Supplementary Information Tables 2020-2021: Health Canada

Table of Contents

• Reporting on Green Procurement
• Details on Transfer Payment Programs
  • Transfer Payment Programs of $5 Million or More
    • Canada Brain Research Fund Program
    • Canadian Thalidomide Survivors Support Program
    • Contribution to Canada Health Infoway
    • Contribution to Canadian Blood Services: Blood Research & Development Program
    • Contribution to Strengthen Canada's Organs and Tissues Donation and Transplantation System
    • Contribution to the Canadian Agency for Drugs and Technologies in Health
    • Contribution to the Canadian Foundation for Healthcare Improvement
    • Contribution to the Canadian Institute for Health Information
    • Contribution to the Canadian Partnership Against Cancer
    • Contribution to the Canadian Patient Safety Institute
    • Health Care Policy and Strategies Program
    • Mental Health Commission of Canada Contribution Program
    • Official Languages Health Program
    • Organs, Tissues, and Blood Program
    • Pan-Canadian Virtual Care Priorities in Response to COVID-19
    • Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative
    • Substance Use and Addictions Program
    • Territorial Health Investment Fund
  • Transfer Payment Programs under $5 Million
    • Climate Change and Health Adaptation Capacity Building Program
    • Innovative Solutions Canada
    • Radon Outreach Contribution Program
• Gender-based analysis plus
• Horizontal Initiatives
  • Addressing the Opioid Overdose Crisis
  • Canadian Drugs and Substances Strategy
  • Chemicals Management Plan
  • Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis
• Up-front multi-year funding
  • Canadian Foundation for Healthcare Improvement
  • Canada Health Infoway
• 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

Reporting on Green Procurement

This supplementary information table supports reporting on green procurement activities in accordance with the Policy on Green Procurement.

Health Canada is bound by the Federal Sustainable Development Act and was required to develop a 2020 to 2023 Departmental Sustainable Development Strategy (DSDS). Health Canada has developed its corresponding 2020-21 DSDS Report, including applicable reporting on green procurement activities. This report can be found on Health Canada's website.

Details on Transfer Payment Programs

Transfer Payment Programs of $5 Million or More

Canada Brain Research Fund Program

General information

Name of transfer payment program

Canada Brain Research Fund Program

Start date

April 1, 2011

End date

March 31, 2022

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2019-20

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

• Program 14: Brain Research

Purpose and objectives of transfer payment program

In Budgets 2011, 2016, and 2019, and through a subsequent funding extension in 2021, the Government of Canada committed a cumulative $200 million, in matched funding with non-federal government donors, for the Canada Brain Research Fund Program "to support the very best Canadian neuroscience" and "to help the medical community better understand the brain and brain health." The Government of Canada's objectives in funding the Canada Brain Research Fund are: 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.

Results achieved

The Canada Brain Research Fund (CBRF) supports research with the greatest potential to lead to scientific discoveries that advance therapies and approaches to improve the health and quality of life of Canadians at risk of, or affected by brain health conditions. The Brain Canada Foundation (Brain Canada), the sole recipient of the fund, works in partnership with a range of donors from across the private and charitable sectors, to provide competitively awarded funding for research across Canada. In 2020-21, despite the barriers and pressures posed by the COVID-19 pandemic, Brain Canada partnered with various institutions, health charities and donors, research networks, provincial agencies and corporations, to raise $28.4 million in funds to match the federal contribution and also to disburse over $16 million in support of 163 research grants and awards.

In 2020-21, Brain Canada launched nine new research competitions to support basic, clinical, and implementation research. These included targeted competitions to address topics such as mental health and brain cancer, and open competitions that allowed researchers to propose innovative and original ideas to address a range of brain and neurological diseases, disorders, illnesses and other health conditions. During 2020-21, Brain Canada supported 40 new research projects resulting from competitions launched over the past two years. Of these, 20% were supported through team awards, which bring together scientists from different disciplines to advance collaborative research on the brain and brain health; 20% were platform awards, which sustain or enhance centralized shared research resources to promote efficient sharing of equipment, expertise, data, and protocols across research networks; and 8% were knowledge translation awards. The remaining 52% of projects were funded through capacity building awards to provide salary support, training, and mentoring to develop the next generation of Canadian brain researchers.

Of particular note were 20 projects selected through Brain Canada's Future Leaders competition, to support early-career researchers within five years of starting their first independent research position. In one promising example, a researcher is examining the mind-gut connection to explore how stress can trigger inflammation and lead to depression, with the aim of developing new ways of treating depression. Through funding for early career researchers, Brain Canada has demonstrated its continued commitment to 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.

A decade since its inception, the CBRF is beginning to yield transformative results. In the last two years, 9 patents, licenses and intellectual rights registrations resulted from CBRF-funded research, increasing the total to 48 since 2011. For example, a project led by a research team at McGill University resulted in a retinal scan that will detect Alzheimer's disease before symptoms progress. This advancement has the potential to aid in proactively identifying the need for treatment. In 2020-21, this new technology was authorized for use in the United States and will be used in partnership with American eye clinics. The retinal scan is nearing its final commercial approval for use in Canada. While the project began in 2015, foundational research laying the ground for this breakthrough dates back to 2011.

Brain Canada continued to assume a convening role within the research community, bringing research stakeholders together to discuss and advance key brain health priorities. Projects undertaken through the CBRF between 2011 and 2021 connected more than 1,000 researchers from over 75 disciplines at 115 institutions across Canada. Brain Canada has built this 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 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Brain Canada Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Canadian Thalidomide Survivors Support Program

General information

Name of transfer payment program

Canadian Thalidomide Survivors Support Program

Start date

March 22, 2019

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

• Program 15: Thalidomide

Purpose and objectives of transfer payment program

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

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

Results achieved

The Canadian Thalidomide Survivors Support Program (CTSSP) supported 121 confirmed survivors as of March 31, 2021.

Ongoing tax-free payments were distributed to 100% of known thalidomide survivors. 100% of payments were made before the end of April 2020, as per the time frame of the service standard of the independent third-party administrator.

The independent third-party program administrator processed 25 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. Based on needs identified in the 2019-20 annual survey of survivors, eligible expenditures under the EMAF were expanded in 2020-21 to include ongoing costs related to medication, chiropractic care, physiotherapy, and attendant services among others.

In 2020-21, a total of 59 new applications were submitted to the CTSSP and are at various stages of the assessment process. The application period for the CTSSP will remain open until June 3, 2024. While no new survivors were confirmed in 2020-21 using the 3-step probability medical assessment process, the CTSSP welcomed one new survivor from the Government Registry of Thalidomide Victims.

Outreach data for 2020-21 showed that 82.6% 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 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with the third party administrator of the CTSSP to discuss the Program progress. In addition, Health Canada provided information about the program to individual Thalidomide survivors, and individuals who believe they are survivors of Thalidomide, and the general public through direct correspondence and online communication.

Contribution to Canada Health Infoway

General information

Name of transfer payment program

Contribution to Canada Health Infoway

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 departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 6: Digital Health

Purpose and objectives of transfer payment program

Canada Health Infoway (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. Finally, in 2020, Infoway was allocated $50 million over two years to support provinces, territories and others to expand virtual health services to Canadians. These funds also flow through a contribution agreement.

Infoway is currently undertaking its Driving Access to Care Strategy which is comprised of two programs: PrescribeIT and ACCESS Health. To date, all 13 jurisdictions have formally agreed to participate in the PrescribeIT program. Infoway has also secured partnerships with several distributers. Infoway also continues to develop its ACCESS Health program, which it has recently renamed the Virtual Care program. After consultations with provinces and territories to ensure its work responds to digital health needs, Infoway decided to terminate its original national ACCESS Gateway project in favour of smaller interoperability projects that will be completed on a jurisdiction-by-jurisdiction basis. Overall, Infoway's virtual care activities, including the activities related to funding allocated in 2020, seek to support provinces, territories and other stakeholders in furthering Canadians' access to virtual care and digital health tools.

Results achieved

The PrescribeIT program continued to grow in fiscal year 2020-21. Memorandums of Understanding to implement the program are signed with all 13 jurisdictions. In 2020-21, 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 5,728 enrolled prescribers (up from 2,442 last year) and 4,699 enrolled pharmacies (up from 3,312 last year).

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada officials worked closely with Infoway to establish activities to be carried out under the Contribution Agreement, and discuss program progress. This included regular communications with Infoway throughout 2020-21, as well as monitoring of compliance with the contribution agreement, performance and results through analysis and follow-up of progress, performance and financial reporting.

In addition, a federal/territorial Assistant Deputy Ministers Working Group, with representatives from all provinces and territories and Health Canada, provided a forum for ongoing discussion, monitoring and progress towards virtual care priorities and objectives.

Contribution to Canadian Blood Services: Blood Research & Development Program

General information

In 2020-21, Health Canada combined this program ("Contribution to Canadian Blood Services: Blood Research & Development Program") with "Strengthen Canada's Organs and Tissues Donation and Transplantation System". Detailed results for both of these programs can be found under the new "Organs, Tissues, and Blood Program".

Contribution to Strengthen Canada's Organs and Tissues Donation and Transplantation System

General information

In 2020-21, Health Canada combined this program ("Contribution to Strengthen Canada's Organs and Tissues Donation and Transplantation System") with the "Canadian Blood Services: Blood Research and Development Program". Detailed results for both of these programs can be found under the new "Organs, Tissues, and Blood Program".

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

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 departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

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

Purpose and objectives of transfer payment program

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.

The contribution agreement provides 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 is able to create and disseminate evidence-based information about the effectiveness and cost of drugs and non-drug technologies. Provinces and territories use this information to help decide whether or not public health plans should include the particular health products in question.

Results achieved

The 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.

During the COVID-19 pandemic, CADTH responded to health system priorities by providing evidence, advice, implementation support, and recommendations on COVID-19 therapies, infection prevention and control, screening and testing for the Canadian health care system through its core business activities.

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CADTH Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Contribution to the Canadian Foundation for Healthcare Improvement

General information

Name of transfer payment program

Contribution to the Canadian Foundation for Healthcare Improvement^{Footnote 1}

Start date

December 10, 2015

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

• Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment program

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: find and promote health care innovators and innovations; drive rapid adoption of proven innovations; enable improvement-oriented systems; and, shape the future of healthcare.

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

Over the coming years, CFHI's activities are expected to result in: health care leaders that are knowledgeable and skilled in carrying out health care improvements; patients, residents, family members, communities and others with lived experience that are engaged in health care improvement and co-design; and improvements to the cultures of participating organizations. Over time, this work is expected to lead to improvements to: patient, resident and family experience of care; the health of patients and residents reached; efficiency of care; and work life of healthcare providers. Ultimately, CFHI will work to sustain, spread and/or scale proven innovative policies and practices within and across organizations, regions and provinces/territories.

Results achieved

CFHI's work was guided by a strategy for the period of 2019 to 2021, which outlined its vision of being an indispensable partner in shaping better healthcare for everyone in Canada.

In 2020-21, 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 2020-21 included:

• Through their program Long Term Care Plus (LTC+), CFHI worked to support 1,000 long-term care and retirement homes, as well as 40 shelters for people experiencing homelessness and residential substance use treatment facilities. The program will continue and be expanded in 2021-22. Initiatives and programming supported by the program has included:
  • Communicating regularly with families;
  • Enhancing consistent COVID-19 messaging with staff and families (e.g. physical distancing, hand hygiene, proper use of PPE); and
  • Improving infection prevention and control measures (e.g. staff being assigned to work in dedicated areas of the home, residents being cohorted based on symptoms/possible exposure status and the hiring of new staff).
• The initial wave of COVID-19 resulted in the implementation of blanket visitor restrictions that prohibited essential care partners from accessing loved ones in health and care facilities. In response, CFHI launched Essential Together – a program to support policy makers, policy implementers and those who were impacted by policies related to family presence during the pandemic and beyond. It worked with policy implementers across health care settings to re-integrate, welcome and engage essential care partners as part of care teams during COVID-19 (with the intent that those lessons will have benefits beyond the pandemic). The Essential Together guidance consists of seven key areas to help organizations identify and prepare essential care partners and then support them as they enter health care facilities.
• Continued its partnership with the Canadian Frailty Network on the "Advancing Frailty Care in the Community Collaborative" which 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.
• Supported leaders through 16 improvement projects across Canada as part of the Executive Training for Research Application (EXTRA) program. Examples of innovative projects undertaken included:
  • The prevention and reduction of workplace violence in long-term care;
  • Hospital harm reduction improvement project, the first step in formally developing a harm reduction program for both in and outpatients of St. Boniface Hospital in Manitoba;
  • Improving access to end-of-life care at home; and
  • Developing and implementing multi-institutional care support measures for users who make repeat visits to the emergency department.

  Findings of audits completed in 2020-21

  Completed: No audit was completed in 2020-21.

  Planned: Not applicable.

  Findings of evaluations completed in 2020–21

  Completed: No evaluation was completed in 2020-21.

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

  Engagement of applicants and recipients in 2020–21

  Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CFHI Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

  Financial information (dollars)

  Type of transfer payment	2018–19 Actual spending	2019–20 Actual spending	2020-21 Planned spending	2020–21 Total authorities available for use	2020–21 Actual spending (authorities used)	Variance (2020–21 actual minus 2020–21 planned)
  Total grants	0	0	0	0	0	0
  Total contributions	17,000,000	17,000,000	17,000,000	23,700,000	23,700,000	6,700,000
  Total other types of transfer payments	0	0	0	0	0	0
  Total program	17,000,000	17,000,000	17,000,000	23,700,000	23,700,000	6,700,000
  Explanation of variances	Additional funds were transferred to CFHI during 2020-21 to support its LTC+: Acting on Pandemic Learning Together program. These funds, totalling $6.7M, came from two sources, internally re-allocated Health Canada money ($2.05M) and the 2020 Fall Economic Statement ($4.65M).

