DIN (including changes to DINs) = 117
NC = 89
ESC = 40
Labels = N/A
Emergency Drug Release = <2 days

Other information:

Acronyms:

NDS:

New Drug Submission

SNDS:

Supplement to a New Drug Submission

ANDS:

Abbreviated New Drug Submission

SANDS:

Supplement to an Abbreviated New Drug Submission

DIN:

Drug Identification Number Application

INDS:

Investigational New Drug Submission

ESC:

Experimental Studies Certificate

NC:

Notifiable Change

NAS:

New Active Substance

OTC:

Over the Counter

Rx:

Prescription

Clin:

Clinical

Comp:

Comparative Bio, Clinical or Pharmacodynamic Studies

C&M:

Chemistry and Manufacturing

N/A:

at time of reporting either no submissions of that type were received or no reviews of that submission type were completed, therefore no performance information available.

Performance:

As per the User Fee Act, when a department fails to meet its service standards by more than 10%, a fee reduction takes place upon tabling of the Departmental Performance Report (DPR). They are in effect until the date of the next DPR.

Where a regulating authority's performance in a particular fiscal year in respect of a user fee does not meet the standards established by it for that fiscal year by a percentage greater than ten per cent, the UFA requires that the user fee be reduced.

When a service standard is missed, the fee is reduced by the percentage missed, up to a maximum of 50%. In 2013-14, for pharmaceutical drug submission reviews, service standards were met for 31 of 35 lines.  However, one of the generic drug pharmaceutical lines did not meet the service standard, and will be assessed penalties. It is:

1. CHEMISTRY & MANUFACTURING /ANDS, with a target of 180 days, and performance of 288 days (penalty 50%).

Three additional lines did not meet the performance standard, but did not exceed the target by more than 10%, so there are no penalties incurred.  They are:

1. COMPARATIVE STUDIES C&M / ANDS, with a target of 180 days, and performance of 196 days.
2. COMPARATIVE STUDIES / C&M / SANDS, with a target of 180 days, and performance of 191 days.
3. DISINFECTANT NDS-D, with a target of 300 days, and performance of 327 days.

User Fee: Pest Control Product Application Examination Service

Fee type:

Regulatory

Fee-setting authority:

Pest Control Product Act (PCPA)

Year last modified:

April 1997

Performance standards:

Target is 90% of submissions in all categories to be processed within  the applicable review time.

PMRA Service Standards: http://www.hc-sc.gc.ca/ahc-asc/legislation/acts-reg-lois/service/aepcp-aerpa-eng.php

Category A: Review time standards range from 285 to 655 days.

Category B: Review time standards range from 158 to 470 days.

Category C: . Review time standards range from 98 to 225 days.

Category D: Review time standards range from 10 to 70 days.

Category E: Review time standards range from 69 to 159.

Performance results:

Category A  =  97%

Category B  =  96%

Category C  =  65%

Category D  =  88%

Category E  =  48%

User Fee: Right or Privilege to manufacture or sell a Pest Control Product in Canada and for Establishing a Maximum Residue Limit in relation to a Pest Control Product

Fee type:

Regulatory

Fee-setting authority:

Financial Administrative Act (FAA)

Year last modified:

April 1997

Performance standards:

100% of all fees for the right or privilege to manufacture or sell a pest control product in Canada are invoiced by April 30th of each fiscal year.

Performance results:

100% of all invoices were issued by April 30, 2013.