Supplementary Information Tables 2019-20 Departmental Results Report: Health Canada

Table of Contents

• Departmental Sustainable Development Strategy
• Details on Transfer Payment Programs of $5 Million or More
  • Contribution to the Canadian Foundation for Healthcare Improvement
  • Health Care Policy Contribution Program
  • 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
  • Canadian Thalidomide Survivors Support Program
  • Territorial Health Investment Fund
• Horizontal Initiatives
  • Addressing the Opioid Crisis
  • Canadian Drugs and Substances Strategy
  • Chemicals Management Plan
  • 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

Contribution to the Canadian Foundation for Healthcare Improvement

General information

Name of transfer payment program

Contribution to the Canadian Foundation for Healthcare Improvement (Voted)

Start date

December 10, 2015

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 1: Health Care Systems Analysis and Policy

Description

The contribution to the Canadian Foundation for Healthcare Improvement (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 and accelerate the spread of promising innovations across Canada by supporting health care organizations to adapt, implement and measure improvements in patient care, population health and value for money for health care system investments.

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 2019-20, 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 2019-20 include:

• Supported numerous large-scale health care improvement initiatives, for example:
  • Through the "Bridge-to-Home Spread Collaborative", 16 teams from seven provinces partnered with patients, families and caregivers and providers to implement a patient-oriented care transition bundle which gives patients and their caregivers the information needed to transition well from hospital to home. The bundle includes: a patient-oriented discharge summary; techniques to improve patient and caregiver understanding about the patient's health condition; ways to engage and partner with patients, family and caregivers during an admission process, inter-professional rounds or discharge planning; and, post-discharge follow-up.
  • Together with the Canadian Frailty Network, the "Advancing Frailty Care in the Community Collaborative" supported 17 teams across Canada to adapt and implement evidence-informed innovations to improve the identification, assessment and management of frailty in primary care. Teams were supported on core frailty intervention areas: frailty identification, geriatric assessment, tailored interventions, person and family-centered care, collaborative care, community supports, quality improvement and measurement.
  • The "Connected Medicine: Enhancing Primary Access to Specialist Consult Collaboration" spread two proven innovations that improved access to specialist advice: the Champlain BASE (Building Access to Specialists through eConsultations – a secure web-based eConsult service) and the Rapid Access to Consultative Expertise (RACE – a telephone advice line). At the completion of the collaboration, more than 12,300 remote consults with specialists to support patient care were initiated by primary care providers. Teams from Newfoundland and Labrador, New Brunswick, Quebec, Manitoba, Saskatchewan, Alberta, British Columbia and the Department of National Defense, enrolled more than 2,200 primary care practitioners and 800 specialists, including many in underserved rural and remote regions. As a result of the collaboration:
    • 85% of eConsults received a response from a specialist within 7 days
    • 53% of eConsults led to an a reduction in unnecessary specialist referral (special e-Consult advice received meant that the original referral was no longer needed)
    • 42% of remote consults led to a reduction in emergency department visits
  • The "Promoting Life Together Collaborative" brought together six multidisciplinary teams from across northern, rural and remote parts of Canada to focus on life promotion, recognizing the need to take a broader and more encompassing approach to the issue of suicide. Together, the collaborative:
    • provided learning opportunities for understanding and applying wise practices for life promotion and First Nations mental wellness frameworks;
    • supported teams to enhance their capacity towards culturally safe environments to promote health transformation;
    • enhanced the capacity of teams to design, implement and evaluate improvement initiatives together and alongside communities; and,
    • strengthened the capacity of CFHI to collaborate with, and learn from Frist Nation and Metis partners and communities on health improvement initiatives.
• Worked 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.
• Worked 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.
• Supported 44 leaders through eleven improvement projects across Canada as part of the Executive Training for Research Application (EXTRA) program. Examples of innovative projects undertaken include:
  • Improving monitoring procedures relating to medical device reprocessing;
  • Reducing reports of neglect and enhancing coordination amongst partners caring for patients in vulnerable circumstances;
  • Embedding mindfulness in operating rooms to improve the well-being of staff;
  • Improving access to nursing care through improved hospital workflow changes; addressing labour issues to meet patients' needs; and
  • Developing targeted mental wellness supports for criminal justice clients;
  • Improving understanding of patient flow to forecast patient volumes and bottlenecks along the patient journey;
• Supported its stream of health system transformation policy work by providing opportunities for healthcare leaders from across Canada to share policy insights, identify ways to advance change and accelerate the transformation of the system, for example, through the Canadian Harkness Fellowship that enables Canadian thinkers and leaders to participate in the Commonwealth Fund's International Program in Health Policy and Practice.
• Disseminated 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 2019–20

Completed: Audit of Grants and Contributions Management Phase 2

Summary of Findings:

The audit found effective solicitation of applicants and selection of recipients, and that the funding agreements complied with the Treasury Board Policy. The audit report also found adequate monitoring of recipients with respect to their reporting requirements.

The audit reported that the solicitation process was lengthy which affected the ability to disburse funds in a timely manner and support departmental objectives. There was limited use of service standards to manage the contribution agreement management process and support continuous improvement. The audit found an absence of documentation for Health Canada employees to identify conflicts of interest in the selection of recipients. The audit also found there was limited information to support recipient risk assessments and inform the annual risk-based recipient audit plan. Finally, there was a limited number of employees engaged in SGBA+ training and limited collection of data through recipient performance measurement plans to support diversity elements of SGBA+.

Planned: Not applicable

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

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 providing feedback on draft deliverables such as the work plan and annual report.

Health Care Policy Contribution Program

General information

Name of transfer payment program

Health Care Policy Contribution Program (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 Health Care Policy Contribution Program (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 mental health, home and palliative care, health care systems innovation, and optimization of the health workforce. 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

In 2019-20, the Health Care Policy Contribution Program (HCPCP) directed funding toward disseminating, exchanging and implementing knowledge to support innovation and implementation of best practices in palliative and end-of-life care, home care and medication safety. The Program also supported projects that contributed to improving access to health care services for all Canadians. Specific examples include:

• The Canadian Home Care Association (CHCA) Operational Excellence in Home-based Palliative Care Project used its website, multiple webinars and live stream conferences to share information and tools to home care provider organizations and formal and informal caregivers. CHCA's focus is to increase awareness of gaps in home-based palliative care operations and address such gaps through identification of high impact practices – leading evidence-informed innovative practices in home-based palliative care. Through this project, CHCA identified and documented five high impact practices and developed an implementation framework to address operational gaps and provide tested interventions resulting in improved efficacy of home-based palliative care. In 2019-20, CHCA held five subject matter expert webinars for 824 attendees, and established 22 collaborative arrangements with a diverse group of stakeholders with a vested interest in improving home-based palliative care, in order to enhance knowledge translation. To build awareness of the high impact practices and facilitate their adoption with frontline service providers, CHCA established 11 Implementation Collaborative teams across the country oriented in implementation science and guided through the improvement process using a selected high impact practice to share the skills acquired in diverse locations and situations. Practical experience and recommendations from participating teams allowed CHCA to study and learn implementation strategies, quality improvement techniques, supportive coaching and targeted education and team activation, which informed the implementation framework. Several of the teams reported improvements in their delivery of home-based palliative care and have made a commitment to continue implementing the intervention, while other teams reported using the tools and learnings in other practices.
• The Choosing Wisely Canada (CWC) project encourages clinicians and patients across Canada to engage in conversations about unnecessary tests, treatments and procedures. In 2019-20, CWC worked with national societies to review and refresh lists of over 340 CWC recommendations. CWC further published 22 new recommendations on 'Things Clinicians and Patients Should Question' related to dermatology, fertility and andrology, neurology and medical biochemistry and published five patient pamphlets for Canadians in Arabic, Punjabi, Simplified Chinese, Spanish and Tagalog. In November 2019, CWC finalized and disseminated Practice Change Statements and tools related to Urinary Tract Infection (UTI) in long-term care to over 4,000 long-term care facilities across the country.
• Pallium Canada's project "Building and Bridging – Palliative Care is Everyone's Business" aims to strengthen home and community palliative care capacity. In 2019-20, Pallium Canada continued to expand learning opportunities through its "Learning Essentials Approaches to Palliative Care" (LEAP) program, which develops and provides inter-professional palliative care education across Canada, and offered 470 training sessions to over 7,000 participants and trained 144 new facilitators through Facilitator Training Workshops. Of those who received training, 72% reported making improvements to the health care system in integrated early palliative care, including earlier initiation of palliative care and initiating a palliative care approach in patients with advanced non-cancer diseases, improved use of opioids and other medications, increased screening of patients for symptoms and other needs, better pain management strategies, and advanced care planning and improved strategies to deal with hydration and nutrition issues in patients with advanced disease.
• The Heart and Stroke Foundation of Canada's project "Advancing Women's Heart Health" targets research on women's heart health, and promotes collaboration between research institutions across the country. This project seeks to ensure women have access to high quality care that is attentive to the inherent differences in the diagnosis and treatment of heart disease and stroke in women and men. In 2019-20, the project continued to contribute new knowledge to accelerate adoption of sex/gender-based analysis and reporting by researchers in Canada. The majority (89%) of targeted researchers reported using sex and gender-based methods in their research on women's heart and brain health, and some researchers used this knowledge and research evidence to inform changes in policies, programs and practice in women's heart and brain health.

Findings of audits completed in 2019–20

Completed: Audit of Grants and Contributions Management Phase 2

Summary of Findings:

The audit found effective solicitation of applicants and selection of recipients, and that the contribution agreements complied with the Treasury Board Policy. The audit report also found adequate monitoring of recipients with respect to their reporting requirements.

The audit reported that the solicitation process was lengthy which affected the ability to disburse funds in a timely manner and support departmental objectives. There was limited use of service standards to manage the contribution agreement management process and support continuous improvement. The audit found an absence of documentation for Health Canada employees to identify conflicts of interest in the selection of recipients. The audit also found there was limited information to support recipient risk assessments and inform the annual risk-based recipient audit plan. Finally, there was a limited number of employees engaged in SGBA+ training and limited collection of data through recipient performance measurement plans to support diversity elements of SGBA+.

Planned: Not applicable

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Funding recipients continued to be engaged through site visits and regular communication. For example Health Canada visited the Canadian Hospice and Palliative Care Association and CHCA to discuss progress against objectives, planned impacts and achievements to date. Program officials continue to have discussions with recipients to guide them in the development of performance measurement plans and to provide feedback on annual performance reports.

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 (Voted)

Start date

April 1, 2008

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 2: Access, Affordability, and Appropriate Use of Drugs and Medical Devices

Description

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

Results achieved

The contribution agreement provided financial support for CADTH's core business activities, namely, the Common Drug Review, pan-Canadian Oncology Drug Review, Health Technology Assessments and Optimal Use Projects. Through these activities, CADTH achieved results through the creation and dissemination of evidence-based information that provide guidance and evidence-based information enabling health system partners to make informed decisions on the adoption and appropriate utilization of drugs and non-drug technologies, in terms of both effectiveness and cost. In particular, CADTH's formulary listing recommendations have been embedded within the decision-processes of public drug plans as a means of increasing transparency across jurisdictions and providing consistency to pharmaceutical reimbursement decisions. Additional funding announced in Budget 2017 supported CADTH's ongoing transition to a health technology management organization in order to deliver results that better meet the needs of the healthcare system.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Health Canada worked with CADTH to establish activities to be carried out under the contribution agreement, and maintained regular contact with CADTH to monitor progress and ensure compliance with terms of the organization's contribution agreement.

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

General information

Name of transfer payment program

Payments to Provinces and Territories for the Purposes of Home Care and Mental Health (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 (2017-2027) to support the provinces and territories (PTs) in improving access to home and community care ($6 billion) and mental health and addictions ($5 billion) services in their jurisdictions as per the Common Statement of Principles for Shared Health Priorities (CSoP). In August 2017, federal, provincial and territorial Ministers of Health agreed to the CSoP which outlines the priority areas of focus for these investments.

On mental health and addictions, PTs 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, PTs 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.

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 contribution agreements.

Following the 2017 federal, provincial and territorial agreement on the Common Statement of Principles, the federal government negotiated and signed bilateral agreements with each province and territory in which equal jurisdiction outlines how it will invest the funding for the first five years of the ten years of investment, based on the priority areas of action agreed to in August 2017. In 2021-22, these agreements will be renewed for the remaining five years (2022-23 to 2026-27) of the 10- year commitment.

As part of the CSoP, all governments also agreed to develop a focused set of common indicators to measure progress on these priority areas. The Canadian Institute for Health Information led a collaborative process which culminated in May 2018 when federal, provincial and territorial Ministers of Health endorsed a suite of 12 common indicators to be implemented over the coming years.

Results achieved

In keeping with the bilateral agreements, federal funding is being used to improve access to home and community care and mental health and addiction services. Action plans annexed to the bilateral agreements allow Canadians to see how the targeted federal funding will be invested in each province and territory.

In May 2019, CIHI released its inaugural annual report on the first three of these indicators, which provides baseline information to begin to track progress. CIHI will continue to work with governments across Canada to report annually on all 12 indicators.

These investments to strengthen home and community care and access to mental health and addiction services are leading 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.

Canadians are beginning to see improvements in the availability and quality of services in their communities and at home. New investments:

• Enabled patients to receive more professional services and better coordinated and integrated care to address their individual needs;
• Enhanced infrastructure through improved digital connectivity, and the use of remote technology, care providers are able to coordinate and plan appropriately for their patients, resulting in more Canadians getting the care they need where they want it;
• Supported caregivers with more education supports and expanded respite services; and
• Improved access to palliative and end-of-life supports, such as greater hospice resources.

PTs are also taking steps to improve access to mental health and addiction services. Many are taking an integrated approach to delivery of these services that recognizes the need to provide people-centred care that is coordinated across the health care system. Specifically, investments in these areas:

• Provided children and youth school-based initiatives for better early prevention, detection and treatment;
• Increased the availability of mental health and addiction services in the community;
• Expanded access to crisis intervention services and integrated multidisciplinary professional services;
• Implemented more comprehensive, collaborative and compassionate approaches based on the best available evidence for providing care to address substance use.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

With respect to mental health and addictions, the Government of Canada has engaged with PTs, National Indigenous Organizations, mental health stakeholders, provincial and territorial medical associations and treatment centres, and experts.

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 experts.

Mental Health Commission of Canada Contribution Program

General information

Name of transfer payment program

Mental Health Commission of Canada Contribution Program (Voted)

Start date

2000 as a Grant, but as of April 1, 2017 it has become a Contribution

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 Mental Health Commission of Canada (MHCC), an arm's length, not-for-profit organization, was 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. This contribution has been extended for 2019-20.

Results achieved

In 2019-20, the MHCC continued to provide valuable mental health expertise and advice to mental health stakeholders. Notable achievements:

Substance Use

The MHCC collected significant data on the evaluation of four stigma reduction interventions using the Opening Minds Scale for First Responders and Health Care Providers on Opioid Use Problems. This evaluation included:

1. the MHCC's Understanding Stigma program,
2. an opioid-use-specific social contact intervention (using a survey of second year nursing students at St. Lawrence College in Brockville, Ontario),
3. an iteration of the Community Addictions Peer Support Association and the Canadian Centre on Substance Use and Addiction (CCSA) "Stigma Ends with Me" workshop, and
4. three iterations of the Fraser Health Authority's Trauma and Resiliency Informed Practice workshop.