  Contribution to the Canadian Institute for Health Information

  General information

  Name of transfer payment program

  Contribution to the Canadian Institute for Health Information

  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 departmental result(s)

  • Core Responsibility 1: Health Care Systems
  • Result 2: Canadians have access to appropriate and effective health services

  Link to the department's Program Inventory

  • Program 7: Health Information

  Purpose and objectives of transfer payment program

  The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization supported by federal, provincial and territorial governments (FPT) that provides essential data and analysis on Canada's health system and the health of Canadians. CIHI was created in 1994 by the FPT 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. In early 2018, the current contribution agreement was signed, providing close to $365 million over five years (2017-18 to 2021-22). Subsequent amendments valued at $11M are as follows:

  • February 2019, an additional $140,000 to undertake an environmental scan of data gaps for addiction treatment services.
  • December 2019 another $500,000 for initiating a pan-Canadian collaborative project to enhance organ donation and transplantation (ODT) data and reporting across the country.
  • October 2020 an additional $3.405 million in funding to CIHI, in partnership with Infoway, to advance the ODT data and reporting system project in 2020-21.
  • March 2021 additional funding (up to $7.245M in fiscal year 2021-22) for enhancing timely data on hospital, ICU, emergency room capacity, long term care and virtual care in response to the pandemic through the Safe Restart Agreement, and accelerate year-3 activities of the ODT project funded under Budget 2019.

  Presently, Health Canada funds 81% of CIHI's total budget, while the provincial and territorial governments contribute 17%. The remaining funds are generated largely through product sales.

  Results achieved

  In 2020-21, 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.

  Highlights of key accomplishments are outlined below:

  In 2019 CIHI in partnership with Canada Health Infoway, was identified as a lead organization to develop a comprehensive data and performance system to improve the approach to organ donation and transplantation in Canada. CIHI implemented this work with the ODT Collaborative (the Collaborative) ^{Footnote 2}, which included provinces and territories (P/Ts), organ donation organizations, transplant programs, research bodies, regulators, ethicists, and patient/advocacy bodies. In particular, CIHI worked with P/Ts, CBS, Transplant Quebec and clinicians to develop a detailed implementation plan to move forward on this initiative. CIHI has made progress in moving forward with the planned data activities over the first two years of the project.

  In 2019-20, CIHI began developing pan-Canadian common indicators, which focused on access to home care and mental health services to track progress achieved in the Common Statement of Principles on Shared Health Priorities. Each year over four years CIHI will develop and publicly report on 3 new indicators based on the original 12 endorsed by federal, provincial and territorial (F/P/T) Health Ministers in 2018. On August 6, 2020, CIHI released results for three new indicators: Self Harm, Including Suicide; Caregiver Distress; and New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home. The results were accompanied by the companion report Common Challenges, Shared Priorities: Measuring Access to Home and Community Care and to Mental Health and Addictions Services in Canada — Volume 2, August 2020, which provided additional information on the indicator results released to date and reports on progress on indicator development. For the remaining 6 indicators, CIHI will continue working with F/P/T governments across Canada to report annually on these indicators and to build on data sources to enable more comprehensive reporting.

  To continue to close existing data gaps, CIHI made progress on the collection of pan-Canadian data to enhance coverage in key areas, including: virtual and primary health care, long term care, home care, community mental health, addictions, palliative care, pharmaceuticals, patient-reported outcomes, organ donation and transplantation and the health of Indigenous populations.

  The COVID-19 pandemic accelerated the demand for adoption of virtual care infrastructure and services across Canada. In the absence of pan-Canadian standardized measures of quality, effectiveness or experience with virtual care, CIHI collaborated with Health Canada and its partners, Pan-Canadian Health Organizations, P/Ts and experts to identify longer-term priorities for virtual care, including the development of pan-Canadian content standards, indicators and measures of patient experience and outcomes.

  CIHI further contributed to Canada's pandemic response by supporting consistent coding of COVID-19 cases in hospital and non-acute care facilities; implementing strategies to acquire real-time hospital data and developing guidelines on regular data submission to reduce interruptions in regular data flow; and by creating, curating and delivering COVID-19 data and information for use by governments, health systems managers and the media though their website and social media channels. CIHI also identified data priorities to better respond to health system needs for subsequent pandemic waves.

  Last, CIHI obtained standardized and timely COVID-19 hospital capacity and utilization data from each P/T to help identify and mitigate hospital-bed and ventilator shortages.

  Findings of audits completed in 2020-21

  Completed: No audit completed in 2020-21.

  Planned: Not applicable.

  Findings of evaluations completed in 2020–21

  Completed: No evaluation was completed in 2020-21.

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

  Engagement of applicants and recipients in 2020–21

  Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CIHI Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Contribution to the Canadian Partnership Against Cancer

General information

Name of transfer payment program

Contribution to the Canadian Partnership Against Cancer

Start date

April 1, 2007

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

• Program 10: Cancer Control

Purpose and objectives of transfer payment program

The Canadian Partnership Against Cancer (CPAC) is an independent, not-for-profit corporation established to implement the Canadian Strategy for Cancer Control. This Strategy was developed in consultation with Canadians, including cancer experts and stakeholders with the following objectives:

• Reducing the expected number of new cases of cancer among Canadians;
• Enhancing the quality of life of those living with cancer; and,
• Lessening the likelihood of Canadians dying from cancer.

CPAC is the sole recipient of the Contribution to the Canadian Partnership Against Cancer Program. 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 2020-21, 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 included:

• Coordinated efforts with a broad group of partners, experts and stakeholders to develop an Action Plan for the Elimination of Cervical Cancer in Canada 2020–2030 and initiated funding for provinces and territories to accelerate action on priorities including planning for and implementing HPV primary screening and follow-up;
• Published Lung Cancer and Equity: A Focus on Income and Geography, a report highlighting differences in access to care and health outcomes for underserved populations;
• Initiated funding for all provinces to accelerate the planning and implementation of lung cancer screening programs for people at high risk;
• Launched funding opportunities across 11 jurisdictions to build cancer screening resilience, focussing on approaches to screening that require fewer in-person interactions with the health-care system and more accessible, highly reliable home-based screening options;
• Launched a Pan-Canadian Framework for Action to Address Abnormal Call Rates in Breast Cancer Screening (PDF 5,400 kb);
• Invested in a multi-year initiative to help provinces and territories better identify populations who are under-screened for colorectal cancer and to work with local communities to remove barriers that prevent access to screening programs;
• Collaborated with the Canadian Network of Surgical Associations of Cancer Care to develop a Guidance for Management of Cancer Surgery During COVID-19 Pandemic (PDF 176 kb);
• Published the Canadian Network of Surgical Associations for Cancer Care's Pan-Canadian Action Plan: Optimizing Cancer Surgical Care in Canada (PDF 1,844 kb) to provide guidance on coordinated efforts needed to deliver high quality, efficient, and coordinated surgical cancer care;
• Supported partners in every jurisdiction with implementation of tobacco cessation strategies for patients with cancer;
• Expanded access to palliative care and reduced demands on emergency departments by collaborating with the newly amalgamated Healthcare Excellence Canada to expand the program to train paramedics to deliver palliative care at home;
• Supported partners in implementing solutions to improve symptom monitoring for patients using Patient Reported Outcome tools;
• Launched a project with the Canadian Cancer Society to develop online tools to improve the navigation of mental health and psychosocial resources, including a focus on special population groups, such as adolescents and young adults;
• Supported the Canadian Cancer Clinical Trials Network (3CTN) to develop the Canadian Remote Access Framework for Clinical Trials (CRAFT) to improve access to clinical trials for those in remote and rural areas. Additional support was provided to 3CTN and a consortium of pediatric clinical trial centers to increase access to clinical trials for pediatric, adolescent and young adults with cancer;
• Supported the Canadian Cancer Research Alliance to lead the development of a Pan-Canadian Vision for Cancer Research to highlight the importance of cancer research in cancer control and influence the direction of cancer research in Canada; and,
• Supported 30 funded initiatives across 13 jurisdictions to improve 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.
  • In response to new challenges faced by partners and cancer patients, CPAC provided immediate funding to support urgent COVID-19 relief projects, for example, purchasing equipment to enable virtual care. Some examples of CPAC's funding for partners throughout the COVID-19 pandemic include: expanded virtual or alternate models of care, for example, improving symptom monitoring for patients with virtual Patient-Reported Outcomes tools when in-person visits were not possible;
  • virtual tobacco cessation counselling and at-home dispensing of nicotine replacement therapies; and
  • collaboration with the Canadian Partnership for Quality Radiotherapy and radiation treatment facilities across the country on personal protective equipment requirements for radiation therapists.

  Findings of audits completed in 2020-21

  Completed: No audit completed in 2020-21.

  Planned: Not applicable.

  Findings of evaluations completed in 2020–21

  Completed: No evaluation was completed in 2020-21.

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

  Engagement of applicants and recipients in 2020–21

  Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CPAC Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Contribution to the Canadian Patient Safety Institute

General information

Name of transfer payment program

Contribution to the Canadian Patient Safety Institute^{Footnote 3}

Start date

April 1, 2013

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

• Program 11: Patient Safety

Purpose and objectives of transfer payment program

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. A new five-year contribution agreement began on April 1, 2013 and concluded on March 31, 2021.

Results achieved

CPSI provided leadership and coordination of efforts to prevent and reduce harm to patients, with an emphasis on four key areas: safety improvement projects; making patient safety a priority across health care systems; influencing policy, standards, and regulations so that they incorporate best patient safety evidence and practices; and creating and strengthening alliances and networks with partners such as patients, governments, and industry who are committed to making care safer.

Over the coming years, CPSI's work is expected to contribute to sustained improvements in patient safety across Canada, resulting in reduced incidence rates of preventable harm, and healthier Canadians.

In 2020-21, 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.
• Launched 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. The framework was presented at a Council of Deputy Ministers meeting, and has already seen significant uptake, including from provincial health authorities who indicated it will be used in their strategic planning.
• Held Canadian Patient Safety Week 2020 (with an online presence, due to COVID-19), 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.
• Released the "Creating a Safe Space: Psychological Safety of Healthcare Workers (Peer to Peer Support and Other Support Models)" manuscript, to assist healthcare organizations support healthcare workers by creating peer-to-peer support programs or other models of supports to improve the emotional well-being of healthcare workers and allow them to provide the best and safest care to their patients.
• Updated and re-released the Safety Competencies Framework, a simple, powerful and flexible framework that includes enabling competencies that can be adopted and adapted by diverse healthcare programs to design curricula to teach safety and quality for any sector or health care program. It is also a valuable resource to policy makers, regulators and accreditors to guide system change.
• 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 several 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 2020-21

Completed: No audit completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CPSI Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Health Care Policy and Strategies Program

General information

Name of transfer payment program

Health Care Policy and Strategies Program

Start date

September 24, 2002

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment program

The Health Care Policy and Strategies Program provides time-limited contribution funding for projects that address specific health care systems priorities, including palliative and end-of-life care, home and community care, mental health, and federal and provincial/territorial and other emerging priorities. Through the implementation of contribution agreements and a variety of stakeholder engagement activities, Health Canada contributes to the development and application of effective approaches to support sustainable improvements to health care systems.

Results achieved

The Program funding supported a wide range of projects designed to ultimately contribute to improvements and transformations in health care systems across Canada. For example, health care innovation projects supported activities that develop, implement and evaluate tools, models, and practices that address identified health care systems priorities. Other projects produced knowledge products and resources that enabled health providers to maximize their roles in a range of settings; provided system managers and decision-makers with data and decision-making tools to enhance system planning and performance; and engaged key stakeholders in collaborative efforts that contribute to specific health care systems improvements relevant to Program priorities.

In 2020-21, the Health Care Policy and Strategies Program directed funding toward disseminating, exchanging and implementing knowledge to support innovation and best practices in areas such as: palliative and end-of-life care, home and community care, mental health, and other federal and provincial/territorial emerging priorities, including COVID-19. The Program also supported projects that contributed to improving access to health care services for all Canadians. Specific examples included:

• Pallium Canada's four-year project "Building and Bridging – Palliative Care is Everyone's Business" was completed in 2020-21. The project aimed to strengthen home and community palliative care capacity by developing new and enhancing existing palliative care courses - "Learning Essentials Approaches to Palliative Care" (LEAP) - that are available to healthcare professionals and carers across Canada.
• Unity Health Toronto's "Choosing Wisely Canada – Phase 3" project aimed to encourage clinicians and patients across Canada to engage in conversations about unnecessary tests, treatments and procedures. In 2020-21, Unity Health Toronto continued to work with key project stakeholders and physician leaders to review and refresh its list of recommendations, and published over 30 new recommendations on a variety of topics, including COVID-19, medical laboratory medicine, rural medicine, and critical care, among others. Additionally, Unity Health Toronto worked on advancing the "Using Antibiotics Wisely" campaign in both primary care and long-term care, which included modifying respiratory tract infection tools for post COVID-19 primary care context. As well, a "Using Blood Wisely" campaign was launched in 2021, including a Taking the Challenge webinar and Using Blood Wisely website, which has an intervention toolbox that include templates, education modules, webinars, and resources.
• The Institute for Health System Transformation and Sustainability's project "Preparing Patients and Families from Culturally Diverse Backgrounds for Enhanced Access to Palliative Care through advance care planning Engagement" focused on developing culturally appropriate and linguistically acceptable tools and resources to facilitate moreinformed palliative and end-of-life decisions in certain cultural communities in British Columbia.
• In 2020-21, Frayme continued to partner with key stakeholders and experts in youth mental health care to advance its project called "Canada's Youth Mental Health and Substance Use Services and Systems Support Network". This project aims to establish a strong, viable, pan-Canadian network that supports the coordination of – and improved evidence-based decision-making for – care and services in the area of youth mental health and addictions. Frayme is a national network that integrates mental health care, health services and social services for youth and young adults in Canada.
• In 2020-21, the Heart and Stroke Foundation of Canada continued to encourage greater stakeholder engagement on its project called "Advancing Women's Heart Health" to improve targeted research on the prevention, diagnosis and treatment of heart disease and stroke in women. Through several key activities, the project contributed to new knowledge to influence policy and practice change as well catalyzing pan-Canadian action to accelerate the adoption of sex- and gender-based analysis and reporting by key partners and institutions across Canada.
• In 2020-21, the Program continued to fund projects in support of the Organ Donation and Transplantation Collaborative initiative with provinces and territories (except Québec), Canadian Blood Services, patients, families, clinical and administrative stakeholders and researchers. This initiative aims to improve pan-Canadian governance of organ and transplantation and policies related to inter-provincial organ sharing. The expert reports produced by the initiative to date will support further stakeholder engagement and development of recommendations to improve the organ donation and transplantation system and encourage timely and effective access for Canadians to quality organ donation and transplantation services.
• In 2020-21, the Program also funded several new projects that responded to emerging pressures, such as the COVID-19 pandemic and the need to address health inequalities experienced by Indigenous peoples in Canada. Specific examples included:
  • The Canadian Association of Schools of Nursing Project called "Essential COVID-19 Skills for Graduating and New Nurses", which created a Virtual Simulation Series to strengthen the capacity of nursing students, new front-line nurses and nurses returning to work to provide care during the COVID-19 health crisis.
  • The "Science Disinformation in a Time of Pandemic" project, implemented by the Public Policy Forum, produced a public discussion paper on disinformation in science and medicine in the context of COVID-19. The goal of the paper was to inform a discussion about how authorities and media companies might best respond to content that seeks to undermine public trust and advocates behaviour that would compromise pandemic management strategies. The paper has been published online and shared via social media channels such as Twitter and LinkedIn.

