Supplementary Information Tables 2018-2019 : Health Canada

Table of Contents

• Departmental Sustainable Development Strategy
• Details on Transfer Payment Programs of $5 Million or More
  • Health Care Policy Contribution Program
  • Contribution to the Canadian Foundation for Healthcare Improvement
  • Contribution to the Canadian Agency for Drugs and Technologies in Health
  • Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative
  • Mental Health Commission of Canada Contribution Program
  • Substance Use and Addictions Program
  • Contribution to Canada Health Infoway
  • Contribution to the Canadian Institute for Health Information
  • Contribution to the Canadian Partnership Against Cancer
  • Contribution to the Canadian Patient Safety Institute
  • Canadian Blood Services: Blood Research and Development Program
  • Official Languages Health Program
  • Canada Brain Research Fund Program
  • Thalidomide Survivors Contribution Program
  • Territorial Health Investment Fund
  • Payments to Provinces and Territories for the Purpose of Emergency Treatment Funding
• Horizontal Initiatives
  • Addressing the Opioid Crisis
  • Canadian Drugs and Substances Strategy
  • Chemicals Management Plan
  • Federal Tobacco Control Strategy
  • Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis
• Gender-Based Analysis Plus
• Response to Parliamentary Committees and External Audits
  • Response to parliamentary committees
  • Response to audits conducted by the Office of the Auditor General of Canada (including audits conducted by the Commissioner of the Environment and Sustainable Development)
  • Response to audits conducted by the Public Service Commission of Canada or the Office of the Commissioner of Official Languages
• Up-Front Multi Year Funding
  • Conditional Grant to Canadian Foundation for Healthcare Improvement
  • Conditional Grant to Canada Health Infoway

Details on Transfer Payment Programs of $5 Million or More

Health Care Policy Contribution Program

General information

Name of transfer payment program

Health Care Policy Contribution Program (HCPCP) (Voted)

Start date

September 24, 2002

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2010-11

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 1: Health Care Systems Analysis and Policy

Description

The HCPCP provides up to $26.9 million per fiscal year in time-limited contribution funding for projects that address specific health care systems priorities, including home and palliative, health care systems innovation, and health human resources. Through the implementation of contribution agreements and a variety of stakeholder engagement activities, Health Canada contributes to the development and application of effective approaches to support sustainable improvements to health care systems.

Results achieved

The Program directed funding toward knowledge development, translation and exchange activities to support innovation and implementation of best practices in key policy areas such as palliative and end-of-life care, medication safety and home care. The Program also supported projects that contributed to improving access to health care services for all Canadians.

Specific examples include:

• Health Canada provided funding to the Canadian Hospice Palliative Care Association for an initiative that focusses on increasing the capacity for advance care planning across Canada. A National Advance Care Planning Day and Speak Up videos will be launched fiscal year 2019-20 to help Canadians think about and share their wishes for future health care with others.
• The Choosing Wisely Canada (CWC) project encourages clinicians and patients across Canada to engage in conversations about unnecessary tests, treatments and procedures. In 2018-19, CWC's work resulted in more than 116 practice recommendations to empower clinicians and patients to make better choices; avoid unnecessary tests; and cultivate increased stewardship of health care resources among physicians and health care delivery organizations. For example, a campaign launched in March 2018 continues to foster awareness and uptake of CWC recommendations in family medicine. The College of Family Physicians of Canada has partnered closely on special campaigns including 'Opioid Wisely' and 'Using Antibiotics Wisely' and deepened the work on developing evidence-informed tools and resources (6 Provinces are now offering Practising Wisely, a continuing professional development program of the Ontario College of Family Physicians. Provinces include Alberta, British Columbia, Ontario, Newfoundland, Quebec and Saskatchewan).
• Pallium Canada's project: "Building and Bridging – Palliative Care is Everyone's Business" aims to strengthen home and community palliative care capacity. In 2018-19, Pallium Canada continued to expand the "Learning Essentials Approaches to Palliative Care" (LEAP) program, which develops and provides inter-professional palliative care education across Canada. Pallium completed the development of the Compassionate Community (CC) Exchange to enable networking and sharing of best practices by CC champions across Canada and around the world. For example, the Children and Youth Grief Network shared several resources, such as The Grief and Death Education Toolkit, which helps teachers feel more comfortable addressing concepts of death and grief within the school setting. As well, under Including Diverse Perspectives, an article, Staying out of the closet: LGBT older adults' hopes and fears in considering end-of-life (2018), provides insight on perspectives of Canadian Lesbian, Gay, Bisexual and Transgender (LGBT) older adults and their experiences on aging and end of life. International interest in Canada's approach to building CC is growing. Pallium signed sharing agreements with partners in the US and Belgium to pilot and adapt the toolkit to their context.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Planned: Audit of Management of Grants and Contributions – Phase 2 is ongoing and is expected to be completed in Fall 2019. This audit will examine the processes and controls at the funding agreement level.

Findings of evaluations completed in 2018-19

Completed: Evaluation of the Health Care Policy Contribution Program completed in 2018-19.

Summary of Findings:

Overall, the evaluation found that funded projects were generally effective in producing and disseminating information products.

Use of these products varied, ranging from the development of guidance documents to participation in training programs. Furthermore, some projects led to improvements in the health care system such as the adoption of professional standards, practices, and policies, to more physicians with rural and remote experience; however, evidence was limited on the impacts of these changes. Collaboration with relevant partner organizations and strong project leadership were seen to be the most crucial elements for ultimate project success. At the same time, Health Canada's role in knowledge translation and strategic direction, as well as more program support for innovative projects, were identified as areas for improvement.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients

Funding recipients continue to be engaged through site visits, and regular communication regarding the progress of funded projects. For example, Health Canada met with Pallium Canada to discuss more effective and efficient reporting processes. Senior Program and Policy Advisors have had discussions with many recipients to guide them in the development of their projects' respective performance measurement plans.

Contribution to the Canadian Foundation for Healthcare Improvement

General information

Name of transfer payment program

Contribution to the Canadian Foundation for Healthcare Improvement (CFHI) (Voted)

Start date

December 10, 2015

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2015-16 (updated in 2017-18)

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 1: Health Care Systems Analysis and Policy

Description

The contribution to CFHI supports the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system, adaptable to the needs of Canadians. It is designed to support CFHI's work to identify savings and efficiencies in the health system by: finding and promoting innovators and innovations; driving rapid adoption of proven innovations; enabling improvement-oriented health systems; and, shaping the future of healthcare.

CFHI previously operated as the Canadian Health Services Research Foundation (CHSRF), an arm's-length, non-profit, charitable organization with a mandate to fund health services research and promote the use of research evidence to strengthen the delivery of health services. CHSRF received $151.5 million in federal funding under three separate grants (1996-97 to 2003-04).

Results achieved

In 2018-19, CFHI continued to support innovations designed to accelerate improvements in health care delivery by working with health care leaders, governments, policy-makers and other leaders. Examples of results achieved by CFHI in 2018-19 include:

• Supporting numerous large-scale health care improvement initiatives, for example:
  • CFHI scaled up its INSPIRED hospital-to-home initiative to six teams across Alberta, Manitoba, Ontario, New Brunswick, Nova Scotia, and Prince Edward Island to help equip patients with chronic obstructive pulmonary disease (COPD) to manage their chronic condition at home and in the community rather than in hospital.
  • CFHI continued to scale up across the province of New Brunswick the Appropriate Use of Antipsychotics Collaborative to reduce the inappropriate use of antipsychotics and improve the quality of life for long-term care residents. In total, all 68 nursing home organizations across New Brunswick were involved in the province-wide expansion, which saw 52% of participating residents who were prescribed antipsychotics without a diagnosis of psychosis having these medications safely reduced or discontinued without an increase in aggressive behaviours.
  • CFHI continued the spread of the Appropriate Use of Antipsychotics approach to long term care homes in Newfoundland and Labrador, Prince Edward Island and Quebec. Early results from the spread of this approach in Quebec show that 85.5% of participating long-term care residents had their antipsychotics reduced or discontinued.
  • As part of its Connected Medicine quality improvement collaborative, CFHI continued to work with the College of Family Physicians of Canada, Canada Health Infoway and the Royal College of Physicians and Surgeons of Canada to spread two leading Canadian innovations that have demonstrably improved primary healthcare access to specialist consultation services. The two leading innovations that the 11 participating improvement teams spread were the Champlain BASE™eConsult Service (BASE™), a secure web-based eConsult service originally launched within the Champlain Local Health Integration Network in Ontario and the Rapid Access to Consultative Expertise (RACE™), a telephone advice line originally launched at Providence Health Care and Vancouver Coastal Health
• Working with seven organizations across five provinces and one territory to spread 'Embedding Palliative Approaches to Care' - a proven innovation that helps staff in long term care identify residents who could benefit from a palliative approach to care, have conversations with them and their families about what they want, and develop and implement comprehensive care plans.
• Working with the Canadian Partnership Against Cancer to provide funding and support to train over 5,000 paramedics to provide palliative and end-of-life care in certain regions in six provinces.
• Supporting 38 leaders through ten improvement projects across Canada as part of the Executive Training for Research Application (EXTRA) program. Examples of innovative projects undertaken include:
  • Enhancing support for practitioners in outlying areas to improve access to care; developing and implementing an improvement strategy for mental health in the workplace; enhancing the client experience during intake and continuity of care; co-developing care plans supporting transitions for older adults; opening a centralized hip and knee assessment clinic; integrating patient outcome documentation in acute care; optimizing access to joint replacement surgery; developing an integrated network of socio-occupational and community services; applying evidence-based assessment to patient care models; and, attaining sustained access, flow and transitions in rural care sites.
• Supporting its stream of health system transformation policy work through activities like a cross-jurisdictional knowledge exchange roundtable on reforming primary care and analyzing lessons learned and opportunities and barriers to value-based innovation in the Canadian context.
• Disseminating results from recent CFHI-led improvement initiatives (e.g., via webinars) in support of a broader knowledge translation strategy so that health care institutions and providers who did not participate in the improvement initiatives can be aware of and adopt the initiatives that have been found to be most effective at improving care in their own settings.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Planned: Audit of Management of Grants and Contributions – Phase 2 is ongoing and is expected to be completed in Fall 2019. This audit will examine the processes and controls at the funding agreement level.

Findings of evaluations completed in 2018-19

Completed: CFHI was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

The 2018 synthesis evaluation noted that the broad issues (e.g., mental health) addressed by most Pan-Canadian Health Organizations represented areas where more progress is needed in order to improve the health system. Pan-Canadian Health Organizations have made progress towards achieving their expected outcomes, with additional evidence required to demonstrate the achievement of longer-term outcomes.

Planned: The next evaluation of Pan-Canadian Health Organizations, including CFHI, is scheduled for 2023-24.

Engagement of applicants and recipients

Health Canada maintained regular contact with CFHI through quarterly meetings to receive updates on its programming and finances. Over the course of the year, it also monitored progress and compliance under the funding agreement, including by providing feedback on draft deliverables such as the work plan and annual report.

Note: CFHI's contribution funding is reported under the "Up-Front Multi-Year Funding" section of the Supplementary Information Tables

Contribution to the Canadian Agency for Drugs and Technologies in Health

General information

Name of transfer payment program

Contribution to the Canadian Agency for Drugs and Technologies in Health (CADTH) (Voted)

Start date

April 1, 2008

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

Updated 2017-18

Terms and Conditions (Ts and Cs) as approved for the Contribution Agreement will apply to future CADTH agreements until such time as they are superseded. The fiscal year for those Ts and Cs follows the traditional fiscal year calendar, from April 1 through March 31 of the following calendar year.

Effective April 1, 2013, the CADTH funding was transitioned to a Contribution Agreement from a Named Grant. The change allows Health Canada to augment monitoring and management of the funds. In December 2017, CADTH submitted a proposal for a five-year renewal of its existing funding (2017 to 2022) and the additional $36 million investment announced in Budget 2017. The new funding agreement is currently being drafted.

The previous Named Grant covered the period of 2008 to 2013.

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 2: Access, Affordability, and Appropriate Use of Drugs and Medical Devices

Description

The CADTH is an independent, not-for-profit agency funded by Canadian federal, provincial, territorial governments and Canada's Research-Based Pharmaceutical Companies (the latter through fees) to provide credible, impartial advice and evidence-based information about the clinical and cost effectiveness of drugs and other health technologies to Canadian health care decision-makers.

The purpose of the renewed Contribution Agreement is to provide financial assistance to support CADTH's core business activities;

• Health Technology Knowledge Products and Services, including Health Technology Assessment (HTA) and Optimal Use, to encourage optimal prescribing, purchasing, and use of health technologies and prescription drugs.
• Formulary Reviews, comprised of the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review, that provide information on the clinical and cost-effectiveness of drugs and issue non-binding formulary listing recommendations to participating public drug plans.
• Transition to a Health Technology Management Agency.

Results achieved

The purpose of the contribution agreement is to provide financial assistance to support CADTH's core business activities, namely, the Common Drug Review, Health Technology Assessments and Optimal Use Projects. Results include the 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. Additional funding announced in Budget 2017 is supporting CADTH's transition to a Health Technology Management organization in order to deliver results that better meet the needs of the healthcare system by employing a lifecycle approach to technology that involves reassessment and disinvestment.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Completed: CADTH was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

The 2018 synthesis evaluation noted that there is a need to continue addressing broad issues addressed by most Pan-Canadian Health Organizations but there is also a need to clarify roles, responsibilities, strategic direction, and priority setting for these organizations. Pan-Canadian Health Organizations have made progress towards achieving their expected outcomes with additional evidence required to demonstrate the achievement of longer-term outcomes. For example, CADTH has improved its collaboration with stakeholders and demonstrated leadership in identifying drug and non-drug topics of importance for customers through broad consultations.

Planned: The next evaluation of Pan-Canadian Health Organizations, including CADTH, is scheduled for 2023-24.

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. CADTH also convenes, connects and collaborates with patients, clinicians and other health care decision-makers to help support the adoption and use of its products.

Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative

General information

Name of transfer payment program

Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative (Voted)

Start date

November 9, 2017

End date

March 31, 2027

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 3: Home, Community and Palliative Care

Program 4: Mental Health

Description

The Government of Canada is investing $11 billion over ten years (2017-27) to support the provinces and territories (PTs) in implementing home care ($6 billion) and mental health and addictions ($5 billion) initiatives in their jurisdictions as per the Common Statement of Principles for Shared Health Priorities (CSoP) adopted on August 21, 2017.

By endorsing the CSoP, PTs fulfilled the conditions set out in the Budget Implementation Act 2017 to receive funding for fiscal year 2017-18 through a statutory appropriation ($300 million). The remaining nine years of funding ($10.7 billion) will be provided through bilateral funding agreements with high-level conditions to report on common indicators.

On mental health and addictions, provinces and territories have agreed to focus on:

• Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
• Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services; and,
• Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

On home and community care, provinces and territories have agreed to focus on:

• Spreading and scaling evidence-based models of home and community care that are more integrated and connected to primary health care;
• Enhancing access to palliative and end of life care at home or in hospices;
• Increasing support for caregivers; and,
• Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community based service delivery.

Over the 2018-19 fiscal year, the Government of Canada worked with jurisdictions to finalize bilateral agreements that set out the details of how each jurisdiction will use federal funding for future years. These agreements also include details on conditions to receive funding including reporting to the Canadian Institute for Health Information on common indicators.

Results achieved

The federal government concluded bilateral agreements with each province and territory that set out details of how each jurisdiction will use federal funding in future years, based on the priority areas of action outlined in the Common Statement of Principles for Shared Health Priorities. Bilateral agreements are posted online.

It is expected that through these investments Canadians will experience tangible improvements in access to home and community care as well as mental health and addictions services. This will lead to better health outcomes and a more sustainable health care system, as care is shifted from expensive hospital care to home and community-based service delivery. These investments could also have a broader, positive impact on Canada's economy, by making the health care system more sustainable in the long term, and by enhancing workforce productivity and social participation.

The Canadian Institute for Health Information (CIHI) led a process with federal, provincial and territorial officials to develop a focused set of common indicators in home and community care and mental health and addiction services to enable Canadians to assess progress on shared priorities. In June 2018, FPT Ministers of Health agreed to a set of 12 common indicators. CIHI will continue to work with governments across Canada to report annually on these indicators.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Planned: An evaluation of Home Care and Mental Health Services Initiative is scheduled for 2021-22.

Engagement of applicants and recipients

Prior to developing the CSoP, with respect to mental health and addictions, the Government of Canada has engaged with provinces and territories, National Indigenous Organizations (NIOs), mental health stakeholders, provincial and territorial medical associations and treatment centres, and academia.

Likewise, with respect to the home and community care, the Government of Canada has engaged with a range of home care stakeholders including representatives from National Organizations working on home, community and palliative care, provincial home care providers, patient and family advocates, and national health professional associations (e.g., the Canadian Medical Association, Canadian Nurses Association and the College of Family Physicians of Canada), as well as academia.

Mental Health Commission of Canada Contribution Program

General information

Name of transfer payment program

Mental Health Commission of Canada Contribution Program (MHCC) (Voted)

Start date

April 1, 2017

End date

March 31, 2021

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2019-20

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 4: Mental Health

Description

The MHCC, an arm's length, not-for-profit organization established in March 2007 with a ten-year mandate to improve health and social outcomes for people and their families living with mental illness. Between 2007 and 2017, the Government of Canada invested $130 million in the MHCC through a grant, to develop a mental health strategy for Canada, conduct an anti-stigma campaign and create a knowledge exchange centre. In 2016, the MHCC's mandate was renewed for a two-year period, from 2017-18 to 2018-19, with a contribution of $14.25 million per year to advance work on mental health priorities, including problematic substance use, suicide prevention, support for at-risk populations and engagement.

Results achieved

In 2018-19, the MHCC continued to provide valuable mental health expertise and advice to mental health stakeholders. Notable achievements included:

Substance Use

Produced a report that discussed the connection between mental health and substance use. In addition, the MHCC completed a comprehensive Pan-Canadian framework for performance measurement in mental health, entitled: Measuring Progress: Resources for Developing a Mental Health and Addiction Performance Measurement Framework for Canada.

Developed the following knowledge products:

• Stigma and the Opioid Crisis
• Opioid Training for Healthcare Providers
• Best Advice Guide: Recovery-Oriented Mental Health and Addiction Care in the Patient's Medical Home

Suicide Prevention

Prepared two suicide prevention toolkits and a fact sheet on older adults and suicide, as well as undertook research on suicide prevention among sexual minorities.

Hosted 60 MHCC events/training across Canada on the topic of suicide prevention, including the Roots of Hope Coalition Meeting on the Burin Peninsula with the Government of Newfoundland and Labrador, and the Mental Health First Aid training programs which teach participants how to recognize mental health problems and illnesses, support others who need help, encourage self-help, and reduce stigma. The programs are designed for various participants including first responders, workers and employers, and Canadians.

Engagement

Conducted a scan on provincial/territorial mental health and addiction strategies and plans in relation to family and caregiver engagement. In addition, the MHCC maintained a number of partnerships across Canada that support and enhance the work of the Commission. These partnerships provide expertise, strengthen community connections, facilitate engagement and spread knowledge.

Population-Based Initiatives

Produced a number of population-specific mental health initiatives (such as fact sheets, interactive maps, reports, and toolkits), including but not limited to the following:

• Immigrant, Refugee, Ethnocultural and Racialized Populations and the Social Determinants of Health: A Review of 2016 Census Data
• Guidelines for Comprehensive Mental Health Services for Older Adults in Canada
• MHCC/W2A Rainbow Youth Health Forum: Creating Safer Spaces for 2SLGBTQ+ Youth in Health Care
• A Clear Business Case for Hiring Aspiring Workers
• Transgender People and Suicide

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Completed: MHCC was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

The 2018 synthesis evaluation noted that the broad issues (e.g., mental health) addressed by most Pan-Canadian Health Organizations represented areas where more progress is needed in order to improve the health system. However, there is a need to clarify roles, responsibilities, strategic direction, and priority setting for Pan-Canadian Health Organizations in order to improve their efficiency. MHCC, like other Pan-Canadian organizations, has made progress towards achieving their expected outcomes. For example, its Mental Health Strategy for Canada has assisted in advancing key priorities related to mental health and mental illness.

Planned: The next evaluation of Pan-Canadian Health Organizations, including MHCC, is scheduled for 2023-24.

Engagement of applicants and recipients

MHCC is the sole recipient of the contribution. Health Canada monitors the recipient's compliance with the funding agreement through the analysis of corporate documents by reviewing their progress/performance reports twice a year (mid-year and year-end) and has bi-weekly meetings with senior management of the organization.

Substance Use and Addictions Program

General information

Name of transfer payment program

Substance Use and Addictions Program (SUAP) (Voted)

Start date

December 4, 2014

End date

March 31, 2022 (Grant)

Ongoing (Contribution)

Type of transfer payment

Grant and Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2014-15^{Footnote 1}

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 5: Substance Use and Addictions

Description

The overall objective of the SUAP is to facilitate the development of responses to legal and illegal substance use issues along the continuum of care from health promotion and prevention to harm reduction, treatment and rehabilitation by: preventing problematic substance use and reducing harms; facilitating treatment and related system enhancements; and improving awareness, knowledge, skills and competencies of targeted stakeholders and Canadians.

Results achieved

In 2018-19, the SUAP launched a refreshed call for proposals seeking additional opioid prevention and treatment initiatives; enhanced and new cannabis public education and research initiatives; new tobacco prevention and cessation initiatives under Canada's Tobacco Strategy and youth vaping prevention initiatives.

The SUAP provided funding to 60 new multi-year community-based and national substance use prevention, harm reduction and treatment initiatives in 2018-19, while four existing initiatives ended. Of the new initiatives, nearly half (48%) began their activities in the last quarter of the fiscal year.

The majority of these initiatives focused on responding to the opioid crisis and Indigenous and community-based cannabis public education. Opioid initiatives included those focused on reducing stigma and engaging people with lived and living experience of past or current substance use, best practices for medication-assisted treatments, improving access to different types of treatment, and innovative models for opioid replacement therapy. Cannabis initiatives funded in 2018-19 included those focused on evidence-informed school curriculum; particular populations with known risk factors including youth and young adults new to Canada as well as older adults; dispelling myths regarding cannabis-impaired driving; and, cannabis education and harm reduction in rural and Indigenous communities.

The Program also implemented a Drug Checking Innovation Challenge, a new innovation / experimentation component linked to the Privy Council Office's Impact Canada Initiative. As a result, funding was awarded to nine organizations to further develop drug checking technology prototypes.

While the majority of the SUAP initiatives were in the very early stages of implementation, over 300 knowledge products (guidelines, toolkits, reports) were produced and over 1,400 learning opportunities (workshops, presentations, webinars) were delivered in 2018-19. Early results indicate that those accessing these materials report that they gained knowledge and skills relevant to reducing the harms of substance use in Canada. Further, early results indicate that stakeholders and Canadians targeted by SUAP-funded initiatives intend to use their new knowledge and skills to make positive changes to behaviour, as well as improvements to substance use policies, programs and clinical practices.

Canadian Centre on Substance Use and Addiction

The SUAP continued to provide core funding to the CCSA, as well as $10 million over five years for research on the impact of cannabis legalization and regulation in Canada. In 2018-19, the CCSA worked with partners in Canada and internationally to gather evidence; share knowledge, best practices and advice on substance use to drive action; while focusing on priorities such as stigma, cannabis policy, the opioid crisis, and the costs of substance use in Canada. Over 36 publications were created to provide evidence, 21 events held in relevant communities, and 58 presentations delivered to share knowledge in 2018-19. The CCSA reported positive results for many of its initiatives. Approximately 95% of participants of the Stigma Ends with Me workshops identified at least one practical action they could take to address stigma, and over 80,000 were reached through CCSA's media related to this workshop. CCSA had over 28,062 downloads on the Cannabis Communication Guide for Youth Allies within seven months following its publication. Over 100 researchers, policymakers, lawenforcement representatives, and youth attended the Cannabis Policy Research Meeting, and the Cannabis Symposium which contributed to the research plan for the five-year cannabis research initiative in partnership with the Canadian Institutes of Health Research (CIHR). More than 200 policymakers, researchers, people with lived experience and others attended the Opioid Symposium, and over 86% of attendees said the symposium helped them identify at least one person for potential collaboration. In 2018-19, the CCSA also updated its Canadian Substance Use Costs and Harms study (the world's first in this area) that calculated the societal costs (health, criminal justice, lost productivity, and others) of substance use across Canada.