The results will be used to support the expansion and scale-up of best practices.

Suicide Prevention

Roots of Hope

The Roots of Hope project has generated a great deal of attention, and new communities continued to express interest. The MHCC's Prevention and Promotion team formalized support of Iqaluit, Nunavut, one of eight communities participating in the five-year research demonstration project: Roots of Hope: A Community Suicide Prevention Project.

Key elements of the Iqaluit suicide prevention action plan are: community engagement, social determinants of health, Inuit-specific approaches to wellness, and land-based programming. The meeting helped to build momentum around specific programs with infrastructure and administrative leadership that will be provided through the project.

Suicide Prevention Conference

The MHCC's Prevention and Promotion team supported the 30th annual Canadian Association for Suicide Prevention national conference in Edmonton (October 2019). The conference focused on reconciliation and the need to heal relationships to drive connectedness, a key element underpinning suicide prevention.

Engagement

Mental Health Needs of Incarcerated or Detained Individuals within the Criminal Justice System

People living with mental illness are over-represented in the criminal justice system, and the justice system is not well equipped to meet their needs. The MHCC worked to mobilize key stakeholders in the health and justice systems to spread best practices, promote evidence-based research, and improve collaboration in the delivery of mental health services for those involved with the law.

To date, key partners and stakeholders have been identified and an advisory committee established. An evidence summary based on three sources from the listening phase (17 key-informant interviews, a national survey with 584 responses, and a scoping review of 391 documents from academic and grey literature) was combined into final key themes. Thirty four participants from various sectors related to mental health and the criminal justice system subsequently met at a national forum. Participants developed specific action items to improve mental health services and supports for people involved in the criminal justice system. Action steps were also identified, and a final report is being developed.

Population-Based Initiatives

National Standard for Psychological Health and Safety of Post-Secondary Students

The MHCC and CSA Group (formerly called the Canadian Standards Association) continue to lead the development of the Standard on Psychological Health and Safety for Post-Secondary Students (PSS Standard) – voluntary guidelines that post-secondary organizations can use to promote mental health and prevent psychological harm among their students.

The MHCC has been leading extensive stakeholder engagement efforts to inform the PSS Standard. The public was invited to review the first draft and share feedback and the MHCC hosted 14 focus groups for select strategic audiences across the country. Participants included students; Francophones; First Nations, Inuit, and Métis; senior leadership; service providers; and the project's executive advisory committee (a total of 230 people). The CSA Group received more than 1,700 comments on the draft, which were shared with the CSA Technical Committee.

The MHCC subsequently hosted a session with representatives from the CSA Technical Committee, CSA Group, and project partners (including Universities Canada, Colleges and Institutes Canada, and their members) to discuss the PSS Standard content and implementation strategies at post-secondary institutions across Canada.

E-Mental Health National Conference

In March 2020, the MHCC, together with the University of British Columbia, the University Health Network, and Centre for Addiction and Mental Health (CAMH), co-hosted the 9th Annual E-Mental Health Conference in Toronto. This year's theme, Caring in a Digital World: Introducing Disruptive Change to Mental Health Care, set out to underline the importance of e-mental health.

Over 250 people (from Canada and international locations) were in attendance, including health-care providers, administrators, system leaders, and people with lived experience.

Pan-Canadian Network for the Implementation of Increased Access to Psychotherapies

Access to psychological services is a significant barrier for many people in need of mental health services, something public funding could reduce. To align key stakeholders, support knowledge sharing, build consensus, and develop recommendations with the goal of increasing access to services, the MHCC created the Psychotherapy Policy Implementation Network, a pan-Canadian group of policy makers, researchers, clinicians, people with lived experience, and other experts. At the group's inaugural meeting (February 21 in Ottawa), 23 members with diverse perspectives (including persons with lived and living experience) discussed ways of increasing access to psychotherapies, building on the thought leaders' meeting of November 29.

Research Demonstration Project for Culturally Adapted Cognitive Behavioural Therapy (CaCBT)

People of South Asian origin living in Canada are the largest visible minority group in the country and are disproportionately impacted by unemployment; low income, education, and literacy; language barriers; and migration stress. To improve mental health outcomes for this population, the MHCC, in collaboration with CAMH, launched a CaCBT project in Toronto on December 10. This project will develop a specialized form of psychotherapy for people in this group who are experiencing anxiety and depression.

The CaCBT launch brought together 83 participants, including policy makers, researchers and research sites, people with lived and living experience, and other stakeholders. The purpose was to communicate the project's goals and approach, build interest, and start recruitment for the first stage. The event included a panel discussion with local media and a research-team meeting. 150 people of South Asian origin from across Canada have expressed interest in participating in the project.

Mental Health Needs of Canadians Living with Chronic Disease

The MHCC held an inaugural call of its Mental Health and Chronic Disease Network on February 25. This knowledge exchange network includes 27 members representing various physical chronic disease groups and organizations in mental health, primary care, and research.

Child and Youth Mental Health

The child and youth mental health incubation project is helping service sectors work together to:

• foster positive early development, mental health, and resiliency, and
• strengthen early prevention and promotion programs as core components of a continuum of mental health and addiction services.

In this reporting period, a listening phase summary report was completed based on three sources of evidence (20 key-informant interviews, a national survey with over 1,800 responses, and a scoping review of the literature), which were combined into final key themes.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Regular meetings with the recipient; analysis and follow-up of progress and financial reporting; and monitoring of performance and results.

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

Substance Use and Addictions Program

General information

Name of transfer payment program

Substance Use and Addictions Program (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

2018-19

Link to the department's Program Inventory

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

Description

The Substance Use and Addictions Program (SUAP) provides funding for a wide range of evidence-informed and innovative problematic substance use prevention, harm reduction and treatment initiatives across Canada at the community, regional and national levels. Initiatives target a range of psychoactive substances, including opioids, cannabis, alcohol and tobacco.

Results achieved

In 2019-20, SUAP provided funding to 105 multi-year community-based and national substance use awareness, prevention, harm reduction and treatment initiatives. Of note, of the 12 existing initiatives ended.

In summer 2019, a call for proposals was launched seeking proposals that enhance the response to the opioid crisis and other emerging issues, such as methamphetamine use. Selected proposals were approved for funding in the fourth quarter of 2020. Initiatives funded in 2019-20 focused on a wide range of issues including:

Controlled Drugs and Substances

67 initiatives address a variety of needs around controlled drugs and substances, including reducing stigma and engaging people with lived and living experience, identifying best practices for medication-assisted treatments, improving access to different types of treatment, and identifying innovative models for opioid replacement therapy.

Cannabis

31 initiatives focus on preventing and reducing harm caused by cannabis misuse, including the development of guidance and tools for health professionals, the development and dissemination of culturally appropriate resources within Indigenous communities, and the development of resources targeting audiences with greater risks and/or harms associated with cannabis use.

Tobacco Use and Vaping

7 initiatives focus on informing Canadians about the harms of tobacco use and vaping, including designing cessation interventions for people who smoke/vape, the development of low-risk nicotine use guidelines, and addressing knowledge gaps.

Together these initiatives produced over 1,700 knowledge products (guidelines, toolkits, reports) and delivered over 2,300 learning opportunities (workshops, presentations, webinars). Over 80% of targeted stakeholders and Canadians indicated that they gained knowledge and skills relevant to reducing the harms of substance use in Canada. In addition, over 65% are using 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 CCSA, as well as funding for research on the impact of cannabis legalization. The CCSA works with a wide range of national and international partners to mobilize efforts, foster knowledge exchange, and develop evidence-informed actions responding to problematic substance use.

Initiatives delivered this fiscal year targeted priorities ranging from educating the public about cannabis following legalization, decreasing substance use stigma to affect changes in the health system, to reducing the harms of problematic alcohol consumption. CCSA's objectives in knowledge sharing and serving as a national convener in the field of problematic substance use were advanced through organizing the national Issues of Substance Conference, and by responding to the urgent knowledge needs in relation to COVID-19 and the impact on substance use and addictions.

CCSA's work informs policy changes, practices and raises awareness. In 2019-20, over 125 knowledge and communication products were created, 56 events were delivered, 95 presentations were given, and close to 4,400 knowledge activities were disseminated through social media. This generated increased national and international interests compared to previous years. In total, CCSA website had over 1,399,205 visits with Canada Low Risk, Drinking Guidelines, National Awareness Week and Cannabis being the most searched. Their social media knowledge dissemination activities had over 11.2 million impressions (an increase of 485%) and 303,000 engagements, which was almost 8 times higher than the previous year. The topics that generated the highest response and impact included Stigma Ends with Me Campaigns, National Awareness Week and Issues of Substance Conference 2019. CCSA's workshops and webinars resulted in increased capacity among participants - surveys suggested an average of 91% satisfaction rate among respondent, 90% increased awareness, 81% in knowledge and 79% in increased skills. Interest in CCSA products also resulted in garnering increased product use requests and citations of their work. In 2019-20, CCSA worked with over 2,000 partners and stakeholders as well as the Mental Health Commission of Canada to affect changes in the health system to address problematic substance use.

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.

In 2019-20, the MHCC continued to work toward the objectives of informing and advancing research, building the evidence base, and mobilizing knowledge on the impacts of cannabis use on mental health. Five knowledge products were developed, including an environmental scan and a scoping review to assess the state of the research on cannabis and mental health outcomes and to identify research gaps. In addition, the MHCC held a number of in-person events, with the goal of exchanging knowledge and identifying research gaps and priorities. Events took place in Ottawa, Ontario, and Goose Bay, Labrador, in partnership with such organizations such as Inuit Tapiriit Kanatami, the CCSA and the Nunatsiavut Department of Health and Social Development.

The MHCC, with the Canadian Institutes of Health Research (CIHR), funded two one-year catalyst grant research projects to explore the potential therapeutic benefit of cannabis and cannabidiol on mental health outcomes. In addition, the MHCC launched a call for 11 additional one-year catalyst research grants to generate new evidence around cannabis and mental health. In partnership with CCSA and CIHR, MHCC also 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. Lastly, the MHCC launched four multi-year team-based research projects in alignment with the CIHR's Integrated Cannabis Research Strategy. These research projects will address key research gaps regarding cannabis use and mental health.

Findings of audits completed in 2019–20

Completed: Audit of Grants & Contributions Management Phase 2

The audit found effective solicitation of applicants and selection of recipients, and indicated that the funding agreements complied with the Treasury Board Policy. The audit report also found adequate monitoring of recipients with respect to their reporting requirements. The audit reported that the solicitation process was lengthy which affected the ability to disburse funds in a timely manner and support departmental objectives. There was limited use of service standards to manage the contribution agreement management process. The audit found an absence of documentation for Health Canada employees to identify conflicts of interest in the selection of recipients. The audit also found there was limited information to support recipient risk assessments and inform the annual risk-based recipient audit plan. Finally, there was a limited number of employees engaged in SGBA+ training and limited collection of data through recipient performance measurement plans to support diversity elements of SGBA+. The program has taken steps to address the deficiencies indicated by the audit.

Planned: Not applicable

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Applicants for funding in 2019-20 were engaged through a national call for proposals, with program staff working closely with successful applicant organizations to shape their initiatives, monitor contribution agreements and obtain required performance measurement and evaluation reports. The program also supported knowledge translation and exchange opportunities between projects, and between Health Canada and other partners and stakeholders through its involvement in various conferences, workshops, and committees. Of note, the program is exploring the development of theme-based Communities of Practices with partners within and external to the federal government.

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

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 flow as a Contribution agreement.

Results achieved

The PrescribeIT program continued to grow in fiscal year 2019-20. Memorandums of Understanding to implement the program are signed with 10 jurisdictions (Yukon, Manitoba, Nova Scotia, Newfoundland and Labrador, Prince Edward Island, Saskatchewan, Northwest Territories, Ontario, Alberta and New Brunswick), and an eleventh is in the process of being signed with Nunavut. In 2019-20, PrescribeIT continued to equip Canadian providers with digital health technologies that aid them in delivering more efficient and high quality health care. The program was operational in five jurisdictions (Alberta, Saskatchewan, Ontario, New Brunswick, and Newfoundland and Labrador), and as a result, enrollment increased with 2,442 enrolled prescribers (up from 897 last year) and 3,312 enrolled pharmacies (up from 877 last year).

The ACCESS Health program is continuing to develop. In 2019-20, Infoway began building the ACCESS Gateway platform, an identity, access, and consent management service that will eventually allow patients and providers to access electronic health records and multiple digital health tools through a single set of login credentials. Infoway is piloting and developing its ACCESS Gateway services as part of ACCESS Atlantic, a collaborative initiative with four Atlantic provinces that aims to make it quicker and easier to access health services in Atlantic Canada. In support of its ACCESS Health program, Infoway continues to use its ACCESS 2022 awareness campaign in an effort to inspire action towards a vision that includes patients, families and clinicians having access to the information and digital services they need to manage their health. Through its ACCESS Health program, Infoway continued to fund the nationwide "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. In 2019-20, the text line had nearly 134,000 texting conversations, saving an estimated five young lives per day. In addition, Infoway expanded its First Nations-developed community health record and personal health record platform, the Mustimuhw Community Electronic Medical Record (cEMR), to benefit 285 First Nations communities across 7 provinces. Infoway also announced an agreement to integrate PrescribeIT into the cEMR.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Health Canada worked with Infoway to establish the activities that it carried out under the contribution agreement, and maintained regular contact with Infoway to monitor progress and compliance under the contribution agreement. Health Canada has a representative on Infoway's Board of Directors, which met 4 times in 2019-20.

Contribution to the Canadian Institute for Health Information

General information

Name of transfer payment program

Contribution to the Canadian Institute for Health Information (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

Link to the department's Program Inventory

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

Description

The Canadian Institute for Health Information (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 2018, the Government of Canada allocated approximately $1,232 million in total to CIHI through a series of contribution agreements. Under the current agreement signed in early 2018, close to $365 million will be delivered to CIHI over 5 years (2017-18 to 2021-22). Presently, Health Canada funds 77% of CIHI's total budget, while the P/T governments contribute 17%. The remaining funds are generated largely through product sales.

In early 2018, the current contribution agreement was signed, providing close to $365 million over five years (2017-18 to 2021-22). A first amendment was signed in February 2019 to provide an additional $140,000 to CIHI to undertake an environmental scan of data gaps for addiction treatment services. A second amendment was signed in December 2019 to provide $500,000 for initiating a collaborative pan-Canadian project to enhance organ donation and transplantation data and reporting across the country.

Results achieved

In 2019 -20, 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.

Selected highlights from the past year:

In 2018, Health Canada initiated the objective of the Collaborative is to inform thinking and encourage action on ways of facilitating and supporting collaboration among and between governments, Canadian Blood Services (CBS) and other stakeholders to improve Canada's organ donation and transplantation (ODT) system performance.