  Findings of audits completed in 2020-21

  Completed: No audit was completed in 2020-21.

  Planned: Not applicable.

  Findings of evaluations completed in 2020–21

  Completed: No evaluation was completed in 2020-21.

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

  Engagement of applicants and recipients in 2020–21

  The Program engages applicants and recipients through discussions on reporting to facilitate the collection of data/information to inform program delivery and results. Recipients are consulted on performance measurement, knowledge translation, and sex and gender based analysis with a view to understanding their needs and the tools they require to meet Program expectations in terms of reporting on results. Training sessions on performance measurement and knowledge translation are available to recipients. Site visits by project officers offer an opportunity to engage recipients in all Program aspects.

  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 Canadian Home Care Association 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.

Mental Health Commission of Canada Contribution Program

General information

Name of transfer payment program

Mental Health Commission of Canada Contribution Program

Start date

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

End date

March 31, 2027

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 4: Mental Health

Purpose and objectives of transfer payment program

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 10-year period, from 2017-18 to 2026-27 to advance work on mental health priorities, including linkages to substance use, suicide prevention, support for at-risk populations and engagement. The Government of Canada has made a contribution of $14.25 million per year since 2017-18 for these mandated priority areas.

This initiative contributes to the improved mental health and well-being of Canadians, specifically in the areas of linkages to substance use, suicide prevention, support for at-risk populations, and engagement.

Results achieved

In 2020-21, the MHCC continued to provide valuable mental health expertise and advice to mental health stakeholders. Notable achievements:

Substance Use

To reduce stigma among first responders and improve service delivery to opioid users, the MHCC validated its Opening Minds Provider Attitudes Towards Opioid Use Scale, and used it to evaluate four stigma reduction programs across Canada.

Suicide Prevention

The MHCC continued expanding its Roots of Hope project, which is a community-based suicide prevention research demonstration project, which includes eight communities.

The MHCC also worked with the Canadian Journalism Forum on Violence and Trauma to update and publish the third edition of the Mindset guidelines to promote safe and responsible conversations about mental health and suicide in the media.

Population-Based Initiatives

People living with mental illness were over-represented in the criminal justice system, and the justice system was not well equipped to meet their needs. Through quarterly teleconferences of its established advisory committee, 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. The MHCC also developed a policy statements about the impacts of COVID-19 on people who are involved in the criminal justice system.

Engagement

Stepped Care 2.0 provided rapid, same day, flexible access to wellness and mental health resources. A stepped care model was a way to organize the delivery of health care so that patients receive the least intensive treatment with the greatest likelihood of improvement.

The MHCC also continued to engage with key stakeholders to improve the area of e-mental health. This included work with the Canadian Agency For Drugs And Technologies In Health around reports on Artificial Intelligence and mental health; partnering with the Canadian Centre on Substance Use and Addiction on virtual care initiatives; and working with the Organization for the Review of Care and Health Apps, Royal Bank Canada, Capitalize for Kids, and other key stakeholders on App Evaluation. The MHCC also hosted three e-Mental Health Collaborative virtual meetings, with more than twenty members, to discuss topics such as virtual health care delivery, implementation and research.

Findings of audits completed in 2020-21

Completed: No audit completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

Planned: The funding for the Mental Health Commission of Canada will be evaluated as part of three separate evaluations. The first two are scheduled for 2022-23 and the third is scheduled for 2023-24.

Engagement of applicants and recipients in 2020–21

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with MHCC Program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Official Languages Health Program

General information

Name of transfer payment program

Official Languages Health Program

Start date

June 18, 2003

End date

March 31, 2022 (Grant)
Ongoing (Contribution)

Type of transfer payment

Grants and Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 13: Promoting Minority Official Languages in the Health Care Systems

Purpose and objectives of transfer payment program

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 the language of their choice. Through the implementation of contribution agreements and micro-grants, Health Canada supports investments that improve the active offer of health services for OLMCs, through training and retention of health care providers, networking activities and innovative projects that increase access to health services for OLMCs.

Results achieved

Program funding supported the training and retention of health professionals, health networking and innovative projects to improve access to health services for OLMCs. These activities increased access to bilingual health professionals in OLMCs, and to increase the offer of health services to OLMCs.

In 2020-21, under Action Plan for Official Languages 2018–2023: Investing in Our Future, Health Canada supported a range of programs and projects through the OLHP. The impacts of these initiatives included: increased 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 2020-21, the OLHP supported a range training and retention of health professionals initiatives to improve the availability of bilingual health providers and access to services in OLMCs. For example:

• Outside of Quebec, 674 French-speaking students graduated from the 108 different health training programs offered by the 16 academic institutions members of the ACUFC-CNFS. In addition, 91% of the surveyed graduates remained to work in OLMCs and 96% of those health professionals are providing services in French in their workplace.
• In Quebec, McGill University registered more than 1,118 health and social services professionals in its language training program aimed at improving the English proficiency of participants so that they can better serve English-speaking patients in their language of choice. In total, 912 health professionals successfully completed their language training - an 83% success rate.

Strengthening and improving local health networking capacity in OLMCs:

In 2020-21, 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) and 10 satellites, managed by both the SSF and CHSSN collaborated with various health sector stakeholders to improve access to health services for OLMCs and thus improve their health status. 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 continued to actively represent the Anglophone community's needs in a number of local and regional tables on senior services, youth services, and early childhood development. The Network also increased the offer of health services in OLMCs and health institutions by producing and disseminating a broad range of health information products, as well as coordinating learning and promotional activities.
• Outside Quebec, through its activities and partnerships, the SSF collaborated with policy decision-makers and health stakeholders to influence the planning of local health networks to better serve Francophone minority communities. For example, the SSF:
  • Contributed to enhancing the French-language internship program, which welcomed nine new health trainees in areas such as speech therapy, social work, and occupational therapy (Nunavut).
  • Supported two organizations that provide long-term healthcare services to improve the range of healthcare services available in French (Prince Edward Island).
  • Developed French language service guidelines used to guide submissions from developing and/or newly appointed Ontario Health Teams. The tool is also used by long-term care homes in their efforts to provide health services for the Francophones they serve.

Projects to improve access to health services for OLMC:

In 2020-21, Health Canada funded innovative projects to improve the availability of bilingual health professionals to address the needs of OLMCs. For example:

• In Quebec, the CHSSN published the study "Health profile of high school students in Quebec by linguistic community: a look at mental well-being and social adjustment problems", to support mental health practitioners working with English-speaking high school to better address their needs.
• Outside Quebec, through its 16 networks and associated partners, the SSF undertook projects in all provinces and territories, to support or implement accessible services and programs, mobilize human resources and enhance community commitment, awareness and capacity.
• In Saskatchewan, the Saskatchewan Health Authority collaborated with Tel-Aide-Outaouais (TAO) to implement Tel-Aide helpline to allow better access to up-stream mental health services along with the continuum of care for all Francophone minority communities living in the province.

Findings of audits completed in 2020-21

Completed: No audit completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

In 2020-21, representatives of the 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.

In addition, in 2020-21, the Federal Health Portfolio Consultative Committee for Canada's OLMCs met several times in order to: 1) renew its mandate and work plan, 2) create a working group on data and research for future priorities, 3) discuss possible collaborations between health, justice and public safety sectors on mental health issues and 4) allow the three federal institutions that are members of the Committee (Health Canada, the Public Health Agency of Canada and the Canadian Institutes for Health Research) to consult community members on the future of programs that directly impact OLMCs.

Organs, Tissues, and Blood Program

General information

Name of transfer payment program

Organs, Tissues, and Blood Program^{Footnote 4}

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 departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 12: Organs, Tissues and Blood

Purpose and objectives of transfer payment program

The Organs, Tissues, and Blood Program ("the Program") provides support for safe, effective, accessible and responsive organ, tissue and blood systems that will improve and extend the quality of the lives of Canadians while respecting federal, provincial, and territorial scopes of authority. Canadian Blood Services is the sole recipient of the Program funding.

Until 2020-21, these were two separate programs - Organ and Tissue Donation and Transplantation Program and Blood Research and Development Program which were funded through the Canadian Blood Services. However, in 2020-21, the 2 programs were combined under "Organs, Tissues, and Blood Program" to replace 2 separate programs and continued to be funded through the Canadian Blood Services.

Results achieved

The Program generated numerous knowledge products and learning events and played a role in public education, engagement and awareness. It also played a significant role in the development of highly qualified people through formal training in the important areas of basic and applied research. It developed collaborative arrangements, established partnerships, and identified areas of emerging interests and needs relating to organ, tissue and blood systems, in collaboration with the provinces and territories - to inform changes in practices and standards while contributing to greater safety, effectiveness, accessibility and responsiveness of the organ, tissue and blood systems to improve and extend the quality of life for Canadian patients.

Blood research and development

Canadian Blood Services generated numerous outputs related to knowledge products (e.g., journal articles, reviews), learning events, collaborative arrangements and the development of highly qualified researchers. For example, its research and education network published 205 peer-reviewed and 66 non peer-reviewed publications, an increase over the prior year. Network members delivered over 270 conference presentations to local, national and international audiences. The average h-index, a measure demonstrating the significance and impact of published work, was 31 for Canadian Blood Services research staff, over three times the average h-index (10.6) for Canadian academic science authors. Canadian Blood Services led or delivered in partnership with more than 20 education events for specialists in transfusion science and medicine and attracted 3,238 professionals. Various stakeholders used the knowledge generated by research and development projects to inform changes to practices and standards in blood.

With funding from the Program, Canadian Blood Services supported 18 research projects under two separate streams: Men who have Sex with Men (MSM) Blood Research and MSM Plasma Research. Of these 18 research projects, 11 are now completed while 7 were incomplete as of March 31, 2021, but are slated to end in spring 2022.There are 4 new publications arising from this research, with numerous others anticipated as project teams complete their data analysis. A multidisciplinary program team is drawing on the research evidence from this work in order for Canadian Blood Services to implement plasma donation behavioural-based screening criteria for MSM. Implementation of these screening criteria are set to begin in Calgary, AB and London, ON in Fall 2021.

As final results from the research projects are published and disseminated, they will also inform Canadian Blood Services' efforts to expand eligibility criteria for whole blood donation by MSM in Canada. For example, results from the previously funded "SAFE" study, have already informed the United Kingdom's proposed change to blood donor eligibility criteria, which was implemented in June 2021. While research results continue to be analyzed, Canadian Blood Services publicly indicated on June 18th, 2021, that it would make a submission to Health Canada regarding a change to gender-neutral, behavior-based donation screening by the end of 2021.

Organ and Tissue Donation and Transplantation

Canadian Blood Services works with partners and stakeholders to influence and improve system performance through the development and implementation of leading practices, professional and public education, engagement and awareness. They are a member of the Organ Donation and Transplantation Collaborative, and continue to support various projects focussed on the priorities identified by the Collaborative that advance transformative, system-level improvements in organ donation and transplantation by 2024.

In 2020-21, significant work was undertaken to support the organ and tissue donation and transplantation community in its response to the pandemic. Canadian Blood Services led national and international meetings, developed and updated national guidance documents and data dashboards, and collected and evaluated research and evidence to inform clinical practice. With the support of provincial organ donation organizations, processes were developed to collect and share national data relative to system performance in near real time.

To better engage and learn from patient and donor family partners, patient advocacy groups, and other stakeholders, Canadian Blood Services hosted its first 2 community forums that included patients, donor family members and representatives from major organ organizations.

Additionally, CBS partnered with Dr. Amy Waterman and her team at the Transplant Research and Education Centre to develop a Canadian version of the Living Donation Storytelling Project, a digital library of video stories recorded by real people focussed on living donor kidney transplant experiences. A Canadian version of My Transplant Coach | Explore Transplant - an interactive tool developed in the U.S. that helps kidney patients understand their condition and assists them in making healthcare decisions - was developed. Versions of the video's script were also developed in French, Cantonese and Punjabi.