Mental Health Commission of Canada

Budget 2018 included a commitment to provide $10 million over five years for the Mental Health Commission of Canada (MHCC) to help assess the impact of cannabis use on the mental health of Canadians.

This first year of funding was a foundational year for the cannabis and mental health project. The MHCC established an executive advisory committee (EAC) to provide independent, expert advice on the project. The MHCC, with the CIHR, selected two one-year catalyst grant research projects which will explore the potential therapeutic benefit of cannabis and cannabidiol (CBD) on mental health outcomes; and, launched a call for proposals for three five-year team grants that will investigate the potential harms and benefits of cannabis, the impact of social determinants of health, as well as the needs of diverse populations experiencing cannabis use disorder and/or mental illness.

Findings of audits completed in 2018-19

Planned: Audit of the Management of Grants and Contributions – Phase 2 is ongoing and is expected to be completed by Fall 2019. This audit will examine the processes and controls at the funding agreement level. A component of this audit will include files from the Substance Use and Addictions Program and an audit of the 2017-18 solicitation process.

Findings of evaluations completed in 2018–19

Completed: N/A

Planned: Will be evaluated as part of the Canadian Drugs and Substances Strategy evaluation that is scheduled to be completed in 2021-2022.

Engagement of applicants and recipients

Applicants for funding in 2018-19 were engaged through a national call for proposals, with program staff working closely with successful applicant organizations to shape their initiatives. Program staff worked regularly with funding recipients to monitor contribution agreements and obtain required performance measurement and evaluation reports.

Contribution to Canada Health Infoway

General information

Name of transfer payment program

Contribution to Canada Health Infoway (Voted)

Start date

April 1, 2016

End date

March 31, 2022

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2016-17 (amended in 2017-18)

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 6: Digital Health

Description

Infoway is an independent, not-for-profit corporation that is federally funded to work with jurisdictions and other stakeholders to support the development and adoption of digital health technologies across Canada. Between 2001 and 2010, the Government of Canada has invested $2.1 billion in Infoway, through grants or up-front multi-year funding, to focus on electronic health records, and other priorities in digital health. Budget 2016 allocated $50 million over two years to Infoway to support short-term digital health activities in e-prescribing and telehomecare, with the funds flowing as a Contribution Agreement. Budget 2017 allocated $300 million over five years to Infoway to expand e-prescribing and virtual care initiatives, support the continued adoption and use of electronic medical records, help patients to access their own health records electronically, and better link electronic health record systems to improve access by all providers and institutions. These funds are to flow as a Contribution Agreement.

Results achieved

The PrescribeIT program continued to grow in fiscal year 2018-19, Memorandums of Understanding to implement the program were signed with 10 jurisdictions (Yukon, Manitoba, Nova Scotia, Newfoundland and Labrador, Prince Edward Island, Saskatchewan, Northwest Territories, Ontario, Alberta and New Brunswick). As a result, enrollment growth of PrescribeIT accelerated significantly with 897 enrolled prescribers and 877 enrolled pharmacies. The ACCESS Health program is continuing to develop including the July 2018 announcement of ACCESS Atlantic, a collaborative initiative that will make it quicker and easier to access health services in Atlantic Canada.

In November 2018, Infoway launched the ACCESS 2022 awareness campaign, which aims to inspire action toward a vision that includes patients, families and clinicians having access to the information and digital services they need to better manage their health. Through its ACCESS Health program, Infoway has launched nationwide the "Crisis Text Line" powered by Kids Help Phone. Available 24/7 in both English and French, this free service provides youth with support for mental health and other issues through text messaging. By the end of 2018, 71,000 texting conversations and nearly 900 active rescues had taken place, saving an estimated two young lives per day. In addition, Infoway has deployed the First Nations-developed community health record and personal health record in 226 communities across 10 provinces and territories. As of March 31, 2019, it was live in 185 of those communities.

Findings of audits completed in 2018-19

The annual independent financial and compliance audits were conducted during the year, and both resulted in unqualified audit reports. There were no other audits scheduled or conducted during the year.

Findings of evaluations completed in 2018-19

Completed: Infoway was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

The 2018 synthesis evaluation noted that the broad issues by most Pan-Canadian Health Organizations represented areas where more progress is needed in order to improve the health system. For example, there a continued need for Infoway to support a national, multi-jurisdictional approach to eHealth in Canada. However, the synthesis evaluation also reported that the roles, responsibilities, strategic direction, and priority setting for Pan-Canadian Health Organizations should be clarified in order to improve their efficiency. Pan-Canadian Health Organizations have made progress towards achieving their expected outcomes, with additional evidence required to demonstrate the achievement of longer-term outcomes.

Planned: The next evaluation of Pan-Canadian Health Organizations, including Infoway, is scheduled for 2023-24.

Engagement of applicants and recipients

Health Canada works with Infoway to establish activities to be carried out under the contribution agreement, and maintains regular contact with Infoway to monitor progress and compliance under the Contribution Agreement. Health Canada is represented on Infoway's Board of Directors, which meet three to four times per year.

Note: Infoway is also reported under the "Up-Front Multi-Year Funding" section of the Supplementary Information Tables.

Contribution to the Canadian Institute for Health Information

General information

Name of transfer payment program

Contribution to the Canadian Institute for Health Information (CIHI) (Voted)

Start date

April 1, 1999

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

New Terms and Conditions (Ts and Cs) for the Health Information Initiative (HII) were approved by Treasury Board on June 15, 2017. These new Ts and Cs provide the Minister of Health the authority to renew Funding Agreements with the recipient without returning to Treasury Board Secretariat. There is no expiry date for the HII's Ts and Cs.

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 7: Health Information

Description

The CIHI is an independent, not-for-profit organization supported by federal, provincial and territorial governments (F/P/T) that provides essential data and analysis on Canada's health system and the health of Canadians. CIHI was created in 1994 by the F/P/T Ministers of Health to address significant gaps in health information.

Between 1994 and 2012 the Government of Canada allocated approximately $757 million in total to CIHI through a series of funding agreements. Under the previous agreement, close to $475 million has been delivered to CIHI over 6 years (2012-13 to 2017-18). Negotiations for a new contribution agreement were completed in early 2018. This contribution agreement will span five years from 2017-18 to 2021-22. Presently, Health Canada funds 78% of CIHI's total budget, while the P/T governments contribute 17%. The remaining funds are generated largely through product sales.

This funding allows CIHI to provide essential information on Canada's health care systems and the health of Canadians. CIHI provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across the continuum of care. CIHI's stakeholders use the broad range of the Institute's health system databases, measurements and standards, together with their evidence-based reports and analyses, in their decision-making processes. CIHI protects the privacy of Canadians by ensuring the confidentiality and integrity of the health care information they provide.

Results achieved

In early 2018, a new contribution agreement was signed, providing close to $365 million over five years (2017-18 to 2021-22).

In 2018-19, CIHI continued to make progress towards producing more and better data, more relevant and actionable analysis, and improved client understanding and use of CIHI data and information products.

Below are selected highlights from CIHI's 2018-19 Annual Report.

CIHI launched a Patient-Reported Outcome Measures (PROMs) program of work in 2015, with hip and knee replacements as a key area of focus. Along with the Organisation for Economic Co-operation and Development (OECD), CIHI has been co-leading an international working group on patient-reported indicators for hip and knee replacement surgery since December 2017. This work is part of a broader OECD initiative that aims to advance the collection and reporting of comparable patient-reported measures to better monitor health system performance and drive continuous improvement among member countries.

To close existing data gaps, CIHI made progress on the collection of pan-Canadian data to enhance coverage in key areas, including: primary health care, home care, community mental health, addictions, palliative care, pharmaceuticals, patient-reported outcomes and the health of Indigenous populations. CIHI's goals through its Corporate Data Advancement Strategy are to close gaps and expand data collection in each province and territory, to make the data submission process more user-friendly, to broaden adoption of CIHI data standards, and to have more timely and linked data for stakeholders.

With new investments from Budget 2017, CIHI is undertaking a multi-year initiative to support the reporting commitments made by the health ministers in the Common Statement of Principles on Shared Health Priorities.

Over the past year, CIHI facilitated the selection and lead the development of pan-Canadian indicators to measure access to home care and mental health services. Health Ministers endorsed 12 indicators in June 2018, which marked an important step toward improving access to health services in sectors for Canadians. CIHI is continuing their work with health ministries across Canada to report annually on established indicators and to build on data sources to enable more comprehensive reporting.

Since signing the Joint Statement of Action to Address the Opioid Crisis in Canada in 2016, CIHI has supported efforts across the country to reduce opioid harms, including working with governments and other partners to improve data collection and produce timely, relevant information that can help inform harm reduction efforts. Opioid harms and prescribing data assists policy-makers to track progress and see the impact their strategies have on the communities affected by this crisis. This data reveals which geographic areas have the highest rates of hospitalizations and emergency department visits due to harms caused by opioids. CIHI also released a report examining opioid harms and opioid prescribing trends across the country.

In October 2018, CIHI hosted a privacy symposium that brought together thought leaders from across the country and internationally to exchange opinions and ideas about improving access to health data in a privacy-sensitive manner. The symposium was an important first step in exploring potential advancements related to pan-Canadian health data governance, where privacy will be a key component. The discussions from this event will help shape future conversations around enhanced access to data to improve health systems.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Completed: CIHI was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

As noted in the 2018 evaluation synthesis, CIHI continues to address a need to provide comparable health information across provinces and territories. Like CIHI, most Pan-Canadian Health Organisations continue to address areas where more progress is needed in order to improve the health system. At the same time, there is also a need to clarify roles, responsibilities, strategic direction, and priority setting for these organisations in order to improve their efficiency. Pan-Canadian Health Organizations have made progress towards achieving their expected outcomes, with additional evidence required to demonstrate the achievement of longer-term outcomes.

Planned: The next evaluation of Pan-Canadian Health Organizations, including CIHI, is scheduled for 2023-24.

Engagement of applicants and recipients

CIHI is the sole recipient of HII funding as per the terms and conditions of the HII.

Contribution to the Canadian Partnership Against Cancer

General information

Name of transfer payment program

Contribution to the Canadian Partnership Against Cancer (CPAC) (Voted)

Start date

April 1, 2007

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 10: Cancer control

Description

CPAC is an independent, not-for-profit corporation established to implement the Canadian Strategy for Cancer Control (CSCC). The CSCC was developed in consultation with more than 700 cancer experts and stakeholders with the following objectives:

• Reduce the expected number of new cases of cancer among Canadians;
• Enhance the quality of life of those living with cancer; and,
• Lessen the likelihood of Canadians dying from cancer.

Health Canada is responsible for managing the funding to the corporation. CPAC received $250 million from the federal government for its first five-year term (2007 to 2012) and $241 million for its second five-year term (2012 to 2017). Budget 2016 confirmed ongoing funding for CPAC, which is governed by a five-year agreement (2017 to 2022) for $237.5 million.

Results achieved

Since inception in April 2007, CPAC has:

• Provided cancer patients and physicians across Canada with current evidence-based 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;
• Improved the quality of life for cancer patients 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 Indigenous People;
• Expanded cancer screening programs in all provinces and territories and encouraged hard-to-reach populations, to undergo screening - which helps doctors detect cancer earlier; and,
• Developed programs to help survivors through the tremendous uncertainty following treatment.

Throughout fiscal year 2018-19, CPAC worked to refresh the CSCC, consulting with over 7,500 Canadians. The refreshed CSCC focuses on improving equity within the cancer system including First Nations, Inuit and Métis priorities. It also focuses on long-term, sustainable impact, so Canadians can benefit from a high-quality, world-class cancer control system for generations to come. In 2018-19, CPAC also: advanced collaboration with the Canadian Agency for Drugs and Technologies in Health (CADTH) on improving oncology drug sustainability and the Canadian Institute for Health Information (CIHI) on informing oncology drug funding decisions; launched funding activities to develop new and improved responses to cancer control gaps specific to First Nations, Inuit and Métis with provincial, territorial and national partners; collaborated with the Public Health Agency of Canada to develop a plan to eliminate cervical cancer through the HPV vaccine and screening; published Changing Cancer in Canada: 10-Years of Collaborationto demonstrate the significant impact of the first decade of implementing the CSCC; and released the 2018 Cancer System Performance Report, engaging provincial cancer agencies and programs on how best to utilize data to effect change.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Completed: CPAC was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

The 2018 synthesis evaluation noted that the broad issues addressed by most Pan-Canadian Health Organizations represented areas where more progress is needed in order to improve the health system. However, there is a need to clarify roles, responsibilities, strategic direction, and priority setting for Pan-Canadian Health Organizations in order to improve their efficiency. CPAC has made progress towards achieving its expected outcomes and contributed to several collaborative projects.

Planned: The next evaluation of Pan-Canadian Health Organizations, including CPAC, is scheduled for 2023-24.

Engagement of applicants and recipients

Health Canada works with CPAC to establish activities to be carried out under the contribution agreement, and maintains regular contact with CPAC to monitor progress and compliance under the contribution agreement through bi-monthly calls between Health Canada representatives and the CPAC leadership team. CPAC also presented at two Health Portfolio Cancer Working Group meetings to update the federal government on their key activities.

CPAC works to engage stakeholders through communication 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.

Contribution to the Canadian Patient Safety Institute

General information

Name of transfer payment program

Contribution to the Canadian Patient Safety Institute (CPSI) (Voted)

Start date

April 1, 2013

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2012-13

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 11: Patient Safety

Description

CPSI supports the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians. It is designed to improve the quality of health care services by providing a leadership role in building a culture of patient safety and quality improvement in the Canadian health care system through coordination across sectors, promotion of best practices, and advice on effective strategies to improve patient safety. The first five-year grant funding agreement with CPSI ended on March 31, 2008, and was renewed for an additional five years, starting April 1, 2008 and ending March 31, 2013. A new five-year contribution agreement began on April 1, 2013 and has been extended by one year to March 31, 2019.

Results achieved

In 2018-19, key results achieved by CPSI included:

• The launch of Patient Safety Right Now, CPSI's new strategy. This strategy focuses on four lines of business: safety improvement projects, which are currently underway; using the patient voice in reporting, campaigns and media to making patient safety a priority; having policy impact; and, strengthening its alliances and networks.
• The launch of three pan-Canadian Safety Improvement Projects in the areas of medication safety, changing approaches to teamwork and communications in health care settings to improve safety, and addressing post-surgical recovery and safety.
• The launch of a Health Standards Organization-CPSI collaboration, the Canadian Quality and Patient Safety Framework for Health and Social Services. This draft framework was developed by HSO/CPSI with input from experts, patients, providers, researchers and indigenous peoples. A national consultation is being conducted on the proposed framework, with the long-term goals of: describing overarching principles and goals for safe, high quality health and social services in Canada; focusing policy, action and resources that improve experience and outcomes from health and social services offered; enhancing collaboration of stakeholders around common goals; reducing care variations across different communities.
• Launch of a new Federal/Provincial/Territorial Patient Safety committee to advise on CPSI's work and to support efforts to make improvements in safety across the country.
• The release of 2018 IPSOS Patient Safety Survey, which demonstrated that the Canadian public is largely unaware of the scale of the patient safety issue in Canada, but that when the public is educated on patient safety, they rank it as a healthcare priority.
• Held Canadian Patient Safety Week 2018, a national annual campaign 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. The 2018 theme was medication safety and included the launch of a new podcast series, PATIENT.
• Training was delivered to increase patient safety capacity in health care organizations, including through the continued efforts of TeamSTEPPS Canada, an evidence-based teamwork system designed to improve patient care through improved teamwork and communication.
• Patients for Patient Safety Canada, a patient-led program of CPSI, continued to strengthen its reach in health care systems, by bringing the patient perspective to collaborations at all levels of care.
• Continuing in its role as a designated World Health Organization Collaborating Centre for Patient Safety and Patient Engagement, through which CPSI is supporting global work on patient safety incident reporting and learning systems, providing coordination support and advice to the global Patients for Patient Safety champion network, supporting global initiatives in achieving safer care, and contributing to planning and implementation of the third Global Patient Safety Challenge on Medication Safety.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Completed: CPSI was evaluated as part of the Synthesis Evaluation of Transfer Payments to Pan-Canadian Health Organizations completed in 2018-19.

Summary of Findings:

As indicated in the 2018 synthesis evaluation, CPSI continues to address a need as persistent rates of harm justify an ongoing focus on patient safety within Canada's health care system. However, the evaluation also found that there is a need to clarify roles, responsibilities, strategic direction, and priority setting for Pan-Canadian Health Organizations in general. Pan-Canadian Health Organizations have made progress towards achieving their expected outcomes, with additional evidence required to demonstrate the achievement of longer-term outcomes.

Planned: The next evaluation of Pan-Canadian Health Organizations, including CPSI, is scheduled for 2023-24.

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 senior staff and program officers. In addition, the Department nominates one representative to CPSI's Board of Directors, and participates as a voting member of the corporation.

Canadian Blood Services: Blood Research and Development Program

General information

Name of transfer payment program

Canadian Blood Services: Blood Research and Development Program (CBS Blood R&D Program) (Voted)

Start date

April 1, 2000

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2013-14

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 12: Blood System, Organs, Tissue and Transplantation

Description

To support basic, applied and clinical research, on blood safety and blood product safety and effectiveness issues under the auspices of the Canadian Blood Services.

Results achieved

The CBS Blood R&D Program has generated numerous outputs related to knowledge products (e.g., journal articles, reviews, etc.) learning events, collaborative arrangements and the development of highly qualified people in the important areas of basic and applied research.

In 2018-19, the program awarded 189 funding grants in support of R&D and training. It also played a key role in building and maintaining research capacity in transfusion science and medicine. For example, fourteen highly qualified people completed training in transfusion science and medicine through numerous fellowship programs and training positions in research laboratories.

The program's research network published 163 peer-reviewed and 83 non peer-reviewed publications and delivered over 315 conference presentations worldwide. The average h-index, a measure demonstrating the significance and impact of published work, was 31 for CBS research staff, an increase over the prior year and almost three times the average h-index (10.6) for Canadian academic science authors. CBS held eight major education events for specialists in transfusion science and medicine and attracted 3,763 professionals. Various stakeholders used the knowledge generated by R&D projects to inform changes to practices and standards. As a result, there were eight changes to guidelines and processes and one Health Canada license amendment leading to greater efficiency and safety of the Canadian blood system.

Under the Men who have Sex with Men (MSM) Research Grant Program, fifteen research projects were funded that will end by spring 2020.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

No evaluation was completed in 2018-19.

Planned: The next evaluation of these programs is scheduled for 2022-23.

Engagement of applicants and recipients

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails) with CBS to discuss program progress. Health Canada continues to monitor the recipient's compliance with the contribution agreement through the analysis of corporate documents and has regular correspondence with senior management of the organization.

Official Languages Health Contribution Program

General information

Name of transfer payment program

Official Languages Health Contribution Program (OLHCP) (Voted)

Start date

June 18, 2003

End date

Ongoing

Type of transfer payment

Grants and Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 13: Promoting Minority Official Languages in the Health Care Systems

Description

The OLHCP has a total budget of $174.3 million (ongoing, over five years). The program is entering a new funding phase for 2018 to 2023.

The Program supports eligible activities under the following three program streams:

1. Training and retention of health professionals
   Provide funding for French language academic health programs in 11 colleges and universities outside of Quebec, and to McGill University for English language academic training and for health professionals and intake personnel in Quebec.
2. Health Networking
   Provide funding to 38 existing community based health networks across Canada to continue increasing or improving access for Official Language Minority Communities (OLMCs) to health services.
3. Innovative Projects to Improve Access to Health Services for OLMCs
   Provide funding for projects aimed at improving access to health services for OLMCs in priority areas such as home care, mental health, and palliative and end of life care. Initiatives must support: health human resource integration; knowledge development and dissemination; and community health improvement.

Results achieved

In 2018-19, Health Canada supported a range of initiatives through the OLHP. The impacts of these initiatives include an increase in the availability of health service providers to meet the needs of OLMCs, enhanced mechanisms for providing effective health services for these communities, and improved understanding and measurement of health issues and challenges.

Through the OLHP, Health Canada continued to provide financial support to community organizations and training institutions (e.g., la Société Santé en français (SSF), l'Association des collèges et universités de la francophonie canadienne (ACUFC)-Consortium national de formation en santé (CNFS), McGill University, Community Health and Social Services Network (CHSSN). These organizations implemented various initiatives to improve access to health services for OLMCs.

Training and retention of health professionals in OLMCs

In 2018-19, the OLHP supported a range of training and retention initiatives to increase the availability of bilingual health professionals and improve access to services in OLMCs. For example:

• In Quebec, McGill University registered more than 1,075 health and social services professionals in its language training program. In total, 828 health professionals successfully completed their language training—a success rate of 77%. Moreover, 11 networking and partnerships initiatives (NPI) joined forces with their health and social services partners to organize dialogue / lunch-and-learn activities for Francophone health and social services professionals taking part in language training. These initiatives resulted in an increased capacity to offer health care services to Anglophone minority communities in their language of choice.
• Outside of Quebec, in 2018-19, the ACUFC-CNFS's 11 member institutions recorded an additional 1,221 registrations and 676 graduates in 100 different health training programs, thereby increasing the pool of health human resources available to meet the needs of Francophone minority communities.
• Moreover, the OLHP funded the addition of five new ACUFC-CNFS member institutions bringing the total to 16. This funding will help to address identified gaps in the recruitment of bilingual students as well as availability of internships in the health care sector in order to better address the needs of OLMCs. Between now and 2023 the addition of the five institutions will boost the number of trained health providers available to serve French-speaking minority communities.

Strengthening and improving local health networking capacity in OLMCs

In 2018-19, the OLHP continued to support initiatives to strengthen and increase networking activities to improve access to health services for English and French speaking minorities. A total of 39 community-based health networks (covering all provinces and territories) managed by both SSF and CHSSN collaborated with various health sector stakeholders to improve access to health services for OLMCs. These efforts had a direct impact on the accessibility of health services for OLMCs across Canada. For example:

In Quebec, through its activities and partnerships, the CHSSN:

• Enhanced its capacity to improve the health status of Quebec's Anglophone community by adding three new networks and 10 satellites in order to further mobilize health institutions, facilities and service providers.
• Worked with the staff of 19 of the integrated health and social services centres (CIUSSS) and integrated university health and social services centres (CIUSSS) to improve access to English-language health and social services, based on the specific needs of the English-speaking minority communities.
• Continued to actively represent the Anglophone community's needs in a number of local and regional tables on senior services, youth services, and early childhood development.
• Increased the active offer of health services in OLMCs and health institutions by producing and disseminating a broad range of health information products, as well as coordinating learning and promotional activities. These activities are the cornerstone to improving access to health care in English and ensuring that the public system meets the needs of the minority Anglophone community.

Outside Quebec, through its activities and partnerships, the SSF:

• Worked with Alberta Health Services to recruit 40 health allies to raise awareness on the importance of actively requesting services in French for the Francophone community. They also raised awareness among health professionals regarding the active offer of services in French. This initiative will further increase the offer of and demand for services in French while improving access to health services for Francophones in Alberta.
• Collaborated with the Réseau Ontario-Sud, and various stakeholders to raise awareness among students of the importance of offering services in French, doing internships in French, considering beginning their careers in French, and holding bilingual positions in the future. This initiative is a prime example of the positive impact of targeted collaborative efforts to improve access to health care in the language of choice of OLMC members.
• Supported an initiative to open a Francophone health community centre (Yukon). The initiative not only facilitated access to health services but will also foster the vitality and development of the province's Francophone communities.