Budget 2019 allocated $36.5M over five years to support the development of a comprehensive data and performance system to improve the approach to organ donation and transplantation across Canada. CIHI, working in partnership with Canada Health Infoway, was identified as the lead organization to implement this initiative. CIHI has initiated this work with the ODT Collaborative (the Collaborative), which includes provinces and territories (PTs), organ donation organizations, transplant programs, research bodies, regulators, ethicists, and patient/advocacy bodies. In particular, CIHI worked with PTs, CBS, Transplant Quebec and clinicians to develop a detailed implementation plan to move forward on this initiative.

In 2019-20 CIHI also facilitated the development and led the selection and reporting of pan-Canadian common indicators focusing on shared health priorities to measure access to home care and mental health services. Over four years, CIHI will publicly report on 12 indicators endorsed by federal, provincial and territorial Health Ministers in June 2018. Each year, CIHI reports the results for three new indicators. The first release, in May 2019, included the following three indicators:

• Hospital stays for harm caused by substance use;
• Frequent emergency room visits for help with mental health and/or addictions; and
• Hospital stay extended until home care services or supports ready.

CIHI will continue working with federal, provincial and territorial governments across Canada to report annually on these indicators and to build on data sources to enable more comprehensive reporting.

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.

CIHI has also undertaken a number of new work streams to support the federal, provincial and territorial response to the pandemic. CIHI will maintain and further enhance their current data supply chains to contribute to understanding of COVID-19 impacts in the near and longer term through supporting coding of COVID-19 cases in hospital and non-acute care, investigating strategies to acquire real-time hospital data and developing guidelines on regular data submission to reduce interruptions in regular data flow. CIHI is also creating, curating and delivering priority COVID-19 data and information for use by governments, health systems managers and the media though their website and social media channels. CIHI is also undertaking an exercise to identify data priorities to better respond to health system needs for subsequent pandemic waves.

CIHI has been monitoring the emergence of new virtual care codes during the COVID-19 pandemic. This work includes monitoring changes in policy directions by provincial and territorial governments in the use of any diagnosis and fee codes when submitting claims to medical care plans during the pandemic. This type of surveillance is routinely undertaken by CIHI to anticipate changes in future billing submissions from P/T governments, and it has taken on added importance during the current crisis.

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.

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.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Health Canada previously worked with CIHI to establish activities to be carried out under the contribution agreement, and maintained regular contact with CIHI to monitor progress and compliance under the contribution agreement.

Contribution to the Canadian Partnership Against Cancer

General information

Name of transfer payment program

Contribution to the Canadian Partnership Against Cancer (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

The Canadian Partnership Against Cancer (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 Canadians, including 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 was eligible to receive $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

In 2019-20, CPAC continued its work in cancer control by accelerating the uptake of new knowledge and coordinating approaches to advance cancer control in Canada. Notable achievements:

• Published the first refresh of the Canadian Strategy for Cancer Control since 2006, encompassing the views of more than 7,500 Canadians and reflecting the current Canadian cancer control and health system landscape;
• Engaged partners and stakeholders across Canada, including provincial and territorial governments, regional health authorities, Indigenous organizations, provincial cancer agencies, cancer charities and the federal government to plan for the implementation of the refreshed Canadian Strategy for Cancer Control, to identify shared priorities and opportunities for action;
• Improved the alignment between research and cancer control by engaging leaders from across the country through the Canadian Cancer Research Alliance to develop a 20-year Canadian vision for cancer research;
• Improved cancer care for First Nations, Inuit and Métis by supporting the development and implementation of Peoples-specific, self-determined cancer strategic plans for the delivery of high-quality, culturally respectful cancer services and programs in all provinces and territories (PTs);
• Helped cancer patients quit smoking by introducing the Pan-Canadian Action Framework for Implementing Smoking Cessation in Cancer Care which provides guidance for stakeholders to implement comprehensive, evidence-based smoking cessation programs in cancer care settings;
• Addressed the unique needs of adolescents and young adults with cancer by releasing the Canadian Framework for the Care and Support of Adolescents and Young Adults with Cancer, co-developed with provincial and territorial governments and stakeholders;
• Worked with the Canadian Foundation for Healthcare Improvement to support the training of paramedics to deliver palliative and end-of-life care at home;
• Supported PTs as they move to implement lung cancer screening programs through the development of a standard business case for lung cancer screening with common core content and jurisdiction-specific cost and resource estimates;
• Increased equitable participation in colorectal cancer screening by providing jurisdictions with training on the use of geo-mapping to identify communities where colorectal screening rates are low; and,
• Engaged with stakeholders and led the effort to develop a Pan-Canadian Action Plan to Eliminate Cervical Cancer.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Health Canada worked 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. Health Canada has an official observer on CPAC's Board of Directors, which met 4 times in 2019-20.

CPAC engaged stakeholders, as planned, through communication activities that included media and on-line vehicles to reach the broader public and the cancer and health communities. In 2019-20 CPAC officials met with partners and stakeholders across Canada, including provincial and territorial governments, regional health authorities, Indigenous organizations, provincial cancer agencies, cancer charities and the federal government to identify Strategy priorities that could be supported, leveraged, shared, or enhanced through collaborative action.

Contribution to the Canadian Patient Safety Institute

General information

Name of transfer payment program

Contribution to the Canadian Patient Safety Institute (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

The Canadian Patient Safety Institute (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. CPSI received grant year funding via five year grant agreements from 2003-2013. The five-year contribution agreement began on April 1, 2013 has been extended to March 31, 2020.

Results achieved

In 2019-20, key results achieved by CPSI included:

• Continued progress for Patient Safety Right Now, CPSI's 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 successful conclusion of the first stage 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. They are now working to spread the successful improvements to other health care facilities.
• The launch of CPSI's policy framework, Strengthening Commitment for Improvement Together: A Policy Framework for Patient Safety. It is focused on how policymakers, healthcare leaders, administrators and providers, can use five policy levers (legislation, regulations, standards, organizational policies and public engagement) to improve patient safety.
• Finalized the Canadian Quality and Patient Safety Framework for Health Services, a Health Standards Organization-CPSI collaboration. This framework was developed by HSO/CPSI with input from experts, patients, providers, researchers and Indigenous peoples. The long-term goals of the framework are: describing overarching principles and goals for safe, high quality health services in Canada; focusing policy, action and resources that improve experience and outcomes from health services; enhancing collaboration of stakeholders around common goals; reducing care variations across different communities.
• Held Canadian Patient Safety Week 2019, 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. In addition, CPSI led the Canadian celebration of the first World Patient Safety Day, as designated by the WHO.
• During Canadian Patient Safety Week, CPSI launched their new public engagement campaign, "Conquer Silence". This campaign aims to reduce systemic silence, defined as silence between patients and providers, between colleagues in healthcare facilities, between administrators in different regions, and between the public and policymakers. 'Conquer Silence' has been a success since its launch halfway through 2019-20, generating: 25 CBC Radio interviews with over 2,100,000 listenership, over 158,000 visits to the Conquer Silence microsite, 6,800 plus clicks to listen to patient safety stories at ConquerSilence.ca and nearly 1,000 broadcasts of recordings on radio stations across the country, with over 92 million impressions.
• 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. Their notable successes included meeting with senior officials (including some ministers) in five provinces, where they presented patient safety policy asks, as well as co-leading the redevelopment of ISMP's consumer medication safety reporting system.
• 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 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Health Canada officials continued regular engagement with CPSI senior staff and program officers to ensure the CPSI contribution agreement is managed in an appropriate and efficient manner. 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 (Voted)

Start date

April 1, 2000

End date

Ongoing

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 12: Blood System, Organs, Tissue and Transplantation

Description

The Canadian Blood Services: Blood Research and Development (CBS - Blood R&D) Program helps maintain and increase the safety, supply and efficiency of the Canadian blood system by advancing innovation and maintaining Canadian capacity in transfusion science and medicine. The program pursues these goals by fostering relevant discovery and development research, facilitating dissemination and application of knowledge, educating the next generation of scientific and health care experts, and engaging with an interdisciplinary network of partners in Canada and beyond.

Results achieved

Blood research and development

In this context, "blood" includes whole blood and blood products, plasma and plasma products and their respective artificial and substitute products.

Under its blood research and development component, 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.

The Program's research network published 122 peer-reviewed and 67 non peer-reviewed publications and delivered over 385 conference presentations worldwide. The average h-index, a measure demonstrating the significance and impact of published work, was 33 for CBS research staff, an increase over the prior year and over three times the average h-index (10.6) for Canadian academic science authors. Canadian Blood Services (CBS) held eight major education events for specialists in transfusion science and medicine and attracted 2,869 professionals. Various stakeholders used the knowledge generated by R&D projects to inform changes to practices and standards in blood. Under the Men who have Sex with Men (MSM) Research Grant Program, 19 research projects, including 4 projects funded for MSM Plasma, were funded that will end by spring 2020.

With blood research investments, one of the 19 funded projects contributed to the blood operators' submissions to Health Canada to reduce the deferral period, from one year to three months, for blood donation from MSM. The change was authorized by Health Canada on April 20, 2019, and implemented on June 3, 2019. This MSM deferral period aligns with the three-month deferral period for MSM in England, Scotland, Wales, the United States and Australia.

A Knowledge Synthesis Forum was held in November 2019 to discuss preliminary findings of the blood research, which targets MSM attitudes toward donation, the impact of question sequence, and remaining research gaps.

In 2019-2020, CBS started to work with Héma-Québec (H-Q) to align business development frameworks that will define all elements of the MSM-Plasma stream and guide its development. Outcomes for the blood and plasma R&D investments include advancing knowledge on the feasibility of MSM plasma donation in Canada; applying knowledge to inform changes in CBS and H-Q plasma donor policies; and, more broadly, reducing barriers to MSM plasma donation if feasible, while maintaining the safety of blood and manufactured plasma products for Canadians.

Organ and Tissue Donation and Transplantation

With the support of the CBS - Blood R&D Program, the contribution of CBS to the organ and tissue donation and transplantation (OTDT) system involves working with partners and stakeholders to influence and improve system performance through development and implementation of leading practices, professional and public education, engagement and awareness, data and analytics services and system performance reporting.

Under the OTDT component of the Program, CBS hosted in collaboration with Trillium Gift of Life Network and Canadian Donation and Transplantation Research Program, a Deceased Organ Donation Symposium at the 2019 Canadian Critical Care Forum. Highlights of this year's symposium include sessions on the complexities of organ donation after circulatory death and medical assistance in dying. The symposium had over 200 attendees. In advance of the Forum and in partnership with Trillium Gift of Life, a donation physician masterclass was delivered to over 60 attendees, focusing on the complexities of donation after circulatory death and the standardized withdrawal of life sustaining measures.

Two additional leading practice initiatives included hosting a national forum on Advancing Living Donation, to understand how the clinical community can do a better job of helping transplant candidates initiate a search and identify a living donor as early as possible in their disease progression, and a national consensus forum with the aim of improving access to cornea donation and transplantation for patients in Canada.

In partnership with all organ donation organizations in Canada and organ donation and transplantation stakeholders, CBS leads a multi-year collaborative process to develop a national, peer-reviewed curriculum that includes multiple education modules informed by leading practices, along with an e-learning and evaluation platform for training health professionals. Currently 2 modules are distributed. To date, more than 315 practitioners working in the field have enrolled in these courses.

In 2019-20, public awareness activities included national campaign planning and the development of easy to use awareness toolkits for National Organ and Tissue Donation Awareness Week (NOTDAW) and Green Shirt day and two social media awareness campaigns focused on living donation. In support of these initiatives a number of tactical information pieces were developed including:

• a video featuring a couple that participated in the Kidney Paired Donation program;
• brochures on living kidney donation and paired exchange (in 10 languages, including 3 Indigenous languages);
• a new web site content including donor and patient stories, and information on living donation and kidney paired donation.

CBS also hosted over 22 screenings of "Her Last Project", the story of Dr. Shelly Sarwal, a physician from Halifax who was diagnosed with an incurable disease. Shelly chose Medical Assistance in Dying and wished to become an organ donor. The screenings reached over 1,200 donation and critical care professionals. "Her Last Project" is a powerful tool for professional awareness and catalyst for the implementation of the Organ Donation and the Conscious Competent Patient guidance policy. Four screenings of "Her Last Project" were open to the public. They were attended by approximately 500 people.

CBS works with their partners and stakeholders to develop, operate, and evolve the national programs to facilitate the sharing of organs across provincial boundaries using the Canadian Transplant Registry. Using this registry, CBS is leading the implementation of a project to develop and implement national policies and processes to efficiently share hearts for hard to match patients inter-provincially. This will improve equity of access for hard to match patients. In October 2019, the project met its first major milestone, implementing functionality that quickly identifies potential matches. This project remains on track for full implementation in 2021.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

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

Engagement of applicants and recipients in 2019–20

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CBS program staff and senior management to discuss program progress. In addition, Health Canada continues to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting. CBS staff are also members of the Organ Donation and Transplantation Collaborative. A workshop of the Collaborative was held in collaboration between Health Canada and CBS in December 2019.

Official Languages Health Program

General information

Name of transfer payment program

Official Languages Health Program (Voted)

Start date

June 18, 2003

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

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 Official Languages Health Program (OLHP) has a total budget of $191.2 million over five years (2018-2023), and $38.46 million per year ongoing after 2023. The Program supports the federal government's commitment to maintain a strong and effective publicly funded health care system by ensuring that official language minority communities (OLMCs) have access to bilingual health services in their communities. Through the implementation of contribution agreements and micro-grants, Health Canada supports investments that improve access to health care services for OLMCs, in the language of their choice through training and retention of bilingual health care providers, networking activities and innovative projects in priority areas, such as home care, mental health, palliative and end-of-life care.

Results achieved

In 2019-20, Health Canada supported a range of initiatives through the OLHP. The impacts of these initiatives included: increased 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 2019-20, the OLHP supported various training and retention initiatives to increase the availability of bilingual health professionals and improve access to services in OLMCs. For example:

• Outside Quebec, the 16 member institutions of the ACUFC-CNFS recorded 1,095 additional registrations and 712 graduates (81% graduation rate) from 108 health training programs.
• In addition, according to the survey conducted in the first half of 2020, 96% of the health professional graduates surveyed declared having acquired the knowledge and skills necessary to work in OLMCs. Also, 88 % of these graduates were employed in OLMCs, which made it possible to increase the human resources available to meet the health needs of Francophone minority communities. It should also be noted that 96% of them reported offering services in French at work.
• In Quebec, McGill University has enrolled more than 1,636 health and social services professionals in its language training program. A total of 1,229 health professionals have successfully completed their language training, a success rate of 75%. In addition, 11 networking and partnership initiatives joined forces with their health and social services partners to organize dialogue / lunch-and-learn activities for health professionals and French-speaking social services, participating in language training, in order to strengthen the skills acquired in English.

Overall, these initiatives resulted in an increased number of health service providers who can offer appropriate services to Anglophones and Francophones minority communities in their language of choice.