Last, CBS worked with their partners and stakeholders to develop, operate, and evolve national programs to facilitate the sharing of organs across provincial boundaries using the Canadian Transplant Registry. Using this registry, CBS led the implementation of a project to develop and implement national policies and processes to share hearts for high-status and sensitized patients inter-provincially (and should be available in the summer of 2021). This project aims to improve equity of access for highly sensitized patients, who are people in critical need of an organ transplant, but are hard to match because of the antibodies in their systems.

Findings of audits completed in 2020-21

Completed: No audit completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

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 continued 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.

Pan-Canadian Virtual Care Priorities in Response to COVID-19

General information

Name of transfer payment program

Contributions for Canada's Home and Community Care and Mental Health and Addiction Services Initiative and Virtual Care Services

Start date

June 30, 2020

End date

March 31, 2022

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 6: Digital Health

Purpose and objectives of transfer payment program

The Government of Canada is working with provinces and territories to support the rapid roll out of virtual care and needed supports for health systems to undertake virtual care and provide health services at a distance. The Pan-Canadian Virtual Care Priorities in Response to COVID-19 provides $150 million to provinces and territories through bilateral agreements to support five priority areas for immediate action to further embedding virtual care services within Canadian health systems:

• Secure messaging and file-transfer platforms or supports to enable end-to-end messaging;
• Secure video-conferencing technology to deliver care to patients remotely;
• Remote patient monitoring technologies;
• Patient access to COVID-19 and other lab results; and
• Back-end supports for integration of new platforms and supports, including needed hardware.

Through these agreements, P/Ts are accelerating their efforts on virtual care to better enable Canadians to engage safely with their regular health care providers via phone, text or video conference. These tools also enable patients to continue to access health services, including primary care, during this time of uncertainty.

Building on consensus on the five priorities for this investment, bilateral agreements between the federal government and eight P/Ts were established by the end of fiscal year 2020-21. As these agreements are completed, they are posted to Health Canada's website and include action plans that enable Canadians to see how targeted federal funding is helping P/Ts put in place digital supports to help Canadians get the information, resources and care they need. Initiatives are helping improve access to primary care, mental health services, and urgent care visits, as well as the communication between patients and health care providers.

Results achieved

To enable Canadians to assess progress, the Canadian Institute for Health Information will report the results of this work, based on jurisdiction-specific performance measures. P/Ts (except Quebec) agreed to provide the Canadian Institute for Health Information with available baseline data on the indicators and expected results identified within their action plan. Furthermore, P/Ts (except Quebec) have also agreed to provide specific indicators and data demonstrating the results of their initiatives, which will be made publically available.

Findings of audits completed in 2020-21

Not applicable

Findings of evaluations completed in 2020–21

Not applicable

Engagement of applicants and recipients in 2020–21

As part of these bilateral agreements, P/Ts agreed to collaborate to advance policy supports through a Federal, Provincial and Territorial (F/P/T) Virtual Care/Digital Table, with a mandate to work collaboratively to develop a proposed plan for accelerating the deployment of virtual care across Canada both during COVID and for the longer-term. The Table has provided a mechanism for ongoing collaboration and engagement, with the P/T as well as a broad range of experts and stakeholders to discuss substantive issues related to virtual care. The Table is supported by a Virtual Care Expert Working Group, with representation from F/P/T government officials, key experts, healthcare stakeholders and pan-Canadian health organizations, which has a mandate to provide advice and guidance on virtual care in response to the COVID-19 pandemic.

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

General information

Name of transfer payment program

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

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 departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 3: Home, Community and Palliative Care
• Program 4: Mental Health

Purpose and objectives of transfer payment program

The Government of Canada has invested $11 billion over ten years (2017-2027) to support the provinces and territories in implementing home care ($6 billion) and mental health and addictions ($5 billion) initiatives in their jurisdictions, in accordance with the Common Statement of Principles for Shared Health Priorities which was jointly agreed to by federal, provincial and territorial (FPT) Ministers of Health (with the exception of Quebec) in August 2017. Governments agreed to common objectives in each of home and community care and mental health and addiction services, and in particular to improving access to mental health and addictions through one or more of the following areas of action:

• 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.

Similarly, on home and community care, FPT governments agreed to work together to improve access to services through one or more of the following areas of action:

• 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.

Governments also agreed to develop a focused set of common indicators to measure progress on these priority areas. The Canadian Institute for Health Information (CIHI) 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. CIHI will continue to work with governments across Canada to report annually on these indicators.

Following agreement on the Common Statement of Principles for Shared Health Priorities in 2017, the federal government negotiated and signed the first of two sequential bilateral agreements with all 13 provinces and territories which set out details of how each jurisdiction is using federal investments to improve access to home and community care and mental health and addiction services. The bilateral agreements with the provinces and territories will be renewed starting in 2021-22 for the remaining five years of the ten-year commitment.

Results achieved

In keeping with the bilateral agreements, federal funding was 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 would be invested in each province and territory.

Pursuant to a shared commitment to report on results under the 2017 Common Statement of Principles on Shared Health Priorities, in 2018 FPT Ministers of Health agreed to 12 common indicators to report on progress. Since then, provinces and territories are progressively reporting indicators, with new indicators released nationally each year.

Over time, these indicators will give Canadians more information about access to home and community care and to mental health and addictions services in their province or territory. In 2020, results for three new indictors were made available:

• Self-Harm, Including Suicide;
• Caregiver Distress;
• New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home.

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 have been taking steps to improve access to mental health and addiction services. Many took an integrated approach to delivery of these services that recognizes the need to provide people-centred care that was 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 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with program staff and senior management to discuss Program progress. In addition, Health Canada continued 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.

Substance Use and Addictions Program Supplementary Information Table

General information

Name of transfer payment program

Substance Use and Addictions Program

Start date

December 4, 2014

End date

March 31, 2022 (Grant)
Ongoing (Contribution)

Type of transfer payment

Grants and Contributions

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 5: Substance Use and Addictions^{Footnote 5}

Purpose and objectives of transfer payment program

The Substance Use and Addictions Program (SUAP)^{Footnote 6} 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 substances, including opioids, stimulants, cannabis, alcohol, and tobacco and vaping products.

Projects funded by the SUAP contribute to individual capacity and organizational, system and community level program, policy and practice change by: preventing problematic substance use and reducing harms; facilitating treatment service and system enhancements; and, improving awareness, knowledge, skills and competencies of targeted stakeholders and Canadians.

Results achieved

In 2020-21, SUAP invested $80 million towards 198 problematic substance use projects across Canada. In response to the worsening opioid crisis and surge in opioid deaths, SUAP funded 63 new community-based projects responding to substance use issues, including those providing frontline services in a COVID-19 context.

Projects funded in 2020-21 focused on:

Controlled Drugs and Substances

One hundred and fifty-six projects addressed a variety of needs including improving access to harm reduction and treatment; naloxone training and distribution; identifying best practices for medication-assisted treatments; improving access to different types of treatment; identifying innovative models for opioid replacement therapy; and addressing problematic alcohol use. This includes 63 new projects funded in winter 2021 to expand the number and scope of short-term safer supply projects and initiatives providing national naloxone training and distribution. People with lived and living experience and those who work with them led many of the new projects.

SUAP also funded 15 pilot projects designed to provide medications as safer alternatives to the contaminated illegal drug supply in Canada ("safer supply" pilot projects) as well as 9 projects exploring new approaches to addressing problematic methamphetamine use. Additional funding supported the distribution of naloxone kits and opioid overdose response training to support communities particularly hard hit by the opioid overdose crisis.

Cannabis

Thirty-three projects were aimed at gathering evidence and providing Canadians, with a focus on youth and at risk groups, on the use of cannabis and its health effects. This included 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 those Canadians on the potential health and safety risks associated with cannabis use.

Tobacco and Vaping Products

Nine projects were focused on prevention, protection and/or cessation of use of tobacco and vaping productsProjects informed Canadians about harms and risk of tobacco and vaping products, including projects designing cessation interventions for people who smoke as well as youth who vape, developing low-risk nicotine use guidelines, and addressing knowledge gaps.

Together these SUAP initiatives produced over 5,300 knowledge products (standards/guidelines, tools, toolkits, and reports), delivered almost 28,000 learning opportunities (training, presentations, and webinars) and reached approximately 10 million individuals. In addition, 72% of targeted stakeholders and Canadians indicated that they gained knowledge relevant to reducing the harms of substance use in Canada. These Canadians intend to use the 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

SUAP continued to provide core funding to the Canadian Centre on Substance Use and Addiction (CCSA) as well as funding for research on the impact of cannabis legalization and regulation. The CCSA works with a wide range of national and international partners to mobilize efforts, foster knowledge exchange and develop evidence-informed actions related to high-risk substances.

In 2020-21, CCSA delivered 27 core initiatives focused on educating the public on the harms of opioids, alcohol, cannabis and other problematic substances, updating jurisdictional based costs and harms of substance use in Canada. These initiatives also advanced national collaboration and knowledge sharing in the problematic substance use field through various engagement activities and responded to the urgent knowledge needs of COVID-19 and its corresponding impact on substance use and addictions.

Overall, CCSA created 149 knowledge and communication products and delivered more than 130 events and presentations. Their social media knowledge dissemination activities had over 4 million impressions, which generated increased national and international interests relative to previous years.

In support of Health Canada's efforts to develop relevant information regarding COVID-19, CCSA developed 24 new resources on COVID-19 and substance use, and provided access to approximately 300 resources from more than 125 organizations in 2020. Canadians accessed the COVID resource section on the CCSA website over 72,000 times and downloaded CCSA resources approximately 54,000 times. To promote these COVID-19 resources, CCSA launched a new COVID-19 webinar series in June 2020, which attracted over 1,400 participants and garnered a 90 percent overall participant satisfaction rating. Other topics that generated the highest interest included alcohol, stigma, opioids and substance use costs and harms related knowledge products with approximately 40,000 downloads in 2020-21.

With the additional cannabis research funding of $2.3 million, CCSA incorporated projects focusing on the impacts of COVID-19 on cannabis legalization and regulation and consumption within the context of the COVID-19 pandemic.
In 2020-21, CCSA provided funding to 29 cannabis research initiatives:

• Five Canadian Institutes of Health Research Catalyst Grants to generate preliminary observations, data or knowledge into the potential benefits and harms of cannabis or cannabis use;
• Five Partnership for Cannabis Policy Evaluation Grants to gather evidence on the impact of different regulatory approaches on key health, social and public safety domains; and
• Nineteen grants for cannabis research projects under "Closing the Gaps in Cannabis Research", which offers the opportunity to study the impacts of cannabis use in a legalized environment.

Through these projects, CCSA developed 9 COVID-19 knowledge products, updated 5 Cannabis research products, and delivered over 10 workshops, presentations and webinars in 2020-21.

Mental Health Commission of Canada

SUAP provided $3.3 million in funding to the Mental Health Commission of Canada (MHCC) to inform and advance research, build the evidence base, and mobilize knowledge on the impacts of cannabis use on the mental health of Canadians.

In 2020-21, the MHCC delivered 6 webinars, virtual workshops, and knowledge exchange events. The MHCC also funded 22 one-year catalyst grants to generate new evidence around cannabis and mental health, which included 18 projects in partnership with the Canadian Institutes of Health Research, Veteran Affairs Canada, the Canadian Consortium for the Early Prevention in Psychosis, and the Schizophrenia Society of Canada Foundation. The MHCC also funded four multi-year team-based research projects in alignment with the Canadian Institutes of Health Research's Integrated Cannabis Research Strategy. These research projects will address key gaps regarding cannabis use and mental health, 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 funded 14 community-based research projects, of which six were Indigenous-led, that explore cannabis use and mental health.

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: No planned audits.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

SUAP applicants and recipients include not-for-profit organizations, provinces and territories, municipalities, indigenous organizations, people with lived and living experience of substance use, universities, and many other groups. These groups are engaged through various methods, including stakeholder outreach, solicitation processes, project development discussions, and performance reporting and monitoring tools, processes and activities. The Program also supports knowledge translation and exchange opportunities between projects, Health Canada and other partners and stakeholders.

SUAP engaged applicants for funding in 2020-21 and worked closely with successful organizations to shape their initiatives, monitor contribution agreements and obtain required performance measurement and evaluation reports. Of note, the program is exploring the development of theme-based Communities of Practice with partners within and external to the federal government.

Territorial Health Investment Fund

General information

Name of transfer payment program

Territorial Health Investment Fund

Start date

April 1, 2014

End date

March 31, 2023

Type of transfer payment

Grant

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18 (extended in 2021-22)

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

• Program 16: Territorial Health Investment Fund

Purpose and objectives of transfer payment program

Building on an initial investment of $70 million in contribution funding (2014-15 to 2017-18), 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) and extended in 2021-22 with an additional $54 million over two years (2021-22 and 2022-23) which represents current funding levels for each territory. To date, $81 million has been allocated to Nunavut, $42.6 million to Northwest Territories and $38.4 million to Yukon. This funding will enable 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.

Results achieved

The THIF supported territorial efforts to innovate and transform their health care systems and helped offset costs associated with medical travel. The expected results for Northerners are: improved access to health care services; health care needs being met; and improved health status.

Funding provided through the THIF in 2020-21 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 2020-21:

• The Northwest Territories continued to pilot a new cultural competency training program for its staff. Key learnings from this phase will inform the final training model, which will be designed for broad participation across the health system, including frontline services. In the area of oral health, it developed and launched a territory-wide, large-scale oral health social marketing campaign, and continued to focus on oral health promotion in schools (for example, through an arts-based learning program on offer in 20 communities).
• In May 2020, Yukon released the final report of its comprehensive review of the health and social services provided across the territory, which included 76 recommendations for the future of Yukon's health and social systems. It also continued to focus on the development of collaborative care delivery models, working with partners and stakeholders to implement the first phases of the 'Aging in Place' Action Plan. Yukon also continued its rollout of 1Health Yukon, an integrated health information system that allows Yukon's authorized health practitioners across the continuum of care to be instantly and securely connected throughout the territory. Once fully implemented, the system will span across all acute care, primary care, and continuing care delivery settings.
• Nunavut continued to increase the number of local Inuit paraprofessionals working in the territory, and as of November 2020, there were 37 mental health and addictions paraprofessionals hired. Nunavut's tuberculosis program continued to be a focus, and as of November 2020, all positions in its program were staffed and all 25 communities had the capacity to conduct tuberculosis screenings and treat active tuberculosis. The community oral health program also continued, with all communities in Nunavut receiving services through the program (children from birth to 12 years of age are eligible for the program).