Projects to improve access to health services for OLMCs

• In 2018-19, Health Canada funded special projects to improve the availability of bilingual health professionals. For example: In Quebec, the Community Health and Social Services Network (CHSSN) carried-out a project to collect more data on access to mental health services for English-speaking residents of Quebec by administering a CROP Survey on Community Vitality. This survey is expected to support decision-making in order to adapt services and mental health resources to the needs of English-speaking people.
• Furthermore McGill University, conducted 13 research projects, including:
  • A project at Laval University entitled "Visualization and Spatial Analysis of Access to English-Language Services and Health Professionals after Health System Reform (Bill 10)", which provided a better understanding of the health service challenges faced by Anglophones following the reform, so that the information can be shared with provincial authorities.
  • A project by McGill University and the Centre hospitalier de l'Université de Montréal (CHUM), entitled "Just-in-time: Training for speech-language pathologists to assess developmental language disorders among bilingual English-speaking children in a minority language context". The project's goal is to develop an effective protocol for assessing language development issues while avoiding redundant testing and optimizing the use of services.
• Outside Quebec, through its 16 networks and associated partners, the SSF funded 42 projects being rolled out in all provinces and territories. These projects aim to support or implement accessible services and programs, mobilize human resources and enhance community commitment, awareness and capacity. For example:
  • Réseau des services de santé en français de l'Est de l'Ontario (RSSFEO) completed version 2.0 of a web portal called OZI. The portal makes it easier to collect information on health human resources capacity with regard to offering health services in French and thus supports decision-making, planning and accountability in health human resource management.
  • In New Brunswick, Société Santé et Mieux-être en français du Nouveau-Brunswick (SSMEFNB) continued its efforts to encourage the province to adopt a health card that indicates the patient's language preference for health services, similar to what has been done in Prince Edward Island. Interest in this initiative is also ongoing in Ontario and Manitoba. The implementation of the new health card would support the offer of health services in the preferred language of Francophone patients, better direct patients to health providers who speak the patient's language of choice, and thus improve health outcomes.
• In addition, the CNFS completed 23 research projects that involved at least five universities, on the following themes: training Francophone health professionals; improving health services in French; health management by Francophone communities; and data on Francophone community health. These research initiatives will help to inform OLMCs and health institutions in their decision-making processes regarding health service planning that takes into account the needs and specific priorities of OLMCs.
• Furthermore, the Official Languages Community Development Bureau (OLCDB) launched an open call for proposals in February 2019 to support projects that align with the Federal, Provincial, and Territorial Common Statement of Principles on Shared Health Priorities, which includes: home and community care, mental health and addictions as well as palliative and end-of-life care to improve access to these health services for OLMCs. The initiatives selected under the open call will be funded in 2019-20.

Findings of audits completed in 2018-19

In 2018-19, Health Canada continued to carry out site visits to ensure that funding for OLMCs is spent effectively and that stakeholder organizations are achieving expected outcomes in compliance with funding agreements and terms and conditions.

No audits were conducted in 2018-19.

Findings of evaluations completed in 2018-19

No evaluation was completed in 2018-19.

Planned: Will be evaluated in 2021-22 as part of the Horizontal Evaluation of the Roadmap for Canada's Official Languages.

Engagement of applicants and recipients

Representatives of OLCDB and departmental senior management attended annual general meetings and meetings of Boards of Directors of OLMC organizations, and were in frequent contact with recipients of the Program.

Further engagement was facilitated through the Federal Health Portfolio Consultative Committee for OLMCs, created in 2017, to inform the Health Portfolio's various programs and policies on the specific needs of OLMCs. In 2018-19, the committee met twice (in June and October) to discuss Health Portfolio priority matters, such as access to palliative care, mental health, child and youth health, and the inclusion of official language considerations in the bilateral agreements negotiated with the provinces and territories. Membership on the Committee includes Health Canada, the Canadian Institutes of Health Research, the Public Health Agency of Canada as well as targeted recipients under the OLHP, including: SSF, CNFS, CHSSN and McGill University.

Canada Brain Research Fund Program

General information

Name of transfer payment program

Canada Brain Research Fund Program (CBRF) (Voted)

Start date

April 1, 2011

End date

March 31, 2020

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2016-17

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 14: Brain Research

Description

In Budget 2011 and 2016, the Government of Canada committed up to $120 million, in matched funding with non-federal government donors, to establish the CBRF Program "to support the very best Canadian neuroscience, and accelerate discoveries to improve the health and quality of life for Canadians who suffer from brain disorders." The Government of Canada's objective in funding the CBRF was:

• to serve as a focal point for private investment in brain research by attracting private and charitable donations to match federal funding; and,
• to support research that advances knowledge of the brain through grants to researchers.

Results achieved

While most research supported by Brain Canada is fundamental and basic in nature, thirty percent of CBRF funding supported clinical trials, interventions and implementation research. As a result, projects targeting several brain diseases led to findings and products adopted by stakeholders in the form of new medical devices, drugs, early disease detection/diagnosis and through knowledge mobilization. Examples of these promising projects include research on Alzheimer's disease and certain types of depression.

To date, CBRF supported projects produced various knowledge products (e.g., journal articles, reviews, etc.), learning events, partnerships, and grants. These projects connect over 74 disciplines involving more than 1,000 researchers at 115 institutions. During 2018-19, investments under the Program have supported the training of more than 110 highly qualified personnel who have contributed to the publication of over 300 research publications. CBRF investments have also generated over 59 new partnerships and continued to support over 240 projects across Canada. To illustrate this impact, as of March 2019, more than 9,980 citations of CBRF-funded publications were made by other authors in Canada and internationally, demonstrating the use of knowledge by other stakeholders to inform solutions to brain diseases and disorders.

In addition, that same year, Brain Canada's partnerships with various institutions, health charities and donors, research networks, provincial agencies and corporations, enabled the organization to raise $14.8 million in funds and disburse $40.6 million to 29 major research grants. For example, in April 2018, Brain Canada and the Azrieli Foundation launched the Early-Career Capacity Building Grant. These grants are intended to accelerate novel and transformative research that aim to fundamentally change scientific understanding of nervous system function and dysfunction and their impact on health.

Over the years, Brain Canada's network has significantly expanded. Brain Canada has taken on the role of a brain research convener and this has created the space to evolve its collaboration involving a constellation of over 100 partners and stakeholders across sectors. The result is a brain research community that has increased coordination to achieve common goals. For example, in February 2018, the Minister of Health, the Honourable Ginette Petitpas Taylor, and MP David Lametti, Parliamentary Secretary to the Minister of Innovation, Science and Economic Development, joined Brain Canada to announce a $10.17 million grant to establish the Canadian Open Neuroscience Platform (CONP). The announcement was made on the first day of the inaugural plenary meeting of the CONP. The goal of the accompanying plenary meeting was to bring together the members and funders of the platform to discuss infrastructure, training, and governance, as well as the research priorities and opportunities.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

No evaluation was completed in 2018-19.

Planned: A second evaluation is not scheduled as the current funding agreement ends March 2020, before the end of the five-year evaluation cycle for this Program.

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.

Thalidomide Survivors Contribution Program

General information

Name of transfer payment program

Thalidomide Survivors Contribution Program (Voted)

Start date

June 19, 2015

End date

April 10, 2019^{Footnote 2} (this program was replaced by the Canadian Thalidomide Survivors Support Program)

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2015-16

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 15: Thalidomide

Description

The program objectives are to ensure that, for the remainder of their lives, eligible thalidomide survivors:

• Receive ongoing tax-free payments based on their level of disability; and,
• Have transparent and timely access to the Extraordinary Medical Assistance Fund.

Results achieved

Ongoing tax-free payments were distributed to 100% of known Thalidomide survivors. 100% of payments were made before the end of April 2018, as per the time frame service standard of the third-party administrator.

The independent third-party program administrator processed 21 Extraordinary Medical Assistance Fund (EMAF) applications. The EMAF assists survivors with costs related to extraordinary health support needs such as specialized surgeries and home or vehicle adaptations. Two new thalidomide survivors were confirmed in 2018-19. One survivor passed away increasing the total from 121 to 122 Canadian thalidomide survivors.

Outreach data for 2018-19 showed that 76% of Thalidomide survivors who responded to the survey said that the Thalidomide Survivors Contribution Program (TSCP) is helping them age with dignity, which aligns with the purpose of the program.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

No evaluation was completed in 2018-19.

Planned: A departmental evaluation is currently scheduled for completion in 2019-20.

Engagement of applicants and recipients

Health Canada engaged the independent third party administrator of the TSCP by responding to inquiries and undertaking regular monitoring activities such as progress and performance measurement reporting, and meetings and ongoing communication to support program implementation.

Health Canada engaged the Thalidomide Victims Association of Canada (TVAC), a key stakeholder, in meetings as needed, regarding program implementation. Health Canada also provided information about the program to individual Thalidomide survivors, the general public and to individuals who believe they are survivors of Thalidomide, through direct correspondence and online.

The administrator continued to implement its outreach strategy (direct mail and web-based) to provide the Thalidomide survivor community with updates on program implementation and results.

Territorial Health Investment Fund

General information

Name of transfer payment program

Territorial Health Investment Fund (THIF) (Voted)

Start date

April 1, 2014

End date

March 31, 2021

Type of transfer payment

Grant

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 16: Territorial Health Investment Fund

Description

THIF was provided an investment of $70 million over three years (2014-15 to 2016-17). Due to a significant delay resulting from a number of factors in implementing the contribution agreements in year one, the terms and conditions were extended, with no additional funding, until 2017-18 to ensure territorial governments could complete projects as planned.) The THIF was subsequently renewed in 2017-18 with an additional $108 million over four years (2017-18 to 2020-21). Of this funding, $54 million will be allocated to Nunavut, $28.4 million to Northwest Territories and $25.6 million to Yukon. This funding will enable each territory to continue pursuing innovative activities in support of strong, sustainable health systems, while at the same time maintaining funding to offset costs associated with medical travel to improve Northerners' access to the health care they need.

Terms and Conditions of the THIF were amended in 2017-18 to enable the transfer of funds as a grant rather than a contribution. The use of grant agreements will minimize the administrative burden on territories related to financial reporting and thereby increase their ability to reduce overhead costs of the THIF.

Results achieved

Renewed THIF funding in 2018-19 continued to offset the medical transportation costs experienced by territorial governments and has supported foundational planning for the adoption of innovations to strengthen territorial health systems. For instance, in 2018-19:

• The Northwest Territories developed and piloted cultural competency training for its staff. In the area of oral health, it introduced a daily tooth-brushing program in licensed daycares and home daycares, implemented a fluoride varnish program, and completed the creation of territorial Oral Health Program Standards.
• Yukon undertook enhancements to client information systems, electronic health records, data collection and performance reporting; as well as began increasing its capacity to provide telehealth, including tele-mental health, and remote patient care delivery.
• Nunavut hired 16 paraprofessionals to support the territorial mental health and addictions system. It also staffed a tuberculosis program team that will be responsible for meeting the territory's tuberculosis program objectives. On oral health, dental screenings and treatments continued for school-aged children and preventative services were offered by community oral health coordinators in 19 communities. On telehealth, a contractor was hired to create a strategic plan in this priority area.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018-19

Completed: An evaluation of the Territorial Health Investment Fund (THIF) was completed in 2018-19.

Summary of Findings:

The 2018 evaluation found that THIF enabled territorial governments to implement strategic and systems-level changes to support better service delivery, and contributed to improved access to health care services for residents. The evaluation also noted that the design of a new THIF grant (launched in 2017-18) was expected to improve efficiency by removing some reporting requirements in order to allow for more flexibility on the part of funding recipients.

Planned: As THIF is scheduled to sunset in 2020-21, there is no further planned evaluation for this fund.

Engagement of applicants and recipients

A federal/territorial Assistant Deputy Ministers (ADMs) Working Group, composed of ADMs from all three territories and Health Canada, continued to provide a forum for ongoing monitoring and progress, including: ensuring individual territorial work plans meet the objectives and intent of the initiative; sharing best practices and collaborating on policy and management approaches; and developing a Progress Report in 2020-21.

Payments to Provinces and Territories for the Purpose of Emergency Treatment Funding

General information

Name of transfer payment program

Payments to Provinces and Territories for the Purpose of Emergency Treatment Funding (Voted)

Start date

April 1, 2018

End date

March 31, 2019

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to the department's Program Inventory

Core Responsibility 2: Health Protection and Promotion
Program 29: Controlled Substances

Description

The one-time Emergency Treatment Fund (ETF) provided funding of $150,000,000 to provinces and territories in 2018-19, through bilateral agreements, to improve access to evidence-based treatment services for problematic substance use, including opioids. The funding is matched by the province and territory beyond the first $250,000 and the jurisdiction has up to five years to match the initial influx of funding. Funding was allocated based on the severity of the opioid crisis in the province or territory and the size of the population in the province or territory. This ensured that provinces and territories most impacted by the crisis had enough support, and those jurisdictions that were not yet as affected were able to prepare for possible future impacts.

As part of each bilateral agreement, an action plan was developed and posted on the Health Canada website. In addition, each province and territory is required to report at regular intervals to demonstrate the progress made to increase access to innovative and evidence-based treatment in their jurisdiction.

Results achieved

Bilateral agreements with all provinces and territories were signed in 2018-19. Health Canada expects that short-term and medium-term outcomes will begin to be achieved in a jurisdiction within a year of signing their bilateral agreement, and those results will continue to be achieved until 2023, as provinces and territories may choose to implement multi-year projects using the one-time federal funding. It is expected that the Emergency Treatment Fund will increase availability of treatment services for problematic substance use across jurisdictions and reduce the harms and deaths associated with problematic opioid use. It should be noted that specific timeframes to achieve expected results will vary by jurisdiction, per the timelines proposed for initiatives in their respective action plans. Provinces and territories have provided baseline data to Health Canada and began reporting results in the fall of 2019.

Findings of audits completed in 2018-19

No audit was completed in 2018-19.

Findings of evaluations completed in 2018–19

No evaluation was completed in 2018-19.

Planned: Will be evaluated as part of the Canadian Drugs and Substances Strategy evaluation that is scheduled to be completed in 2021-22.

Engagement of applicants and recipients

Negotiations with provinces and territories to develop bilateral agreements and action plans under the ETF began in 2018-19. All 13 bilateral agreements were signed by March 31, 2019. Health Canada continues to engage with provinces and territories to monitor implementation and ensure compliance with the bilateral agreements.

Horizontal Initiatives

Addressing the Opioid Crisis

General information

Name of horizontal initiative

Addressing the Opioid Crisis

Lead department

Health Canada

Federal partner departments

Canada Border Services Agency (CBSA)
Public Health Agency of Canada (PHAC)
Public Safety Canada (PS)
Statistics Canada (StatCan)

Note: Other government departments (e.g., Correctional Service Canada) are supporting the federal response to the opioid crisis. However, they are not captured in this Horizontal Initiative table, as they have not received funding through the Treasury Board Submission "Addressing the Opioid Crisis."

Non-federal and non-governmental partners

N/A

Start date of the horizontal initiative

April 1, 2018

End date of the horizontal initiative

Ongoing

Description of the horizontal initiative

Illegal drugs and problematic substance use have always presented health and safety challenges in Canada and around the world. Recently, however, there has been a dramatic rise in the number of overdoses and deaths due to problematic opioid use. In 2016, there were 3,017 opioid-related deaths in Canada, 4,100 in 2017, and 4,460 in 2018.

The federal government is taking significant actions in areas of federal jurisdiction to address the crisis. However, despite significant efforts to date, the opioid crisis in Canada continues. According to data from the Public Health Agency of Canada, 11,577 people lost their lives in Canada between January 2016 and December 2018 related to opioids. It is estimated that approximately 250,000 Canadians do not have access to treatment when seeking help for problematic substance use. Since people who use drugs have traditionally been stigmatized, Canadians struggling with substance use disorder often encounter barriers when accessing health, medical and social services. Further, fentanyl and its analogues continue to poison the illegal drug supply, contributing to increased overdoses among people who use illegal drugs.

While the Government of Canada is taking a number of actions to respond to the opioid crisis, this horizontal initiative is specific to measures announced in Budget 2018 to:

• support additional prevention and treatment interventions through an expansion of the Substance Use and Addictions Program (SUAP);
• address the stigma surrounding people who use drugs, which creates barriers for those seeking treatment, through the launch of a public education campaign and training for law enforcement;
• enhance capacity to identify and intercept illegal substances at the border by equipping border agents with additional tools at ports of entry; and,
• improve the availability of and access to public health data by expanding public health surveillance, conducting special studies, and redesigning the Canadian Coroner and Medical Examiner Database (CCMED).

Ultimately, these complementary activities are intended to contribute to a reduction in opioid-related harms and deaths in Canada.

Governance structures

The Government of Canada has put in place a robust governance structure to facilitate whole-of-government coordination in implementing a comprehensive federal response to the opioid crisis. Each department/ agency will be responsible for leading its respective initiatives and providing updates to the interdepartmental Assistant Deputy Minister (ADM) level Working Group on Opioids chaired by the Associate-ADM of Health Canada's Controlled Substances and Cannabis Branch. This working group will be used as a forum for information and consultation on next steps toward a comprehensive, collaborative federal response to the opioid crisis. Updates and decisions from this working group will feed into the federal, interdepartmental Deputy Ministers Task Force on the Opioid Crisis as required. This Task Force, chaired by the Deputy Minister of Health Canada, serves as a time-limited forum to provide leadership and oversight of federal initiatives to respond to the opioid crisis. The Task Force will remain an established committee until such time that the public environment no longer requires it.

The Government is committed to ongoing collaboration and consultation with provincial and territorial partners. Departments and agencies will provide updates to, and consult with, provincial and territorial colleagues as required through the federal/ provincial/ territorial (FPT) ADM-level Problematic Substance Use and Harms Committee (PSUH), co-chaired by Health Canada and British Columbia and comprised of ADMs responsible for drug policy in their jurisdiction. They will also provide updates to and consult with PT colleagues as required through the FPT Special Advisory Committee on the Epidemic of Opioid Overdoses (SAC), co-chaired by the Chief Public Health Officer of Canada and Saskatchewan's Chief Medical Officer of Health and comprising of Chief Medical Officers of Health from each jurisdiction. While the PSUH is an established committee intended as a long-term forum for drug policy discussions, the SAC is a time-limited mechanism for public health collaboration and information sharing between jurisdictions related to the opioid crisis in Canada. Upon sun setting, activities under SAC will be transferred to established committees and organizations as needed.

Total federal funding allocated (from start to end date) (dollars)

$82,241,365 and $12,523,446 ongoing

Total federal planned spending to March 31, 2019 (dollars)

$21,467,133

Total federal actual spending to March 31, 2019 (dollars)

$13,855,445

Date of last renewal of the horizontal initiative

Not applicable

Total federal funding allocated at the last renewal, and source of funding (dollars)

Not applicable

Additional federal funding received after the last renewal (dollars)

Not applicable

Funding contributed by non-federal and non-governmental partners (dollars)

Not applicable

Fiscal year of planned completion of next evaluation

2021-22

Shared outcome of federal partner departments

Reducing harms and deaths related to opioid use.

Performance indicator(s)

PI 1 Number of hospital admissions due to opioid poisoning (including overdoses) per 100,000 population (by gender, age, region)

PI 2 Number of apparent opioid-related deaths per 100,000 population (by gender, age, region)

Target(s)

T1 & T2 Percent reduction^{Footnote 1} by March 31, 2021

Results/Data Source/Frequency:

R1 Opioid poisoning hospitalizations^{Footnote 2}

Data Source: Canadian Institute for Health Information (CIHI): Opioid-Related Harms in Canada, December 2018. Ottawa, ON: CIHI; 2018

Frequency: TBD^{Footnote 7}

R2 Apparent opioid-related deaths

Data Source: Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada (January 2016 to March 2019). Web Based Report. Ottawa: Public Health Agency of Canada; September 2019

Frequency: Quarterly

Expected outcome of non-federal and non-governmental partners

Not applicable

Name of theme (1)

Supporting additional prevention and treatment interventions

Theme outcome

Targeted stakeholders^{Footnote 11} use evidence-informed information^{Footnote 12} on opioid use to change policies, programs, and practice

Theme performance indicator(s)

Percentage of targeted stakeholders reporting that they made evidence informed^{Footnote 13} improvements to opioid use policies, programs and practice (by type of improvement^{Footnote 13})

Theme target(s)

Target will be established by September 2019 following the establishment of an aggregated baseline by June 2019^{Footnote 14}.

Theme results/Data Source/Frequency:

Funding recipients were in the early stages of project implementation in 2018-19. These recipients have not yet submitted data to Health Canada. Progress towards results will be reported in future reporting cycles as data becomes available.

Name of theme (2)

Addressing Stigma

Theme outcome

Increased perception among Canadians of drug use as a public health issue

Theme performance indicator(s)

Percentage of Canadians who believe that the opioid crisis in Canada is a public health issue

Theme target(s)

Increase by 5%^{Footnote 15} by March 31, 2021

Theme results/Data Source/Frequency:

Initial benchmarks to be available late July 2019 and will be reported in the 2019-20 Departmental Results Report (DRR).

Data source: Contracted public opinion research.

Frequency: As needed.

Name of theme (3)

Taking Action at Canada's Borders

Theme outcome

Enhanced capability to interdict illegal cross-border movement of drugs, such as opioids, at ports of entry

Theme performance indicator(s)

Percentage of interdictions of drugs, including opioids, using detector dogs (compared to random resultant rate)

Percentage of interdictions of drugs, including opioids, resulting from targeted examinations (compared to random resultant rate)

Theme target(s)

A target will be established in 2019-20 once a baseline has been established. The objective will be to maintain or exceed previous years' results.

Theme results/Data Source/Frequency:

Results not applicable for fiscal year 2018-19^{Footnote 16}.

Data source: Commercial and Trade Branch, Commercial Compliance Division, Non-Intrusive Inspection Unit (CBSA)

Frequency: Annually.

Name of theme (4)

Enhancing the Evidence Base

Theme outcome

Enhanced quality surveillance^{Footnote 17} data is available

Theme performance indicator(s)

1. Number of opioid-related evidence products^{Footnote 18} disseminated publicly
2. Percentage of data files published on time

Theme target(s)

1. 11 by March 31, 2020
2. 100% by March 31, 2020

Theme results/Data Source/Frequency:

1. 14

Data Sources:

• Government of Canada website: Opioid-related harms and deaths in Canada
• Government of Canada website. Health Promotion and Chronic Disease Prevention in Canada, Research, Policy and Practice

Frequency: Annually

b. 100%

Data sources:

• Government of Canada website: Opioid-related harms and deaths in Canada
• Government of Canada website. Health Promotion and Chronic Disease Prevention in Canada, Research, Policy and Practice

Frequency: Annually

Performance highlights

Health Canada

• Funded 16 opioid-related projects under the SUAP for years 2018-19 to 2021-22 targeting prevention and treatment issues.
• Launched a national public education campaign to address the stigma surrounding people who use drugs and to inform Canadians about harm reduction measures in two phases: opioid awareness in fall 2018 and stigma in winter 2019. Both campaigns were assessed through a post-campaign evaluation.

Public Safety Canada

Although no opioid-based funding was accessed during fiscal year 2018-19 period, the following activity was completed:

Commenced project planning and held a preliminary engagement session with law enforcement representatives to increase awareness and support for Public Safety's opioids de-stigmatization awareness training initiative. This activity was completed using modest internally reallocated resources.

Canada Border Services Agency

• Procured, trained and deployed six new Detector Dog Service teams in the field.
• Procured 15 fume hoods for the 2018-19 deliverable; procurement of additional fume hoods is underway to meet the deliverable of 25 Designated Safe Examination Areas by March 2020
• As a result of initiatives dedicated to augmenting intelligence and risk assessment capacity, the CBSA has interdicted illicit drugs being smuggled into Canada since its implementation in fiscal year 2018-19.

Public Health Agency of Canada

• Placed 13 Public Health Officers in provinces and territories to support data systems, public reporting and contribute to public health action related to problematic substance use.
• Released 6 national surveillance reports on apparent opioid-related deaths and harms to better describe the distribution of these events and monitor changes.

Statistics Canada

• Received agreement from 85% of coroners and medical examiners to supply information to the Canadian Coroner and Medical Examiner Database.

Contact information

Health Canada

Guy Morissette
Director General
Key Initiatives
Controlled Substances and Cannabis Branch
Guy.Morissette@canada.ca
613-954-2686

Expected results

Health Canada

• ER 1.1.1 Targeted stakeholders and Canadians are equipped with the capacity (knowledge, skills and supports) to inform their decisions and actions related to opioid use.
• ER 1.1.2 Targeted stakeholders use evidence-informed information on opioid use to change policies, programs and practice.
• ER 2.1.1 Increased sympathy among Canadians for people using opioids.
• ER 2.1.2 Increased perception among Canadians of drug use as a public health issue.

Public Safety

• ER 2.2 Increased awareness and support amongst law enforcement community about de-stigmatization of people who use opioids.
• ER 3.1 Increased knowledge generation and sharing of information on targeted issues related to reducing the illegal supply of opioids in Canada.

Canada Border Services Agency

• ER 3.2.1 Increased capacity to identify high-risk goods at ports of entry.
• ER 3.2.2 Increased ability to risk assess and identify high risk shipments.
• ER 3.2.3 Increased communications related to threat assessment information and intelligence provided to personnel and partnering agencies.
• ER 3.2.4 Enhanced capability^{Footnote 20} to interdict illegal cross-border movement of drugs, such as opioids, at postal locations.