Strengthening and improving local health networking capacity in OLMCs

In 2019-20, 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 the 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:
  • Produced and disseminated a series of provincial and regional socio-demographic portraits of Anglophone health care needs in the province to inform the planning, development and implementation of initiatives to meet their needs and strengthen the effectiveness of the health care system.
  • Continued to collaborate with staff from 19 Integrated Health and Social Services Centers and Integrated University Health and Social Services Centers to improve access to English-language health and social services in the province.
  • Supported the establishment of access committees and the implementation of programs to access health and social services in the English-speaking community of Quebec in the English language.
• Outside Quebec, through its activities and partnerships, the SSF:
  • Developed and implemented a health human resource-planning tool that captures linguistic capacity (the OZI portal). The tool is being used in Ontario, Manitoba and Yukon. Other jurisdictions (Prince Edward Island (PEI), Saskatchewan, and Newfoundland and Labrador) are interested in its implementation as well.
    • In Manitoba, the data captured by the OZI tool was submitted to the Manitoba Francophone Affairs Secretariat, in order to determine the next steps related to health human resource planning. This approach will allow the Manitoba Department of Health to identify and implement the provincial mechanisms necessary to identify the linguistic variable and collect evidence (e.g., health card, electronic medical record) to meet the needs of Francophones living in the province.
    • In collaboration with the Eastern Ontario Health Network and the Yukon Health Network, the SSF presented the OZI tool to many stakeholders including Yukon's Health and Social Affairs Department. Subsequently, the province integrated OZI as a human resources management tool not only for the French language services within the Department of Health but also in all Yukon departments.
  • Signed an agreement with the "Association francophone de l'âge d'or" in PEI and the Foyer Beach Grove to increase access to French services for seniors in the province. This agreement made it possible to recruit 35 volunteers from long-term care establishments, who are now registered in the directory and identified as being able to offer services in French.

Projects to improve access to health services for OLMCs

In 2019-20, Health Canada funded innovative projects to improve the availability of bilingual health professionals to address the needs of OLMCs. For example:

• In Quebec, 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 6 research projects, including:
  • A project which aims to assess the effectiveness of language-sensitive mental health interventions for allophone migrants suffering from anxiety and/or depression, who receive care in English in a real clinical setting at the Center for Clinical Health Research (CCHR) newly created at Concordia University. In addition, the project aims to identify specific communication problems that may arise in psychotherapy in the event of a therapist-client language mismatch, to provide more informed and competent tools to health practitioners working in a linguistically discordant environment, and in which French and English are the languages of care.
  • A project which aims to develop a better understanding of the challenges, stressors and better strategies implemented by palliative care providers, with regard to care for the English-speaking population in contexts where resources in English are limited or may not be readily available. The project also aims to make English-speaking Quebecers better understand the provisions of the Health and Social Services Act with regard to palliative and end-of-life care in Quebec and thereby contribute to their better access to palliative care and to the range of the continuum of services.
• Outside Quebec, through its 16 networks and associated partners, the SSF undertook projects 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:
  • In Southern Ontario, as part of the Welcoming Community 2.0 project and the activities of the FrancoDoc liaison committee, the SSF and the Ontario-South Network, collaborated with various stakeholders including, the Schulich School of Medicine & Dentistry, Western University, a French-Language Health Services Planning Entity Erie - St. Claire and the Association of Medicine Faculties of Canada. This collaboration led to identifying 32 first year medical students and 3 bilingual surgeons and paired them with representatives of the local Francophone community with a view to potentially recruiting them. This initiative is a good example of the positive impact generated by targeted collaborative efforts to improve access to health care in the language of choice of OLMC members.
  • Also, through the collaborative leadership of SSF, in PEI, the program "Caring for older adults in the community and at home (COACH)" now identifies its French-speaking clients and service providers to facilitate matchmaking and obtaining a better understanding of their specific needs.
• In addition, the CNFS completed 37 research projects on the following themes: understanding emotions in young Francophone children; training Francophone health professionals; improving health services in French; health management by Francophone communities; and data on Francophone community health. These research results informed 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 OLHP launched an open call for proposals to improve access to health care in OLMCs in the department's priority areas, namely, mental health and addiction care, home and community care and palliative care. Of the 112 letters of intent received, thirteen were recommended to proceed to the full application stage, and eight projects were ultimately recommended for funding. contribution agreements have been concluded and activities for these projects are currently underway. Funded projects include:
  • The Saskatchewan Health Authority is working to establish a partnership with Tel-Aide Outaouais to provide mental health support in French to Francophone residents of Saskatchewan. It will also increase the active offer of French-language services in home care, mental health and palliative care through the implementation of a health human resources planning tool that allows the efficient distribution / deployment of French-speaking providers throughout the province's health system to better meet the needs of OLMCs.
  • Health PEI is assessing the need for home care services in French in rural and urban areas in order to plan and implement a strategy that would allow access to appropriate care, by the right provider in the right environment for members OLMCs. It will also seek to provide safe, quality, person-centered home care in order to optimize resources and processes to support a viable health care system that takes language barriers into account.
  • The Jeffery Hale-Saint Brigid Hospital is developing a real-time database model to assess the needs for home care / home support and shelter accommodation for the elderly in order to better assess the needs and effectiveness of the health and social services system. The data and tools developed will help locate customers who need services and identify their needs to match them with existing services.
  • In addition, in August 2019 the OLHP launched a call for micro-grants in order to mobilize different actors in the promotion of compassionate communities that support those at the end of life (and their families). A total of 13 proposals were received for 2019-20, 10 of which met the eligibility criteria and the applicants received $ 1,000 each in grants.

It is expected that these initiatives will further improve access to health care services that take into account the specific needs and priorities of patients (targeted areas) living in OLMCs in Canada.

Findings of audits completed in 2019–20

In 2019-20, Deloitte LLP was retained to conduct the audit of fiscal year 2017-18 of the ACUFC and McGill University, two recipients of the OLHP.

The audits assessed the overall management of each recipient's Contribution Agreement. For the ACUFC, the audit indicated the need to recover an amount of $985 and the OLHP will follow-up with the ACUFC to recover the amount. No recovery is needed for McGill.

Opportunities for improvement identified by the auditor for the ACUFC were the need to put in place systems to formalise the approval of salary increases; better monitoring of the allocation of working hours by staff; ensuring taxes on inputs purchased outside of Ontario reflect the correct tax rate; providing different accounting credentials to people responsible of the accounting system; and, ensuring all numbers in the general ledger match financial reports. For McGill University, the auditor indicated the need to ensure that financial reports are provided on time and that unspent funds be signalled to Health Canada in advance of the end of the fiscal year to provide enough time to reallocate them. In both cases, the OLHP will ensure that robust processes are implemented to ensure proper monitoring of expenses on a timely basis as per the recommendations of the audit.

In 2019-20, the OLHP also continued to carry out site visits to ensure that funding is spent effectively and that stakeholder organizations are achieving expected outcomes in compliance with contribution agreements and terms and conditions.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

Planned: The next evaluation of the 2018-2023 Canada's Official Languages Action Plan: Investing in our future, including the OLHP, is scheduled for 2021-22.

Engagement of applicants and recipients in 2019–20

In 2019-20, representatives of Official Languages Community Development Bureau 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.

Also, 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 2019-20, the committee met in May to discuss priority issues in the Health Portfolio, such as OLMCs data collection and analysis to overcome current limitations. Committee members include Health Canada, the Canadian Institutes of Health Research, the Public Health Agency of Canada as well as targeted recipients under the OLHP, including the SSF, CNFS, CHSSN and McGill University.

Canada Brain Research Fund Program

General information

Name of transfer payment program

Canada Brain Research Fund Program (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 Budgets 2011 and 2016, the Government of Canada committed up to $120 million in matched funding with non-federal government donors, to establish the Canada Brain Research Fund 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 Canada Brain Research Fund was: 1) to serve as a focal point for private investment in brain research by attracting private and charitable donations to match federal funding; and 2) to support research that advances knowledge of the brain through grants to researchers. Notably, the program was renewed through Budget 2019 following the period covered by this report with the commitment of an additional $40M over 2 years beginning in 2020-21.

Results achieved

The Canada Brain Research Fund (CBRF) supported research leading to scientific discoveries that are essential to advancing therapies and approaches to improve the health and quality of life of Canadians at risk of or affected by brain health conditions. To this end, the Recipient, in partnership with a range of donors from across the private and charitable sectors, provided competitively-awarded funding for research across Canada. In 2019-20, Brain Canada partnered with various institutions, health charities and donors, research networks, provincial agencies and corporations, to raise $13.6 million in funds to match the federal contribution and also to disburse over $28 million to 119 research grants and awards.

To capture the breadth of possibilities that can spur innovation, the CBRF supported projects ranging from basic and fundamental research to clinical trials, interventions, and implementation research. Grants in all project categories are intended to accelerate transformative research toward improved understanding of nervous system function and dysfunction and their impact on health. In 2019-20, 8% of funding disbursed was invested in basic research, resulting in the completion of 21 projects that lay the foundations for longer-term health care improvements. In one prominent example, researchers explored a potential new avenue for treating Parkinson's disease by boosting the energy-efficiency of implicated cells, which may be vulnerable to stress and damage because they often function at a burn-out level. In addition to basic research, 75% of funding disbursed in 2019-20 supported 32 translational and clinical research projects that set the stage for more tangible advancements such as new treatments, devices, and early detection/diagnosis practices. One example resulted in the development of a new retinal scan that could allow for earlier detection and diagnosis of Alzheimer's disease. The remaining 17% of funding in 2019-20 supported projects related to knowledge translation to shape future research priorities and advance the implementation of ideas.

Perspectives and experiences of members of diverse populations, such as individuals with lived experience of neurological and mental health conditions, are being increasingly considered in Brain Canada's work. For example, in March 2020, Brain Canada held a Youth Mental Health workshop attended by 40 participants including youth, practitioners and care providers, researchers, non-profit and charitable organizations, and private sector representatives. The participants formulated funding priorities in the area of youth mental health to inform Brain Canada's upcoming research competitions.

Since the inception of the program, Brain Canada has demonstrated its continued commitment to developing the next generation of Canadian researchers and supporting trainees and early-career researchers. Since 2011, the program has supported more than 500 PhD students and postdoctoral fellows. To meet its goals over the past year, the CBRF disbursed over $6 million in capacity-building grants. Further, in November 2019 Brain Canada launched the 2019 Future Leaders in Canadian Brain Research Program, which was open to all researchers within five years of their first independent academic appointment conducting research in the field of neuroscience.

Brain Canada plays a convening role within the research community, bringing research stakeholders together to discuss and advance key priorities. Projects undertaken through the CBRF since its inception, including over the past year, connected over 75 disciplines involving more than 1,000 researchers at 115 institutions across Canada. Brain Canada builds cohesion through the alignment of over 100 funding and research partners and engagement with an array of stakeholders. Brain Canada's collaborative work has successfully informed and influenced the research agenda, as demonstrated through more than 35,000 citations of CBRF-funded publications in Canada and internationally.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

Planned: The next evaluation is scheduled for 2021-22.

Engagement of applicants and recipients in 2019–20

Brain Canada participated in engagement opportunities with other recipient organizations to advance and share knowledge on the implementation of best practices in performance measurement, knowledge translation, and sex, gender and diversity analysis.

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 had regular correspondence with senior management of the organization.

Canadian Thalidomide Survivors Support Program

General information

Name of transfer payment program

Canadian Thalidomide Survivors Support Program (Voted)

Start date

March 22, 2019 (replaced the Thalidomide Survivors Contribution Program, which started in 2015)

End date

Ongoing

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 1: Health Care Systems
• Program 15: Thalidomide

Description

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

1. receive ongoing tax-free payments based on their level of disability; and
2. have transparent and timely access to the Extraordinary Medical Assistance Fund.

Results achieved

The Canadian Thalidomide Survivors Support Program (CTSSP) supported 120 confirmed survivors as of March 31, 2020.

Ongoing tax-free payments were distributed to 100% of known thalidomide survivors. 100% of payments were made before the end of April 2019, as per the time frame service standard of the independent third-party administrator.

The independent third-party program administrator processed 24 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.

The application period for the CTSSP launched June 3, 2019 and will remain open for five years, closing June 3, 2024. While no new survivors were confirmed in 2019-20, 132 applications were submitted to the program and are being assessed.

Outreach data for 2019-20 showed that 88% of thalidomide survivors who responded to the survey said that the CTSSP is helping them age with dignity, which aligns with the purpose of the program.

Findings of audits completed in 2019–20

Not Applicable

Findings of evaluations completed in 2019–20

Completed: Evaluation of the Thalidomide Survivors Contribution Program 2015 to 2019^{Footnote 1}

Summary of Findings:

Overall, the evaluation found that the program made a notable contribution to help thalidomide survivors age with dignity and access care, treatment, and support. More than half of the thalidomide survivors surveyed reported having peace of mind, as the program's benefits have provided them with improved financial stability. Respondents whose needs were not met by the program reported that the financial assistance provided could not fund the full costs of massage or physiotherapy treatments, nor could it fund the full costs of the health care supports they require. The evaluation also found that the program was delivered efficiently in a relatively short timeframe, with low administrative costs. Continued monitoring of variance between budgeted and actual expenses for the new program was identified as an area for consideration moving forward, as was maintaining the annual survey of thalidomide survivors conducted by a third-party administrator to monitor trends on the challenges faced by thalidomide survivors.

Planned: The next evaluation is scheduled for 2024-25.

Engagement of applicants and recipients in 2019–20

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

The Thalidomide Victims Association of Canada, a key stakeholder, participated in meetings with the independent third-party administrator and Health Canada 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, e-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 (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: The Territorial Health Investment Fund

Description

Building on an initial investment of $70 million (2014-15 to 2017-18), which flowed as contribution funding, the Territorial Health Investment Fund (THIF) was renewed as a grant program in 2017-18 with an additional $108 million over four years (2017-18 to 2020-21). Of this funding, $54 million was allocated to Nunavut, $28.4 million to Northwest Territories and $25.6 million to Yukon. This funding has enabled each territory to continue pursuing innovative activities in support of strong, sustainable health systems and to offset costs associated with medical travel to support Northerners' access to the health care they need.

The use of grant agreements rather than contribution agreements for the new investment minimizes the administrative burden on territories associated with participating in the program.

Results achieved

Funding provided through THIF in 2019-20 continued to offset the medical transportation costs experienced by territorial governments and supported the development and implementation of innovative activities intended to transform territorial health systems. For instance, in 2019-20:

• The Northwest Territories piloted a new cultural competency training program for its staff, and delivered 10 pilot training sessions as of January 2020 (with more planned). Key learnings from this phase will inform the final training model. In the area of oral health, it celebrated April 2019 as Oral Health Month with a territory-wide promotion that included a poster campaign and a set of school activities. To improve oral health delivery, oral health screening, assessment and anticipatory guidance was added to the Prenatal Record Users Guide for integration into prenatal primary health care practice.
• Yukon launched a comprehensive review of health and social services provided across the territory to identify areas of improvement and for increased efficiency. It also continued to focus on the development of collaborative care delivery models, including the implementation of four hub-based service delivery models that provide access to a comprehensive array of providers. In November 2019, 1Health Yukon was launched. This integrated health information system will allow Yukon's authorized health practitioners across the continuum of care to be instantly and securely connected throughout the territory.
• Nunavut expanded its tuberculosis program, including staffing five new positions (such as a tuberculosis epidemiologist) and providing paediatric care. Other efforts in this area included the development of an innovative clinical care model, and a tuberculosis database that will allow for better monitoring and surveillance. In the dental program, the community oral health program continued, with 20 Community Oral Health Coordinator positions filled in March 2020. Work also continued to increase the number of local Inuit paraprofessionals working in the territory.