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Health Canada worked with territorial governments to establish four-year work plans for use of the grant funding and to secure grant agreements. In 2021-22, territorial governments will be required to develop two-year work plans to account for the work to be undertaken under the extended THIF. Health Canada received annual updates on planned activities from the territorial governments (including through a Federal/Territorial Assistant Deputy Minister Working Group, which is intended to facilitate learning and information sharing across governments). Health Canada will work with territorial governments throughout the life of the agreements to monitor progress and compliance under the grant agreements.

Transfer Payment Programs under $5 Million

Climate Change and Health Adaptation Capacity Building Program

General information

Name of transfer payment program

Climate Change and Health Adaptation Capacity Building Program

Start date

April 1, 2018

End date

2020-21 (Grant)

2021-22 (Contribution)

Type of transfer payment

Grant and Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

Link to departmental result(s)

• Core Responsibility 2: Health Protection and Promotion
• Result 4: Canadians are protected from unsafe consumer and commercial products and substances

Link to the department's Program Inventory

• Program 23: Climate Change

Purpose and objectives of transfer payment program

The purpose of the Climate Change and Health Adaptation Capacity Building Program is to protect and improve the health of Canadians in a changing climate through better understanding of risks and effective adaptation measures, and by building needed capacity to implement them.

Results achieved

The Climate Change and Health Adaptation Capacity Building Program (HealthADAPT) funds projects to help health system actors (including provincial, territorial and regional health stakeholders) to prepare, prevent, and respond to impacts of climate change.

As of March 31, 2021, 80% (8 of 10) of HealthADAPT climate change adaptation projects are on track for completion.

These projects involve ten health authorities across five provinces and territories (British Columbia, Ontario, Quebec, New Brunswick, and the Northwest Territories).

Some projects and activities were delayed due to the impacts of COVID-19 on business operations. The focus for the current year is to finish vulnerability assessments and develop adaptation plans. Funding recipients regularly report on their projects and should they not meet their planned completion dates, the HealthADAPT program team works with funding recipients to adjust project goals and/or (if possible) the time frame for completion.

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

Planned: The next evaluation is scheduled for 2025-26.

Engagement of applicants and recipients in 2020–21

This program supports health authorities (including provincial/territorial ministries of health; province-wide, regional and local health authorities; and public health units) to deliver projects that will help prepare for and respond to the impacts of climate change. These HealthADAPT projects help facilitate climate change adaptation across Canada, with the aim of building climate resilience and protecting human health.

With support from Health Canada, funding recipients are on track to complete their climate change and vulnerability assessments, to inform adaptation plans by March 2022.

The Department regularly engaged with the 10 funding recipients through email, monthly meetings, and bilateral meetings. Health Canada also reviewed and provided feedback on project drafts, annual work plans and progress reports.

The HealthADAPT team regularly met with funding recipients to provide guidance and support with projects and to facilitate knowledge exchange among funding recipients who provide peer support. The team provided resources, guidance and materials to funding recipients, such as reference lists for projecting the burden of illness and health economics. For example, during the year-end meeting for 2020-21, Health Canada provided funding recipients with expert guidance on health systems resilience and climate change and health communication.

The Department hosted a webinar on climate change, health, and homelessness with leading researchers in the field, and a webinar on health equity and climate change to support funding recipients with monitoring and evaluating the disproportionate risks of climate change on populations experiencing health inequities. Moreover, the HealthADAPT team posted information on climate and health related training, webinars, and materials to the working group website on a weekly basis.

Health Canada held its third annual year-end meeting with national and international speakers on key climate change and health related topics on February 23 and 24, 2021. Officials from the 10 funded health authorities across Canada at local, provincial, and territorial level participated. Special guests from the World Health Organization, Pan American Health Organization, and the United States Centers for Disease Control and Prevention attended. The virtual meeting included a wide range of expert presentations and plenary discussions to help support health partners in their efforts to assess climate change and health vulnerabilities in their respective jurisdictions and identify effective adaptation and resilience strategies.

Innovative Solutions Canada

General information

Name of transfer payment program

Innovative Solutions Canada

Start date

August 23, 2019

End date

March 31, 2023

Type of transfer payment

Grant

Type of appropriation

Estimates

Fiscal year for terms and conditions

2019-20

Link to departmental result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems
• Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

• Program 1: Health Care System Analysis and Policy

Purpose and objectives of transfer payment program

Innovative Solutions Canada is a horizontal Government of Canada initiative, coordinated by Innovation Science and Economic Development Canada, in which participating departments and agencies can issue challenges to Canadian businesses to develop solutions for operational or sector-specific issues and fund the early stage research and development of these innovations. Health Canada's participation will enable innovators to generate novel solutions to help Canadians maintain and improve their health.

Results achieved

Health Canada's participation contributed to the short, medium and long-term results and outcomes of the Innovative Solutions Canada program, including funding R&D and testing prototypes of novel solutions to challenging issues facing Canada. Implementation of the ISC program within Health Canada focused on maintaining and improving the health of Canadians.

Health Canada funded 3 Phase I challenges, addressing the oversubscription of antibiotics, supporting better transplant outcomes, and identifying Microbial Mixtures. Health Canada is currently evaluating the proof-of-concept solutions developed for the first phase of the challenge, with those deemed successful being invited to apply for funding for a second phase focused on prototype development.

The Department also partnered with National Research Council, and Environment and Climate Change Canada on two challenges to develop environmentally safer, compostable PPE.

Last, Health Canada also sponsored the testing of three projects within the Canadian health system under the Innovations Solutions Canada Testing Stream. Respectively, these were aimed at developing environmentally safer, compostable face pieces to replace surgical masks, improving communication mental health care settings for enhanced patient care, and improving triage capacity in hospital emergency departments through AI-enabled digital solutions for improved efficiency and care.

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation completed in 2020-21.

Planned: The timing for next evaluation will be determined during the update for the 2022-23 to 2026-27 Departmental Evaluation Plan.

Engagement of applicants and recipients in 2020–21

Health Canada engaged with companies who were successful in the 2019-20 challenges to support their work in implementing the first phase of their challenge

Innovation, Science and Economic Development Canada, however leads the engagement with applicants and recipients of funding for Phase I and Phase II as part of the application process under Innovative Solutions Canada.

Radon Outreach Contribution Program

General information

Name of transfer payment program

Radon Outreach Contribution

Start date

April 1, 2018

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

• Core Responsibility 2: Health Protection and Promotion
• Result 4: Canadians are protected from unsafe consumer and commercial products and substances

Link to the department's Program Inventory

• Program 31: Radiation Protection

Purpose and objectives of transfer payment program

The purpose of this program is to protect and improve human health and well-being in Canada from the impacts of indoor radon exposure, by aiding in the education of Canadians about the importance of testing their homes, schools and workplaces for radon and reducing the radon levels where necessary.

Results achieved

Health Canada continued to increase awareness on the risks, health impacts and mitigation strategies related to radon gas - the leading cause of lung cancer for non-smokers.

Since the establishment of the Radon Outreach Contribution Program in 2018, 17 proposals have been funded. The funded projects are focused on innovative ways of motivating action and behaviour change to reduce radon exposure, particularly in populations that have been identified as at-risk, such as those in areas with high radon, smokers, residents of social housing, First Nation communities, schools, childcare facilities, young families, and lung cancer patients.

Measures/Indicators:

Indictor 1: The 2019 Households and the Environment Survey showed that 63% of Canadians surveyed are knowledgeable about radon. Note: these are the most recent available results. This survey is conducted every two years; results from the 2021 survey will be available in 2023.

Indicator 2: The 2019 Households and the Environment Survey showed that 6% of Canadian homeowners surveyed had tested their homes for radon. Note: these are the most recent available results. This survey is conducted every two years; results from the 2021 survey will be available in 2023.

Findings of audits completed in 2020-21

Completed: No audit was completed in 2020-21.

Planned: Not applicable.

Findings of evaluations completed in 2020–21

Completed: No evaluation was completed in 2020-21.

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

Engagement of applicants and recipients in 2020–21

Engagement activities were completed as planned. A total of 14 active multi-year contribution agreements were in place in 2020-21. The recipients of these agreements included: provincial and municipal government organizations, non-governmental organizations, regional health authorities, and academic institutions. Each agreement incorporated mechanisms to measure reach and impact to ensure return on investment, as well as challenges and successes that can be incorporated into future efforts.

Gender-based analysis plus

Section 1: Institutional GBA Plus Capacity

In 2020-21, Health Canada continued to build on the Sex and Gender Action Plan, launched in 2017, while preparing for its next phase. The Action Plan strengthened the Department's foundation of integrating SGBA Plus^{Footnote 7} considerations into its work and ensured its responses to the COVID-19 pandemic took into account key intersecting sex, gender and diversity barriers.

The Action Plan: i) provides a framework that strengthens the systematic integration of sex, gender and other intersectional factors (such as age and language) in departmental work and decision-making; and ii) supports the Government of Canada's priorities on diversity and inclusion as well as the advancement of gender equality.

Priorities of the Action Plan are to:

• Increase departmental capacity to apply SGBA Plus;
• Strengthen the sex, gender and diversity-related evidence base and expertise;
• Increase accountability for and transparency in implementing SGBA Plus.

These priorities will remain as the Department moves into the next phase of its Action Plan, with increased considerations of diversity factors beyond sex and gender (e.g., age, race, socioeconomic status, etc.), enhanced provision of collaborative tools, resources and training, and greater accountability for the systematic integration of SGBA Plus into all areas of Health Canada's work.

Key 2020-21 initiatives in support of SGBA Plus integration include:

Health Canada's centre of expertise on SGBA Plus –The Gender and Health Unit (GHU) provided expert guidance to support the integration of SGBA Plus considerations in the Department's COVID-19 pandemic response, along with ongoing efforts to assist programs in systematically integrating SGBA Plus into departmental work through the following activities:

• Continued collaboration with Health Canada employees by providing advice and guidance on incorporating sex, gender and diversity considerations into research, legislation, policies, regulations, services and program funding. This included reviewing and tracking the use and quality of SGBA Plus in Memoranda to Cabinet, Treasury Board submissions, budget proposals, regulations and sex and gender indicators tracked and monitored through Performance Information Profiles (PIPs). Through the PIP development process, senior management reviewed and enhanced the integration of SGBA Plus in their respective programs.
• Collaborated with Health Portfolio partners to assess progress on SGBA Plus and enhance understanding of the intersectional aspects of SGBA Plus in our work, including conducting a biennial employee survey and revising the Health Portfolio Sex and Gender-Based Analysis Policy. The employee survey showed increases in employee awareness and importance of SGBA Plus while also that more progress is needed in training and the practical application of SGBA Plus in work processes. The revised Policy will place greater emphasis on intersectionality and make more explicit the roles and responsibilities of management and employees in the application of SGBA Plus.
• Gathered, consolidated and reported on Health Canada's SGBA Plus progress to the Department for Women and Gender Equality through the GBA Plus Implementation Survey. Results showed a continued commitment to the integration of SGBA Plus in program and frontline service delivery, evaluation, and consultation activities, enhanced SGBA Plus training requirements in various Health Canada functional areas, and increased institutional GBA Plus capacity.
• Supported HC data custodians to ensure where possible departmental information holdings are consistent with the Treasury Board Secretariat's Policy Direction to Modernize the Government of Canada's Sex and Gender Information Practices and available for use in decision-making. In 2020-2021, the GHU completed a mapping and engagement exercise that resulted in increased employee awareness, improved data accuracy and advancement toward greater alignment with the Policy Direction.
• Updated and improved its SGBA Plus training, tools, resources and guidance to support programs with SGBA Plus integration into decision-making processes. This included: training focussed on program management and integrating SGBA Plus with knowledge translation and performance measurement; an International Women's Day Event on women in the COVID-19 pandemic; customized training for Health Canada's programs including the Scientific Advisory Committee on Health Products for Women; and the integration of SGBA Plus into research through the Health Canada Science Forum. Many Health Canada staff used the tools and guidance to help them apply SGBA Plus in their work and the events and training sessions were well attended and led to enhanced awareness and capacity.
• Supported the departmental evaluation of the Sex and Gender Action Plan, 2017-2020 and used its findings and those from employee surveys to begin work collaboratively with programs across the Department. The areas of focus included: strengthening Health Canada's SGBA Plus governance and reporting structure, supporting branch-led planning to integrate SGBA Plus into organizational processes and addressing key SGBA Plus knowledge gaps through tools and training.

Health Canada's response to COVID-19 – In response to the COVID-19 pandemic, Health Canada incorporated SGBA Plus into its decision-making process and initiatives. For example, GHU developed and maintained an evergreen SGBA Plus and COVID-19 guidance document, conducted weekly COVID-19 SGBA Plus environmental scans to monitor trends, and researched and analysed the disproportionate impact of the pandemic on at-risk groups. The GHU also supported the integration of GBA Plus considerations across key emergence files such as long-term care, palliative care, virtual care, mental health, health human resources, and access to affordable medication. In addition, the GHU developed a COVID-19 resource table on the Health Portfolio SGBA Plus GCpedia page for rapid access to COVID-19 impacts on communities in conditions of vulnerability such as women and LGBTQ2S+ community members. These tools helped guide the development of comprehensive COVID-19 policy and program responses that would address the range of needs and inequities faced by at-risk populations.