Public Health Agency of Canada

• ER 4.1 Enhanced quality surveillance data is available.

Statistics Canada

• ER 4.2 Increased use and relevance of CCMED among stakeholders.

Performance indicators

Health Canada

• PI 1.1.1 Percentage of targeted stakeholders and Canadians reporting that they have the social and physical supports they need related to opioid use.
• PI 1.1.2 Percentage of targeted stakeholders reporting that they made evidence informed improvements to opioid use policies, programs and practice.
• PI 2.1.1 Percentage of Canadians who have sympathy for people using opioids.
• PI 2.1.2 Percentage of Canadians who believe that opioid-related substance use disorder is a disease.

Public Safety Canada

• PI 2.2 Percentage of police service members who completed the online course.
• PI 3.1 Percentage of completed planned engagement activities with law enforcement community, stakeholders and partners to address policy issues related to the illegal supply of opioids.

Canada Border Services Agency

• PI 3.2.1.1 Number of designated safe examination areas, allowing ports of entry to be equipped to identify, detect, and interdict opioids.
• PI 3.2.1.2 Percentage of CBSA officers at ports of entry identified for safe examinations training that have completed that required training (Designated Safe Examination Areas).
• PI 3.2.1.3 Number of items per year of suspected opioid-containing packages sampled and identified at safe sampling areas (outside of the laboratory) (Designated Safe Sampling Areas).
• PI 3.2.2 Number of streams/ risk rules supporting advanced risk assessment.
• PI 3.2.3 Number of intelligence products produced by the CBSA.
• PI 3.2.4.1 Percentage of interdictions of drugs, including opioids, using detector dogs (compared to random resultant rate).
• PI 3.2.4.2 Percentage of interdictions of drugs, including opioids, resulting from targeted examinations (compared to random resultant rate).

Public Health Agency of Canada

• PI 4.1 Number of opioid-related evidence products^{Footnote 21} disseminated publicly.

Statistics Canada

• PI 4.2 Percentage of clients satisfied with statistical information from CCMED.

Targets

Health Canada

• T 1.1.1 Target will be established by September 2019 following the establishment of an aggregated baseline by June 2019.^{Footnote 22}
• T 1.1.2 Target will be established by September 2019 following the establishment of an aggregated baseline by June 2019.^{Footnote 22}
• T 2.1.1 Increase by 5%^{Footnote 23}
• T 2.1.2 Increase by 5%^{Footnote 24}

Public Safety Canada

• T 2.2 25% of eligible police service members
• T 3.1 100%

Canada Border Services Agency

• T 3.2.1.1 25
• T 3.2.1.2 100%^{Footnote 25}
• T 3.2.1.3 1,003^{Footnote 26}
• T 3.2.2 N/A^{Footnote 27}
• T 3.2.3 N/A for fiscal year 2018-19^{Footnote 28}
• T 3.2.4.1 A target will be established in March 2020, once a baseline has been established.
• T 3.2.4.2 A target will be established in March 2020, once a baseline has been established.

Public Health Agency of Canada

• T 4.1 11

Statistics Canada

• T 4.2 A baseline and target will be established in March 2020, once CCMED is available.

Actual Results

Health Canada

• AR 1.1.1 Funding recipients are in the early stages of project implementation, and therefore data on this indicator is not currently available.
• AR 1.1.2 Funding recipients are in the early stages of project implementation, and therefore data on this indicator is not currently available.
• AR 2.1.1 Results are being collected and will be reported in the 2019-20 DRR.
• AR 2.1.2 Results are being collected and will be reported in the 2019-20 DRR.

Public Safety Canada

• AR 2.2 N/A^{Footnote 29}
• AR 3.1 100%

Canada Border Services Agency

• AR 3.2.1.1 15
• AR 3.2.1.2 100%
• AR 3.2.1.3 N/A^{Footnote 30}
• AR 3.2.2 N/A^{Footnote 31}
• AR 3.2.3 N/A^{Footnote 32}
• AR 3.2.4.1 N/A^{Footnote 30}
• AR 3.2.4.2 N/A^{Footnote 30}

Public Health Agency of Canada

• AR 4.1 14

Statistics Canada

• AR 4.2 N/A^{Footnote 33}

Variance Explanation:

Health Canada: The variance between actual and planned spending is mainly due to recipients underspending as a result of delays in project implementation.

Public Health Agency of Canada: The variance between actual and planned is due to delays in staffing and unexpected departure of employees.

Public Safety Canada: The variance between actual and planned is due to the Department not receiving funding for this program in 2018-19. Funds were internally reallocated to support the program needs.

Statistics Canada: The variance between actual and planned spending is mainly due to delays in determining a common information technology approach for a central database. Funds were reallocated to support the individual offices to ensure each jurisdiction has an electronic case management system.

Canadian Drugs and Substances Strategy

General information

Name of horizontal initiative

Canadian Drugs and Substances Strategy

Lead department

Health Canada

Federal partner departments

• Canada Border Services Agency (CBSA)
• Canada Revenue Agency (CRA)
• Canadian Institutes of Health Research (CIHR)
• Correctional Service Canada (CSC)
• Department of Justice Canada (DOJ)
• Financial Transactions and Reports Analysis Centre of Canada (FINTRAC)
• Global Affairs Canada (GAC)
• Indigenous Services Canada (ISC)
• Parole Board of Canada (PBC)
• Public Health Agency of Canada (PHAC)
• Public Prosecution Service of Canada (PPSC)
• Public Safety Canada (PS)
• Public Services and Procurement Canada (PSPC)
• Royal Canadian Mounted Police (RCMP)

Non-federal and non-governmental partners

Not applicable

Start date of the horizontal initiative

April 1, 2017

End date of the horizontal initiative

March 31, 2022 and ongoing

Description of the horizontal initiative

The Government of Canada is committed to a comprehensive, collaborative, compassionate and evidence-based approach to drug policy, which uses a public health approach when considering and addressing drug issues. To that end, on December 12, 2016, the Minister of Health announced an updated drug strategy for Canada: The Canadian Drugs and Substances Strategy (CDSS).

The CDSS is led by the Minister of Health, supported by Health Canada and 14 other federal departments and agencies. The CDSS formally restores harm reduction as a key pillar of Canada's drug strategy alongside prevention, treatment and enforcement. With this change, harm reduction-focused policies — such as support for properly established and maintained supervised consumption sites, and increased access to naloxone — are now a formal part of the Government's strategy. The public health focus of the CDSS, along with the inclusion of harm reduction as a core pillar of the strategy, will better enable the Government to address the current opioid crisis, and to work toward preventing the emergence of new challenges. Following the Budget 2017 announcement, CDSS received $102.4 million over 5 years (2017-18 to 2021-22) and $23.0 million ongoing to Health Canada, the Public Health Agency of Canada, Indigenous Services Canada^{Footnote 1} and the Canadian Institutes of Health Research to support the CDSS, building on its ongoing existing funding.

The CDSS replaced the National Anti-Drug Strategy (NADS). The NADS was established in 2007 and lead by the Department of Justice. Allocated federal funding from 2007-12 was $570.4 million, with $114.1 million ongoing, for twelve federal departments and agencies for prevention, treatment and enforcement action plans. In 2014, the NADS was expanded to activities to address problematic prescription drug use (with an additional investment of $44.32 million over 5 years (2014-15 to 2018-19) with $5.01 million ongoing (2019-20 onwards) to Health Canada and the Canadian Institutes of Health Research.

The objective of the Canadian Drugs and Substances Strategy (CDSS) is to strengthen Canada's current approach to problematic drug and substance use by:

• Adopting a comprehensive, collaborative, and compassionate approach;
• Using a public health lens to address problematic drug and substance use issues;
• Employing a strong evidence base; and
• Addressing a broad range of legal and illegal substances, including cannabis^{Footnote 2}, alcohol, opioids^{Footnote 3} and other kinds of substances that can be used problematically.

The four pillars of the CDSS are:

• The prevention pillar supports and implements evidence-based initiatives to increase awareness of the risks of substance use, and reduce the use of controlled substances;
• The treatment pillar supports evidence-based treatment options, improvements to treatment services, and collaboration and knowledge sharing on innovative approaches to treatment and rehabilitation;
• The harm reduction pillar supports measures that reduce the negative health, social and economic effects of substance use on individuals, families and communities, including measures to address the harms caused by stigma; and
• The enforcement pillar increases the capacity of law enforcement to target organized crime, supports the criminal justice system to investigate and prosecute drug related crimes, helps identify and control new and dangerous psychoactive substances, and helps to reduce the risk of diversion of controlled substances from otherwise legal activities.

A strong evidence base supports the use of timely, comparable, national-level data to help develop effective drug and substance policies.

The CDSS recognizes that the national approach to substance use requires coordinated efforts from all levels of government working in their respective areas of jurisdiction. It also recognizes the importance of incorporating stakeholder views on an ongoing basis, including people with lived and living experiences.

Governance structures

The CDSS is led by the Minister of Health. The strategy is currently coordinated through a Director-General (DG) level steering committee that reports to Assistant Deputy Ministers.

Current federal/provincial/territorial (F/P/T) engagement is achieved through a number of F/P/T mechanisms, including the F/P/T Committee on Problematic Substance Use and Harms Committee that is co-chaired by Health Canada and the Province of British Columbia. Secretariat support for the CDSS is provided by the Controlled Substances Directorate of Health Canada.

Health Canada is currently working with federal partners under the CDSS to assess the existing governance structure of the strategy in order to increase its effectiveness and support the goals of the CDSS.^{Footnote 4}

Total federal funding allocated (2017-18 to 2021-22) (dollars)

$660,073,934

Total federal planned spending to March 31, 2019 (dollars)

$260,759,664

Total federal actual spending to March 31, 2019 (dollars)

$305,582,320

Date of last renewal of the horizontal initiative

Not applicable

Total federal funding allocated at the last renewal, and source of funding (dollars)

Not applicable

Additional federal funding received after the last renewal (dollars)

Not applicable

Funding contributed by non-federal and non-governmental partners (dollars)

Not applicable

Fiscal year of planned completion of next evaluation

2021-22

Shared outcome of federal partner departments

Health Canada is working with other federal CDSS partners to update the shared outcomes to better reflect the direction and goals of the CDSS, which is focussed on implementing a comprehensive, collaborative, compassionate and evidence-based approach to drug policy that is based on a public health approach. The following are the current shared long-term outcomes:

• Reduced problematic prescription drug use (PPDU) in Canada;
• Reduced demand for illegal drugs in targeted populations and areas;
• Reduced negative health and social impacts and crime related to illegal drug use and problematic prescription drug use;
• Reduced supply of illegal drugs; and,
• People who use drugs and substances experience reduced negative health impacts.

Performance indicators / targets / data sources and frequency of monitoring and reporting / results

Health Canada is working with the other federal CDSS partners to update the performance indicators and targets (including their associated data source and frequency of monitoring and reporting) for the shared long term outcomes.

Expected outcome of non-federal and non-governmental partners

Not applicable

Name of theme (1)

Prevention

Theme outcomes/performance indicators/targets / data source and frequency of monitoring and reporting

Health Canada will work with the other federal CDSS partners to review and update the theme outcomes (and their associated performance indicators and targets) for the Prevention pillar to reflect the direction and goals of the CDSS.

Theme results

Theme results will be reported once outcomes, indicators and targets are identified.

Name of theme (2)

Treatment

Theme outcomes/performance indicators/targets / data source and frequency of monitoring and reporting

Health Canada will work with the other federal CDSS partners to review and update the theme outcomes (and their associated performance indicators and targets) for the Treatment pillar to reflect the direction and goals of the CDSS.

Theme results

Theme results will be reported once outcomes, indicators and targets are identified.

Name of theme (3)

Harm Reduction

Theme outcome

Reduction in risk-taking behaviour among people with problematic drug or substance use.

Theme performance indicator(s)

• #1: Percentage of targeted Canadians reporting they used knowledge and skills by: sex, Official Language; type of behaviour change (reduced use, safer use, not using, etc.)^{Footnote 5}
• #2: Percentage decrease of sharing drug use equipment among people who use drugs
• #3: Average percentage of First Nations people and Inuit per community who received problematic substance use community-based supports^{Footnote 6}

Theme target(s)

• #1: 60% of targeted Canadians reporting they used knowledge and skills to take positive actions with respect to substance use behavior by 2021 (Baseline to be established in 2018-19)
• #2: 10% decrease by 2020; 15% decrease by 2022
• #3: 14.04% by March 2021

Data source and frequency of monitoring and reporting

• #1 Aggregated data from multiple recipients of Substance Use and Addictions Program contribution funding (secondary data sources), collected annually with reporting starting in 2019-20.
• #2 Centre for Communicable Diseases and Infection Control Grants and Contributions reporting data collected annually starting in 2019-20.
• #3 Data from the Community-Based Reporting Template collected annually.

Theme results

• #1: Not applicable
• #2: Not applicable
• #3: Not available

Name of theme (4)

Enforcement

Theme outcomes/performance indicators/targets

Health Canada will work with the other federal CDSS partners to revise and update the shared outcomes (and their associated performance indicators and targets) for the Enforcement pillar to reflect the direction and goals of the CDSS.

Theme results

Theme results will be reported once outcomes, indicators and targets are identified.

Name of theme (5)

Evidence Base

Theme outcome

Data and research evidence on drugs, and emerging drug trends, are used by members of the federal Health Portfolio and their partners.

Theme performance indicator(s)

Percentage of targeted stakeholders reporting that they made evidence-informed improvements to substance use policies, programs and practice by: type of improvement^{Footnote 7}

Theme target(s)

60% of targeted stakeholders reporting evidence-informed improvements to substance use policies, programs, and practices by 2021 (Baseline to be established in 2018-19).

Data source and frequency of monitoring and reporting

Aggregated data from multiple recipients of Substance Use and Addictions Program contribution funding (secondary data sources), collected annually with reporting starting in 2019-20.

Theme results

Not available

Performance highlights

In 2018-19, CDSS partners continued to work to address problematic substance use in Canada, including the opioid crisis, across the four pillars of the strategy. Key activities included efforts to inform Canadians about the health risks of problematic substance use and the negative impacts of stigma; providing emergency treatment funding to provinces and territories and removing federal regulatory barriers to evidence-based treatment options; advancing harm reduction efforts including further streamlining supervised consumption site applications, launching a Drug-Checking Technology Challenge, and rolling out a Prison Needle Exchange Program; taking measures to address organized drug crime, including drug trafficking with a focus on toxic substances like fentanyl; and ensuring compliance with federal controlled substances regulations.

Other activities include ongoing research and evidence collection; proposing regulations to restrict the alcohol content in single-serve flavoured purified alcohol beverages; hosting a Law Enforcement Roundtable on Drugs; and advancing public health focussed issues including stigma at the UN Commission on Narcotic Drugs. CDSS partners also reviewed CDSS objectives, outcomes and performance indicators to ensure they align with the strategic focus, and consulted the public to obtain new ideas on potential next steps under the CDSS.

Contact information

Michelle Boudreau
Director General
Controlled Substances Directorate
Controlled Substances and Cannabis Branch
Michelle.Boudreau@canada.ca
613-960-2496

Total Funding Allocation and Planned Spending amounts are shown including EBPs @ 20% and PWGSC accommodation premium @ 13%, unless specified otherwise.

Comments on variances

Health Canada
The variance between actual and planned spending is mainly due to the costs related to advancing harm reduction efforts, including the expansion of supervised consumption and overdose prevention sites (from 2 to 40 sites), launching a Drug Checking Technology Challenge, the increased level of engagement respecting international drug policy and consulting the public to obtain new ideas on potential next steps under the CDSS.

Substance Use and Addictions Program (SUAP):

• The variance between actual and planned spending is mainly due to unspent funds by the recipients in 2018-19.

Public Health Agency of Canada
The variance between actual and planned spending is mainly due to delays in staffing and projects.

Canada Revenue Agency
The variance between actual and planned spending is mainly due to additional resources required for higher than anticipated audits.

Indigenous Services Canada
The variance between actual and planned spending is mainly due to internal reallocations to meet the program needs and priorities.

Financial Transaction and Reports Analysis Centre of Canada (FINTRAC)
FINTRAC is an unfunded partner within CDSS. The variance between actual and planned spending is mainly due to internal allocations to support this initiative.

2018-19 Expected Results

Health Canada

ER 1.1

• a) Authorizations to perform legitimate activities with controlled substances, precursor chemicals and industrial hemp are processed in a timely manner.
• b) Increased compliance and reduced risk of diversion of controlled substances, prescription drugs and precursor chemical.

ER 1.2

• a) Increased availability of harm reduction services.
• b) Increased availability of data and research evidence on drugs and substances.

ER 1.3

Provide up to $26.3 million under the Substance Use and Addictions Program (SUAP) to support evidence-informed and innovative health promotion, prevention, harm reduction and treatment initiatives to address substance use, including core funding for the Canadian Centre on Substance Use and Addition (CCSA). In 2018-19, the focus will be on funding and supporting the early implementation of a new cohort of prevention, treatment and harm reduction initiatives resulting from a call for proposals launched late in the 2017-18. As a result, performance measurement will focus on program output and short-term indicators.

ER 1.4

• a) Increased effectiveness in drug analysis.
• b) Data and research evidence on drugs and emerging drug trends are used by members of the federal Health Portfolio and their partners.

ER 1.5

• a) Increased availability of data and research evidence on drugs and substances.
• b) Increased compliance and reduced risk of diversion of controlled substances, prescription drugs and precursor chemicals.

ER 1.6

Effective coordination of the CDSS.

Public Health Agency of Canada

ER 2.1

The Public Health Agency of Canada, through national-level surveillance of opioid-related deaths and other harms, will provide a pan-Canadian picture of the public health impact of opioid overdoses to effectively guide policy, prioritize and develop evidence-based interventions, and drive research.

ER 2.2

Support for time-limited projects are expected to increase knowledge of how to reduce risk behaviours related to the sharing of injection and inhalant drug use equipment, and result in a reduction in risk-taking behaviours. The program will result in enhanced capacity to prevent infections associated with shared drug use equipment and increased access to harm reduction and other services, while also reducing stigma and discrimination among this population.

Canadian Institutes of Health Research

ER 3.1

In alignment with the CDSS goals, in 2018-19, the Canadian Institutes of Health Research (CIHR) will continue to fund the Canadian Research Initiative in Substance Misuse (CRISM) Network, a national research consortium in problematic substance use, with four research Nodes across Canada (located in British Columbia, the Prairies, Ontario, and Quebec and the Maritimes) that enhances collaboration between researchers, service providers, policy makers and people with lived experience.

In 2018-19, it is expected that CRISM will:

• Continue to conduct research to enhance prevention, harm reduction and/or treatment for people living with problematic substance use;
• Increase research capacity in the field of problematic drug and substance use disorder;
• Build relationships with health care practitioners, policy makers and people with lived experience;
• Continue recruitment of patients to the pan-Canadian clinical trial, OPTIMA, that compares two models of care for the treatment of opioid use disorder; and,
• Hold an annual meeting of their Network Executive Committee to discuss coordination of nationally-relevant activities, strategies, progress, best practices and challenges.

In 2018-19, CIHR will deliver up to 18 knowledge syntheses relevant to one or more of the four pillars of the CDSS (i.e., prevention, harm reduction, treatment and enforcement) and the opioid crisis.

ER 3.2

In 2018-19, a baseline will be established for the percentage (%) of federal health publications in areas related to problematic substance use (from Health Canada and the Public Health Agency of Canada) citing CIHR-funded research.

Indigenous Services Canada

ER 4.1

Indigenous Services Canada's First Nations and Inuit Health Branch has the capacity to fund a range of treatment services and programs to First Nations and Inuit communities.

With ongoing CDSS investments, First Nations and Inuit Health Branch (FNIHB) plans to maintain the availability of, and access to, effective treatment services and programs for First Nations and Inuit populations in areas of need. The progress of this strategy will be measured by the nature of services that have been made available through funding in targeted areas and are based on research or best practices.

With CDSS investments, FNIHB also plans to maintain treatment programs and services to address substance use in First Nations and Inuit populations in areas of need. The progress of this plan will be measured by:

• the proportion of treatment facilities accredited;
• the proportion of addictions counsellors in treatment centres who are certified;
• the changes in stakeholder perceptions regarding the extent to which treatment services have been improved in Strategy-supported investment areas;
• the types of collaborative/partnerships with Indigenous organizations to strengthen systems, programs and services; and
• the number of First Nations and Inuit communities that deliver harm reduction programming

Department of Justice

ER 5.1

The criminal justice system supports alternative ways of responding to the causes and consequences of offending.

ER 5.2

Increased availability of, and access to, drug treatment services and programs for youth involved in the justice system.

Public Safety Canada

ER 6.1

Coordinated enforcement action to address illegal drugs and substances, including illegal opioids.

Royal Canadian Mounted Police

ER 7.1

The RCMP will increase awareness of drugs and illegal substances among stakeholders by developing education products, supporting outreach and engagement efforts, and building new partnerships.

ER 7.2

The RCMP will focus its efforts to undertake investigations and initiatives focussing on the highest threats related to organized crime networks including those involved in the importation and trafficking of illegal drugs, including illegal opioids.

Correctional Service Canada

ER 8.1

Timely case preparation and supervision of provincial offenders with a drug offence (Schedule II).

Parole Board of Canada

ER 9.1

Conditional release decisions contribute to keeping communities' safe.

ER 9.2

The timely exchange of relevant information with victims, offenders, observers, other components of the criminal justice system, and the general public.

Public Prosecution Service of Canada

ER 10.1

Provision of pre-charge legal advice and litigation support, as well as the prosecution of drug offences under the CDSA in all provinces and territories regardless of which police agency investigates the alleged offences, except Quebec and New Brunswick. In these two provinces, the PPSC prosecutes only drug offences investigated by the RCMP.

ER 10.2

Provision of pre-charge legal advice and litigation support, as well as the prosecution of serious drug offences under the CDSA to which mandatory minimum penalties are applicable.

ER 10.3

Support the work of the program by providing key corporate services.

Canada Border Services Agency

ER 11.1.1

Continue to increase awareness and capacity to gather information and intelligence of illegal drug issues relative to the border.

ER 11.1.2

Continue to increase intelligence and analytical support to regional enforcement activities to interdict goods entering and leaving Canada under the CDSS.

ER 11.1.3

Continue to improve relationships and communication with partner agencies under the CDSS to identify opportunities and improve intelligence activities such as targeting, information sharing and laboratory analysis related to illegal drugs and other goods (such as precursor chemicals) identified under the CDSS as they relate to the border.

ER 11.2

Continue to sample, analyse and use of mobile laboratory capabilities to assist in the detection of precursor chemicals at the ports of entry.

Global Affairs Canada

ER 12.1

To assist the United Nations Office on Drugs and Crime (UNODC) and the Organization of American States-Inter-American Drug Abuse Control Commission (OAS-CICAD) to fulfill their respective mandates in the fight against drugs and transnational crime, including efforts to reduce the supply and availability of illegal drugs. The expected results for fiscal year 2018/2019 will be increased capacity of port officials in selected countries in the Americas to intercept and seize illegal drug smuggled via legal maritime containerized cargo.

Canada Revenue Agency

ER 13.1

30 audits of taxpayers involved in the production and distribution of illegal drugs resulting in (re) assessments of $2.0 million of federal taxes.

Public Services and Procurement Canada

ER 14.1

Increased operational capacity to provide forensic accounting services to law enforcement agencies. Forensic accounting services assist law enforcement and prosecution agencies in determining whether the assets of suspects were derived from criminal activities, thereby allowing the Government of Canada to seize the assets and remove the financial incentives for engaging in criminal activities.

Financial Transactions and Reports Analysis Centre of Canada

ER 15.1

In 2018-2019 FINTRAC will continue to be an unfunded partner within the CDSS. Given the importance of the CDSS initiative, FINTRAC will continue to work with law enforcement and intelligence agencies to ensure they receive financial intelligence related to drug production and distribution that is useful for further actions.

2018-19 Performance Indicators

Health Canada

PI 1.1

Percentage of licensed dealers inspected that are deemed to be compliant with the Controlled Drugs and Substances Act and its regulations.

PI 1.2

• Percentage of applications for an exemption to operate a Supervised Consumption Site that receive a decision within the service standard from the time the review is complete.
• Percentage of the United Nations Annual Report Questionnaire completed with Canadian data.