Findings of audits completed in 2019–20

Completed: No audit was completed in 2019-20.

Planned: Not applicable.

Findings of evaluations completed in 2019–20

Completed: No evaluation was completed in 2019-20.

Planned: Not applicable.

Engagement of applicants and recipients in 2019–20

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 continued to meet the objectives and intent of the initiative; sharing best practices and collaborating on policy and management approaches. They will work to develop a Progress Report in 2020-21.

Horizontal Initiatives

Addressing the Opioid Crisis

Canadian Drugs and Substances Strategy

Chemicals Management Plan

General information

Name of horizontal initiative

Chemicals Management Plan

Lead department

Health Canada

Environment and Climate Change Canada

Federal partner organization(s)

Public Health Agency of Canada

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) was designed to address substances of concern in Canada to protect human health and the environment.

Jointly managed by Health Canada and Environment and Climate Change Canada, 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 relies on authorities set out in 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.

The third phase (CMP3) includes both substance groupings and single substance assessments. Similar to CMP2, groupings are created where possible to gain efficiencies in the assessment process. Where groupings are not possible, single substance assessments are conducted.

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

The same core functions that have been part of phases one and two continue in phase three 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 Environment and Climate Change Canada 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 Environment and Climate Change Canada Deputy Ministers.

The CMP ADM Committee is supported by a Director General (DG) Committee. The CMP DGs Committee consists of DGs from all partner programs within Health Canada and Environment and Climate Change Canada, 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

Total federal planned spending to date (dollars)

$1,209,522,110

Total federal actual spending to date (dollars)

$1,169,292,888 (includes Phases I, II and Phase III)

Date of last renewal of the horizontal initiative

October 2014

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

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

Additional federal funding received after the last renewal (dollars)

Not applicable

Total planned spending since the last renewal

$394,629,160

Total actual spending since the last renewal

$393,207,740

Fiscal year of planned completion of next evaluation

Not applicable as the CMP program is scheduled to sunset in March 2021. The last evaluation was completed in 2019-20.

Performance highlights

Summary

In 2019-20, 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. New substance notifications were also 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 as well as 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 2019-20, Health Canada continued developing and publishing drinking water quality guidelines. 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 to inform risk assessment and risk management activities and to address outstanding questions and knowledge gaps related to the effects and exposure of chemical substances to humans.

Compliance promotion strategies and enforcement plans were also developed and delivered for CMP substances. The focus in 2019-20 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, the Healthy Home social marketing campaign on chemicals and pollutants in and around the home, which was launched in late 2018-19, was actively rolled out in 2019-20 and promoted through a combination of Health Canada and digital influencer social media, national media (print and radio) and in-person events across the country. The 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.

The most recent evaluation found that the CMP had made progress in all functional activity areas, including risk assessment, risk management, stakeholder engagement and public outreach, research, monitoring and surveillance, and compliance and enforcement. The evaluation concluded that there was some evidence of Canadians and stakeholder groups accessing and using CMP information to avoid or minimize risks posed by harmful substances, as well as some evidence demonstrating industry compliance with certain risk management measures. There was limited evidence to support conclusions about whether the CMP had reduced the potential for exposure to harmful substances, although biomonitoring and environmental monitoring trend data is beginning to emerge.

Performance Details

Risk Assessment/Risk Management

In 2019-20, ECCC and HC published 28 Draft Screening Assessment Reports (dSARs) (representing 253 substances) and nine Final Screening Assessment Reports (fSARs) (representing 35 substances).

In 2019-20, HC's Pest Management Regulatory Agency (PMRA) completed three proposed re-evaluation decisions (risk assessment) for consultation on old pesticides (those registered prior to 1995), seven cyclical re-evaluations (those registered after 1995) and three special reviews. The planned publication of six proposed decisions in March 2020 were delayed as a result of the COVID-19 pandemic.

In 2019-20, HC's PMRA completed four re-evaluation decisions for older pesticides (those registered prior to 1995). Eight final decisions for cyclical re-evaluations and one special review were also completed. One older pesticide re-evaluation decision and three cyclical re-evaluation decisions on the published re-evaluation and special review work plan were also completed ahead of schedule.

Targeted risk management activities were published in 2019-20 for substances that were deemed harmful to human health and/or the environment. In total, there were seven risk management instruments put in place to manage more than 64 toxic substances, including six proposed risk management instruments and one final risk management (RM) instrument. Eight RM Scope documents and three RM Approach documents were also published, covering more than 174 substances.

In 2019-20, ECCC and HC collaboratively developed and finalized a Performance Measurement Evaluation Strategy on the Risk Management of Toxic Substances, in response to the Commissioner for the Environment and Sustainable Development's 2018 audit. The Strategy details the approach to performance measurement, including the selection of substances, expected results and how information will be shared with Canadians. Over time, implementation of the Strategy is expected to provide Canadians with greater confidence in ECCC and HC's efforts to manage toxic substances.

In 2019-20, 409 new substance notifications were received pursuant to section 81 of CEPA and the New Substances Notification Regulations (Chemicals and Polymers) and 379 were assessed. Seven Notices were published applying the Significant New Activity (SNAc) provisions to seven substances; seven Ministerial Conditions came into force on five new substances. Three SNAc Notices of Intent (NOIs) were issued for existing substances on a total of 111 substances.

During 2019-20, 27 notifications of new animate products of biotechnology were received and 18 were assessed under the New Substances Notification Regulations (Organisms). While no SNAc Notices or ministerial conditions were issued for new living organisms in 2019-20, an NOI proposing to apply the SNAc provisions to two existing living organisms was published.

HC also contributed to risk management activities related to drinking water quality in 2019-20, publishing 10 final and four draft Guidelines for Canadian Drinking Water Quality online. These are used by all jurisdictions in Canada to inform their regulatory requirements.

The Consumer Product Safety Program (CPSP) continued to manage potential risks related to chemicals in consumer products and cosmetics. The program completed its cyclical enforcement projects for eight product groups, which included 174 inspections and 180 samples, leading to 23 recalls. Program risk assessors and risk managers drafted two dSARs (parabens, and lotus corniculatus) that were published in 2019-20, as well as authored two dSARs (Sucrose Acetate Isobutyrate and triclocarban) and one FSAR (talc) which are planned to be published in 2020-21. Moreover, CPSP provided cosmetic notification data to support the assessment for a number of CMP substances. The Product Safety Laboratory developed methods and completed a survey to quantify chloro-phosphate flame retardants in consumer products. The lab also completed two surveys to identify chemical compositions to support the risk assessment of consumer products and chemicals (diethanolamine (DEA)/cocamide DEA and terpenes and terpineol oils).

The Health Products and Food Branch 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.

The Healthy Environments and Consumer Safety Branch (HECSB) and the Regulatory Operations and Enforcement Branch (ROEB) of HC continued to develop Human Health Soil Quality Guidelines to support the development of Canadian Council of Ministers of the Environment (CCME) Canadian Soil quality Guidelines for the Protection of Environmental and Human Health. Guidelines for perfluorooctane sulfonate (PFOS) and lead were finalized and submitted to CCME for publication and public review. HECSB and ROEB are also developing Soil Screening Values for a suite of energetic substances.

Stakeholder Engagement and Public Outreach

Stakeholder engagement activities delivered in 2019-20 focussed on targeted stakeholders in order to facilitate information sharing. The CMP Stakeholder Advisory Council (SAC) held one meeting in 2019-20. 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. A vacancy on SAC was filled in 2019-20 with an occupational health specialist. A multi-stakeholder meeting was also held in 2019-20 to allow for a broader representation of interested stakeholders to participate in consultations on current and future CMP topics.

The CMP Science Committee 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 Science Committee met in June 2019 to discuss the topic "New Approaches for Integrating Chemical Fate and, Spatial and Temporal Scales in Exposure Assessment" and in February 2020 to discuss the topic "Considerations for Identifying Potential Risks from Exposure to Chemicals in the Workplace."

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.

Building upon the previous year's launch of the Healthy Home campaign, social media posts on Facebook and Twitter were issued throughout the year to provide Canadians with tips on how to protect their families from chemicals and pollutants within the home. The Department partnered with parenting digital influencers to further promote the Healthy Home campaign and spread the message about household chemical risks and how parents can protect their families. Social media posts on Facebook and Twitter were issued throughout the year to inform Canadians of CMP assessment results in plain language for high profile substances of concern.

Public outreach activities (e.g., trade shows, workshops, learning events, etc.) were conducted across the country 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, more than 20,000 Canadians attended such events, including numerous healthcare professionals and early childhood educators who act as influencers and further disseminate environmental health information through their professional networks. Parents, new Canadians and Indigenous Peoples were also among the attendees, providing important representation from vulnerable populations.

Public outreach activities continued to be enhanced through the development of new outreach tools using a variety of technologies such as Virtual Reality and video animation. HC Regional Offices also began work on initiatives to explore alternative, virtual delivery formats to replace in-person workshops and learning events.

Research

Research at HC 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 2019-20, one targeted research project was carried out to address short-term data needs for risk assessment to help meet 2020 CMP commitments. In addition, 30 research and monitoring and surveillance 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 and monitoring and surveillance projects were used to support the publication of eight DSARs.

At ECCC, 19 new research projects were initiated in fiscal year 2019-20. These projects will generate new knowledge to support risk assessment and risk management decision-making on priority substance, such as perfluoroalkyl carboxylic acids (PCFAs) and perfluoroalkane sulfonates (PFSAs), Organic Flame Retardants, selected Rare Earth Elements, metals mixtures, textile mill effluents, benzophenones and nanomaterials.

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 20 substances and/or groups of substances were measured in select media: fresh water, sediments, fish, bird eggs, ambient air, municipal wastewater, and biosolids.

At HC, 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, a follow-up study called MIREC-ENDO started to study the effects of prenatal exposure to environmental chemicals on puberty and metabolic function in the child, as well as maternal health. In 2019-20, 277 MIREC families were recruited to take part to the MIREC-ENDO study. The goal is to recruit 1,000 MIREC families by March 2021.

In summer 2019, a study was conducted to generate biomonitoring data from DEET, a common name for N,N-Diethyl-m-toluamide, an active ingredient in personal insect repellents, used by children in a camp setting. This study complements other HC studies that measure chemical exposures in children from typical use, will provide a better understanding of Canadian children's exposure to DEET, and will inform any future recommendations.

In November 2019, the Fifth Report on Human Biomonitoring of Environmental Chemicals in Canada was released providing human biomonitoring results from cycle 5 of the Canadian Health Measures Survey (CHMS). The report included data for 99 environmental chemicals (e.g., alternate plasticizers, pesticides, and VOCs) in samples collected from approximately 5,800 Canadians between the ages of three and 79 years at 16 sites across Canada in 2016-17. The report provides important new knowledge to our understanding of Canadians' exposure to chemicals, including measurements of bisphenol A (BPA), metals, plasticizers, parabens, perfluoroalkyl substances and pesticides. In addition, sample collection for cycle 6 of the CHMS was completed in December 2019, and a project was initiated to analyze CHMS biobank samples to meet near-term data needs of stakeholders. Both ECCC and HC contribute to the Northern Contaminants Program (NCP) led by Crown-Indigenous Relations and Northern Affairs Canada. Four human biomonitoring and health project proposals were funded in 2019-20 under the NCP.

Information Gathering

HC and ECCC continue to conduct information gathering activities with industry to understand commercial use, import and manufacture of chemical substances, which help to inform prioritization, risk assessment, risk management, and performance measurement. The CMP information gathering approaches have evolved over time to include a range of mechanisms from the use of voluntary approaches and alternative data sources to targeted approaches. In 2019-20, voluntary surveys were conducted for Methylethyl ketone oxime (MEKO)/Ethyl Benzene to inform the performance measurement of the MEKO code of practice and to determine if SNAc provisions are needed for ethylbenzene. Additionally, a voluntary survey was conducted for Alkylbenzene sulfonates (ABS) and their derivatives to inform risk assessment activities.

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 913 inspections related to CMP regulations and issued 229 enforcement measures.

In 2019-20, compliance promotion activities were carried out for regulatory and non-regulatory instruments related to CMP substances. 11,414 known or potential regulatees received compliance promotion awareness materials and 6,132 stakeholders contacted compliance promotion officers for clarification of regulatory requirements and/or additional information.

Public Health Agency of Canada

During 2019-20, 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. The Agency conducts 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.

Ninety-six percent (96%) of conveyance and facility operators successfully met public health requirements during or in response to 332 inspections. The number of inspections completed compared to previous years was reduced as a result of a shift in focus of Agency activities towards the COVID-19 response, In addition to completing inspections and providing guidance to partners and stakeholder groups, EHOs have provided emergency services and support in response to the COVID-19 global pandemic.

Contact information

Health Canada

Suzanne Leppinen
Director, Chemicals and Environmental Health Management Bureau
Healthy Environments and Consumer Safety Branch
Suzanne.Leppinen@canada.ca
613-941-8071

Environmental and Climate Change Canada

Thomas Kruidenier
Acting Executive Director, Program Development and Engagement
Science and Technology Branch
Thomas.kruidenier@canada.ca
819-938-5086

Christina Paradiso
Executive Director, Chemicals Management Division
Environmental Protection Branch
Christina.Paradiso@canada.ca
819-938-4590

Shared Outcomes

Performance information

Horizontal initiative overview

SO-AR1: Over the duration of the CMP, significant investments have been and continue to be made towards measuring the final outcome in a meaningful manner. Specific to 2019-20, and building on the biomonitoring surveillance data collected as part of the Canadian Health Measures Survey (CHMS), a retrospective public health focused pilot project has been developed with Statistics Canada. The pilot project will begin in 2020 with the goal to identify potential temporal trends in all 201 substances that were studied in the five cycles of the CHMS by linking biomonitoring data with critical health and diagnostic information from provincial medical records. Preliminary analysis is expected to be completed by end of the 2020-21 fiscal year.

SO-AR2: Work is ongoing to monitor the extent to which the Program's risk management activities are reducing the potential for exposure to harmful substances. In 2019-20, a Performance Measurement Strategy for the risk management of toxic substances was developed, which will be used to determine whether risk management actions have collectively met substance specific objectives. The evaluations for performance were also completed for Bisphenol A, Polybrominated Diphenyl Ethers (PBDEs), Lead, Mercury, Isoprene, Pigment Red 3 and MEKO.

Theme 1 horizontal initiative activities

Expected results

Health Canada

• ER 1.1 Information on risks of substances to inform risk management, monitoring and surveillance and research activities.
• ER 1.2 Risk management measures under CEPA, PCPA, CCPSA and F&DA.
• ER 1.3 Guidelines for Canadian Drinking Water Quality are available to be used by provinces / territories.
• ER 1.4 Science-based information on the risks posed by substances, in accordance with annual research plans.
• ER 1.5 Data generated on the use, release, exposure and presence of substances of concern in humans, the environment, food and consumer products.
• ER 1.6 Engagement, consultation and communication products to inform the public and stakeholders.