Throughout COVID-19 vaccine development, Health Canada asked sponsors to be inclusive in their vaccine trial recruitment strategies to ensure that COVID-19 safety and efficacy data would be produced for diverse populations (e.g., sex, age, race/ethnicity, comorbidities, etc.).

Health Canada incorporated SGBA Plus in the early development of its COVID-19 response measures, including expanding and improving access to mental wellness services and helping at-risk Canadians, to ensure these initiatives were responsive and inclusive of the needs of diverse Canadians. For example, SGBA Plus was applied when developing the measures announced as part of the 2020 Fall Economic Statement to help the provinces and territories protect residents of long-term care and other supportive care facilities.

Health products for women – The Department leveraged its Scientific Advisory Committee on Health Products for Women to obtain patient-centered, scientific, technical, medical and clinical advice on current and emerging issues regarding women's health and the regulation of medical devices and drugs.

The Committee advised on current and emerging issues regarding women's health and the regulation of medical devices and drugs, such as: patients' experiences with mesh implants, identifying the need for more user-friendly reporting forms and for strengthened transparency initiatives; and SGBA Plus considerations in the testing and authorization of COVID-19 vaccines and national roll-out recommendations in collaboration with the National Advisory Committee on Immunization to identify priority high risk groups for the vaccine roll-out.

Additionally, the Medical Devices Directorate in the Health Products and Food branch created a new full-time SGBA Plus position to facilitate the implementation of SGBA Plus considerations in regulatory decision-making and to lead and support internal projects and training initiatives.

Healthy eating policies – In 2020, Health Canada established the Nutrition Science Advisory Committee. This group of external expert advisors provide the Department with timely, independent scientific and technical advice on nutrition. The Committee's input will ensure that Health Canada is benefiting from the best available evidence in fulfilling its mandate of supporting the nutritional health of Canadians, particularly populations at increased risk, with particular attention to how language, culture, ethnic identity and gender contribute to health inequalities.

Supporting sex, gender and diversity policies for informal caregivers – In 2018-19, Health Canada helped to develop a framework that addressed sex, gender and diversity considerations for digital technology to support informal caregivers. In 2020-21, the Department disseminated this tool to stakeholders. It will continue to use the project tools and findings to inform the development of sex, gender and diversity sensitive policies.

For more information on SGBA Plus, please refer to the 2020-21 Departmental Results Report.

Section 2: Gender and Diversity Impacts, by Program

The data presented in the tables below reflect GBA Plus indicators from 2020-21 (or the earliest available) as monitored through Health Canada program Performance Information Profiles as well as external sources (e.g., contribution agreement recipients, the Canadian Institute for Health Information, Statistics Canada, etc.). The Department is committed to evidence-based decision-making, through the implementation of GBA Plus, and to continuous improvement of its indicators and outputs to ensure programs meet the needs of all Canadians.

Subject to program scope and data availability, the Distribution of Benefits section presents the aggregated (total) impact of each Program's activity streams on gender, age and/or income groups.

The Key Impacts sections present quantitative and qualitative information on SGBA plus Program impacts by sex, gender and/or other diversity factors.

The GBA Plus Data Collection Plan section highlights how the program plans to collect and use new or additional sources of GBA Plus data for future analysis.

Definitions

Target Population: See Finance Canada definition of Target Group in the following document: User Instructions for the GBA Plus Departmental Summary - Budget 2020 - Canada.ca

Gender Scale:

• First group: Predominantly men (e.g. 80 per cent or more men)
• Second group: 60 per cent - 79 per cent men
• Third group: Broadly gender-balanced
• Fourth group: 60 per cent - 79 per cent women
• Fifth group: Predominantly women (e.g. 80 per cent or more women)

Income Level Scale:

• First group: Strongly benefits low income individuals (Strongly progressive)
• Second group: Somewhat benefits low income individuals (Somewhat progressive)
• Third group: No significant distributional impacts
• Fourth group: Somewhat benefits high income individuals (Somewhat regressive)
• Fifth group: Strongly benefits high income individuals (Strongly regressive)

Age Group Scale:

• First group: Primarily benefits youth, children and/or future generations
• Second group: No significant inter-generational impacts or impacts generation between youth and seniors
• Third group: Primarily benefits seniors or the baby boom generation

Gender Results Framework Pillars: see definitions at the following page: Gender Results Framework - Women and Gender Equality Canada)

Quality of Life Domains: See definitions in Annex-5-eng.pdf (budget.canada.ca)

Section 3: Program Links to Gender Results Framework

Core Responsibility 1 – Health Care Systems

Program Name	Program Links to Gender Results Framework
Health Care Systems Analysis & Policy	Education and Skills Development
Access, Affordability & Appropriate Use of Drugs & Medical Devices	Poverty Reduction, Health and Well-Being
Home, Community & Palliative Care	Economic Participation and Prosperity Poverty Reduction, Health and Well-Being
Mental Health	Poverty Reduction, Health and Well-Being
Substance Use & Addictions	Poverty Reduction, Health and Well-Being
Digital Health	Poverty Reduction, Health and Well-Being
Health Information	Poverty Reduction, Health and Well-Being
Medical Assistance in Dying (MAID)	Education and Skills Development
Cancer Control	Poverty Reduction, Health and Well-Being
Patient Safety	Education and Skills Development
Organs, Tissues and Blood	Education and Skills Development
Promoting Minority Official Languages in the Health Care Systems	Education and Skills Development Poverty Reduction, Health and Well-Being
Brain Research	Education and Skills Development Economic Participation and Prosperity Poverty Reduction, Health and Well-Being
Territorial Health Investment Fund (THIF)	Poverty Reduction, Health and Well-Being

Core Responsibility 2 – Health Protection and Promotion

Program Name	Program Links to Gender Results Framework
Pharmaceutical Drugs	Poverty Reduction, Health and Well-Being
Biologics & Radiopharmaceutical Drugs	Poverty Reduction, Health and Well-Being
Medical Devices	Poverty Reduction, Health and Well-Being
Natural Health Products	Poverty Reduction, Health and Well-Being
Food & Nutrition	Poverty Reduction, Health and Well-Being
Air Quality	Poverty Reduction, Health and Well-Being
Climate Change	Poverty Reduction, Health and Well-Being
Water Quality	Poverty Reduction, Health and Well-Being
Health Impacts of Chemicals	Poverty Reduction, Health and Well-Being
Consumer Product Safety	Poverty Reduction, Health and Well-Being
Workplace Hazardous Products	Poverty Reduction, Health and Well-Being
Tobacco Control	Poverty Reduction, Health and Well-Being
Controlled Substances	Poverty Reduction, Health and Well-Being
Cannabis	Poverty Reduction, Health and Well-Being
Radiation Protection	Poverty Reduction, Health and Well-Being
Pesticides	Poverty Reduction, Health and Well-Being
* Programs not listed in the table declared no program links to the Gender Results Framework

Section 4: Program Links to Quality of Life Framework

Core Responsibility 1 – Health Care Systems

Program Name	Program Links to Gender Results Framework
Health Care Systems Analysis & Policy	Health Society
Access, Affordability & Appropriate Use of Drugs & Medical Devices	Health
Home, Community & Palliative Care	Prosperity Health Society
Mental Health	Health
Substance Use & Addictions	Health
Digital Health	Health
Health Information	Health
Medical Assistance in Dying (MAID)	Health
Cancer Control	Health
Patient Safety	Health
Organs, Tissues and Blood	Health
Promoting Minority Official Languages in the Health Care Systems	Health
Brain Research	Prosperity Health
Thalidomide	Health
Territorial Health Investment Fund (THIF)	Health

Core Responsibility 2 – Health Protection and Promotion

Program Name	Program Links to Gender Results Framework
Pharmaceutical Drugs	Health
Biologics & Radiopharmaceutical Drugs	Health
Medical Devices	Health
Natural Health Products	Health
Food & Nutrition	Health
Air Quality	Health Environment
Climate Change	Health Environment
Water Quality	Health Environment
Health Impacts of Chemicals	Health Environment
Consumer Product Safety	Health
Workplace Hazardous Products	Health
Tobacco Control	Health
Controlled Substances	Health
Cannabis	Health
Radiation Protection	Health Environment
Pesticides	Health Environment
* Programs not listed in the table declared no program links to the Quality of Life Framework

Horizontal Initiatives

Addressing the Opioid Overdose Crisis

General information

Name of horizontal initiative

Addressing the Opioid Overdose Crisis

Lead department

Health Canada

Federal partner organization(s)

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

Start date

April 1, 2018

End date

March 31, 2023 and ongoing

Description

Illegal drugs and problematic substance use have always presented health and safety challenges in Canada and around the world. Recently, however, there has been a dramatic rise in the number of opioid-related overdoses and deaths. The people most affected in this overdose crisis continue to be young to middle-aged individuals and men. Deaths are mostly accidental and largely due to the contamination of the illegal drug supply with highly toxic fentanyl and/or fentanyl analogues. Fentanyl is an inexpensive way for drug dealers to make street drugs more powerful and it is causing high rates of overdoses and overdose deaths. A few grains can be enough to cause a fatal overdose.

The federal government's actions to address the overdose crisis are guided by the Canadian Drugs and Substances Strategy^{Footnote 23}, which takes a comprehensive, collaborative, and compassionate approach to substance use issues using a public health lens. The federal government is deeply concerned about the number of overdoses and deaths, and is taking significant actions in areas of federal jurisdiction to address the crisis. However, despite significant efforts to date, the overdose crisis in Canada continues. According to data from the Public Health Agency of Canada, more than 22,828 people lost their lives in Canada between January 2016 and March 2021 to apparent opioid-related overdoses. In addition, it is estimated that approximately 250,000 Canadians do not have access to treatment when seeking help for problematic substance use. Since people who use drugs have traditionally been stigmatized, Canadians struggling with substance use disorder often encounter barriers when accessing health, medical and social services.

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

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

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

Governance structures

The Government of Canada has put in place a robust governance structure to facilitate whole-of-government coordination in implementing a comprehensive federal response to the overdose crisis. Each department/agency is responsible for leading its respective initiatives and providing updates to the interdepartmental Assistant Deputy Minister (ADM) level Working Group on Opioids chaired by the Associate-ADM of Health Canada's Controlled Substances and Cannabis Branch. This working group is used as a forum for information and consultation on next steps toward a comprehensive, collaborative federal response to the overdose crisis. Updates and decisions from this working group feed into the federal, interdepartmental Deputy Ministers Task Force on the Opioid Crisis as required. This Task Force, chaired by the Deputy Minister of Health Canada, serves as a time-limited forum to provide leadership and oversight of federal initiatives to respond to the overdose crisis. The Task Force will remain an established committee until it is not longer required.

The Government is committed to ongoing collaboration and consultation with provincial and territorial partners. Departments and agencies will provide updates to, and consult with, provincial and territorial colleagues as required through the federal/provincial/territorial (FPT) ADM-level Problematic Substance Use and Harms Committee (PSUH), co-chaired by Health Canada and British Columbia and comprised of ADMs responsible for drug policy in their jurisdiction.

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

$108,794,405 & $17,527,500 ongoing (includes existing funding)^{Footnote 24}

Total federal funding planned spending to date (dollars)

$75,784,000^{Footnote 25}

Total federal actual spending to date (dollars)

$64,600,313

Date of last renewal of initiative

Not applicable

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

Not applicable

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

Not applicable

Total actual spending since last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2021-22

Performance highlights

All federal partners work collaboratively to address the overdose crisis in a comprehensive, robust, and effective manner. Planning highlights specific to this horizontal initiative in 2020-21 included:

• ongoing monitoring and support of 22 prevention and treatment projects funded under the Substance Use and Addictions Program (SUAP);
• ongoing public education through the KNOW MORE tour and advertising to continue to raise awareness of the impacts of stigma towards people who use drugs;
• delivering opioid de-stigmatization awareness training to law enforcement members across Canada to ensure that they are mindful of the negative impacts of stigma when interacting with people with problematic substance use disorder;
• establishing new Designated Safe Examination Areas and regional screening facilities to conduct safe examinations of goods suspected of containing opioids at ports of entry;
• training and deploying six detector dog teams to conduct random non-intrusive inspections of goods and people suspected of containing opioids in the postal stream;
• developing risk assessment and intelligence products to help identify high-risk shipments and intelligence for operations and other central agencies;
• continuing supporting the provinces and territories in enhancing the National Opioids and Substance-Related Harms Surveillance System through Public Health officers located in the regions; continuing collaboration with provinces and territories, as well as key federal partners, on a variety of activities surrounding the Canadian Coroners and Medical Examiners Database aimed at strengthening and co-ordinating new and more timely data analysis and insights as well as enhancing monitoring/surveillance activities associated with overdose death data;
• continuing monitoring and support of 16 provincial/territorial substance-related harms surveillance capacity building initiatives funded under the Substance-Related Harms Division Program; and,
• ongoing specialized training and support to the substance-related harms Public Health Officers deployed to provinces and territories to support overdose surveillance and response.

All federal partners work collaboratively to address the opioid overdose crisis in a comprehensive, robust, and effective manner. This includes initiatives that span the continuum from gathering data and evidence to better understand the opioid crisis, to conducting public education and awareness activities, to supporting prevention and treatment projects, and enhancing enforcement capabilities.