PI 1.3

1. Number of knowledge products created by funding recipients.
2. Number of learning opportunity delivered by funding recipients.
3. Number of individuals accessing the knowledge products.
4. Number of participants in learning opportunities.
5. Percentage of target population reporting that they have the social and physical supports they need.
6. Percentage of target population reporting that they intend to use the knowledge and skills.
7. Percentage of stakeholders and Canadians reporting that they gained knowledge.
8. Percentage of stakeholders and Canadians reporting that they gained skills.

PI 1.4

1. Percentage of samples analyzed within service standards (60 days or negotiated date).
2. Number of alerts issued to clients and to provincial and territorial health authorities on newly identified potent illegal drugs in communities.

PI 1.5

Percentage of pharmacies inspected that are deemed to be compliant with the Controlled Drugs and Substances Act and its regulations.

PI 1.6

CDSS performance measurement strategy revised and implemented.

Public Health Agency of Canada

PI 2.1

• Number of apparent opioid-related deaths per 100,000 population.
• Percentage of provinces and territories reporting on a quarterly basis.

PI 2.2

• Percentage reduction in the number of new HIV diagnoses associated with injection drug use.
• Percentage decrease of sharing drug use equipment among people who use drugs.

Canadian Institutes of Health Research

PI 3.1

The proportion of funded research projects with a nature and scope that support CDSS' goals

PI 3.2

• Percentage of grant recipients producing policy-relevant knowledge products, such as research publications, policy briefs, guidelines for policies or practice, presentations to policy audiences, and media mentions.
• Number of health research publications related to problematic substance use^{Footnote 9}.
• Percentage of federal health publications in areas related to problematic substance use (from Health Canada and the Public Health Agency of Canada) citing CIHR-funded research.

Indigenous Services Canada

PI 4.1

1. Number of First Nations and Inuit communities that deliver harm reduction programming.
2. Average percentage of First Nations people and Inuit per community who received substance use community-based supports.

Department of Justice

PI 5.1

Percentage of Drug Treatment Court participants retained for 6 months or longer in the court-monitored treatment program.

PI 5.2

Number of active projects funded under Youth Justice Fund's Drug Treatment component per fiscal year.

Public Safety Canada

PI 6.1

Timely sharing of evidence-based knowledge and intelligence to support law enforcement actions against illegal drugs and substances, including illegal opioids.

Royal Canadian Mounted Police

PI 7.1

Awareness:

1. Number and nature of awareness products.
2. Number and category (targeted audiences) of stakeholders reached.
3. Percentage of participants from targeted audiences who demonstrate an increase in awareness of problematic drug and substance use.

Partnerships:

4. Number and nature of number of partnerships and collaborations.
5. Qualitative assessment of extent partners have been engaged.

PI 7.2

Investigations:

1. Number and nature of collaboration and coordination efforts related to enforcement with domestic partners.
2. Number and nature of collaboration and coordination efforts related to enforcement with international partners.
3. Number of investigations initiated regarding illegal drug production and/or distribution.
4. Number/type/nature of seizures made by Federal Serious and Organized Crime (FSOC) units related to investigations on illegal drug production and/or distribution.

Correctional Services Canada

PI 8.1

• Total number of provincial offenders convicted of a drug offence (Schedule II) supervised by CSC.
• Total number of provincial offenders convicted of a drug offence (Schedule II) with a residency requirement.
• Total number of case preparation reports (pre- and post-release) completed for all provincial offenders.

Parole Board of Canada

PI 9.1

The number and proportion of provincial offenders convicted of drug offences who successfully complete parole.

PI 9.2

The percentage of individuals (i.e., general public and victims) who are satisfied with the quality of the service.

Public Prosecution Service of Canada

PI 10.1

• Number of litigation files related to the prosecution of drug offences under the CDSA referred to the PPSC during the fiscal year.
• Number of files for which legal advice was provided by PPSC counsel.

PI 10.2

• Number of litigation files related to the prosecution of serious drug offences under the CDSA referred to the PPSC during the fiscal year to which mandatory minimum penalties are applicable.
• Number of files for which legal advice was provided by PPSC counsel where mandatory minimum penalties are applicable.

PI 10.3

Percentage of overall CDSS-related expenditures for corporate support to in-house legal staff.

Canada Border Services Agency

PI 11.1

Average dollar value of goods, shipments and conveyances seized attributed to Intelligence.

Global Affairs Canada

PI 12.1

• The number of illegal drug seizures made by GAC-financed/UNODC trained Port Control Units in beneficiary countries.
• The volume of illegal drug seized by GAC-financed/UNODC trained Port Control Units in beneficiary countries.

Canada Revenue Agency

PI 13.1

80% or more of audits resulting in (re) assessments.

Public Services and Procurement Canada

PI 14.1

• The number of active CDSS files (projects) worked on related to determining whether the assets of a suspect were derived from criminal activities.
• Number of reports produced. This is further measured by classifying stage or status of each report (for example; still in legal process, settled, gone to trial, or dropped).

Financial Transactions and Reports Analysis Centre of Canada

PI 15.1

Total number of FINTRAC disclosures of actionable financial intelligence made to regime partners, and the number of unique disclosures of actionable financial intelligence that relate to at least one drug-related offence.

2018-19 Targets

Health Canada

T 1.1

The risk-based methodologies behind assigning compliance ratings for licensed dealers are evolving. The target value will be identified /determined by March 31, 2020.^{Footnote 10}

T 1.2

• 90% by March 31, 2019
• 90% by April 1, 2022

T 1.3

• a-f. The target value will be determined by March 31, 2019, once the current call for proposals and recipient performance measurement plans are complete.^{Footnote 11}
• g-h. 80% of stakeholders and Canadians targeted under SUAP funded initiatives report that they gained knowledge by March 31, 2019.

T 1.4

1. 95% of certificates of analysis issued within service standards or negotiated date.
2. Demand driven.

T 1.5

95%^{Footnote 12} by March 31, 2019.

T 1.6

Implemented by March 31, 2019.

Public Health Agency of Canada

T 2.1

• Decrease in baseline year over year to 2022^{Footnote 13}
• 100% by 2017-18.

T 2.2

• 25% decrease by 2022.
• 10% decrease in sharing of drug equipment among people who use drugs, by 2020, 15% decrease by 2022.

Canadian Institutes of Health Research

T 3.1

100% annually.

T 3.2

• 75% of grant recipients produce policy-relevant knowledge products by 2022.
• 100% of grant recipients producing research publications related to problematic substance use by 2022.^{Footnote 14}
• 18% of federal health publications in areas related to problematic substance use (from Health Canada and the Public Health Agency of Canada) cite CIHR-funded research by 2022.

Indigenous Services Canada

T 4.1

• 8 communities by March 2019 (Number of First Nations and Inuit communities that deliver harm reduction programming).
• 14.04% by March 2021 (Average percentage of First Nations people and Inuit per community who received substance use community-based supports).

Department of Justice

T 5.1

50% of participants are retained for six months in federally funded Drug Treatment Court programs.

T 5.2

The budget allocation is fully committed to support drug treatment programming for youth involved in the justice system.

Public Safety Canada

T 6.1

100% completion of planned coordination activities based on an integrated law enforcement work plan.

Royal Canadian Mounted Police

T 7.1

1. 5 drug related awareness products.
2. Approximately 500 stakeholders will be reached (stakeholders include Police, Public/Youth, and Industry/Other stakeholders).
3. 85% of participants from targeted audiences will demonstrate an increase in awareness
4. At least 20 partnerships/collaborations.
5. Qualitative assessment.

T 7.2

Targets are not applicable as these will vary by province/territory and is based on need.

Correctional Services Canada

T 8.1

• Approximately 52 provincial offenders convicted of a drug offence (Schedule II) are supervised by CSC.
• Approximately 34 provincial offenders convicted of a drug offence (Schedule II) have a residency requirement.
• Approximately 832 case preparation reports (pre- and post-release) are completed for all provincial offenders.

Parole Board of Canada (PBC)

T 9.1

98% of provincial offenders serving sentences for drug offences who are on parole are not convicted of a violent offence during their supervision period.

T 9.2

80% of individuals are satisfied with the quality of the service.

Public Prosecution Service of Canada

T 10.1

Targets are not applicable owing to the nature of the PPSC's workload and mandate.

Canada Border Services Agency

TI 11.1

9:1 ratio.

Global Affairs Canada

T 12.1

• Illegal drug seizures are made in all beneficiary countries benefiting from GAC-financed/UNODC trained port control units.
• At least 20 tons of illegal drugs are seized by GAC-financed/UNODC trained port control units.

Canada Revenue Agency

T 13.1

30 audits of taxpayers involved in the production and distribution of illegal drugs resulting in (re) assessments of $2.0 million of federal taxes.

Public Services and Procurement Canada

T 14.1

The Forensic Accounting Management Group (FAMG) is expected to maintain the equivalent of three dedicated resources to work with law enforcement agencies. The targets are dependent on the projects assigned to FAMG by law enforcement agencies and are based on the resource capacity of the three senior forensic accounts.

Financial Transactions and Reports Analysis Centre of Canada

T 15.1

FINTRAC seeks to closely align its financial intelligence products with the needs and priorities of its investigative partners. As such, the Centre does not set specific targets for the number or types of drug-related case disclosures it produces in any fiscal year.

2018-19 Actual Results

Health Canada

AR 1.1 100%

AR 1.2

• 91%
• 70%

AR 1.3

1. 226
2. 360
3. 17,646
4. 11,847
5. Funding recipients have not yet reported on this indicator; data is expected in future reporting cycles.
6. 82%
7. 95%
8. 53%.^{Footnote 15}

AR 1.4

1. 96.8% (118, 604 Certificates of Analysis issued within service standards out of 122,519)
2. 40 alerts issued

AR 1.5 75%

AR 1.6

DG CDSS Steering Committee approved a new draft logic model in April 2019. In 2019-20, the CDSS Evaluation and Reporting Working Group will review and update the indicators and targets to support the new logic model.

Public Health Agency of Canada

AR 2.1

• 4,614^{Footnote 16}
• 100%

AR 2.2

Project-level performance data will be reported to the Agency at the end of fiscal year 2019-20 once the two-year projects have been completed. As such, program-level results will not be available until early 2020-2021.

Canadian Institutes of Health Research

AR 3.1

Baseline to be established in 2020-21

AR 3.2

• Baseline to be established in 2020-21
• Baseline to be established in 2020-21
• 46%

Indigenous Services Canada

AR 4.1

• 13 communities
• Not available^{Footnote 17}

Department of Justice

AR 5.1

46%

AR 5.2

10 projects

Public Safety Canada

AR 6.1 100%

Royal Canadian Mounted Police

AR 7.1

1. 4 drug related awareness products (a national presentation on "The Meth Situation in Canada"; a "Methamphetamine Fact Sheet"; "Identification and Reporting of Suspicious Chemical Transactions" fact sheet; and a national standardized presentation on the opioid crisis) and 1 fact sheet on fentanyl (2017) for a Canadian Broadcasting Corporation (CBC) news report on fentanyl toxicity and naloxone.
2. 852 stakeholders (approximately), including police, public, youth, industry, indigenous communities and other stakeholders.
3. 57%^{Footnote 18} increased their awareness of synthetic opioids such as fentanyl; 8 of the 9^{Footnote 19} youth drug prevention programs (for 210 youth in Saskatchewan) demonstrated increased awareness of the harms of drug use.
4. 21 new engagement opportunities were identified between domestic and international police services, international-based government officials serving in public safety and security roles, and the Canadian Association of Chiefs of Police (CACP) Drug Advisory Committee.
5. Coordinated and led learning exchanges for enhancing law enforcement awareness of opioids, good practices in forensic drug lab analyses/techniques, and strategies employed by the Combined Forces Special Enforcement Units (CFSEU) in tackling drugs, gangs and organized crime. The Drug Abuse Resistance Education^{Footnote 20} program was delivered 704 times in various communities throughout Canada. Over 200 Aboriginal Shield Programs^{Footnote 21} were delivered throughout Canada.

AR 7.2

1. 2 collaborative working arrangements (30 meetings and teleconferences) related to opioids.
2. 2 collaborative working arrangements (8 meetings) related to opioids.
3. 10,040 occurrences.^{Footnote 22}
4. 21,732 drug seizures^{Footnote 23} valued at $101,134,206.

Correctional Services Canada

AR 8.1

• 43^{Footnote 24}
• 28^{Footnote 25}
• 718

Parole Board of Canada

AR 9.1

100%

AR 9.2

89%

Public Prosecution Service of Canada^{Footnote 26}

AR 10.1

• 8,535
• 1,115

AR 10.2

• 326
• 40

AR 10.3

11%

Canada Border Services Agency

AR 11.1

20:10^{Footnote 27}

Global Affairs Canada

AR 12.1

• Illegal drug seizures are made in all beneficiary countries benefiting from GAC-financed/UNODC trained port control units. All beneficiary countries have had successful drug seizures so far this year.
• At least 20 tons of illegal drugs are seized by GAC-financed/UNODC trained port control units.

Canada Revenue Agency

AR 13.1

35 audits

Public Services and Procurement Canada

AR 14.1

• 40 open and active CDSS investigations at the beginning of 2018-19; added 40 new investigations; 24 were closed, leaving 56 open and active investigations at the end of the year.
• Regarding the 24 closed investigations: 2 went to trial and received a court decision; 17 were settled by the client/crown before trial; 1 investigation the crown declined to approve charges and 4 were closed by the client.
• 44 CDSS Forensic Account Reports were issued to clients.

Financial Transactions and Reports Analysis Centre of Canada

AR 15.1

2,276, including 678 unique cases. These case disclosures relate to suspicions of money laundering or terrorist financing where the predicate offence is believed to be drug distribution or production.

Chemicals Management Plan

General information

Name of horizontal initiative

Chemicals Management Plan

Lead department

Health Canada
Environment and Climate Change Canada

Federal partner departments

Public Health Agency of Canada

Non-federal and non-governmental partners

Not applicable

Start date of the horizontal initiative

2007-08

End date of the horizontal initiative

2020-21

Description of the horizontal initiative

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 timelines for, and conducting or developing risk assessment and risk management of, chemicals and other substances 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 and other substances; and,
• Engaging industry to inform risk assessment and risk management action while also enhancing trust in the program.

Jointly delivered by Health Canada and Environment and Climate Change Canada (ECCC), 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, 1999 (CEPA), the Canada Consumer Product Safety Act (CCPSA), the Food and Drugs Act (F&DA), the Pest Control Products Act (PCPA), the Fisheries Act and the Forestry Act.

In the second phase of CMP (CMP2, 2011-12 to 2015-16), priority setting for existing substances was refined and the remaining substances were grouped to provide efficiencies for risk assessment and risk management as a result of lessons learned from the first phase of the program (CMP1, 2007-08 to 2010-11). The third phase (CMP3, 2016-17 to 2020-21) includes both substance groupings and single substance assessments. Similar to CMP2, groupings are created where possible to gain efficiencies in the assessment process and to consider substances that may be used as alternatives. Where groupings are not possible, single substance assessments are conducted.

Integration across government programs remains critical since many substances are found in consumer, cosmetic, health, drug and other products. In addition to releases from products, substances may be released at various points in their life cycle, such as during their manufacturing and disposal.

The same core functions that have been part of the first two phases continue in the third phase of the CMP: risk assessment; risk management, compliance promotion and enforcement; research; monitoring and surveillance; stakeholder engagement and risk communications; and, policy and program management. Information gathering is a key activity undertaken to support these core functions.

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

Governance structures

In the overall delivery of the CMP, Health Canada and ECCC have a shared responsibility in attaining objectives and results. In meeting their obligations pursuant to the CMP, the Departments fulfill their responsibilities through established internal departmental governance structures, as well as a joint CMP governance structure to address shared responsibilities. Efforts are also made to harmonize vertical and horizontal performance reporting indicators (e.g. CMP Performance Management Strategy, the CMP contribution to the Federal Sustainable Development Strategy, etc.) for CMP.

The CMP has a horizontal governance framework which ensures integration, co-ordination, joint decision making and clear accountabilities. Under the CMP Integrated Horizontal Governance Framework, the joint CMP Assistant Deputy Ministers Committee (CMP ADM Committee) reports to both the Health Canada and ECCC Deputy Ministers.

The CMP ADM committee is supported by a Director General (DG) committee. The CMP DG Committee consists of DGs from all partner programs within Health Canada and ECCC, and provides strategic direction, oversight and a challenge function for the CMP's overall implementation. The CMP DGs also play a lead role in directing, monitoring and providing a challenge function for the core elements of the CMP, namely the delivery of the chemicals agenda under CEPA.

This DG level committee is supported by the CMP Steering Committee, which is a Director level committee intended to provide oversight on CMP issues related to the CEPA chemicals agenda.

Total federal funding allocated (from start to end date) (dollars)

$1,308,179,400 (includes all three phases)

Total federal planned spending to March 31, 2019 (dollars)

$1,110,864,820

Total federal actual spending to March 31, 2019 (dollars)

$1,069,428,868

Date of last renewal of the horizontal initiative

October 2014

Total federal funding allocated at the last renewal, and source of funding (dollars)

Phase three, $493,286,450; Source of funding: Budget 2015

Additional federal funding received after the last renewal (dollars)

Not applicable

Funding contributed by non-federal and non-governmental partners (dollars)

Not applicable

Fiscal year of planned completion of next evaluation

2019-20

Shared outcome of federal partner departments

Shared (Final) Outcome (1)

Reduced threats to health and the environment from harmful substances

Performance indicator(s)

Long-term risk of a selected group of representative or significant harmful substances where risk management actions have been put in place

Target(s)

This is a long term outcome with no specific annual targets. The target value is substance-dependent. However, in general, the CMP is aimed at reducing risks to human health and the environment, and therefore a reduction in risk is desired

Results/Data Source/Frequency

Results are expected to be available by March 2028.

Over the life of the CMP, significant investments have been and continue to be made towards measuring the final outcome in a meaningful manner. Specific to 2018-19 and building on previous work, a commissioned study to identify a subset of pilot projects for examination and undertaking of a statistical analysis to identify potential temporal trends was completed. This study confirmed that temporal trends for four substances (BPA, lead, mercury and PBDE) are possible, but that additional years of data collection would be required.

Data Source: Literature Review, Canadian Health Measures Survey and other available monitoring data

Frequency: 10-20 years

Shared Outcome (2)

Risk management measures reduce the potential for exposure to harmful substances

Performance indicator(s)

Exposure or release levels for a select group of substances where risk management measures are in place. (Substance-based Performance Measurement)

Target(s)

The target value is substance-dependent. However, in general, risk management actions are taken in order to reduce exposure, and therefore a downward trend in exposure levels is desired

Results/Data Source/Frequency

Results are expected to be available by March 31, 2022.

Work is on-going to monitor the extent to which the Program's risk management activities are reducing the potential for exposure to harmful substances. Substance-Based Performance Measurement (SBPM), and potentially Instrument-Based Performance Measurement (IBPM), will continue to be used to determine whether or not risk management actions have collectively met substance specific objectives. Specific to 2018-19, a performance evaluation for the bisphenol A (BPA) health component of the risk management approach was conducted in December 2018. It found a 96% decrease in exposures of infants to BPA.

Data Source: Literature Review, Canadian Health Measures Survey and other available monitoring data

Frequency: Other^{Footnote 1}

Shared Outcome (3)

Canadians use the information (that meets their needs on the risks and safe use of substances of concern) to avoid or minimize risks posed by substances of concern

Performance indicator(s)

• i) Percentage of Canadians taking appropriate actions to address risks (targeted stakeholders/intermediaries); and,
• ii) Percentage of Canadians taking appropriate actions to address risks (general public)

Target(s)^{Footnote 2}

• i) TBD
• ii) TBD

Results/Data Source/Frequency

Results:^{Footnote 3}

• i) Not available
• ii) Not available

Data Source:

• i) TBD
• ii) TBD

Frequency:

• i) TBD
• ii) TBD

Shared Outcome (4)

Canadians and stakeholder groups have access to information that meets their needs on the risks and safe use of substances of concern

Performance indicator(s)

• i) Percentage of knowledge transfer activities completed as planned related to substances of concern (risk communication); and,
• ii) Percentage of knowledge transfer activities completed as planned related to substances of concern (research)

Target(s)

• i) 100%
• ii) 100%

Results/Data Source/Frequency

Results:

• i) 100%
• ii) 100%

Data Source:

• i) Social media stats, quarterly reports from regions and stats on outreach activities
• ii) Operational planning and budgeting project templates

Frequency:

• i) Annually
• ii) Annually

Shared Outcome (5)

Knowledge, information and data on substances of concern is made available to Health Canada and ECCC recipients (or other stakeholders) to inform risk management; risk communication and stakeholder engagement; research; risk assessment; monitoring and surveillance; and international activities

Performance indicator(s)

Percentage of CMP research projects conducted that address risk assessment, risk management, economic research, monitoring and surveillance, research and international priorities

Target(s)

100%

Results/Data Source/Frequency

Results: 100%

Data Source: Operational Planning templates

Frequency: Annually

Shared Outcome (6)

Industry conforms/complies with established risk management measures

Performance indicator(s)

Industry conforms or complies with established risk management instruments

Target(s)

ECCC Enforcement Branch to complete an analysis of compliance in high risk regulated sectors

Results/Data Source/Frequency

Results: Non-Compliance Detection level for CMP Regulations: 17%^{Footnote 4}

Data Source: Gavia (ECCC's Enforcement Database)

Frequency: Annually

Expected outcome of non-federal and non-governmental partners

Not applicable

Name of theme

Not applicable

Performance highlights

Summary

In 2018-19, Health Canada (HC) and Environment and Climate Change Canada (ECCC) continued to assess and manage the potential health and ecological risks from priority existing substances. Screening Assessment Reports and Risk Management Strategies for most priorities identified in a publicly available work plan were completed, and risk management measures continued to be developed, implemented, tracked and monitored. As well, new substance notifications were assessed within their mandated timelines, and risk management instruments were developed within mandated timeframes as required for substances considered harmful to human health and/or the environment.

HC continued to conduct risk assessments and develop and implement risk management measures to address risks posed by harmful substances 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 initiation requirements under the Pest Control Products Act.

In 2018-19, Health Canada modernized the process for developing drinking water quality guidelines by enhancing transparency, finding efficiencies and focusing on key information. As a result, the number of new or updated guidelines published has increased as compared to previous year. These guidelines are used by all Federal, Provincial and Territorial jurisdictions in Canada as the basis for establishing their drinking water requirements.

The program continued to conduct research and monitoring programs to address existing and emerging substances of concern, and to inform risk assessment and risk management activities.

Compliance promotion strategies and enforcement plans were also developed and delivered for CMP substances. The focus in 2018-19 was on delivering compliance promotion and enforcement activities for the highest priority instruments as determined by the compliance and enforcement priority setting processes.

In the areas of stakeholder engagement and public outreach, a key milestone in 2018-19 was the launch of a new Healthy Home social marketing campaign on chemicals and pollutants in and around the home. The new Healthy Home web site makes it easier for Canadians to find CMP information that is relevant to the general public and includes general safety messaging along with plain language information on CMP substances of concern. A new top 10 tips brochure was released to support outreach efforts. With this new campaign, public outreach continues to be delivered through multiple platforms such as national media (print and radio), social media, print products, and grass roots outreach through Health Canada regional offices.

Performance Details

Risk Assessment/Risk Management

In 2018-19, 128 CMP substances were assessed in Draft Screening Assessment Reports (DSARs). ECCC and HC also published Final Screening Assessment Reports (FSARs) for 599 substances.

In 2018-19, HC's Pest Management Regulatory Agency (PMRA) completed two proposed re-evaluation decisions (risk assessments) for consultation on old pesticides (those registered prior to 1995), six cyclical re-evaluations (those registered after 1995) and three special reviews.

Targeted risk management activities were published in 2018-19 for substances that were deemed harmful to human health and/or the environment. In total, there were ten risk management instruments put in place to manage these toxic substances, including three proposed risk management instruments and seven Final risk management (RM) instruments. Seven RM Scope documents and one RM Approach documents were also published.

In 2018-19, 371 new substance notifications were received pursuant to section 81 of CEPA and the New Substances Notification Regulations (Chemicals and Polymers). Seven Notices were published applying the SNAc Significant New Activity (SNAc) provisions to seven substances; 12 Ministerial Conditions were published on 11 new substances. Six SNAc Notices of Intent (NOIs) were issued for existing substances on a total of 20 substances.