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.

Environment and Climate Change Canada

• ER 3.1 Information on risks of substances to inform risk management, monitoring and surveillance and research activities.
• 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.
• 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.
• ER 3.5 Information on obligations to conform or comply with risk management control measures.
• ER 3.6 Inspections, investigations and enforcement actions.

Performance indicators

Health Canada

• PI 1.1.1 Timely response to chemical-related risks to health.
• PI 1.1.2 Percentage of food ingredients, food additives, food contaminants and food packaging material chemicals re-evaluated for which Chemicals Management Plan assessments and new scientific knowledge identify potential risk.
• PI 1.1.3 Percentage of substances assessed within prescribed timelines (Existing Substances).
• PI 1.1.4 Percentage of substances assessed within prescribed timelines (New Substances).
• PI 1.1.5 Percentage of the annual target of proposed re-evaluations decisions (PRVDs) as set out in the published re-evaluation and special review work plan.
• PI 1.2.1 Percentage of actions taken in a timely manner to protect the health of Canadians from substances found to be a risk to human health.
• PI 1.2.2 Percentage of the annual target for re-evaluations decisions (final RVDs) met as set out in the published re-evaluation and special review work plan.
• PI 1.3 Percentage of planned final water quality guidelines / guidance documents published in Canada Gazette, Part I and online.
• PI 1.4 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 1.5 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 1.6 Percentage of knowledge transfer activities completed as planned related to substances of concern.

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).
• 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 implemented 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 non- compliance addressed by an enforcement action.

Targets

Health Canada

• T 1.1.1 100%
• T 1.1.2 100%
• T 1.1.3 100%
• T 1.1.4 100%
• T 1.1.5 80%
• T 1.2.1 100%
• T 1.2.2 80%
• 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 85%

Actual Results

Health Canada

• AR 1.1.1 100%
• AR 1.1.2 100%
• AR 1.1.3 73%
• AR 1.1.4 100%
• AR 1.1.5 32%
• AR 1.2.1 100%
• AR 1.2.2 71%
• AR 1.3 77%
• AR 1.4 100%
• AR 1.5 100%
• AR 1.6 100%

Public Health Agency of Canada

• AR 2.1 96%

Environment and Climate Change Canada

• AR 3.1.1 73%
• AR 3.1.2 82.6%
• AR 3.2 100%
• AR 3.3 100%
• AR 3.4 100%
• AR 3.5 11,424
• AR 3.6 84%

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 organization(s)

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."

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 the 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 objectives of the framework are to protect public health and public safety. 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 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 involvement in the illicit 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 has put in place 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: an Assistant Deputy Minister's Committee that serves as a forum for government-wide coordination of policy and implementation activities; a Directors-General Committee that is responsible for coordinating 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 established, 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. Other F/P/T working groups and committees have also been established to facilitate ongoing engagement in key priority areas, including public education and awareness, data development and information sharing, national inventory tracking, ticketing and implementation. In addition, existing F/P/T bodies are also considering the implications of cannabis legalization, including F/P/T Deputy Ministers Responsible for Justice, Public Safety and Finance, and F/P/T Ministers Responsible for Health, Justice and Labour.

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

$546,807,456

Total federal planned spending to date (dollars)

$292,264,123

Total federal actual spending to date (dollars)

$258,201,556

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

Total planned spending since the last renewal

Not applicable

Total actual spending since the last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Performance highlights

The Cannabis Act and its associated regulations came into force on October 17, 2018, with the objective of protecting the public health and public safety of Canadians, particularly youth, while providing adults with legal access to regulated cannabis and reducing illicit activities. On the same date, the cost recovery regime was implemented to recover the Government's regulatory costs of administering the cannabis framework by fairly charging those that benefit from the new legal market, thereby reducing costs to taxpayers. It is expected that the Cannabis Fees Order will result in a transfer of costs from taxpayers to industry in the amount of $204 million over four years^{Footnote 1}. Since the coming into force of the Cannabis Act, significant progress has been made towards achieving the government's public health and public safety objectives.

Rules for legal production and sale of edible cannabis, cannabis extracts and cannabis topicals were established.

On October 17, 2019, amendments to the Cannabis Regulations came into force, setting rules for the legal production and sale of edible cannabis, cannabis extracts and cannabis topicals. The Government of Canada worked closely with provinces and territories, Indigenous communities, the regulated industry, public health organizations and law enforcement to implement the amended Cannabis Regulations. The amended regulations contain safeguards to mitigate the public health and public safety risks associated with the new cannabis products, such as appeal to youth (e.g. restrictions on the use of ingredients such as sweeteners), overconsumption (e.g. standardized labels, health warning messages, tetrahydrocannabinol limits, and prohibiting health claims that might encourage consumption), and accidental consumption (e.g. child-resistant packaging). These new cannabis products became available for purchase by adult consumers in mid-December 2019.

A legal cannabis supply chain capable of displacing illegal activities has been established.

Early results show that spending on legally-sourced cannabis (medical and non-medical) has grown from $133 million in the third quarter of 2018 (just prior to coming into force of the Cannabis Act) to $709 million in the first quarter of 2020, with the share of legal spending on cannabis increasing from 9% to 46% during that same period. Legal spending from between the coming into force of the Cannabis Act in the fourth quarter of 2018 until the first quarter of 2020 totaled just over $3.4 billion^{Footnote 2}.

To further support the establishment of a legal supply chain, Health Canada introduced changes to the cannabis licensing process in May 2019 to improve efficiency and overall wait times for licence approval. At the end of March 2020, 344 sites were licensed for cultivation, processing, and/or sale for medical purposes, including a growing number of micro licence sites, in addition to 1,513 sites for research, analytical testing, industrial hemp, and cannabis drug licences. Health Canada has also maintained a system that provides reasonable access to cannabis for medical purposes. The number of individuals registered to access cannabis for medical purposes, and the amount of cannabis sold, continues to grow.

Health Canada worked closely with Indigenous leaders, organizations and communities across the country to assist interested Indigenous groups in participating in the regulated cannabis sector, while also ensuring that their specific interests related to cannabis are carefully considered and addressed as appropriate. As of March 31, 2020, there were close to 200 engagement sessions with First Nations, Metis and Inuit leaders, organizations and communities to share information and seek feedback regarding their interests and needs related to the legalization and regulation of cannabis. As of March 31, 2020, there are 19 Indigenous-owned or -affiliated businesses located across Canada that received a Health Canada licence to cultivate or process cannabis, including one located on a reserve. As of March 31, 2020, approximately 60 Indigenous-owned or affiliated licensee applications from across Canada are in various stages of application review. Of these, 12 are located on reserves. Health Canada offers flexibility in the federal licensing process for Indigenous applicants, who have the option to submit their application without an already fully built site. Additionally, a dedicated cannabis licensing advisor supports Indigenous clients to strengthen their application before submission. Following application submission, the Indigenous Navigator Service helps clients through the federal application review process.

In accordance with the Federal Government's commitment to a renewed, nation-to-nation relationship with Indigenous peoples, Health Canada has engaged with Indigenous communities directly to assist in advancing their interests in the regulated cannabis sector. Since December 2018, under the direction of Ministers, federal officials engaged in trilateral discussions with First Nations communities and the provinces of Ontario, Saskatchewan and British Columbia.

Attitudes and behaviours towards cannabis use are stable.

Public education and awareness is a fundamental component of the Government's public health approach to reducing the harms associated with cannabis, especially for youth. The Government continues its extensive public education efforts – in collaboration with provinces and territories, Indigenous partners and other organizations – to help Canadians understand the health effects of cannabis use. This included continuing its national advertising campaign to raise awareness of the health effects of cannabis, lower-risk use practices and the differences between inhaling and ingesting cannabis. Health Canada also launched a do-it-yourself version of the Pursue Your Passion initiative to equip youth leaders and educators with the tools and resources to deliver cannabis education events that provide youth with fact-based information, thought-provoking activities, and inspiration to pursue a passion without the use of cannabis. Other public education initiatives aimed at increasing knowledge of the risk of developing psychosis or schizophrenia when cannabis is used more frequently^{Footnote 3} and the risk of cannabis use while trying to conceive or while pregnant and/or breastfeeding^{Footnote 4}.

In 2019-20, Health Canada developed new health warning messages, which are evidence-based warnings that must be displayed on the labels of all cannabis products, to effectively communicate health risks associated with cannabis, including for dried cannabis and new cannabis products (edible cannabis, cannabis extracts and cannabis topicals). Updates were also made to Health Canada's Consumer Information Sheet, which is a public education resource providing consumers with important information about cannabis at the point of sale. Updates to the health warning messages and Consumer Information Sheet were informed by advice from scientific experts, the best available evidence from peer-reviewed scientific publications, the outcomes of public opinion research conducted in May 2018 and February 2019, and the feedback received during the public consultation on the proposed amendments to the regulations. Health Canada also updated information on its website about the new cannabis products and lower-risk use guidelines to support adult consumers in making informed decisions. In collaboration with partners, educators, and health professionals, the Public Health Agency of Canada developed tailored public education messages to help build resilience and prevent/reduce problematic cannabis use.

Although it is too early to determine the long-term impact of the Cannabis Act on public health and individual behavior, initial data is encouraging. According to the National Cannabis Survey, the rate of cannabis use has not changed among young people since the Cannabis Act came into force (e.g., remained unchanged at 27% when comparing the third quarter of 2018 and the third quarter of 2019). Among individuals who report having used cannabis in the past year, there has been no increase in the proportion that report using cannabis on a weekly or daily basis, which is one of the high risk behaviours closely being monitored by Health Canada (Canadian Cannabis Survey, 2019). Canadians understanding of the risks posed by cannabis also seems to be improving. When asked about how much they thought a person risked harming themselves by using various products on a regular basis, the majority of people overall perceived either moderate or great risk for smoking cannabis (74%, an increase from 72% in 2018), vaping cannabis (72%, an increase from 70% in 2018), and eating cannabis (68%, an increase from 66% in 2018).

Public Safety Canada also continued public education and awareness activities in 2019-20 with the Don't Drive High campaign, to provide Canadians, and in particular young Canadians aged 16-24, with information on the legal implications and laws associated with cannabis use and driving. Don't Drive High's third year featured two successful advertising campaigns, which took place in April to June 2019 and in March 2020. Advertisements were seen across Canada, on national television networks, in cinemas, on Spotify, Instagram, Snapchat, YouTube, websites and mobile applications. Digital advertisements alone were displayed over 142 million times. According to the Canadian Cannabis Survey, the proportion of respondents who believe cannabis use negatively affects driving increased in the year following the coming into force of the Cannabis Act from81% (2018) to 85% (2019). However, this change in attitudes has not yet translated into a change in behaviour. Continued efforts are still required to fully address drug-impaired driving.

Compliance, law enforcement and border controls continue to be implemented.

The Government of Canada has established, promoted compliance with, and enforced regulatory requirements to protect public health and public safety. Health Canada implemented an updated Compliance Promotion Strategy in the fall of 2019 to increase awareness, improve understanding, and foster ongoing compliance with the amended Cannabis Regulations among regulated parties, federal partners, provinces and territories. During inspections of licence holders in 2019-20, Health Canada found a 98% compliance rate with controls established under the Cannabis Act and regulations.

The RCMP played a key coordinating role in engaging partners, and in the development and sharing of national awareness and public education products to ensure consistency and support for stakeholder outreach. Through in-person engagement and the use of technology, the RCMP continued to focus on increasing awareness and education of cannabis legalization and regulation, with an emphasis on possession, production, and distribution of cannabis for Indigenous and youth populations.

In 2019-20, the RCMP aligned activities of its cannabis resources both at National Headquarters and across the country to identify trends related to organized crime infiltration and moneymaking schemes in relation to both the legitimate and the illegal markets. The RCMP worked collaboratively to develop appropriate responses, including targeted awareness products, through ongoing interactions with stakeholders.

In 2019-20, the RCMP also undertook activities to support the establishment of a federally licensed and regulated industry through the completion of law enforcement records checks to screen licence applicants. Work was undertaken to support the development and dissemination of intelligence to national law enforcement agencies, such as through the hosting of a national-level symposium on organized crime, which brought together law enforcement and non-law enforcement institutions to enhance knowledge of the threats posed by organized crime, including groups involved in the criminal cannabis market.

Cannabis interdictions continue to be a key area of enforcement for the CBSA, as the unauthorized cross-border movement of cannabis remains a criminal offence. Since coming into force of the Cannabis Act, there has been an observed increase in voluntary forfeitures by travellers, and the postal and courier environments have seen a 23% higher importation interdiction rate than the traveller stream. As part of a broad public education campaign to mitigate the risks of unintentional violations to national laws, the CBSA developed messaging, updated its website, and leveraged social media to inform Canadians and travelers to Canada of the prohibition against transporting cannabis across international borders without a valid permit or exemption issued by Health Canada. In fiscal year 2019-20, CBSA acknowledged 89% of the appeals received within 10 calendar days and decided 88% of the Enforcement and Trusted Traveller appeals within 180 days. In addition, the CBSA laboratory analyzed 26.5% of the suspect cannabis samples received from the ports of entry within 30 days. This percentage is expected to increase as testing and analysis methods continue to be refined over the next year. The CBSA also continued to develop policies and procedures related to the new traveller Administrative Monetary Penalty regime for contraventions of the Customs Act involving cannabis.

Public Safety Canada, in collaboration with federal, provincial and territorial partners and law enforcement agencies, also developed an action plan to address illicit online sales of cannabis. Additionally, an Act to provide no-cost, expedited record suspensions for simple possession of cannabis came into force on August 1, 2019. This Act expedites the pardons process for people convicted only of simple possession of cannabis, eliminating the application fee and any wait periods. Between the coming into force of the legislation and March 31, 2020, the Parole Board of Canada received a total of 436 applications for cannabis record suspensions. Of those, 240 applications were accepted, 178 applications were returned due to ineligibility or incompleteness; and 18 applications had not yet been accepted for processing by the end of the fiscal year.

The impacts of cannabis legalization and regulation are being monitored closely through ongoing population-based surveys. Health Canada is working closely with the Canadian Institutes of Health Research, the Canadian Centre on Substance Use and Addiction (CCSA) and the Mental Health Commission of Canada (MHCC) on cannabis research priorities to better inform Canadians on the benefits and risks of cannabis use. 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 progress towards the objectives of the Act, initial impact on public health and safety, and represents an opportunity for Canadians and stakeholders to share their perspective on Canada's new cannabis control framework.

Contact information

Health Canada

John Clare
Director General
Controlled Substances and Cannabis Branch
John.Clare@canada.ca
613-941-8371

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

Shared outcomes:

• SO 1: Cannabis is kept out of the hands of Canadian children and youth
• SO 2: Criminal involvement in the illicit cannabis market is reduced

Performance information

Theme 1: Establish, implement and enforce the new horizontal initiative

Expected results

Health Canada

• ER 1.1.1 A federally licensed and regulated (non-medical) industry is established.
• ER 1.1.2 The federally licensed industry understands the legislation and regulatory requirements.
• ER 1.1.3 The federally licensed industry is found to be compliant with regulatory requirements.