Key achievements in 2020-21 include:

• provided ongoing funding and support to 22 opioids-related projects under SUAP to improve prevention and treatment efforts;
• updated the KNOW MORE tour to a virtual platform for the 2020-21 school year, allowing for greater reach to rural and remote schools across Canada. Since its launch in 2018, the tour has had over 150,000 interactions with youth, visiting 486 schools, 43 festivals and 68 campuses and has engaged with students in sessions in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, Nova, Scotia, Prince Edward Island, Newfoundland & Labrador, Yukon and the Northwest Territories;
• conducted phase four of a national advertising campaign featuring advertisements on the impacts of stigma surrounding people who use drugs and the Good Samaritan Drug Overdose Act, surpassing minimum targets with 98.8 million impressions and an increase in opioid-related web traffic by 60%;
• launched Public Safety Canada's Drug Stigma Awareness Training for law enforcement to provide law enforcement members with additional tools to support their interactions with those suffering from a substance use disorder;
• implemented 41 Designated Safe Examination Areas and effectively integrated detector dog teams in postal operations;
• continued to support the provinces and territories in enhancing the national opioids and substance-related harms surveillance system through Public Health Officers located in the regions;
• continued collaboration with provinces and territories, as well as key federal partners, on a variety of activities surrounding the Canadian Coroners and Medical Examiners Database, aimed at strengthening and co-ordinating new and more timely data analysis and insights as well as enhancing monitoring/surveillance activities associated with overdose death data; and,
• continued support for and funding of provincial and territorial surveillance capacity building initiatives with dissemination of knowledge generated and lessons learned to national partners.

Health Canada

The Department continued ongoing monitoring and support of 22 opioid-related projects funded through SUAP (for the period 2018-19 to 2023-24) targeting prevention and treatment issues. Funded projects located across the country included such activities as: developing curricula, tools and supports related to safe prescribing as well as resources and networks that support health and social service professionals to offer addictions services; increasing access to Opioids Agonist Treatment (OAT) across the country, including training and performance measurement activities; and research activities including the development of best practices in OAT.

Health Canada also launched phase four of a national advertising campaign to address the stigma surrounding people who use drugs and inform Canadians about harm reduction measures. This phase included content on opioid awareness, stigma, and the Good Samaritan Drug Overdose Act over 5.5 weeks from February to March 2021. It built on the previous campaigns, more specifically from those implemented in fall 2018 and winter 2019.

Public Safety Canada

As planned, the Department launched its Drug Stigma Awareness Training for law enforcement agencies across Canada in September 2020. The online training reinforced that substance use disorder is a mental health condition and provides law enforcement personnel with additional tools and resources they can refer to when interacting with individuals who use drugs. The training was hosted on the Canadian Police Knowledge Network website and has been made readily available and free of charge to all law enforcement personnel across Canada until September 2022. Additionally, Public Safety Canada worked with the Canadian Centre on Substance Use and Addiction to promote the training and raise awareness of the impacts of drug stigma among law enforcement through a March 2021 webinar.

Due to the ongoing pandemic, Public Safety hosted a virtual fourth Law Enforcement Roundtable on Illicit Drugs in March 2021. Comprised of multiple virtual sessions and building on past roundtables, the event focused on further advancing information-sharing within the law enforcement community around best practices and effective law enforcement responses to the current opioids crisis and other emerging drug threats. With an overarching focus on British Columbian efforts to combat the dual challenges of the COVID-19 pandemic and the opioid crisis, the corresponding the virtual sessions highlighted current and emerging trends in the illicit drug supply change, approaches to diverting people who use drugs away from the criminal justice system, and the challenges of policing in a time of simultaneous public health crises (e.g. overdose crisis and pandemic). Thanks to the online platform, more than 200 participants were able to join representing municipal, provincial and federal police agencies across Canada and the United States as well as representatives from academia, the private sector and government.

The Department continued to work with portfolio partners to advance its illicit drug supply reduction efforts. This included working with partners to bolster efforts to detect and seize mail and parcels containing illegal substances, and curtailing the availability of surface websites and social media platforms that promote the sale of illegal substances as well as equipment used in the manufacture of illicit substances.

Canada Border Services Agency

The Canada Border Services Agency (CBSA) implemented 41 Designated Safe Examination Areas, exceeding its target of implementing 25 such Areas. As well, all CBSA Officers required to work in these areas were trained and are operational.

CBSA also made progress on developing and implementing its Regional Screening facilities. Two of the locations were 90% complete by year-end and are now operational. Staffing of chemists to operate the facilities progressed having hired three who are currently completing training. In addition, all detection equipment was purchased on time and under budget and plans to communicate about these tools at Screening Facilities have received approval to move to the planning phase. Work continued to progress through the CBSA IT governance process. Lastly, detector dog teams have been integrated as well in postal operations and have demonstrated great success.

Public Health Agency of Canada

All of the ten funded Public Health Officer (PHO) positions are staffed. As well, given the importance and priority of the work, the Public Health Agency of Canada (PHAC) endeavored to provide additional PHOs in four provinces when additional support was requested. Despite numerous COVID-19 related delays and closures, PHAC has continued to advance data collection and analysis for the phase 2 national epidemiological study involving chart review of coroner and medical-examiner files on drug- and alcohol-related acute toxicity deaths. A publication on phase 1 of the national epidemiological study involving qualitative data collection from coroners and medical examiners was drafted.

A total of 24 evidence products were released. These included 12 national surveillance reports on apparent opioid-related deaths and harms, 4 updates of a joint brief with Health Canada on federal actions on opioids. 3 brief reports on opioid-related hospitalizations and harms, 2 releases of modelling opioid-related deaths during COVID-19, and 3 peer-reviewed publications.

Funding and support for provincial and territorial substance-related harms surveillance capacity building initiatives were also renewed with expanded focus on alcohol-related surveillance activities for jurisdictions with a high need to put in place best practices of engaging peers in the development of harm-reduction strategies at the community level.

Statistics Canada

Statistics Canada continued its work in modernizing and enhancing the Canadian Coroners and Medical Examiners Database (CCMED). As it relates to the database itself, Statistics Canada entered into a data-sharing agreement with Newfoundland and Labrador received data for the first time, successfully re-integrated Alberta, Saskatchewan, New Brunswick and Nova Scotia into the database and renewed data-sharing agreements with Ontario, Yukon and the Northwest Territories. In addition to the development of new data sources, collaborations were undertaken with key data users in injury prevention leading to new infographics, analytical articles, and the release of new data tables.

Two additional key developments of the CCMED pertain to continued improvements around timeliness and comprehensiveness. Statistics Canada continues to release data from the CCMED twice per year and will be annually updating linkages of these data to the central data repository to allow for data integration to other datasets such as census, tax, hospital data and additional social domain data. These integrated datasets will allow for a more complete picture of the decedent, providing further insights to the circumstances surrounding deaths, including overdose deaths. Statistics Canada is also leveraging machine learning expertise within the organization, including topic modelling techniques, to look at changes to trends in the unstructured text narrative reports for each death investigation, and to classify information from these free text fields into coded variables for more efficient analysis.

Contact information

Jennifer Novak
Executive Director, Opioid Response Team
Controlled Substances and Cannabis Branch
jennifer.novak@hc.sc.gc.ca
613-816-6478

Horizontal Initiative:

Addressing the Opioid Crisis

Shared outcomes:

Performance Information

Horizontal Initiative Overview 4

Team 1: Comments on Variances

Health Canada

The variance between actual and planned spending is due to the reallocation of funds from other initiatives to address the opioid crisis in Canada.

CBSA

The variance between actual and planned spending is mainly due to reallocation of funds from previous year to build Designated Safe Sampling Areas at the ports of entry across the country, as well as to train and deploy the detector dog teams to conduct random inspection of goods and people.

Public Health Agency Canada

The variance between actual and planned spending is due to COVID-19 related measures caused delays in projects with provinces and territories, and also resulted in a lack of available contractors/facilities. This reduced the overall ability to spend this fiscal and to put planned contracts in place in a timely manner. Furthermore, travel restrictions prevented training, conferences, in-person events, and relocation costs from being incurred.

Public Safety

The variance between actual and planned spending is due to COVID-19 travel restrictions, which directly impacted actual O&M spending.

Supporting Additional Prevention and Treatment Interventions

Expected results

Health Canada

ER 1.1.1 The department continues to identify an appropriate indicator, target and target date. It is anticipated that this work will be completed by spring 2020

ER 1.1.2 The department continues to identify an appropriate indicator, target and target date. It is anticipated that this work will be completed by spring 2020

Performance indicators

Health Canada

PI 1.1.1 The department continues to identify an appropriate indicator, target and target date. It is anticipated that this work will be completed by spring 2020

PI 1.1.2 The department continues to identify an appropriate indicator, target and target date. It is anticipated that this work will be completed by spring 2020

Targets

Health Canada

T 1.1.1 The department continues to identify an appropriate indicator, target and target date. It is anticipated that this work will be completed by spring 2020

T 1.1.2 The department continues to identify an appropriate indicator, target and target date. It is anticipated that this work will be completed by spring 2020

Actual results

Health Canada

AR 1.1.1 Not applicable per footnote 10

AR 1.1.2 Not applicable per footnote 11

Theme 2: Addressing Stigma

Expected results

Health Canada

ER 2.1.1 Increased sympathy among Canadians for people using opioids

ER 2.1.2 Increased perception among Canadians of drug use as a public health issue

Public Safety Canada

ER 2.2 Increased awareness and support amongst law enforcement community about de-stigmatization of people who use opioids

Performance indicators

Health Canada

PI 2.1.1 Percentage of Canadians who have sympathy for people using opioids

PI 2.1.2 Percentage of Canadians who believe that opioid-related substance use disorder is a disease

Public Safety Canada

PI 2.2 Percentage of police service members who completed the online course

Targets

Health Canada

T 2.1.1 Increase by 5 percentage points

T 2.1.2 Increase by 5 percentage points

Public Safety Canada

T 2.2 25% of eligible police service members

Actual results

Health Canada

AR 2.1.1 25% of Canadians surveyed have sympathy for people using opioids as of July 2019, representing a 4% increase from the 2017 baseline

AR 2.1.2 There was a 2% increase to 63% of Canadians surveyed who believe opioid-related substance use disorder is a disease as of July 2019

Public Safety Canada

AR 2.2 Completed the development of its stigma awareness training materials for law enforcement^{Footnote 26}

Theme 3: Taking Action at Canada's Borders

Expected results

Public Safety Canada

ER 3.1 Increased knowledge generation and sharing of information on targeted issues related to reducing the illegal supply of opioids in Canada

Canada Border Services Agency

ER 3.2.1 Increased capacity to identify high-risk goods at ports of entry

ER 3.2.2 Increased ability to risk assess and identify high risk shipments

ER 3.2.3 Increased communications related to threat assessment information and intelligence provided to personnel and partnering agencies

ER 3.2.4 Enhanced capability to interdict illegal cross-border movement of drugs, such as opioids, at postal locations

Performance indicators

Public Safety Canada

PI 3.1 Percentage of completed planned engagement activities with law enforcement community, stakeholders and partners to address policy issues related with the illegal supply of opioids

Canada Border Services Agency

PI 3.2.1.1 Number of designated safe examination areas, allowing ports of entry to be equipped to identify, detect, and interdict opioids

PI 3.2.1.2 Percentage of CBSA officers at ports of entry identified for safe examinations training that have completed the required training

PI 3.2.1.3 Number of items per year of suspected opioid-containing packages sampled and identified at safe sampling areas (outside of the laboratory)

PI 3.2.2 Number of streams/risk rules supporting advanced risk assessment

PI 3.2.3 Number of intelligence products produced by the CBSA

PI 3.2.4.1 Percentage of interdictions of drugs, including opioids, using detector dogs (compared to random resultant rate)

PI 3.2.4.2 Percentage of interdictions of drugs, including opioids, resulting from targeted examinations (compared to random resultant rate)

Targets

Public Safety Canada

T 3.1 100%

Canada Border Services Agency

T 3.2.1.1 25

T 3.2.1.2 100%

T 3.2.1.3 1,000

T 3.2.2 1 multi-mode pre-arrival stream with five active risk rules

T 3.2.3 Increase by 10%

T 3.2.4.1 Baseline – 2020-21: 3.00%

T 3.2.4.2 TBD

Actual results

Public Safety Canada

AR 3.1 100%^{Footnote 27}

Canada Border Security Agency

AR 3.2.1.1 23^{Footnote 28}

AR 3.2.1.2 100%^{Footnote 29}

AR 3.2.1.3 525 items were sampled^{Footnote 30}

AR 3.2.2 Original stream built did not perform as well as expected. An upcoming pilot will be used to provide additional data^{Footnote 31}

AR 3.2.3 56 Opioid Intelligence products^{Footnote 32} were produced (56 Opioids Intelligence products were produced)

AR 3.2.4.1 4.5%

AR 3.2.4.2^{Footnote 33}

Theme 4: Enhancing the Evidence Base

Expected results

Public Health Agency of Canada

ER 4.1 Enhanced quality surveillance data is available

Statistics Canada

ER 4.2 Increased use and relevance of CCMED among stakeholders

Performance indicators

Public Health Agency of Canada

PI 4.1 Number of opioid-related evidence products^{Footnote 34} disseminated publicly

Statistics Canada

PI 4.2 Percentage of clients satisfied with statistical information from CCMED

Targets

Public Health Agency of Canada

T 4.1 11

Statistics Canada

T 4.2 83%

Actual results

Public Health Agency of Canada

AR 4.1 PHAC published 24 total products

AR 4.2 87%

Canadian Drugs and Substances Strategy

General information

Name of horizontal initiative

Canadian Drugs and Substances Strategy

Lead department

Health Canada

Federal partner organization(s)

• Canada Border Services Agency
• Canada Revenue Agency
• Canadian Institutes of Health Research
• Correctional Service Canada
• Department of Justice Canada
• Financial Transactions and Reports Analysis Centre of Canada
• Global Affairs Canada
• Indigenous Services Canada
• Parole Board of Canada
• Public Health Agency of Canada
• Public Prosecution Service of Canada
• Public Safety Canada
• Public Services and Procurement Canada
• Royal Canadian Mounted Police

Start Date

April 1, 2017

End Date

March 31, 2022 and ongoing

Description

The Government of Canada is committed to a comprehensive, collaborative, compassionate and evidence-based approach to drug policy, which uses a public health lens when considering and addressing problematic substance use. The Canadian Drugs and Substances Strategy (CDSS) is led by the Minister of Health, supported by Health Canada and 14 federal departments and agencies. The CDSS covers a broad range of legal and illegal substances, including cannabis^{Footnote 35}, alcohol, opioids^{Footnote 36} and other kinds of substances that can be used problematically. The goal of the strategy is to protect the health and safety of all Canadians by minimizing harms from substance use for individuals, families and communities.