During 2018-19, 30 notifications of new animate products of biotechnology were received and were assessed under the New Substances Notification Regulations (Organisms). While no SNAc Notices were issued for new living organisms, an Order applying the SNAc provisions to five existing living organisms was published in 2018-19.

HC also contributed to risk management activities related to drinking water quality in 2018-19, publishing online six final and ten draft Guidelines for Canadian Drinking Water Quality / guidance documents, to be used by all jurisdictions in Canada as the basis for their regulatory requirements.

The Consumer Product Safety Program (CPSP) continued to manage potential risks related to chemicals in consumer products and cosmetics, including the completion of cyclical enforcement projects for lead in kettles, boric acid and phthalates in toys, chemical requirements of ceramic foodware products, methylisothiazolinone/ methylchloroisothiazolinone (MI/MIC) in cosmetics, levels of lead and cadmium in children's jewellery, lead in surface coatings of children's products, and consumer chemicals under the requirements of the Consumer Chemicals and Containers Regulations, 2001 (CCCR, 2001). In total, the cyclical enforcement projects included 166 inspections, where 236 samples were collected, leading to 20 recalls and 15 stop sales. In addition, final amendments to regulations for children's jewellery and lead in consumer products were published in 2018-19. Consumer Product Safety risk assessors and risk managers co-authored a DSAR for talc, as well as drafting DSARs for parabens, lotus corniculatus and triclocarban, which are planned to be published in 2019-20. CPSP provided cosmetic notification data to support the assessment of numerous CMP substances. The Product Safety Laboratory developed a method and conducted testing of children's rubber products to identify and quantify the presence of mercaptobenzothiazole (MBT).

The Health Products and Food Branch (HPFB) of HC continued to provide information to support the development of CMP screening assessments as well as provide a review function for food-related sections of those assessments. It also continued its commitment to re-evaluate and assess food additives, food contaminants, other food ingredients and food packaging materials for which CMP screening assessments and new science identified potential risks for consumers and where CMP assessments identified food as a contributing/main source of exposure.

In 2018-19, HC's Pest Management Regulatory Agency (PMRA) made 12 re-evaluation decisions for older chemicals (those registered prior to 1995). 26 Final decisions for cyclical re-evaluations; and two special reviews were also completed.

Stakeholder Engagement and Public Outreach

Stakeholder engagement activities delivered in 2018-19 focussed on targeted stakeholders in order to facilitate information sharing. The CMP Stakeholder Advisory Council (SAC) held two meetings in 2018-19. The purpose of the Council is to obtain advice and feedback from stakeholders regarding implementation of the CMP and to foster dialogue between stakeholders and the government to address any related concerns. The program published two issues of the CMP Progress Report in July 2018 and March 2019. The third term of the CMP Science Committee began in the fall of 2018, and continues to provide a strong science foundation to the CMP by enabling external science professionals from national and international sources to share their expertise with HC and ECCC.

The program managed a rigorous posting schedule for the Chemical Substances Website content on Canada.ca to ensure the public had the opportunity to participate in CMP.

Materials and information for the Healthy Home Campaign were developed, piloted and implemented throughout 2018-19, culminating in the launch and national roll out of a new Healthy Home social marketing campaign on chemicals and pollutants in and around the home. In January 2019, the new Healthy Home website was released on Canada.ca. This website delivers CMP and related environmental health information in plain, non-technical language, making it easier for Canadians to find CMP information that is relevant to the public. Healthy Home website materials also include general safety messaging along with plain language information on CMP substances of concern, a look up section containing information on common chemicals and pollutants found in the home, and a new top 10 tips brochure. Social media posts on Facebook and Twitter were issued throughout the year to inform Canadians of assessment results for high profile substances of concern

Public outreach activities (e.g., trade shows, workshops, etc.) were conducted through HC Regional Offices to increase Canadians' awareness of the health risks of chemicals in and around the home and provide information for them to take action to protect their health and that of vulnerable populations. Across Canada, 62 public outreach activities related to chemical effects on health resulted in approximately 20,723 interactions with Canadians.

Research

Research continued to address CMP3 priorities identified under the following themes: a) Nanomaterials; b) Integrated Hazard Characterization and Exposure Assessments for CMP3 priority chemicals, mixtures or CEPA substances; c) Monitoring and surveillance of CMP priority chemicals; and, d) Methods and Tools Development for the assessment of CMP3 priority chemicals, mixtures or CEPA substances.

In 2018-19, six targeted research projects were carried out to address short term data needs for risk assessment to help meet 2020 CMP commitments. In addition, 20 research projects were conducted to support CMP3 priority substances in collaboration with RA and RM and to support key scientific regulatory areas. Data generated from CMP research projects were used to support the development of nine DSARs and nine FSARs.

At ECCC, 20 research projects were completed by the end of fiscal year 2018-19. These projects were conducted on priority chemicals, such as: flame retardants; benzotriazoles and benzothiazoles; hindered phenols; platinum group elements: and, rare earth elements.

Monitoring and Surveillance

HC and ECCC continued to conduct monitoring programs to address existing and emerging chemicals of concern, and to inform risk assessment needs and risk management activities. At ECCC, a total of 17 substances and/or groups of substances were measured in select media: fresh water; sediments; fish and wildlife; ambient air; municipal wastewater; and, biosolids.

The Maternal-Infant Research on Environmental Chemicals (MIREC) continued the assessment of prenatal exposure to chemicals and established national estimates of maternal and fetal exposures. In 2018-19, participant recruitment began for the latest MIREC Research Platform study, MIREC-ENDO. MIREC ENDO studies the effects of prenatal exposure to environmental chemicals on puberty and metabolic function in the child, as well as maternal health. HC's human biomonitoring efforts continued in 2018–19 with the Canadian Health Measures Survey (CHMS), measuring environmental chemical exposures in blood and urine of a nationally representative sample of Canadians aged 3 to 79.

Both ECCC and HC contribute to the Northern Contaminants Program (NCP) led by Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC). Four human biomonitoring and health project proposals were funded in 2018-19 under the NCP.

Compliance and Enforcement

Compliance promotion activities focused on pollution, including the release of toxic substances to air, water or land, and the import and export of hazardous waste that presents a risk to the environment and/or human health. These activities aimed to increase voluntary compliance with regulatory and non-regulatory instruments, thereby mitigating consequential enforcement actions. ECCC conducted 1,162 inspections related to CMP regulations and issued 312 enforcement measures. ECCC also conducted 184 inspections relating to the Environmental Emergency Regulations, 2019, and issued 33 enforcement measures.

In 2018-19, compliance promotion activities were carried out for regulatory and non-regulatory instruments related to CMP substance. 13,137 known or potential regulatees received compliance promotion awareness materials and 1,179 stakeholders contacted Compliance Promotion Officers for clarification of regulatory requirements and/or additional information.

Public Health Agency of Canada

During 2018-19, the Public Health Agency of Canada (the Agency) Environmental Health Officers (EHOs) continued their risk-based inspection program to identify and address human health risks associated with water, food and sanitation on passenger conveyances such as aircraft, trains, cruise ships and ferries. Ninety-four percent (94%) of conveyance and facility operators successfully met public health requirements during or in response to 471 inspections. The Agency conducts these inspections to measure compliance with the Department of Health Act, the Potable Water on Board Trains, Vessels, Aircraft and Buses Regulations as well as food safety provisions of the Food and Drugs Act.

Contact information

Suzanne Leppinen
Director, Chemicals and Environmental Health Management Bureau
Safe Environments Directorate
Healthy Environments and Consumer Safety Branch
Health Canada
269 Laurier Avenue West
Ottawa, Ontario, K1A 0K9
Postal Locator: 4905B
Telephone: 613-941-8071
E-mail: Suzanne.Leppinen@canada.ca

Nicole Davidson
Executive Director, Program Development and Engagement
Program Development and Engagement
Science and Risk Assessment Directorate
Environment and Climate Change Canada
351, boul. Saint-Joseph, 6th Floor
Gatineau, QC, K1A 0H3
Telephone: 819-938-5055
Email: Nicole.Davidson@canada.ca

Performance information

Federal organizations	Link to department's Program Inventory	Horizontal initiative activities	Total federal allocation (from start to end date)	2018–19 Planned spending (dollars)	2018–19 Actual spending (dollars)	2018–19 Expected results	2018–19 Performance indicators	2018–19 Targets	Date to achieve target	2018–19 Actual results
Health Canada	Health Impacts of Chemicals	Health Products: Risk Assessment	9,437,645	1,227,329	1,055,741	ER 1.1	PI 1.1.1	T 1.1.1	March 2019	AR 1.1.1
		Health Products: Risk Management, Compliance Promotion and Enforcement	27,105,536	850,390	759,322	ER 1.2	PI 1.2	T 1.2	March 2019	AR 1.2
		Health Products: Research	2,479,000	-	-	ER 1.3	PI 1.3	T 1.3	March 2019	AR 1.3
		Health Products: Monitoring and Surveillance	1,172,000	-	-	ER 1.4	PI 1.4	T 1.4	March 2019	AR 1.4
		Food and Nutrition: Risk Assessment	15,820,926	1,237,393	1,194,983	ER 1.1	PI 1.1.2	T 1.1.2	March 2019	AR 1.1.2
							PI 1.1.3	T 1.1.3	March 2019	AR 1.1.3
							PI 1.1.4	T 1.1.4	March 2019	AR 1.1.4
		Food and Nutrition: Risk Management, Compliance Promotion and Enforcement	17,370,505	1,180,315	1,205,183	ER 1.2	PI 1.2	T 1.2	March 2019	AR 1.2
		Food and Nutrition: Research	8,255,875	695,239	681,171	ER 1.3	PI 1.3	T 1.3	March 2019	AR 1.3
		Food and Nutrition: Monitoring and Surveillance	10,176,044	951,486	925,208	ER 1.4	PI 1.4	T 1.4	March 2019	AR 1.4
		Food and Nutrition: Stakeholder Engagement and Risk Communications	1,872,830	169,685	140,822	ER 1.5	PI 1.5	T 1.5	March 2019	AR 1.5
		Environmental Risks to Health: Risk Assessment	119,216,074	10,353,388	10,369,492	ER 1.1	PI 1.1.5	T 1.1.5	March 2019	AR 1.1.5
							PI 1.1.6	T 1.1.6		AR 1.1.6
							PI 1.1.7	T 1.1.7		AR 1.1.7
		Environmental Risks to Health: Risk Management, Compliance Promotion and Enforcement	148,668,626	7,086,237	7,556,720	ER 1.2	PI 1.2	T 1.2	March 2019	AR 1.2
						ER 1.6	PI 1.6	T 1.6	March 2019	AR 1.6
		Environmental Risks to Health: Research	127,637,665	9,964,515	11,140,264	ER 1.3	PI 1.3	T 1.3	March 2019	AR 1.3
		Environmental Risks to Health: Monitoring and Surveillance	126,597,444	9,859,704	12,757,426	ER 1.4	PI 1.4	T 1.4	March 2019	AR 1.4
		Environmental Risks to Health: Stakeholder Engagement and Risk Communications	24,214,067	2,815,217	2,280,649	ER 1.5	PI 1.5	T 1.5	March 2019	AR 1.5
		Environmental Risks to Health: Policy and Program Management	23,160,059	2,208,318	2,414,829	N/A	N/A	N/A	N/A	N/A
		Consumer Product Safety and Workplace Hazardous Materials: Risk Assessment	24,878,577	2,419,633	1,772,732	ER 1.1	PI 1.1.4	T 1.1.4	March 2019	AR 1.1.4
		Consumer Product Safety and Workplace Hazardous Materials: Risk Management, Compliance Promotion and Enforcement	38,292,551	2,549,795	2,950,095	ER 1.2	PI 1.2	T 1.2	March 2019	AR 1.2
	Pesticides	Pesticides: Risk Assessment	53,620,643	4,563,436	4,211,342	ER 1.1	PI 1.1.8	T 1.1.8	March 2019	AR 1.1.8
		Pesticides: Risk Management, Compliance Promotion and Enforcement	22,204,309	846,416	1,125,576	ER 1.2	PI 1.2	T 1.2	March 2019	AR 1.2
		Pesticides: Research	1,734,562	-	-	ER 1.3	PI 1.3	T 1.3	March 2019	AR 1.3
	Internal Services – Health Canada		77,301,654	6,995,944	6,995,944	N/A	N/A	N/A	N/A	N/A
Public Health Agency of Canada	Border and Travel Health	Border Health: Risk Management, Compliance Promotion and Enforcement	25,462,808	3,182,851	2,487,969	ER 2.1	PI 2.1	T 2.1	March 2019	AR 2.1
Environment and Climate Change Canada	Substances and Waste Management	Substances and Waste Management: Risk Assessment	48,911,770	3,873,467	3,626,392	ER 3.1	PI 3.1.1	T 3.1.1	March 2019	AR 3.1.1
							PI 3.1.2	T 3.1.2	March 2019	AR 3.1.2
		Substances and Waste Management: Risk Management	195,879,665	13,524,953	13,520,655	ER 3.2	PI 3.2	T 3.2	March 2019	AR 3.2
		Substances and Waste Management: Research	21,114,525	1,884,158	1,884,158	ER 3.3	PI 3.3	T 3.3	March 2019	AR 3.3
		Substances and Waste Management: Monitoring and Surveillance	73,584,555	4,879,935	3,978,633	ER 3.4	PI 3.4	T 3.4	March 2019	AR 3.4
		Compliance Promotion and Enforcement – Pollution: Compliance Promotion	8,609,790	854,409	792,592	ER 3.5	PI 3.5	T 3.5	March 2019	AR 3.5
		Compliance Promotion and Enforcement – Pollution: Enforcement	22,357,970	2,215,135	2,179,937	ER 3.6	PI 3.6	T 3.6	March 2019	AR 3.6
	Internal Services – ECCC		31,041,725	2,267,943	2,267,943
Total for all federal organizations			1,308,179,400	98,657,290	100,275,778

Note: The amounts above include contributions to Employee Benefit Plans, Shared Services Canada Core Information Technology Services, and Public Services and Procurement Canada accommodation costs.

Variance Explanation: Not applicable

Expected Results:

Health Canada

• ER 1.1 Information on risks of substances to inform risk management, monitoring and surveillance and research activities (Risk Assessment)
• ER 1.2 Risk management measures under CEPA, PCPA, CCPSA and F&DA (Risk Management, Compliance Promotion and Enforcement)
• ER 1.3 Science-based information on the risks posed by substances, in accordance with annual research plans (Research)
• ER 1.4 Data generated on the use, release, exposure and presence of substances of concern in humans, the environment, food and consumer products (Monitoring and Surveillance)
• ER 1.5 Engagement, consultation and communication products to inform the public and stakeholders (Stakeholder Engagement and Risk Communications)
• ER 1.6 Drinking water quality guideline technical documents/guidance documents (Risk Management, Compliance Promotion and Enforcement)

Public Health Agency of Canada

• ER 2.1 Mitigation of human health risks associated with contamination of water, food and sanitation on board passenger conveyances (Risk Management, Compliance Promotion and Enforcement)

Environment and Climate Change Canada

• ER 3.1 Information on risks of substances to inform risk management, monitoring and surveillance and research activities (Risk Assessment)
• ER 3.2 Risk management measures under CEPA and/or Fisheries Act
• ER 3.3 Science-based information on the risks posed by substances, in accordance with annual research plans (Research)
• ER 3.4 Data generated on the use, release, exposure and presence of substances of concern in humans, the environment, food, consumer products and waste (Monitoring and Surveillance)
• ER 3.5 Information on obligations to conform or comply with risk management control measures (Compliance Promotion)
• ER 3.6 Inspections, investigations and enforcement actions (Enforcement)

Performance Indicators:

Health Canada

• PI 1.1.1 Timely response to chemical-related risks to health (Health Products)
• PI 1.1.2 Percentage of food ingredients, food additives, food contaminants and food packaging material chemicals re-evaluated for which Chemical Management Plan assessments and new scientific knowledge identify potential risk (Foods)
• PI 1.1.3 Percentage of dietary exposure assessments and/or hazard characterizations completed for substances for which Chemical Management Plan assessments have identified food as the contributing / main source of exposure (Foods)
• PI 1.1.4 Number of CMP risk assessments that used information provided/generated by CMP partners (Foods, Consumer Products)
• PI 1.1.5 Percentage of substances assessed within prescribed timelines (Existing Substances) against two-year rolling work plan
• PI 1.1.6 Percentage of substances assessed within prescribed timelines (New Substances)
• PI 1.1.7 Percentage of substances assessed within prescribed timelines (Revised In Commerce List)
• PI 1.1.8 Percentage of re-evaluations initiated for registered pesticides according to the re-evaluation work plan
• PI 1.2 Percentage of actions taken in a timely manner to protect the health of Canadians from substances found to be a risk to human health against planned
• PI 1.3 Percentage of CMP research projects conducted that support priorities for risk assessment, risk management, research, monitoring and surveillance, and international activities related to the health impacts of chemicals
• PI 1.4 Percentage of monitoring and surveillance projects funded by CMP that support priorities for risk assessment, risk management, research, monitoring and surveillance, and international activities related to the health impacts of chemicals
• PI 1.5 Percentage of risk communication outreach activities and material distributed against plan
• PI 1.6 Percentage of planned final water quality guidelines / guidance documents approved through federal-provincial-territorial collaborative processes

Public Health Agency of Canada

• PI 2.1 Percentage of inspected passenger transportation operators that meet public health requirements

Environment and Climate Change Canada

• PI 3.1.1 Percentage of substances assessed within prescribed timelines (Existing Substances) against two-year rolling work plan
• PI 3.1.2 Percentage of substances assessed within prescribed timelines (New Substances)
• PI 3.2 Percentage of risk management controls of substances assessed as posing a risk to the environment under CEPA are introduced within 42 months of being deemed harmful to the environment
• PI 3.3 Percentage of CMP research projects conducted that support priorities for risk assessment, risk management, research, monitoring and surveillance, and international activities related to the environmental impacts of chemicals
• PI 3.4 Percentage of monitoring and surveillance projects funded by CMP that support priorities for risk assessment, risk management, research, monitoring and surveillance, and international activities related to the environmental impacts of chemicals
• PI 3.5 The number of targeted regulatees under the Chemicals Management Plan contacted by the Compliance Promotion Program
• PI 3.6 Percentage of follow-up inspections confirming a return to compliance

Targets:

Health Canada

• T 1.1.1 100% response time/year
• T 1.1.2 100%
• T 1.1.3 100%
• T 1.1.4 N/A^{Footnote 5}
• T 1.1.5 100%
• T 1.1.6 100%
• T 1.1.7 100%
• T 1.1.8 80%
• T 1.2 100%
• T 1.3 100%
• T 1.4 100%
• T 1.5 100%
• T 1.6 100%

Public Health Agency of Canada

• T 2.1 95%

Environment and Climate Change Canada

• T 3.1.1 100%
• T 3.1.2 100%
• T 3.2 100%
• T 3.3 100%
• T 3.4 100%
• T 3.5 All regulatees identified in the Compliance Promotion Program database subject to priority instruments
• T 3.6 TBD^{Footnote 6}

Actual Results

Health Canada

• AR 1.1.1 100%
• AR 1.1.2 100%
• AR 1.1.3 100%
• AR 1.1.4 37^{Footnote 7}
• AR 1.1.5 92%
• AR 1.1.6 100%
• AR 1.1.7 100%
• AR 1.1.8 100%
• AR 1.2 88%
• AR 1.3 100%
• AR 1.4 100%
• AR 1.5 100%
• AR 1.6 100%

Public Health Agency of Canada

• AR 2.1 94%

Environment and Climate Change Canada

• AR 3.1.1 92%
• AR 3.1.2 100%
• AR 3.2 50%
• AR 3.3 100%
• AR 3.4 100%
• AR 3.5 13,137
• AR 3.6 Not available^{Footnote 8}

Horizontal initiative close-out report

Name of horizontal initiative: Federal Tobacco Control Strategy

Start date: April 1, 2001

End date: March 31, 2019

Lead department: Health Canada (HC)

Number of times renewed: 3 (2007, 2012, 2018)

Partner departments: Indigenous Services Canada (ISC), Public Health Agency of Canada (PHAC), Public Safety Canada (PS), Royal Canadian Mounted Police (RCMP), Canada Border Services Agency (CBSA), Canada Revenue Agency (CRA), and Public Prosecutions Service Canada (PPSC)

Other non-federal partners: Not applicable

Expenditures

Total federal funding from 2007-08 to 2018-19^{Footnote 1} (authorities and actual)

Themes and internal services	Authorities (according to the TB submission)		Actual spending	Variance(s)
Federal Tobacco Control Strategy	HC	$518,866,663	$446,263,939	$72,602,724
	ISCFootnote 2	$10,000,000	$11,768,071	-$1,768,071
	PHACFootnote 3	$15,294,958	$11,836,913	$3,458,045
	PS	$7,245,375	$7,255,097	-$9,722
	RCMP	$20,685,877	$18,394,718	$2,291,159
	CBSA	$65,763,069	$56,419,851	$9,343,218
	CRA	$10,733,220	$10,638,698	$94,522
	PPSCFootnote 4	$12,839,709	$11,870,401	$969,308
Internal services	(see note below)
Totals	$661,428,871		$574,447,688	$86,981,183

Note: Internal Services and Public Services and Procurement Canada accommodation costs are included in the above numbers.

Comments on Variances:

Health Canada:

The variance between actual spending and authorities is mainly due to lower than anticipated provincial and territorial funding requirements for the pan-Canadian Quitline and the Canadian Student Tobacco, Alcohol and Drugs Survey. As a result, the funding was reallocated to other departmental priorities.

Indigenous Services Canada:

The variance between actual spending and authorities is mainly due to new funding to begin implementing the Canada's Tobacco Strategy in 2018-19.

Public Health Agency of Canada:

The variance between actual spending and authorities is mainly due to the complex process required to negotiate new projects under the Healthy Living & Chronic Diseases Prevention Multi-Sectoral Partnership program and the requirement for partnerships, matches funding & pay for performance milestones.

Royal Canadian Mounted Police:

The variance between actual spending and authorities is mainly due to reallocation of resources to other RCMP priorities.

Canada Border Services Agency:

The variance between actual spending and authorities is mainly due to lower spending than anticipated with respect to the FTCS initiative as planned.

Results

Performance indicator(s) and trend data for shared outcome(s)

Shared outcome: Reduced smoking prevalence among Canadians.

Performance indicators	Trend dataFootnote 5
Prevalence of current smokers (daily and occasional) in Canada (aged 15+)	2001	22%
	2006	19%
	2011	17%
	2013	15%
	2015	13%
	2017	15%

Brief explanation of performance

The Federal Tobacco Control Strategy (FTCS) was introduced in 2001 as a ten-year strategy with the goal of reducing tobacco-related disease and death in Canada. Over the first five years, key tobacco control activities included mass media; development and enforcement of regulations pursuant to the Tobacco Act; research and surveillance; national co-ordination of tobacco control efforts; collaboration with federal partners to monitor contraband tobacco; support for First Nations and Inuit tobacco reduction programs; and funding various activities through Grants and Contributions (G&Cs).

Five objectives were set out as the basis for key measures of FTCS effectiveness, including reducing smoking prevalence from 25% to 20%. A summative evaluation conducted in 2006 found that almost all of the FTCS objectives were either met or exceeded.

The strategy was renewed in 2007 with a revised overarching goal of further reducing smoking prevalence in Canada from 19% to 12% by 2011. Health Canada's functions with respect to surveillance, research, regulations, and compliance remained similar to those described in 2001. However, emphasis on compliance shifted from retailers to manufacturers, and intelligence gathering with respect to the industry. Policy functions also remained similar, but additional focus was placed on international activities and examining the next generation of tobacco control.

An evaluation completed in 2017 found that overall, the strategy contributed to some decline in smoking prevalence through its labelling and youth access regulations, as well as its support to implement provincial second-hand smoke bans. However, the goal of reducing prevalence to 12% by 2011 was not met.

In 2012 the strategy was renewed for an additional five years with the goal of preserving the gains made over the previous decade and continuing the downward trend of smoking prevalence. Key activity areas of the renewed FTCS included Policy and International Commitments; Research and Surveillance; Regulations and Compliance; and Community Interventions, including First Nations and Inuit Community-Based Projects.

Canada's Tobacco Strategy (CTS) was launched in May 2018 with the goal of reaching less than 5% tobacco use by 2035, committing more than $330 million over 5 years to help Canadians who smoke to quit while protecting the health of young people and non-smokers from the dangers of nicotine.