Royal Canadian Mounted Police

• ER 1.2 Law Enforcement Records Checks (LERCs) are conducted in support of HC's security clearance decisions.

Performance indicators

Health Canada

• PI 1.1.1.1 Number of licence applications decisions per year.
• PI 1.1.1.2 Percentage of licensed applications reviewed within internal service standards.
• PI 1.1.2 Percentage of federally licensed industry that indicates that they understand the regulatory requirements.
• PI 1.1.3 Percentage of federally licensed industry that is found to be compliant with regulatory requirements.

Royal Canadian Mounted Police

• PI 1.2 Percentage of LERCs completed within negotiated service standards.

Targets

Health Canada

• T 1.1.1.1 1,050
• T 1.1.1.2 75%
• T 1.1.2 80%
• T 1.1.3 95%

Royal Canadian Mounted Police

• T 1.2 75%^{Footnote 8}

Actual Results

Health Canada

• AR 1.1.1.1 2,261
• AR 1.1.1.2 Not available^{Footnote 6}
• AR 1.1.2 Not available^{Footnote 7}
• AR 1.1.3 98%

Royal Canadian Mounted Police

• AR 1.2 49%^{Footnote 9}

Theme 2: Provide Canadians with information needed to make informed decisions and minimize health and safety harms

Expected results

Health Canada

• ER 2.1.1 Canadian youth understand the potential health and safety risks associated with cannabis use.
• ER 2.1.2 Canadians use information to make informed decisions about the potential health and safety risks associated with the use of cannabis.

Public Health Agency of Canada

• ER 2.2.1 Health care and social service professionals and public health officials have access to high-quality public health information.
• ER 2.2.2 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 2.3.1 Canadians are aware of the legal implications associated with cannabis use, and understand the laws associated with the new legislation.
• ER 2.3.2 Canadians use information provided by the program to make informed, lawful decisions.

Performance indicators

Health Canada

• PI 2.1.1 Percentage of youth (grades 7-12) who perceive that there is "no risk" in smoking cannabis on a regular basis.
• PI 2.1.2 Percentage of parents who discuss cannabis with their teens.

Public Health Agency of Canada

• PI 2.2.1 Number of health care and social service professionals and public health officials accessing high-quality public health information and data products developed.
• PI 2.2.2 Percentage of Public Health Network members using information, knowledge and data products to make informed decisions.

Public Safety Canada

• PI 2.3.1 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 2.3.2 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.

Targets

Health Canada

• T 2.1.1 7%
• T 2.1.2 TBD by December 31, 2020^{Footnote 11}

Public Health Agency of Canada

• T 2.2.1 150,000
• T 2.2.2 75%

Public Safety Canada

• T 2.3.1 22%
• T 2.3.2 34% - legal storefront, 20% - legal online source

Actual Results

Health Canada

• AR 2.1.1 7%^{Footnote 10}
• AR 2.1.2 86%^{Footnote 12}

Public Health Agency of Canada

• AR 2.2.1 175,318
• AR 2.2.2 89%

Public Safety Canada

• AR 2.3.1 19%^{Footnote 13}
• AR 2.3.2 31% - legal storefront 17% - legal online source^{Footnote 14}

Theme 3: Build law enforcement knowledge and engage partners and stakeholders on public safety

Expected results

Public Safety Canada

• ER 3.1.1 Law enforcement is well-informed to apply the new legislation.
• ER 3.1.2 Evidence-based decision-making on organized crime and policing issues.
• ER 3.1.3 Research projects related to cannabis and performance measurement implemented.
• ER 3.1.4 Policy development and decision-making is informed by evidence and performance measurement.

Royal Canadian Mounted Police

• ER 3.2.1 RCMP prevention and engagement activities support enhanced understanding among targeted partners and stakeholders, including youth and Indigenous communities.
• ER 3.2.2 Enhanced capacity of target populations, including partners and stakeholders, youth and Indigenous communities, to respond to the new cannabis regime.

Performance indicators

Public Safety Canada

• PI 3.1.1 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 3.1.2.1 Percentage of stakeholders who indicate that the materials informed decision making.
• PI 3.1.2.2 Number of working meetings and consultations with stakeholders held.
• PI 3.1.2.3 Number of new initiatives considered for implementation.
• PI 3.1.3 Percentage of research projects related to performance measurement completed and disseminated.
• PI 3.1.4 Percentage of stakeholders indicating that policy development and decision making was based on performance measurement results and lessons learned.

Royal Canadian Mounted Police

• PI 3.2.1.1 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 3.2.1.2 Number of information inquiries responded to by the Centre for Youth Crime Prevention.
• PI 3.2.2.1 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 3.2.2.2 Percentage of youth resource officers who positively assessed the impact of training.

Targets

Public Safety Canada

• T 3.1.1 33% of frontline police officers access materials

75% of officers with access to materials find the materials helpful.

• T 3.1.2.1 75%
• T 3.1.2.2 15
• T 3.1.2.3 2
• T 3.1.3 100%
• T 3.1.4 50%

Royal Canadian Mounted Police

• T 3.2.1.1 45%
• T 3.2.1.2 150
• T 3.2.2.1 30%
• T 3.2.2.2 80%

Actual Results

Public Safety Canada

• AR 3.1.1 57%^{Footnote 15} - access materials 87% 16 - found materials helpful
• AR 3.1.2.1 N/A^{Footnote 17}
• AR 3.1.2.2 23
• AR 3.1.2.3 3
• AR 3.1.3 40%^{Footnote 18}
• AR 3.1.4 N/A^{Footnote 17}

Royal Canadian Mounted Police

• AR 3.2.1.1 46%
• AR 3.2.1.2 143^{Footnote 19}
• AR 3.2.2.1 40%
• AR 3.2.2.2 100%^{Footnote 20}

Theme 4: Provide criminal intelligence, enforcement and related training activities

Expected results

Royal Canadian Mounted Police

• ER 4.1.1 Information and intelligence products/advice related to illicit substances (including cannabis) are shared with Canadian law enforcement agencies and available to be used to target organized crime.
• ER 4.1.2 Canadian law enforcement agencies have intelligence information to nationally coordinate activities to target organized crime groups involved in the Canadian cannabis market.
• ER 4.1.3 RCMP staff have access to required training in regards to enforcement of the new cannabis regime.
• ER 4.1.4 RCMP employees have an increased ability to enforce the new cannabis regime.

Performance indicators

Royal Canadian Mounted Police

• PI 4.1.1 Number of RCMP information / intelligence products / advice 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 4.1.2.1 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 4.1.2.2 Number of information and intelligence products that are used to guide enforcement against organized crime groups in the Canadian cannabis market.
• PI 4.1.3 Percentage of target audience who have received the appropriate cannabis related training.
• PI 4.1.4 Percentage of training participants who reported an increased level of knowledge and ability to enforce the new cannabis regime.

Targets

Royal Canadian Mounted Police

• T 4.1.1 10
• T 4.1.2.1 TBD by December 31, 2022^{Footnote 21}
• T 4.1.2.2 3
• T 4.1.3 FP training: 100%

Learning and Development: 80%

• T 4.1.4 FP training: 90%

Learning and Development: 100%

Actual Results

Royal Canadian Mounted Police

• AR 4.1.1 44
• AR 4.1.2.1 N/A^{Footnote 22}
• AR 4.1.2.2 44
• AR 4.1.3 14%^{Footnote 23}
• AR 4.1.4 74.1%^{Footnote 24}

Theme 5: Prevent and interdict prohibited cross-border movement of cannabis while maintaining the flow of legitimate travellers and goods

Expected results

Canada Border Services Agency

• ER 5.1.1 Travellers understand the requirements to declare cannabis and cannabis-related products when entering Canada.
• ER 5.1.2 Travellers are provided a clear opportunity to declare cannabis in their possession at all primary inspection sites.
• ER 5.1.3 CBSA has enhanced capacity to promote compliance and to enforce import-related laws.
• ER 5.1.4 Prohibited cross border movement of cannabis is detected.
• ER 5.1.5 Travellers and the import/export community have access to recourse mechanisms to challenge certain CBSA actions and decisions in a timely manner.

Performance indicators

Canada Border Services Agency

• PI 5.1.1.1 Percentage of ports of entry with displayed signage on cannabis.
• PI 5.1.1.2 CBSA awareness tools are in place to inform travelling public on prohibition of cross-border movement of cannabis.
• PI 5.1.2 Percentage of relevant primary inspection kiosks, systems, training materials, operational guidelines and forms in all modes updated.
• PI 5.1.3 Number of cannabis import interdictions at ports of entry.
• PI 5.1.4 Percentage of referred cannabis samples analyzed within 30 days.
• PI 5.1.5.1 Number of cannabis seizures appealed.
• PI 5.1.5.2 Number of Trusted Travelers appeals due to cannabis-related enforcement action.
• PI 5.1.5.3 Number of Trade related appeals due to classification disputes of cannabis.
• PI 5.1.5.4 Percentage of appeals received that are acknowledged within 10 calendar days.
• PI 5.1.5.5 Percentage of Enforcement and Trusted Traveller appeals received that are decided within 180 calendar days.
• PI 5.1.5.6 Percentage of Trade related appeals – Tariff Classification – that are decided within 365 calendars days (for cases never held in abeyance).
• PI 5.1.5.7 Number/Percentage of appeal decisions further appealed at the Courts or Tribunals and defended by Recourse.
• PI 5.1.5.8 Percentage of cannabis-related complaints for which CBSA provides a final written response to the complainant within 40 calendar days after a written complaint is received.
• PI 5.1.5.9 Percentage of cannabis-related complaints for which the CBSA contact the complainant within 14 calendar days after a written complaint is received.

Targets

Canada Border Services Agency

• T 5.1.1.1 75% of major ports and 100% of other priority ports.
• T 5.1.1.2 100% of the digital strategy launched.
• T 5.1.2 100%
• T 5.1.3 10% reduction (+/- 5%variance) to baseline of 20,933
• T 5.1.4 90%
• T 5.1.5.1 Not applicable^{Footnote 27}
• T 5.1.5.2 Not applicable^{Footnote 27}
• T 5.1.5.3 Not applicable^{Footnote 27}
• T 5.1.5.4 85%
• T 5.1.5.5 80%
• T 5.1.5.6 85%
• T 5.1.5.7 Not applicable
• T 5.1.5.8 90%
• T 5.1.5.9 85%

Actual Results

Canada Border Services Agency

• AR 5.1.1.1 100%^{Footnote 25}
• AR 5.1.1.2 100%^{Footnote 25}
• AR 5.1.2 100%^{Footnote 25}
• AR 5.1.3 18,197 cannabis imports (13% reduction)
• AR 5.1.4 26.5%^{Footnote 26}
• AR 5.1.5.1 Not applicable^{Footnote 27}
• AR 5.1.5.2 Not applicable^{Footnote 27}
• AR 5.1.5.3 Not applicable^{Footnote 27}
• AR 5.1.5.4 89%
• AR 5.1.5.5 88%
• AR 5.1.5.6 Not applicable^{Footnote 28}
• AR 5.1.5.7 Not applicable^{Footnote 29}
• AR 5.1.5.8 89%
• AR 5.1.5.9 61%^{Footnote 30}

Variance Explanations:

Canada Border Services Agency

The variance between actual and planned spending is a result of not spending the planned contingency fund. In addition, IT work related to CBSA system enhancements to implement AMPs was delayed and resulted in the carry forward of some funds to FY 2020-21. Also, a change to internal CBSA funding allocation processes resulted in the work associated to policy being split amongst various program inventories.

Health Canada

The variance between actual and planned spending is due to additional funding received for advertising activities and a $7.1M reprofile for CSB accommodations (approved to 2020-21).

Public Safety Canada

The variance between actual and planned spending is due to events being rescheduled as a result of the COVID-19 pandemic.

Gender-Based Analysis Plus

Institutional GBA+ Capacity

In 2019-20, Health Canada continued to strengthen the implementation of Gender-Based Analysis plus (GBA+) through its Sex and Gender Action Plan launched in 2017. The Action Plan provides a framework that strengthens the integration of sex, gender and diversity considerations (such as age and ethnicity) in externally as well as internally facing work of the Department. The priorities of the three-year Action Plan are to build departmental capacity, strengthen the evidence base and expertise, and increase accountability. Note that the terms Gender-Based Analysis Plus (GBA+) and Sex and Gender-Based Analysis Plus (SGBA+) refer to the same concept. Health Canada has chosen to use SGBA+ to emphasize the fact that differences between women, men and gender-diverse individuals can be biological (sex related) and/or socio-cultural (gender related).

Each branch participated in at least one sex, gender and/or diversity related activity. The Department, in collaboration with the Canadian Institutes of Health Research (CIHR), established research-policy partnerships, which support researchers, who have both subject matter and SGBA+ expertise, to engage with departmental staff on priority Health Canada initiatives.

Accountability mechanisms such as the requirement to include SGBA+ findings in Memoranda to Cabinet (MCs), Treasury Board (TB) submissions, budget proposals and regulations as well as the Department Results Framework, Performance Information Profiles, help ensure that sex, gender and diversity are systematically integrated in departmental decision-making processes.

The Gender and Health Unit, responsible for supporting the implementation of SGBA+ and integrating sex, gender and diversity related findings into departmental work, also tracks the use and quality of SGBA+ in decision-making processes such as those mentioned above. This information is included in reports to departmental senior management as well as the Women and Gender Equality Canada, and published annually on the Health Canada website. The integration of sex, gender and diversity in departmental work has also been advanced by the federal government's focus on gender equality, diversity and inclusion. This has increased the number of requests for SGBA+ advice and assistance and resulted in the need for more staff. The unit added a Director and an Analyst during this period.