Programs receiving ongoing funding

Program	Ongoing funding	Purpose
HC	$41,950,316	Helping Canadians Addicted to Tobacco (Cessation and Harm Reduction) - Modernize cessation services and deliver grant and contribution funding Protecting Young Canadians and Non-users - Support regulatory agenda and compliance and enforcement and prevent vaping in non-tobacco-users Strengthening our Foundation - Bolster tobacco research and surveillance programs to better address emerging products
PHAC	$4,705,000	Helping Canadians Addicted to Tobacco (Cessation and Harm Reduction) - Bolster targeted tobacco cessation and prevention projects for populations with high prevalence
ISC	$9,310,000	Co-develop Distinctions-Based Approaches with Indigenous peoples - Co-develop and implement distinctions-based approaches to reduce commercial tobacco use
PS	$3,340,000	Protecting Young Canadians and Non-users - Increase understanding of the illicit tobacco market through evidence-based research
RCMP	$3,000,000	Protecting Young Canadians and Non-users - Increase knowledge and understanding of the illicit tobacco market and links to organized crime
CBSA	$3,019,208	Protecting Young Canadians and Non-users - Support the identification and interception of illicit tobacco through evidence-based research
CRA	$888,910	Protecting Young Canadians and Non-users - Administer the Excise Duty Program
Total	$66,213,434

Plans (including timelines) for evaluation and/or audit

Based on Health Canada's Departmental Evaluation Plan for 2019-20 to 2023-24, an evaluation of Health Canada's tobacco activities is scheduled for June 2020 – June 2021.

An evaluation of Indigenous Services Canada's Healthy Living Program, including activities for tobacco, is currently underway and planned to be completed in 2019-20.

Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis

General information

Name of horizontal initiative

Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis

Lead department

Health Canada

Federal partner departments

Health Canada
Canada Border Services Agency (CBSA)
Public Health Agency of Canada (PHAC)
Public Safety Canada (PS)
Royal Canadian Mounted Police (RCMP)

Note: Other government departments (e.g., the Department of Justice) are supporting the new federal cannabis framework. However, they are not captured in this Horizontal Initiative table, as they have not received funding through the Treasury Board Submission "Implementing a New Federal Framework for the Legalization and Regulation of Cannabis."

Non-federal and non-governmental partners

Not applicable

Start date of the horizontal initiative

April 1, 2017

End date of the horizontal initiative

March 31, 2022

Description of the horizontal initiative

The objective of this horizontal initiative is to implement and administer a new federal framework to legalize and strictly regulate cannabis. The Cannabis Act received Royal Assent on June 21, 2018, and came into force on October 17, 2018. The initiative is designed to follow through on the Government's key objective of protecting public health, safety, and security. More specifically, the initiative aims to prevent young persons from accessing cannabis, to protect public health and public safety by establishing strict product safety and product quality requirements, and to deter criminal activity by imposing serious criminal penalties for those operating outside the legal framework.

Federal partner organizations implement the ongoing delivery of the regulatory framework including: licensing; compliance and enforcement; surveillance; research; national public education and awareness activities; and, framework support.

The initiative also supports law enforcement capacity to collect and assess intelligence on the evolution of organized crime's involvement in the illegal cannabis market and other related criminal markets.

Activities are organized by five high-level themes:

1. Establish, implement and enforce the new legislative framework;
2. Provide Canadians with information needed to make informed decisions and minimize health and safety harms;
3. Build law enforcement knowledge and engage partners and stakeholders on public safety;
4. Provide criminal intelligence, enforcement and related training activities; and,
5. Prevent and interdict prohibited cross-border movement of cannabis while maintaining the flow of legitimate travelers and goods.

Governance structures

The Government of Canada continues to support a robust governance structure to facilitate whole-of-government coordination in implementing and administering the new federal framework to legalize and strictly regulate cannabis. At the federal level, this governance structure includes: regular engagement among Deputy Ministers of Health, Justice and Public Safety to provide strategic direction and oversight on implementation activities; an Assistant Deputy Ministers' Committee that coordinates policy and implementation activities; a Directors-General Committee that coordinates policy, regulatory development, and implementation activities across federal departments and agencies; an interdepartmental Communications Working Group to lead cannabis communications, public awareness and education efforts; and, a Federal Partners Cannabis Data Working Group to promote horizontal collaboration and support evidence-based policy and program development.

Health Canada's Controlled Substances and Cannabis Branch assumes a central coordinating role in tracking key project milestones and in reporting to federal Ministers.

The Government is committed to ongoing collaboration and consultation with provincial and territorial partners. In May 2016, the Federal/Provincial/Territorial (F/P/T) Senior Officials Working Group on Cannabis Legalization and Regulation was struck, to enable F/P/T governments to exchange information on important issues about the legalization and regulation of cannabis throughout the consultation, design and implementation of the legislation, regulations, and non-regulatory activities. Supporting F/P/T working groups and committees also facilitate ongoing engagement in key priority areas, including public education and awareness, data development and information sharing, national inventory tracking, and drug-impaired driving. In addition, existing F/P/T bodies, are also considering the implications of cannabis legalization and regulation, including F/P/T Deputy Ministers responsible for Justice and Public Safety, and F/PT Ministers responsible for Finance.

Total federal funding allocated (from start to end date) (dollars)

$546,807,456

Total federal planned spending to March 31, 2019 (dollars)

$168,865,207

Total federal actual spending to March 31, 2019 (dollars)

$142,359,398

Date of last renewal of the horizontal initiative

Not applicable

Total federal funding allocated at the last renewal, and source of funding (dollars)

Not applicable

Additional federal funding received after the last renewal (dollars)

Not applicable

Funding contributed by non-federal and non-governmental partners (dollars)

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Shared outcome of federal partner departments (1/2)

1. Cannabis is kept out of the hands of Canadian children and youth

Performance indicator(s)

PI 1. Percentage of Canadians (aged 15-17 and 18-24) who have used cannabis in the last 12 months (Health Canada)

Target(s)

T1. To be established in 2020 (baseline: 17.5% of Canadians aged 15-17 and 28.4% of Canadians aged 18-24, data from 2015)

Data source and frequency of monitoring and reporting

1. 2017 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) (data collected between February and December 2017). CTADS is conducted biennially.

Results

R1: 26.9% overall (ages 15-24) or 14.2% of Canadians aged 15-17 and 31.4% of Canadians aged 18-24

Expected outcome of non-federal and non-governmental partners

Not applicable

Shared outcome of federal partners (2/2)

2. Criminal involvement in the illegal cannabis market is reduced

Performance indicator(s)

PI 2. Qualitative assessment on trends related to criminal involvement in the illicit cannabis market (RCMP)
PI 3. Number of cannabis import interdictions at the border (CBSA)

Target(s)

T2. To be established in 2020
T3. To be determined once CBSA establishes a monitoring and reporting framework, which will also identify an appropriate baseline. CBSA could be in a position to report on this indicator in 2020.

Data source and frequency of monitoring and reporting

2. 2018-19 National Criminal Intelligence Estimate on Illicit Drugs. Data is reported on an annual basis. Moving forward, a stand-alone assessment of organized crime group (OCG) involvement in the cannabis market will be completed.
3. To be determined once CBSA establishes a monitoring and reporting framework.

Results

R2: With regards to trends related to criminal involvement in the cannabis market, Criminal Intelligence Service Canada (CISC), an entity stewarded by the RCMP and responsible for providing criminal intelligence products and services to the law enforcement community, completed a preliminary assessment within four months of the passage of the Cannabis Act as part of its National Criminal Intelligence Estimate on Illicit Drugs. This assessment found that approximately 44 percent of assessed OCGs were involved in the cannabis market in the period of time leading up to the implementation of the Cannabis Act. Almost all of these groups were also involved in at least one other illicit drug market and are unlikely to be disrupted by legalization given their alternate streams of revenue. In the short term (1-2 years), as the supply of legal cannabis continues to adjust to meet market demand, OCGs can be expected to continue to fill any supply gaps. However, the number of OCGs in the illicit cannabis market is expected to decrease incrementally over the long term (3+ years), as the licit market supply increases.

The RCMP acknowledges that four months post-legalization was not sufficient time to conclusively assess the new framework's mid- to long-term impact on OCG involvement in the cannabis market. Consequently, a stand-alone assessment of OCG involvement in the cannabis market will be completed by December 2019 to identify OCG involvement, and current and future trends.

R3: Automated cannabis reporting functionality is under development with the expectation that systematic reporting will be available in April 2020.

Expected outcome of non-federal and non-governmental partners

Not applicable

Name of theme

Not applicable

Performance highlights

The Cannabis Act and its regulations came into force on October 17, 2018. Together, they create a new legal framework that aims to protect public health and safety and, in particular, to protect the health of young persons by restricting their access to cannabis; protecting young persons and others from inducements to use cannabis; providing for the legal production of cannabis to reduce illicit activities in relation to cannabis; deterring illicit activities in relation to cannabis through appropriate sanctions and enforcement measures; reducing the burden on the criminal justice system in relation to cannabis; providing access to a quality-controlled supply of cannabis; and enhancing public awareness of the health risks associated with cannabis use.

Working with provincial and territorial governments, the Government of Canada has established a legal framework for a well-regulated, legal supply chain that is capable of displacing the illegal market. In 2018-19, the number of cannabis licence holders increased by more than three times the number that existed in May 2017 to meet the demand for legal cannabis while protecting the health and safety of Canadians. Legal sales of cannabis have also grown from $133 million to $672 million between the third quarter of 2018 and the third quarter of 2019 and the legal industry's share of the estimated total market demand has increased from 9% to 40%.

Health Canada has also maintained a system that provides reasonable access to cannabis for medical purposes. When the Cannabis Act and Cannabis Regulations came into force in October 2018, targeted improvements to the medical access program were implemented, including the ability for patients to request the transfer of their medical document between federally licensed sellers. The Government will continue to actively monitor the medical access program and will evaluate the framework within 5 years of the coming into force of the Cannabis Act.

The Government of Canada has also established, promoted compliance with, and enforced regulatory standards to protect public health and safety. On October 17, 2019, amendments to the Cannabis Regulations came into force that reduce the health and safety risks, including appeal to young persons, associated with the new classes of cannabis products, namely edible cannabis, cannabis extracts and cannabis topicals. During inspections of licence holders in 2018-19, Health Canada found a 97% compliance rate with controls established under the Cannabis Act.

The Cannabis Act and strong drug-impaired driving laws are also being enforced and the capacity to enforce the new laws continues to increase. The CBSA implemented border-related compliance strategies to assist in preventing the movement of cannabis and cannabis-related products across the border. The Royal Canadian Mounted Police (RCMP) developed new courses on cannabis and impaired driving to increase law enforcement capacity, and tripled its capacity to process security clearances to identify criminality or associations to criminal organizations. Public Safety Canada provided training and information packages to increase law enforcement capacity. As of March 31, 2019, the number of active Drug Recognition Experts in Canada had increased by approximately 43% since 2017, and the number of officers trained to detect drug-impaired driving continues to increase.

Public education efforts are fundamental to achieving the Government's objective of protecting public health and safety, especially for youth. Health Canada has made significant investments in 2018-19 to support Canadians in making informed decisions about cannabis and to help minimize the health impacts of cannabis use. Health Canada activities include the advertising campaign entitled "Your Cannabis Questions, Answered. Get the Honest Facts" which provides evidence-based answers to Canadians' questions about cannabis; and, the "Pursue Your Passion" interactive tour to help youth and young adults learn about cannabis health and safety and encourage them to make healthy lifestyle choices. The Public Health Agency of Canada also worked with partners and stakeholders for priority populations, such as health care professionals and new or expectant parents, to help inform them about cannabis health and safety. The Canada Border Services Agency installed signage at all major ports of entry, updated its website to include information on cannabis-related border rules, included a new cannabis-related question at primary inspection lines, and released short videos on social media informing travellers of the continued prohibition of taking cannabis across the border. We anticipate that some of the impacts of these efforts on performance indicators will be available in 2020.

The Government of Canada is closely monitoring the impacts of cannabis legalization through research and surveillance activities to inform operational planning and policy development, and to assess the effectiveness of the program. Key early results have indicated no reported increase in the prevalence of cannabis consumption, including among young people, while the share of household spending on cannabis from the legal market also continues to rise.

The Cannabis Act is subject to a legislative review three years following its coming into force (to be completed by April 2023), which will provide an opportunity to assess the impact, progress and results of the Act on public health and safety.

Contact information

John Clare
A/Director General
Cannabis Legalization and Regulation Secretariat
Controlled Substances and Cannabis Branch
Health Canada
613-941-0355
John.Clare@canada.ca

Expected Results

Health Canada

• ER 1.1 A federally licensed and regulated industry is established
• ER 1.2 The federally licensed industry understands the legislation and regulatory requirements
• ER 1.3 The federally licensed industry is compliant with regulatory requirements
• ER 1.4 Canadian youth understand the potential health and safety risks associated with cannabis use
• ER 1.5 Canadians use information to make informed decisions about the potential health and safety risks associated with the use of cannabis

Canada Border Services Agency

• ER 2.1 Travellers understand the requirements to declare cannabis and cannabis-related products when entering Canada
• ER 2.2 Travellers are provided a clear opportunity to declare cannabis in their possession at all primary inspection sites
• ER 2.3 CBSA has enhanced capacity to promote compliance and to enforce import-related laws
• ER 2.4 Border-related regulations, accompanying policies and procedures, agreements, studies, and monitoring framework are developed and implemented
• ER 2.5 Prohibited cross border movement of cannabis is detected
• ER 2.6 Travellers and the import/export community have access to recourse mechanisms to challenge certain CBSA actions and decisions in a timely manner

Public Health Agency of Canada

• ER 3.1 Health care and social service professionals and public health officials have access to high-quality public health information
• ER 3.2 Health care and social service professionals and public health officials use information, knowledge and data products related to the public health impacts of cannabis and interventions to address them

Public Safety Canada

• ER 4.1 Canadians are aware of the legal implications associated with cannabis use, and understand the laws associated with the new legislation
• ER 4.2 Canadians use information provided by the program to make informed, lawful decisions
• ER 4.3 Law enforcement is well-informed to apply the new legislation
• ER 4.4 Evidence-based decision-making on organized crime and policing issues
• ER 4.5 Research projects related to cannabis and performance measurement implemented
• ER 4.6 Policy development and decision-making is informed by evidence and performance measurement

Royal Canadian Mounted Police

• ER 5.1 LERCs are conducted in support of HC's security clearance decisions
• ER 5.2 RCMP prevention and engagement activities support enhanced understanding among targeted partners and stakeholders, including youth and Indigenous communities
• ER 5.3 Enhanced capacity of target populations, including partners and stakeholders, youth and Indigenous communities to respond to the new cannabis regime
• ER 5.4 Information and intelligence products related to illicit substances (including cannabis) are shared with Canadian law enforcement agencies and available to be used to target organized crime
• ER 5.5 Canadian law enforcement agencies have intelligence information to nationally coordinate activities to target organized crime groups involved in the Canadian cannabis market
• ER 5.6 RCMP staff have access to required training in regards to enforcement of the new cannabis regime
• ER 5.7 RCMP employees have an increased ability to enforce the new cannabis regime

Performance indicator(s)

Health Canada

• P 1.1.1 Number of licence applications approved per year^{Footnote 5}
• P 1.1.2 Percentage of licence applications reviewed within internal service standards
• P 1.2.1 Percentage of federally licensed industry that indicates that they understand the regulatory requirements
• P 1.3.1 Percentage of federally licensed industry that is found to be compliant with regulatory requirements
• PI 1.4.1 Percentage of youth (grades 7-12) who perceive that there is "no risk" in using cannabis
• PI 1.5.1 Percentage of parents who discuss the health and safety risks of cannabis with their teens

Canada Border Services Agency

• PI 2.1.1 Percentage of ports of entry with displayed signage on cannabis
• PI 2.1.2 CBSA awareness tools are in place to inform travelling public on prohibition of cross-border movement of cannabis
• PI 2.2.1 Percentage of relevant primary inspection kiosks, systems, training materials, operational guidelines and forms in all modes updated
• PI 2.3.1 Number of cannabis import interdictions at ports of entry
• PI 2.4.1 Percentage of regulations and agreements completed on time
• PI 2.5.1 Percentage of cannabis samples analyzed within 30 days
• PI 2.6.1 Number of cannabis seizures appealed
• PI 2.6.2 Number of Trusted Travelers appeals due to cannabis-related enforcement action
• PI 2.6.3 Number of Trade related appeals due to classification disputes of cannabis
• PI 2.6.4 Percentage of appeals received that are acknowledged within 10 calendar days
• PI 2.6.5 Percentage of Enforcement and Trusted Traveller appeals received that are decided within 180 calendar days
• PI 2.6.6 Percentage of Trade related appeals – Tariff Classification – that are decided within 365 calendars days (for cases never held in abeyance)
• PI 2.6.7 Number of cannabis-related complaints made against the CBSA. Complaints may be submitted to the Agency's Enhanced Complaints Mechanism
• PI 2.6.8 Number of appeal decisions further appealed at the Courts or Tribunals and defended by Recourse

Public Health Agency of Canada

• PI 3.1.1 Number of health care and social service professionals and public health officials accessing high-quality public health information and data products developed
• PI 3.2.1 Percentage of Chief Public Health Officer's Health Professionals Forum member organizations using information, knowledge and data products to make informed decisions^{Footnote 6}

Public Safety Canada

• PI 4.1.1 Percentage of Canadians (aged 15-24) who indicate that they are aware of the new legislation, and the consequences related to making certain decisions involving cannabis
• PI 4.2.1 Percentage of Canadians (aged 15-24) who have indicated that they have made informed, lawful decisions around cannabis that protected themselves, and the safety of others
• PI 4.3.1 Percentage of law enforcement knowledgeable about the changes to the new regime, and able to use the legislative framework as a result of the training materials
• PI 4.4.1 Percentage of stakeholders who indicate that the materials informed decision making
• PI 4.4.2 Number of working meetings and consultations with stakeholders held
• PI 4.4.3 Number of new initiatives considered for implementation
• PI 4.5.1 Percentage of research projects related to performance measurement completed and disseminated
• PI 4.6.1 Percentage of stakeholders indicating that policy development and decision making was based on performance measurement results and lessons learned

Royal Canadian Mounted Police

• PI 5.1.1 Percentage of LERCs completed within negotiated service standards
• PI 5.2.1 Percentage of targeted federal partners and stakeholders who strongly agree or agree with the statement "RCMP Federal Policing contributes to increased understanding specific to the new cannabis regime, organized crime, and the illicit cannabis market"
• PI 5.3.1 Number of information inquiries responded to by the Centre for Youth Crime Prevention
• PI 5.3.2 Percentage of targeted partners/stakeholders who strongly agree or agree with the statement "RCMP Federal Policing contributes to an increased skills/ability to respond to the new cannabis regime"
• PI 5.3.3 Percentage of youth resource officers who positively assessed the impact of training
• PI 5.4.1 Number or Percentage of RCMP information / intelligence products incorporating organized crime groups' activities in the Canadian cannabis market shared with RCMP senior management, divisions, domestic partners (including Canadian law enforcement) or international partners
• PI 5.5.1 Number of organized crime groups involved in the illicit cannabis market for which there are intelligence gaps is reduced (which will result in efficient and accurate targeting by the law enforcement community)
• PI 5.5.2 Number or percentage of information and intelligence products that are used to guide enforcement against organized crime groups in the Canadian cannabis market
• PI 5.6.1 Percentage of employees who have received the appropriate cannabis related training
• PI 5.7.1 Percentage of operational training participants who reported an increased level of knowledge and ability to enforce the new cannabis regime

Target(s)

Health Canada

• T 1.1.1 1,050
• T 1.1.2 75%
• T 1.2.1 80%
• T 1.3.1 95%
• T 1.4.1 TBD
• T1.5.1 TBD

Canada Border Services Agency

• T 2.1.1 75% of major ports; 100% of other priority ports
• T 2.1.2 100%
• T 2.2.1 100%
• T 2.3.1 TBD^{Footnote 7}
• T 2.4.1 100%
• T 2.5.1 90%
• T 2.6.1 TBD
• T 2.6.2 TBD
• T 2.6.3 TBD^{Footnote 8}
• T 2.6.4 85%
• T 2.6.5 80%
• T 2.6.6 85%
• T 2.6.7 The CBSA will aim to contact the client within 14 calendar days after a written complaint is received – 85%
  The CBSA will aim to provide a final written response to the client within 40 calendar days after a written complaint is received-90%^{Footnote 9}
• T 2.6.8 TBD in FY 2019-20. The CBSA will be able to report on this indicator once baseline data is known

Public Health Agency of Canada

• T 3 1.1 TBD^{Footnote 10}
• T 3.2.1 75%

Public Safety Canada

• T 4.1.1 TBD
• T 4.2.1 TBD
• T 4.3.1.1 33% of frontline police officers access materials
• T 4.3.1.2 75% of officers with access to materials find the materials helpful
• T 4.4.1 75%
• T 4.4.2 TBD
• T 4.4.3 TBD
• T 4.5.1 100%
• T 4.6.1 50%

Royal Canadian Mounted Police

• T 5.1.1 TBD^{Footnote 11}
• T 5.2.1 TBD
• T 5.3.1 150
• T 5.3.2 TBD
• T 5.3.3 100%
• T 5.4.1 TBD
• T 5.5.1 TBD
• T 5.5.2 TBD
• T 5.6.1 80%
• T 5.7.1 100%

Actual Results

Health Canada

• AR 1.1.1: 399^{Footnote 12}
• AR 1.1.2: Not available^{Footnote 13}
• AR 1.2.1: Not available^{Footnote 14}
• AR 1.3.1: 97%
• AR 1.4.1: 9%^{Footnote 15}
• AR 1.5.1: 86%^{Footnote 16}

Canada Border Services Agency

• AR 2.1.1: 100%
• AR 2.1.2: 100%
• AR 2.2.1: 100%
• AR 2.3.1: Not available^{Footnote 17}
• AR 2.4.1: 100%
• AR 2.5.1: 10%
• AR 2.6.1: 13
• AR 2.6.2: 1
• AR 2.6.3: 0
• AR 2.6.4: 93%
• AR 2.6.5: 75%
• AR 2.6.6: See footnote^{Footnote 18}
• AR 2.6.7: 5^{Footnote 19}
• AR 2.6.8: See footnote^{Footnote 20}

Public Health Agency of Canada

• AR 3.1.1: 175,318
• AR 3.2.1: 89%

Public Safety Canada

• AR 4.1.1: Not available^{Footnote 21}
• AR 4.2.1: Not available^{Footnote 21}
• AR 4.3.1.1: 51%
• AR 4.3.1.2: 75%
• AR 4.4.1: Not available^{Footnote 22}
• AR 4.4.2: 15
• AR 4.4.3: 1
• AR 4.5.1: Not available^{Footnote 23}
• AR 4.6.1: Not available^{Footnote 24}

Royal Canadian Mounted Police

• AR 5.1.1: 99%
• AR 5.2.1: 40%^{Footnote 25}
• AR 5.3.1: 262
• AR 5.3.2: 29%^{Footnote 26}
• AR 5.3.3: 100%^{Footnote 27}
• AR 5.4.1: 4
• AR 5.5.1: 4
• AR 5.5.2: 9^{Footnote 28}
• AR 5.6.1: 51%
• AR 5.7.1: 83%

Variance Explanations:

CBSA

The variance between planned and actual is mainly due to delay in the development of an IT system and the fact that there has been no litigation cost in 2018-19.

PSC

The variance between actual and planned spending is mainly due to lower than expected costs related to training for law enforcement and research.

RCMP

The variance between actual and planned spending is explained in part due to delays in implementation at the RCMP and funds have been reprofiled to future years to account for these delays.

Gender-based analysis plus

Governance structures

The implementation of Gender-based analysis plus^{Footnote 3} (GBA+), or better known as Sex and Gender-based analysis plus (SGBA+) at Health Canada, is focussed around our Sex and Gender Action Plan 2017-20. Each branch of the Department participates with at least one signature activity. These efforts have been further advanced by the federal government's focus on gender equality, diversity and inclusion, which have increased the demand from across the department for SGBA+ advice and assistance.

Accountability mechanisms such as the requirement of SGBA+ in Memorandums to Cabinet (MCs), Treasury Board (TB) submissions and regulations as well as the department results framework, performance information profiles, and budget proposals help ensure that sex, gender and diversity are integrated in departmental decision-making processes.

The Gender and Health Unit, the responsibility unit for implementing the use of SGBA+ and integrating sex, gender and diversity related findings into Departmental work, tracks the use and quality of SGBA+ in decision-making processes such as MCs, TB submissions and through sex and / or gender specific indicators in the department's performance information profiles, as appropriate. This information is included in reports to departmental senior management as well as the Department of Women and Gender Equality, and published annually on our website.

Human resources

The total number of full-time equivalents (FTEs) focussed on SGBA+ at Health Canada for 2018-19 was 17.5. There were three FTEs working in the SGBA+ Responsibility Unit and 14.5 FTEs distributed across the Department in various roles such as policy, regulatory development, drug and chemical review, research, etc.

Major initiatives: results achieved

Launched in 2017, Health Canada's Sex and Gender Action Plan provides a framework that strengthens the integration of sex, gender and diversity considerations (such as age, ethnicity and disability status) in externally as well as internally facing work of the department. The Action Plan aims to: i) increase positive impacts on health outcomes and the health status of Canadians by designing initiatives to address the diverse needs of Canadian women, men, girls, boys and gender-diverse individuals; and ii) maximize positive impact on workplace health and engagement by developing policies and processes to address the diverse needs of our employees.

Current priorities of the three-year Action Plan are to i) increase departmental capacity to apply sex and gender based analysis (SGBA+); ii) strengthen the sex, gender and diversity-related evidence base and expertise; and iii) increase the accountability and transparency for implementing SGBA+.

Each branch has identified at least one signature initiative and the Department in collaboration with the Canadian Institutes of Health Research (CIHR) has established research-policy partnerships, which support researchers, with both subject matter and SGBA+ expertise, to engage with departmental staff on priority Health Canada initiatives.

Key Sex and Gender related results include:

Cannabis

Health Canada, in collaboration with CIHR, co-funded a researcher with sex and gender expertise, and supported the development, testing and delivery of gender-sensitive cannabis messages. These were in the form of fact sheets for key population sub-groups such as pregnant women and LGBTQ2 individuals. Training was provided for Health Portfolio staff on evidence-based sex, gender diversity and cannabis related issues. The findings have helped to shape public education and awareness campaigns through more focussed targeting of sub-populations by sex and age as well as key messages. These evidence-based insights will also be used to frame harm reduction messages.

The Department also designed its new Canadian Cannabis Survey to collect additional demographic variables, including sex, gender identity and sexual orientation, to better understand cannabis use.

Evaluation

The Department piloted the application of PHAC's Health Equity Tool in the evaluation of Health Canada's Food Safety Program. Findings included: communications and outreach efforts to Canadians have been targeted toward those most at risk (i.e., seniors, those with compromised immune systems, pregnant women, and children under five years of age), and specific products (e.g., pamphlets and posters) have been developed to reach them. The Program has conducted surveys of Canadians' knowledge and behaviours related to food safety, which helps to better target high-risk groups. In addition, the tool was updated to align with the Treasury Board 2016 Policy on Results and the Treasury Board guidance document "Integrating GBA+ into Evaluation", and is now being applied as the Public Health Agency of Canada/Health Canada Program Evaluation Division's SGBA+ Lens for Evaluation.

Health product labelling

Health Canada is proposing to change the regulations for the labelling of Natural Health Products to make them easier for consumers to read and understand. As part of this initiative, the Department along with research partners from McGill University completed a sex-based analysis on public opinion data. The data shows that both male and female consumers rely on product labels to display important safety and other information about the product; however, the desired information varies based on sex. A higher proportion of males than females read the warning labels on products and desire more information than males on the package regarding directions for use, dosage, and product features. A higher proportion of males read the labels to learn about the ingredients in the product and check for endorsements. The results are being used to help support the proposal for improved labelling of natural health products by showing there is a need for this information to be easily available on the products label and that different sex's desire different information on the product necessitating a range of information be available to consumers at the point of purchase.

Health products – risk communications

The Department is applying a sex and gender lens to risk communications for health products. An initial literature review indicated that there are gender-relevant considerations for risk communications such as differences in risk perception, negative dominance (tendency towards a negative interpretation), and trust determination concepts. These were incorporated into bilingual Sex Gender and Risk Communication Webinars provided over 2018-19. An advisory group was created to guide future work on this issue.

Home care

Over 2018-19, Health Canada launched an initiative to develop an evidence-based technology assessment framework that explicitly addresses sex, gender and diversity considerations for digital technology to support informal caregivers. The process included a Canada-wide survey as well as interviews with informal caregivers, which suggest significant differences in technology preferences between male and female caregivers. The results are being disseminated to stakeholders in the field and can be used by Health Canada to develop sex, gender and diversity sensitive policies.

Pest management

Pesticides must undergo a high level of scientific evaluation before they can be registered for use in Canada. Companies applying to register a pesticide must provide Health Canada with a large number of health and environmental studies, which must follow internationally accepted scientific standards. When a pesticide is being evaluated for its potential risks to human health, the Department takes into account that chemicals may pose higher risks to groups of people based on differences in biology and behaviour, for example differences due to sex, gender, age and occupation. In 2018-19, Health Canada's Pest Management Regulatory Agency (PMRA) produced an infographic illustrating how sex, gender and vulnerable populations are taken into consideration in the regulation of pesticides in Canada, for use in outreach activities.

Vaping

In May 2018, the government enacted the new Tobacco and Vaping Products Act, regulating the sale of vaping products. Health Canada is committed to integrating sex, gender and diversity considerations into all aspects of its emerging vaping products framework, including policy, programs, regulations, communications, surveillance, research and evaluations. The Department has incorporated sex and gender identity factors into surveillance activities. These activities include: the new Canadian Tobacco and Nicotine Survey (CTNS), set to be launched in 2020; an ongoing 'vapers' panel survey; public opinion research using peer-group segmentation; and the development and implementation of a new grants and contributions stream through the Substance Use and Addictions Program that incorporates requirements for reporting SGBA+ data. The findings from these activities would be expected to improve the quality of data and decision-making.

Workplace health

Health Canada is developing a toolkit that applies a sex and gender lens to mental health in the workplace. It will contribute to a better understanding of how sex, gender and diversity contribute to the experiences of mental health within a workplace. Based on early findings, a training session was provided to departmental staff and a gender sensitive "Mental Health in the Workplace Tool Kit" is being prepared to contribute to how sex, gender and diversity can impact workplace mental health.

Similarly, the Department is applying a sex, gender and diversity lens to Employee Assistance Service (EAP) policies, procedures and services through a review of the literature, key informant interviews and a mapping of processes. Based on the recommendations, a Management Response and Action Plan was created to implement and monitor progress. These findings will be used to better tailor services to employee needs.

Reporting capacity and data

SGBA+ is applied to all policies and programs developed in the department. Results of the Health Canada Program Inventory indicate that 24 programs have completed SGBA+ between 2014 and 2018.

Most of our externally facing programs have a broad, higher level focus and do not collect individual level micro data.

Health Canada is in the process of completing a department wide data / information mapping exercise as part of the modernization of our Sex and Gender Information Practices. This exercise will identify all databases and datasets that include sex and / or gender identity information and review them to ensure that they are consistent with the new Treasury Board Secretariat (TBS) Policy Direction to Modernize the Government of Canada's Sex and Gender Information Practices. This information will be reported as required by the TBS.

Response to parliamentary committees and external audits

Response to parliamentary committees

Organ Donation in Canada

The House of Commons Standing Committee on Health (HESA) heard that the federal government could help strengthen Canada's organ donation and transplantation system by:

• supporting the adoption of best practices in organ donation and transplantation across all jurisdictions;
• investing in national public education and awareness campaigns to promote conversations among family members regarding organ donation;
• creating more opportunities for Canadians to register their decisions regarding organ donation; and
• providing sustained funding for research and data collection to ensure that organ transplantation results in improved health outcomes for Canadians.

HESA agrees with witnesses that the federal government has a leadership role to play in strengthening Canada's organ donation and transplantation system in these areas. It also believes that a more accessible and equitable organ donation and transplantation system in Canada requires closer collaboration between federal, provincial and territorial governments, which can be achieved through a stronger role for Canadian Blood Services in the coordination of organ donation and transplantation across the country. HESA believes that the seven recommendations outlined in its report supports these objectives.

The Government Response acknowledges HESA's efforts, highlighting the Minister of Health's mandate commitments in this area, and indicating areas of alignment between the Report and areas for action emerging from the activities supported by the Government to improve the organ donation and transplantation system in Canada. In addition, the Response highlights the Government's recent demonstrations of concrete support, as seen in an October 2018 research funding announcement. The Government also supported Bill C-316, An Act to amend the Canada Revenue Agency Act (organ donors) at second reading and referred it to HESA.

For further information, please visit:

• Committee report
• Government response

Pre-Mixed Drinks Combining High Alcohol, Caffeine, and Sugar Content

The House of Commons Standing Committee on Health (HESA) recommended that restrictions be placed on the alcohol, sugar and caffeine content of high alcohol, caffeine, and sugary beverages. It also recommends that the labelling, packaging, marketing and branding of alcoholic beverages that are targeted to youth be prohibited through stronger regulations. Finally, it also recommends an increase in federal excise taxes on highly sweetened pre-mixed alcoholic beverages to make them more expensive, along with the consideration of establishing a national minimum price for alcohol per standard serving. Given the increasing harms, both in terms of hospitalization rates and deaths attributed to alcohol dependency and poisoning among Canadians, particularly youth, HESA believes that it is necessary to re-examine more broadly current approaches for the regulation of alcohol in Canada.

The Government Response acknowledges HESA's efforts and underlines the specific commitments made by the Government to restrict the amount of alcohol in single-serve containers of highly sweetened alcoholic beverages. In addition, the Response indicates the Government's support for efforts to address negative impacts of alcohol consumption in Canada, as well as to consult publically on a broader approach to addressing alcohol-related harms through the Canadian Drugs and Substances Strategy (CDSS). To ensure that policies under the CDSS continue to be based on a strong foundation of evidence, the Government launched consultations in the fall of 2018 with the public and key stakeholders.

For further information, please visit:

• Committee report
• Government response

Pharmacare Now: Prescription Medicine Coverage for All Canadians

The House of Commons Standing Committee on Health (HESA) believes that the best way to move forward in establishing a universal single payer public prescription drug coverage program is by expanding the Canada Health Act to include prescription drugs dispensed outside of hospitals as an insured service under the Act. A study by the Office of the Parliamentary Budget Officer, which was commissioned by HESA, examined this approach and found that it has the potential to reduce total annual prescription pharmaceutical expenditures by $4.2 billion, based upon prudent estimates. Such an approach would also ensure that all Canadians have equitable and affordable access to life saving prescription drugs. The report contains 18 concrete recommendations that HESA believes will lay the framework for the provision of pharmacare to all Canadians.

The Government Response notes that, in Budget 2018, the Government announced the creation of an Advisory Council on the Implementation of National Pharmacare. The Response also highlighted that the management of drugs in Canada is an area of shared responsibility across Federal, Provincial and Territorial governments and improving the affordability, accessibility and appropriate use of prescription drugs for Canadians is a shared priority. The Government of Canada is committed to providing leadership and to working collaboratively with Provinces and Territories on its pharmaceuticals agenda which supports this priority. Initiatives underway are closely aligned with the Report's recommendations and address many of the system inefficiencies identified in the Report.

For further information, please visit:

• Committee report
• Government response

Managing the Risk of Fraud

The House of Commons Public Accounts Committee (PACP) held hearings to study the matters raised in the Office of the Auditor General of Canada's Managing the Risk of Fraud audit. Throughout these hearings, PACP found that all five federal organizations selected for this audit (including Health Canada) did not appropriately manage all of their fraud risks; however, PACP did recognize that there were a number of sound practices in all the organizations examined.

Health Canada (HC) agrees with the recommendations set out in PACP's Thirty-Sixth Report and developed a comprehensive departmental action plan to address the report findings. All recommendations in the report have now been implemented. HC's response to PACPs Reportacknowledges the need for the Government of Canada to make sure that it effectively manages the risk of fraud to maintain Canadians' confidence in public services, preserve employee morale and avoid the loss of public money or property.

For further information, please visit:

• Committee Report
• Government response

Response to audits conducted by the Office of the Auditor General of Canada (including audits conducted by the Commissioner of the Environment and Sustainable Development)

Response to audits conducted by the Commissioner of the Environment and Sustainable Development (CESD)

Report 1, Audit of Toxic Substances, tabled on October 2, 2018

Summary of Findings:

CESD concluded that Environment and Climate Change Canada (ECCC) and Health Canada (HC) still had significant work to do in selected areas to effectively control the risks of toxic substances. Specifically regarding HC's role, the CESD concluded that ECCC and HC had not evaluated whether they had achieved their overall objectives to reduce risks to the environment and human health for the six toxic substances examined. However, both departments had made satisfactory progress with developing action plans for lead and mercury.

CESD also concluded that HC communicated to the public the risks of toxic substances using various communication tools. However, the information on its website was often unclear and difficult to find.

Response:

HC agreed with CESD's results and acknowledged that a more systematic process was needed to assess the efffectiveness of risk management actions. HC confirmed that work is under way to finalize remaining substance-based performance measurement evaluation reports and discussions with ECCC counterparts have begun to develop a more systematic approach to review the effectiveness of risk management already in place.

Recognizing that each substance may represent different risks (hazards and exposures), each substance may require different approaches, both in how risks are managed and how progress is evaluated. HC noted that it will work with ECCC to develop a performance measurement strategy that will establish a long-term approach to systematically assess the effectiveness of risk management controls for substances and risk management instruments.

HC also indicated that it has several activities under way to communicate to Canadians on toxic substances and improve outreach and communications to the public. Furthermore, HC has a five-year strategy and timelines related to communicating toxic substances (including web-based information and social media), which has guided its recent outreach efforts.

Based on an analysis of the public opinion research findings conducted in 2017, HC will launch a new suite of activities and messaging per the strategy to address the information needs of Canadians. Most notably, following the audit Health Canada launched the Healthy Home social marketing campaign, which included new supporting web content and social media outreach to help Canadians more easily find relevant and useful information‎ about toxic substances.

Although the communication teams in both departments already consult and collaborate on toxic substances that pose risks to both human and environmental health, they also committed to expanding the scope of that work and collaborating on a risk-based approach to communications, to help the public avoid or minimize the environmental and human health risks posed by toxic chemicals.

Audit Report

Report 2, Audit of Departmental Progress in Implementing Sustainable Development Strategies, tabled on October 2, 2018

Summary of Findings:

CESD concluded that the organizations examined (including HC) adequately applied the Cabinet Directive on the Environmental Assessment of Policy, Plan and Program Proposals to most policy, plan, and program proposals submitted for approval to Cabinet in 2017. Overall, the organizations had applied the Directive to 93% of proposals (HC was 100% compliant), which represents a significant improvement in comparison with observations made in previous reports on the same topic over the past five years. These organizations also made satisfactory progress toward meeting their commitments to strengthening their strategic environmental assessment practices.

Response:

The OAG made no recommendations to HC, as such, there was no response from the Department.

Audit Report

Report 4, Environmental Petitions Annual Report, tabled on October 2, 2018

Summary of Findings:

This Report informed Parliament and Canadians that the Office of the Auditor General of Canada received 10 environmental petitions between July 1, 2017 and June 30, 2018, that addressed a wide variety of issues. HC received three petitions, including one related to the United Nations' 2030 Agenda for Sustainable Development and the Sustainable Development Goals; one on Electromagnetic Radiation; and one on non-fuel radioactive waste (the Minister of Health advised the Petitioner that the Minister of Natural Resources would provide the joint Government of Canada Response for this one, due to the nature of the issues raised in the petition).

CESD conducted petitioner satisfaction surveys this year and the results showed some common themes. For example, petitioners noted that they found departmental and agency responses vague or not addressing the questions that had been asked. However, the petitioners gave positive ratings to the responses that included specific examples and detailed information that supported the responses' conclusions.

Response:

The petitions and their responses are an important source of information when CESD decides on the issues they intend to audit. However, the annual reports do not provide recommendations and as such, there were no departmental responses.

Environmental Petitions Annual Report

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

Response to audits conducted by the Public Service Commission of Canada (PSC)

Results of the System-Wide Staffing Audit, published on December 19, 2018

Summary of Findings:

PSC's review of 386 appointments from 25 participating departments and agencies (across Canada), indicated full compliance with staffing system requirements, and all organizations made the changes to their staffing systems as required by the New Direction in Staffing. Regarding appointments, the PSC found high levels of compliance with legislative, regulatory and policy requirements with respect to merit, consideration of persons with a priority entitlement, and appointment-related authorities (Attestation Form and Oath/Solemn Affirmation).

The audit results also pointed to some areas that required improvement, particularly those related to obligations regarding official languages and the application of the order of preference. Exchanges with participating departments and agencies suggest that a lack of awareness and understanding is the primary cause of non-compliance in applying the order of preference. As for official languages, many of the discrepancies identified between the English and French versions of key staffing documents (assessment tools) point to a lack of quality control on the part of delegated departments and agencies.

Additionally, the PSC found that some appointments were not supported by sufficient information. Although departments and agencies were subsequently able to provide the required information for the majority of appointments, in some cases the required information could not be provided, and as a result, compliance could not be determined.

Furthermore, results revealed general awareness and understanding of applicable requirements by staffing advisors and hiring managers associated with the sample of appointments covered by the audit, but only a modest indication of staffing culture change was observed at the time of the audit.

Response:

All recommendations that emerged from this audit were directed towards the PSC to support policy adjustments and program improvements, as required. Hence, no recommendations were made to HC and as such, there was no HC response.

Audit Report

Up-Front Multi-Year Funding

Conditional Grant to Canadian Foundation for Healthcare Improvement

General information

Name of recipient

Canadian Foundation for Healthcare Improvement (CFHI), formerly the Canadian Health Services Research Foundation (CHSRF)

Start date

1996-97

End date

N/A

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 1: Health Care Systems Analysis and Policy

Description

When CHSRF was established as an independent organization, its priorities were to bring researchers and decision-makers together to identify gaps in applied health services research, fund the researchers who could investigate those gaps, and promote best practices of health services delivery and their outcomes. To reflect the evolution of its work, CHSRF was renamed the Canadian Foundation for Healthcare Improvement (CFHI) in 2012. CFHI aims to identify proven innovations and accelerate their spread across Canada by supporting healthcare organizations to adapt, implement and measure improvements in patient care, population health and value-for-money.

Up-front multi-year funding to CFHI has included:

• 1996-97: A $66.5 million endowment established the CHSRF. Additional federal grants were provided to CHSRF for the following purposes:
• 1999: $25 million to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health system restructuring (Nursing Research Fund).
• 1999: $35 million to support its participation in the Canadian Institutes of Health Research.
• 2003: $25 million to develop a program to equip health system managers and their organizations with the skills to find, assess, interpret and use research to better manage the Canadian health care system (Executive Training for Research Application or EXTRA).

Audit findings by the recipient during the reporting year, and future plan

CFHI's financial records are reviewed and audited annually by independent external auditors. The 2018-19 external financial and pension audits showed no major concerns.

Evaluation findings by the recipient during the reporting year, and future plan

CFHI pursues ongoing internal evaluative and measurement work of its activities and reports its results through its website and annual reports.

Summary of results achieved by the recipient

No new results associated with the conditional grant to report for 2018-19. CFHI held the remaining up-front multi-year funding (approximately $11 million) in reserve for costs related to its potential organizational wind-down (e.g., legal obligations related to its pension plan and contracts), should it be required in the future.

Note: CFHI's contribution funding is reported under the Details on Transfer Payment Programs of $5 Million or More section of the Supplementary Information Tables.

Conditional Grant to Canada Health Infoway

General information

Name of recipient

Canada Health Infoway (Infoway)

Start date

March 31, 2001^{Footnote 4}

End date

March 31, 2015^{Footnote 5}

Link to the department's Program Inventory

Core Responsibility 1: Health Care Systems
Program 6: Digital Health

Description

Canada Health Infoway Inc. 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.

Between 2001 and 2010, the Government of Canada committed $2.1 billion to Infoway in the form of grants and up-front multi-year funding consisting of: $500 million in 2001 to strengthen a Canada-wide health infostructure, with the EHRs as a priority; $600 million in 2003 to accelerate implementation of the EHRs and Telehealth; $100 million in 2004 to support the development of a pan-Canadian health surveillance system; $400 million in 2007 to support continued work on EHRs and wait time reductions; and $500 million in 2010 to support continued implementation of EHRs, implementation of electronic medical records (EMRs) in physicians' offices, and integration of points of service with the EHR system^{Footnote 6}. 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.

Audit findings by the recipient during the reporting year, and future plan

The annual independent financial and compliance audits were conducted during the year, and both resulted in unqualified audit reports. There were no other audits scheduled or conducted during the year.

Evaluation findings by the recipient during the reporting year, and future plan

N/A

Summary of results achieved by the recipient

Results associated with Infoway's legacy activities funded under Up-Front Multi-Year Funding (2001 to 2010) to Canada Health Infoway include the following initiatives and activities^{Footnote 7}.

Closing the Circle of Care First Nations Expansion Project^{Footnote 8}

Infoway and Mustimuhw Information Solutions Inc. are partnering on the Mustimuhw solution, which focuses on the community health centre and will give people access to their health information when combined with the Mustimuhw Personal Health Record. This solution was developed by First Nations for First Nations. Secure messaging is an important component of the solution, enhancing interactions between patients and providers. This is especially helpful in northern and remote care settings. As of March 31, 2019, this initiative was serving 185 communities out of a target of 226 communities across 10 provinces and territories.

Patient Portals

Patient portals are gaining momentum in several jurisdictions. They can include features such as access to appointment bookings, diagnostic imaging reports, lab test results, vaccines and immunization histories and prescription and medication history. Specific Infoway projects include:

• Carnet Santé^{Footnote 9} in Quebec had more than 373,000 registered users as of March 31, 2019. The service has received consistently good user satisfaction ratings, and additional functions are expected to be implemented in 2019.
• There were more than 17,000 users of MyHealth NS in Nova Scotia as of March 31, 2019, triple the number from a year ago. Nova Scotia was the first province to offer this digital health service province-wide.
• The Southwestern Ontario Regional Patient Portal, enabled by MyChart™, had more than 1,300 registered users as of March 31, 2019, and 70 per cent of the region's acute care hospitals are scheduled to link with the portal throughout 2019.
• MyHealth Records launched province-wide in Alberta in March 2019, after a successful pilot project involving 1,200 users. MyHealth Records gives citizens access to some of their health information from Alberta Netcare, the provincial electronic health record.
• After a successful pilot project involving 1,100 users, Saskatchewan is preparing to roll out its Citizen Health Information Portal across the province in 2019.

Telehomecare

In 2018-19, Infoway continued to support telehomecare projects for individuals with chronic conditions such as chronic obstructive pulmonary disease and congestive heart failure Recent telehomecare reports indicate a 44-85% reduction in hospitalizations and a 35-63% reduction in trips to the emergency department. These projects have also resulted in improved patient experience and knowledge about their illness. Specifically, 91% of telehomecare patients feel more informed about their chronic condition, 91% are better able to manage their health condition as a result of the program, and 87% feel they have improved quality of life.

The use of Telehealth, including virtual technologies such as videoconferencing and tele-dermatology has exceeded one million consultations a year across Canada for the first time. This represents growth of more than 500 per cent since 2010. Virtual technologies such as tele-mental health and tele-stroke helped patients living in rural and remote communities avoid more than $420 million in costs and more than 280 million kilometres of travel in 2018. More than 40,000 Canadians have been enrolled in telehomecare programs since 2010, with 8,500 having been enrolled in 2018-19.

Pan-Canadian Leadership in Digital Health Knowledge and Collaboration

In 2018-19, Infoway continued to provide national leadership and insights in areas such as privacy, security, solution architecture and standards, interoperability, clinical engagement, change management and benefits evaluation. The 2018 Infoway Partnership Conference, "Driving Access to Care" included a diverse line-up of national and international speakers who discussed opportunities and addressed the challenges of transforming health care delivery in Canada. Infoway also hosted representatives of the privacy oversight community (Information Commissioners and similar roles) and ministries of health for one of two meetings of the Pan-Canadian Privacy Forum held in 2018-19.

The Canadian Clinical Drug Data Set, a new national drug terminology, was co-developed by Health Canada and Infoway. It was published monthly in 2018-19 to enable the electronic prescribing of new drugs approved for use in Canada.

Note: Budget 2016 and 2017 contribution funding to Infoway is reported under the Details on Transfer Payment Programs of $5 Million or More section of the Supplementary Information Tables.