Highlights of GBA+ Results by Program

Internal Services

• SGBA+ Employee Survey, reported in April 2019, highlighted areas for departmental focus in capacity building, including employee training, and the development of evidence and accountability.
• In line with the TB Policy Direction on Modernizing the Government of Canada's Sex and Gender Information Practices to support the collection of more accurate sex and gender data, the Department started compiling and verifying an inventory of sex and gender related information. This improved data accuracy will help to strengthen departmental decision-making,
• Employee training was provided in several sex and gender related areas. These included: increasing awareness of how SGBA+ could influence the development of policies and guidelines; the application of SGBA+ to risk communication; and the integration of the SGBA+ and Indigenous lenses in the development and delivery of National Inspector training (done in collaboration with Inspector-Facilitators and an Advisory Group). The latter will have a "downstream" impact on Inspector interactions with regulated parties.
• The Department launched a "Learning and Integration for Impact Initiative", led by a project team of specialists on SGBA+, Knowledge Translation (KT) and Performance Measurement (PM). The project team collaborated with colleagues and funding recipients, providing advice, training and tools that promoted an organizational learning culture where the purposeful integration of KT, PM and SGBA+ at all stages helps to improve how we design, plan, manage, deliver, report and evaluate our programs. As a result, this initiative increased the likelihood of achieving strategic outcomes and cultivates critical thinking, innovation and the capacity to link program management with positive impact for Canadians.
• The second annual Sex and Gender Symposium, hosted in February 2020, engaged senior leaders, policy developers, academics and practitioners to share their vision and priorities for sex, gender and diversity in health and bridge connections between research, policy and practice. Discussions this year focused on gender and diversity in the key current societal issues of mental health, digital technologies and climate change with all panels including an Indigenous perspective. Along with the panel discussions, a Marketplace provided an opportunity for Health Canada to share findings and results in incorporating sex, gender and diversity into priority initiatives as part of the Sex and Gender Action Plan 2017-20.
• Sex, gender and diversity sensitive resources, developed as part of a research-policy partnership, were incorporated into a Mental Health First Aid Toolkit for all employees – The resources focused on Worklife Stress and Mental Health; Work Life Balance; Workplace Diversity, Discrimination, and Bias; Bullying and Harassment; Stigma Disclosure and Help Seeking. The development process connected findings from the literature; available data; and "lived experience" based on key stakeholder focus groups centred on sex, gender and diversity in relation to mental health in the workplace. These tools will be accessible through GCpedia. Further, a poster "Application of a Sex and Gender Lens in Support of Psychologically Healthy Workplaces" describing the process was presented at the Health Canada Science Forum 2020 as well at the second SGBA+ Symposium.
• The Employee Assistance Program (EAP) applied a SGBA+ lens to its policies, procedures and services. For example: the Employee Assistance Services (EAS) expanded the demographics in all client surveys to better assess client feedback and respond to diverse client needs. Furthermore, counsellors now identify any diverse ethnic or cultural client backgrounds, as well as LGBTQ2+ groups to ensure clients can be appropriately matched with a counsellor who has "lived experience" or other expertise with the specific group. In addition, based on 2018-19 research, EAS modified communications to better engage specific groups, such as males, a demographic that traditionally under-uses EAP services. For example, social media outreach during "Movember" used language that resonates better with this target group. Also, when supporting federal responders during the COVID-19 repatriation efforts (February to April 2020), EAS ensured psychosocial teams deployed at quarantine sites comprised of at least one male and one female, taking gender sensitivity into account during this particularly stressful situation for affected Canadians.
• Developed a SGBA+ Resource Tool for evaluation, which is aligned to the TB Policy on Results and the TB guidance document "Integrating GBA+ into Evaluation", and supports tools which provide guidance for using the new SGBA+ Lens in evaluation. This tool is used for all evaluations, as appropriate.

External Services

Controlled Substances

• Substance Use and Addictions Program funding recipients are required to take sex (biological) and/or gender (socio-cultural) differences into account. This has helped to support decision-making at the project-level. Recipients need to use a sex and/or gender sensitive approach in data collection, the development of resources and/or in tailored interventions.

Cannabis

• The 2019 Canadian Cannabis Survey collected additional demographic variables, including sexual orientation and whether respondents were Canada born, to better understand cannabis use and priority populations.
• Published the report "Sex, Gender and Cannabis", prepared by Dr. Lorraine Greaves as part of a research-policy partnership. The report reviewed evidence from existing cannabis research, literature and surveys, and outlined possible implications/ recommendations for cannabis policy and public education from a sex and gender perspective.

Consumer Product Safety

• A research-policy partnership with McGill University investigated consumer perceptions and behaviours in relation to health product labelling for cosmetics, natural health products and non-prescription drugs.
• In July 2019, the partnership completed an SGBA+ comparative analysis of the Consumer Health Product Survey. The results of this report are being used to inform policy decisions related to improving the way health and safety information is communicated to consumers for natural and non-prescription health products.

Tobacco Control

• SGBA+ results helped inform the development of new health-related labelling on tobacco product packages.

Food and Nutrition

• The development of tools and resources for Canada's Food Guide continues to be informed through an SGBA+ lens.
  • Health Canada delivered targeted healthy eating content and promotional material to reach Canadians across various settings, ages, and population groups.
• In addition to Canada's two official languages, Canada's Food Guide Snapshot was made available in 9 Indigenous languages and 20 multicultural languages. This translated guidance will help people whose first language is not English or French make healthy eating choices for themselves and their families.
• Launched in April 2019, Canada's Food Guide monthly e-newsletter featured tips and resources that are inclusive of different audiences. For example, the newsletter covered themes such as healthy eating on a budget and the importance of culture and food traditions.

Health Impacts of Chemicals

• Research, monitoring, surveillance and risk assessment activities included greater consideration of populations vulnerable to specific health risks. The unique exposure of certain subpopulations was taken into account, as appropriate, as well as health effects that are linked to certain life stages (such as effects on the developing fetus). An example, the draft screening assessment for parabens estimated exposure to parabens from a number of products used by children. The consideration of populations more vulnerable to exposures to parabens will be carried through in risk management activities, where actions will be proposed to reduce exposures to such populations, whether they were the highest exposed and/or the most susceptible. For public outreach, the diverse needs of Canadians, particularly those most vulnerable to specific health risks continued to be a focus (e.g., regional staff deliver materials and workshops to educate and enable "key intermediaries" or populations, e.g., daycare workers, Indigenous groups, youth and nurses).

Pesticides

• Similarly, 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 which 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.

Response to parliamentary committees and external audits

Response to parliamentary committees

CANADIANS AFFECTED BY RARE DISEASES AND DISORDERS: IMPROVING ACCESS TO TREATMENT

The House of Commons Standing Committee on Health (Committee) held five meetings and heard from 24 witnesses, including government officials, physicians, researchers, industry representatives and patient groups, and received 10 written submissions. These witnesses outlined key challenges Canadians face in accessing treatment for rare diseases in the following areas:

• regulatory approval of drugs for rare diseases for sale;
• pricing;
• reimbursement for drug costs through provincial and territorial drug coverage plans; and
• access to diagnostics for these diseases.

Witnesses told the Committee that there is a lack of coordination between federal regulatory approval processes for the sale of drugs for rare diseases and provincial and territorial processes that make reimbursement decisions about these drugs. This lack of coordination leads to delays in treatment for patients. Health Canada also needs to do a better job of communicating its regulatory decisions to physicians and patients.

The biggest barrier limiting patients' access to these drugs is their affordability. Drugs for rare diseases can cost between $500,000 to $4.9 million per person per year.

With more and more of these drugs coming to market, governments may not be able to cover the costs of the drugs without sacrificing other health care priorities. Governments also face difficulties justifying spending funds on the reimbursement of these drugs when there is limited evidence showing that they offer significant health benefits. At the same time, drug manufacturers must continue to have incentives to invest in the development of treatments in this area and to seek market authorization for the sale of these drugs in Canada.

The Committee agreed with witnesses that it is time to change Canada's approach towards drugs for rare diseases. The Committee made 19 recommendations in this report that focused on:

• establishing coordinated processes for the approval and reimbursement of drugs for rare diseases in Canada;
• implementing the proposed amendments to the Patented Medicines Regulations that will lead to lower drug prices;
• short- and long-term options for covering the costs of drugs for rare diseases; and
• supporting research that examines the real-world benefits and risks of drugs for rare diseases.

The Government Response supported the general intent of the Committee's Report.

Budget 2019 proposed investments to move forward on three foundational elements of national pharmacare building on the Government's ongoing commitment to its pharmaceuticals agenda. This included up to $1 billion over two years, starting in 2022-23, with up to $500 million per year ongoing, to help Canadians with rare diseases access the drugs they need by establishing a national strategy for high-cost drugs for rare diseases. This strategy will be developed in collaboration with Provincial and Territorial (PT) governments and other stakeholders. In addition, this strategy will be informed by the recommendations of the Advisory Council on the Implementation of National Pharmacare in their June 2019 final report.

Since 2016, improving the affordability, accessibility and appropriate use of prescription drugs for Canadians has been a shared priority of Federal, Provincial and Territorial governments. The Government continues to provide leadership and work collaboratively with PT governments to achieve improved coordination and greater efficiency in the management of prescription drugs in Canada. These actions have resulted in more timely and improved access to prescription drugs including high-cost drugs for rare diseases for Canadians and respond to many of the Report's recommendations.

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)

2018-19 Environmental petitions annual report

This year's Annual Report of the Commissioner of the Environment and Sustainable Development indicates that 12 petitions, addressing a wide range of issues, were received between July 1, 2018 and June 30, 2019 and three of these were directed to Health Canada. Canadians petitioned Health Canada for information regarding the use of the herbicide glyphosate (two petitions) as well as pesticides (one petition).

The report was tabled on December 10, 2019.

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

Horizontal audit on credential validation

The objectives of the audit conducted by the Public Service Commission of Canada (PSC) were:

• To identify the prevalence of instances where credentials could not be validated with academic institutions or professional associations; and
• To identify credential validation practices for appointments and determine whether additional guidance or support is needed when establishing an appropriate credential validation approach.

The audit examined a representative sample of 278 external appointments made between April 1, 2015, and March 31, 2016, across 15 departments and agencies, and across 20 occupations with responsibilities related to the health, safety or security of Canadians.

The audit findings indicate a high level of compliance with respect to educational and professional qualification requirements. The audit confirmed that all credentials claimed by appointees in 269 appointments were valid and issued by legitimate institutions. However, there were 9 appointments (out of the total sample of 278 appointments) where the audit team did not have enough information to complete validation, for reasons outlined in the report.

While the authenticity of the credentials claimed by appointees was largely confirmed, the audit did reveal a lack of understanding of the requirement for appointees to provide proof of Canadian equivalency for foreign credentials. Qualification standards, established by the Treasury Board of Canada, stipulate that candidates with foreign credentials must have those credentials assessed against Canadian educational standards and found to be comparable. Sub-delegated managers did not follow through on this requirement in 12 of the 24 appointments (50%) where it applied. This observation leads to the single recommendation stemming from the audit (made to the PSC). There were no recommendations for Health Canada.

The report was published on May 29, 2019.

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

Not applicable

Link to the 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 2019-20 external financial and pension audits showed no major concerns. Independent external auditors will continue to perform audits on an annual basis.

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. It also undertook an independent 5-year corporate evaluation for the period of 2014-2019 in 2019-20 to examine the relevance, effectiveness and efficiency of CFHI's work. The results were released in late June 2020 and included: CFHI is in very good alignment with the priorities and requirements of the various stakeholder groups it woks with; it has greatly contributed to the acceleration of healthcare improvements in Canada and it has achieved a high degree of success in achieving its outcomes; and it has a well-defined governance mechanism and policies in place at the Board of Directors level.

Summary of results achieved by the recipient

CFHI facilitates ongoing interaction, collaboration, and exchange of ideas and information between governments and others from the public and private health care sectors; patients, families and caregivers; and health and social service providers; It does so by finding and promoting innovators and innovations; driving rapid adoption of proven innovations; enabling improvement-oriented systems; and, shaping the future of healthcare. There are no new results associated with the conditional grant to report for 2019-20. With the announcement of ongoing funding through contribution funding (separate from this endowment funding) in Budget 2017, CFHI has been considering how to best use its remaining up-front multi-year funding (approximately $11 million) that has been held in reserve for potential costs related to a potential organizational wind-down (e.g., legal obligations related to its pension plan and contracts) should it be needed. In late 2019-20, CFHI and the Canadian Patient Safety Institute decided to amalgamate their organizations and as amalgamation activities and costs are finalized, CFHI may rely on a portion of its remaining up-front multi-year funding to cover amalgamation costs.

Conditional Grant to Canada Health Infoway

General information

Name of recipient

Canada Health Infoway (Infoway)

Start date

March 31, 2001(a)

(a) The original allocation (2001) was governed by a Memorandum of Understanding. Presently, Infoway is accountable for the provisions of three active funding agreements, signed in: March 2003 (encompasses 2001 and 2003 allocations), March 2004, and March 2010.

End date

March 31, 2015(b)

(b) As per the 2010 funding agreement, the duration of the agreement is until the later of: the date upon which all Up-Front Multi-Year Funding provided has been expended; or March 31, 2015. Funds from the 2007 funding agreement (which was signed in March 2007) were expended in 2018-19.

Link to the 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 EHRs system^{Footnote 2}. 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

Not applicable

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 3}.

Closing the Circle of Care First Nations Expansion Project^{Footnote 4}

Infoway and Mustimuhw Information Solutions Inc. are partners 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, 2020, this initiative was serving 285 communities in seven provinces, 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 5} in Quebec had more than 551,000 registered users as of March 31, 2020.This is a 48% increase from the same time last year when there were 373,000 enrolled users.
• The Southwestern Ontario Regional Patient Portal, enabled by MyChart™, had more than 25,000 registered users as of March 31, 2020, with approximately 23,700 new users registering in 2019-20.
• 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. Alberta is now leveraging its MyHealth Records portal for its new Connected Care program that will support more options for patients and their health professionals. By March 31, 2020, 141,000 Albertans were using the service.
• After a successful pilot project involving 1,100 users, Saskatchewan launched MySaskHealthRecord province-wide. MySaskHealthRecord gives Saskatchewan residents access to health information such as lab results, medical imaging results and clinical visit summaries. As of March 31, 2020, almost 42,000 residents were using the service.

Telehomecare

In 2019-20, Infoway continued to support telehomecare projects for individuals with chronic conditions such as chronic obstructive pulmonary disease and congestive heart failure. In 2019-20, Infoway helped Newfoundland and Labrador deploy digital solutions in the homes of 913 patients living with chronic diseases and conditions, and the Ontario Community Paramedicine Remote Patient Monitoring project enrolled just under 1,300 patients. Recent (2018) telehomecare reports indicate a 44-85% reduction in hospitalizations and a 35-63% reduction in trips to the emergency department. These reports also indicate that telehomecare projects have 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 second year in a row. More than 1.4 million visits were offered through telehealth in 2019, an increase of more than 25% from 2018. Virtual technologies such as tele-mental health and tele-stroke helped patients living in rural and remote communities avoid more than 355 million kilometres of travel in 2019, resulting in an estimated annual reduction of 97,000 metric tons of CO₂ emissions. More than 55,000 Canadians have enrolled in telehomecare programs since 2010, with 14,819 enrolling in 2019-20.

Pan-Canadian Leadership in Digital Health Knowledge and Collaboration

In 2019-20, 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 2019 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 supported the work of the Canadian Medical Association, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada, in the development and release of the Virtual Care Task Force's final report and recommendations for scaling up virtual care services in Canada. In partnership with the Canadian Nurses Association and the Canadian Nursing Informatics Association, Infoway conducted a survey to understand the current use of electronic record/clinical information systems by nurses in Canada across clinical practice settings.

In 2018-19, Infoway and Health Canada co-developed a national drug terminology called the Canadian Clinical Drug Data Set. This drug terminology is an important component of many digital health systems that Canadians rely on, such as e-prescribing, hospital discharge reports, and adverse drug reaction reporting. It will also be a foundational support for national pharmacare because information systems will need consistency in the language they use to describe medication characteristics, strengths, and forms. In 2019-20, the Canadian Clinical Drug Data Set was translated into French so that it is now operational in digital health systems across the country in both official languages.