The CDSS has four pillars: prevention, treatment, harm reduction and enforcement, supported by a strong, evidence base. The public health focus of the CDSS, based on four pillars including harm reduction, has enabled the Government to take a comprehensive and evidence-based approach to the current drug overdose crisis and to work toward reducing the harms related to substance use.

The CDSS recognizes that a national approach to substance use requires coordinated efforts from all levels of government working in their respective areas of jurisdiction. It also recognizes the importance of engaging stakeholders including people with lived and living experience. Reducing the stigma experienced by people who use drugs is integral to the CDSS and a priority for the Government of Canada.

Governance structures

The CDSS is led by the Minister of Health. The Strategy is coordinated through the CDSS Director General (DG) Steering Committee that reports to Assistant Deputy Ministers (ADMs).

The DG Steering Committee is designed to reflect and support the CDSS' comprehensive approach to substance use issues. The Committee is comprised of DGs from federal departments/agencies whose mandates are relevant to drug and substance use (including departments that formally received CDSS funding and those that do not). The Committee meets at least twice a year as well as on an ad hoc basis as needed.

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

Total federal funding allocated from 2017-18 to 2021-22

$642,271,740^{Footnote 36}

Total federal funding planned spending to March 31, 2021

$521,662,953

Total federal actual spending to March 31, 2021

$615,907,988

Date of last renewal of initiative

Not applicable

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

Not applicable

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

Not applicable

Total actual spending since last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Performance highlights

In 2020-21, substance use-related harms continued to cause devastating health and social effects on Canadians from every walk of life. For many people, and in many jurisdictions, the COVID-19 pandemic exacerbated these harms – evidence shows that substance-related hospitalizations and deaths increased in Canada during the pandemic compared to the same period in 2019. According to data from the Public Health Agency of Canada, more than 24,626 people lost their lives in Canada between January 2016 and June 2021 to apparent opioid-related overdoses. Nationally, there were 1,720 apparent opioid toxicity deaths between April and June 2021, similar to the period from January to March 2021 (1,792 deaths), but representing a 2% increase compared to April to June 2020 (1,680 deaths) and a 66%% increase compared to April to June 2019 (1,038 deaths). Health Canada, working with its other federal partners under the CDSS, continued to support efforts to: improve access to treatment and harm reduction services; strengthen enforcement to help reduce the toxic illegal drug supply; increase awareness and prevention efforts; and build the evidence base through federal investments in research and surveillance.

Since the beginning of the COVID-19 pandemic, Health Canada implemented critical and timely measures to enable support to the health system to address the needs of people who use substances and those at risk of overdose. For example, the Department facilitated access to medications necessary for opioid agonist treatment (e.g. suboxone and methadone). Health Canada also issued 63 COVID-19 regulatory exemptions to the Controlled Drugs and Substances Act (including extensions of those exemptions) to support province, territories and municipalities. This enabled jurisdictions to quickly establish overdose prevention sites to address urgent public health needs in a variety of locations, including in temporary community shelters. Regulatory actions also allowed health practitioners and pharmacists to manage the compounding effects of the overdose crisis and the COVID-19 pandemic. For example, in October 2020, the Department extended the subsection 56(1) class exemption from the Controlled Drugs and Substances Act thatallowed health practitioners to verbally prescribe controlled substances, and authorizedpharmacists to prescribe, sell, or provide (including the transfer of prescriptions) controlled substances in limited circumstances. The exemption also allowed individuals to deliver controlled substances, on behalf of a pharmacist, to those in isolation. To facilitate knowledge of these measures, including the various legislative and regulatory exemptions, in May 2020, Health Canada released a tool kit, which allows health care professionals to facilitate flexible models of care during the pandemic. The toolkit contains: prescribing and practice guidelines for the symptoms of withdrawal; information for people who use drugs on medications and treatment supports; and, information for service providers and stakeholders to access a safer, pharmaceutical grade alternative to the toxic illegal drug supply, among other tools.

In spring 2020, following the launch of Health Canada's Controlled Substances E-Services Portal, Health Canada conducted 164 suspicious loss and theft follow ups to contribute to the improved monitoring of legal domestic drug supply chain. Follow up activities were conducted with various types of establishments, such as community and hospital pharmacies, dental surgeons, and veterinary clinics, to increase compliance, improve enforcement and reduce the risk of diversion of controlled substances, prescription drugs and precursor chemicals.

In March 2021, the Minister of Health established an Expert Task Force on Substance Use to provide Health Canada with independent, expert advice and recommendations on the government's drug policy, the CDSS, with the objective of further strengthening the government's approach to substance use. The Task Force also provided advice regarding alternatives to criminal penalties for the simple possession of controlled substances, with the goal of reducing the impacts of criminal sanctions on people who use drugs, while maintaining support for community and public safety. In addition, the final stage of Health Canada's Drug Checking Technology Challenge (DCTC) was completed this year with the selection of a grand prize winner by the DCTC's Judging Panel. Health Canada launched the DCTC in 2018 to improve drug checking technology to allow the community of people who use drugs, and those who support them, to make more informed decisions based on the composition of a drug to reduce harm.

In addition to Health Canada's actions, CDSS partners continued to work to address problematic substance use in Canada in 2020-21. Ongoing key activities include continued efforts to educate and inform Canadians about the negative impacts of stigma towards people who use drugs; promoting Canadian drug policy priorities and public health issues at the international level, including promoting the use of non-stigmatizing approaches at the UN Commission on Narcotic Drugs; and, advancing evidence-based prevention, treatment, harm reduction and drug regulation/enforcement activities. Some key highlights include:

• The Public Health Agency of Canada (PHAC) published Welcoming environments: Preventing problematic substance use through positive youth development that demonstrates the value of fostering welcoming environments to prevent problematic substance use among students.
• The Public Prosecution Service of Canada (PPSC) developed a new Guideline 5.13 Prosecution of Possession of Controlled Substances Contrary to s. 4(1) of the Controlled Drugs and Substances Act, released on August 17, 2020. This guideline directs prosecutors to focus upon the most serious cases raising public safety concerns for prosecution and to otherwise pursue suitable alternative measures and diversion from the criminal justice system for simple possession.

Contact information

Health Canada
Jennifer Saxe
Director General
Controlled Substances and Cannabis Branch
jennifer.saxe@hc-sc.gc.ca
613-816-1739

Horizontal initiative framework: departmental funding by theme (dollars)

Horizontal initiative: Canadian Drugs and Substances Strategy

Shared outcomes:

• Problematic substance use is addressed as a health and social issue by governments, communities, stakeholders and Canadian society.
• Rates of problematic substance use in Canada are minimized, especially for youth and those most at risk of harm, including preventing, reducing and/or delaying the use of drugs and other substances.
• Canadians and their communities are supported with evidence-based tools, programs and services to be safer, healthier and more resilient.

Performance information

Theme 1: Comments on Variances

Health Canada

• The variance between planned and actual spending is mainly due to the receipt of an internal reallocation for costs related to implementing the Minister's mandate priorities and directed responses to the ongoing Opioid Overdose Crisis, made worse by the COVID-19 pandemic. Examples of targeted activities include supporting improved access to treatment and life-saving services; national implementation of harm reduction measures, like the operation of supervised consumption sites (SCS) and urgent public health need (UPHN) sites across Canada, including regulatory actions to address them.

Correctional Services Canada

• The variance between planned and actual spending is mainly due to a reduction in the number of provincial offenders being supervised and requiring community-based accommodation services. Decreased costs are attributed to a decrease in available capacity due to the pandemic and concerted efforts to divert offenders away from congregate living arrangements (community-based residential facilities) where safe to do so.

Department of Justice

• The variance between the planned and actual spending for the Youth Justice Fund's Drug Treatment component is mainly due to the COVID-19 pandemic.

Financial Transaction and Reports Analysis Centre of Canada (FINTRAC)

• FINTRAC is an unfunded partner within CDSS. FINTRAC continues to work with law enforcement and intelligence agencies to ensure they receive financial intelligence related to drug production and distribution that is useful for further actions.

Parole Board of Canada

• The variance between planned and actual spending is due to the difference in the number of provincial reviews (planned versus actual). The estimated planned spending for 2020-21 of $295K was based on an annual average over the last five years (i.e., 141 reviews). The actual number of reviews in 2020-21 was 96 at a cost of approximately $212K.

Public Health Agency of Canada

• The variance between planned and actual spending is mainly due to the allocation of funds to other programs, as some planned activities did not materialize until closer to year-end due to COVID-19 disruptions.

Public Prosecution Service of Canada

• The variance between planned and actual spending is mainly due to internal allocations to support this initiative.

Public Safety Canada

The variance between planned and actual spending is due to COVID-19 travel restrictions.

Theme 1: Prevention

Expected results

Health Canada

ER 1.1.1 Targeted stakeholders and Canadians are equipped with the capacity (knowledge, skills and supports) to inform their decisions and actions related to substance use.

ER 1.1.2 Targeted stakeholders use evidence-informed information on substance use to change policies, programs, and practice.

ER 1.1.3 Increased compliance and reduced risk of diversion of controlled substances, prescription drugs and precursor chemicals.

Royal Canadian Mounted Police

ER 1.2 The RCMP will increase awareness of drugs and illegal substances among stakeholders by developing education products, supporting outreach and engagement efforts, and building new partnerships.

Performance indicators

Health Canada

PI 1.1.1 Percentage of stakeholders and Canadians reporting that they gained knowledge^{Footnote 38}.

PI 1.1.2 Percentage of targeted stakeholders reporting that they made evidence-informed improvements to substance use policies, programs and practice.^{Footnote 39}

PI 1.1.3 Percentage of pharmacies inspected that are deemed to be compliant with the Controlled Drugs and Substances Act (CDSA) and its regulations.

Royal Canadian Mounted Police

PI 1.2.1 Number of awareness products.

PI 1.2.2 Number of stakeholders reached.

PI 1.2.3 Percentage of partners and stakeholders who demonstrate an increase in awareness of illegal drugs.

PI 1.2.4 Number of partnerships and collaborations.

PI 1.2.5 Number of new engagement opportunities identified.

Targets

Health Canada

T 1.1.1 70%

T 1.1.2 70%

T 1.1.3 80%

Royal Canadian Mounted Police

T 1.2.1 5 drug related awareness products will be produced and/or updated.

T 1.2.2 Approximately 500 stakeholders will be reached (stakeholders include Police, Public/Youth, and Industry/other stakeholders).

T 1.2.3 50% of partners and stakeholders agree that Federal Policing contributed to an increased awareness/understanding of illegal drugs.

T 1.2.4 At least 3 partnerships/collaborations.

T 1.2.5 5

Actual Results

Health Canada

AR 1.1.1 not applicable

AR 1.1.2 86%

AR 1.1.3 84%

Royal Canadian Mounted Police

AR 1.2.1 Three (3) drug-related awareness products were developed and/or updated on the topics of illegal synthetic drug labs, methamphetamine, and fentanyl.

AR 1.2.2 More than 4,841 stakeholders were reached including domestic and international police, other first responders, the health sector, and government representatives.

AR 1.2.3 Forty-three percent (43%) of partners and stakeholders reported an increase in awareness of illegal drugs.

AR 1.2.4 Eight (8) partnerships and/or collaborations were undertaken with domestic and international police services.

AR 1.2.5 One (1) new engagement opportunity identified.

Theme 2: Treatment

Expected results

Canadian Institutes of Health Research

ER 2.1 Support for research in priority areas.

Department of Justice Canada

ER 2.2.1 The criminal justice system supports alternative ways of responding to the causes and consequences of offending.

ER 2.2.2 Increased availability of, and access to, drug treatment services and programs for youth involved in the justice system.

Performance indicators

Canadian Institutes of Health Research

PI 2.1 Percentage of funded research projects with a nature and scope that support CDSS' goals.

Department of Justice Canada

PI 2.2.1 Percentage of Drug Treatment Court participants retained for 6 months or longer in the court-monitored treatment program.

PI 2.2.2 Number of active projects funded under Youth Justice Fund's Drug Treatment component per fiscal year.

Targets

Canadian Institutes of Health Research

T 2.1 100%

Department of Justice Canada

T 2.2.1 50%

T 2.2.2 100% of the budget allocation is committed to support drug treatment programming for youth involved in the justice system.

Actual Results

Canadian Institutes of Health Research

AR 2.1 100%

Department of Justice Canada

AR 2.2.1 68.14% of participants were retained for more than six months in federally funded Drug Treatment Court programs during 2020-2021^{Footnote 40}.

AR 2.2.2 There were 7 active Youth Justice-Drug Treatment (YJ-DT) projects in FY 2020-21^{Footnote 41}.

Theme 3: Harm reduction

Expected results

Health Canada

ER 3.1 Increased availability of harm reduction services.

Indigenous Services Canada

ER 3.2 Reduction in risk-taking behaviour among drug or substances users.

Public Health Agency of Canada

ER 3.3 Reduction in risk-taking behaviour among drug or substances users.

Performance indicators

Health Canada

PI 3.1 Percentage of applications for an exemption to operate a Supervised Consumption Site that received a decision within the service standard from the time the review is complete.^Footnote42

Indigenous Services Canada

PI 3.2 Number of First Nations and Inuit communities that deliver harm reduction programming.^{Footnote 43}

Public Health Agency of Canada

PI 3.3 Percentage decrease in the number of people who use drugs who report sharing drug use equipment.

Targets

Health Canada

T 3.1 90%

Indigenous Services Canada

T 3.2 11

Public Health Agency of Canada

T 3.3 10% decrease

Actual Results

Health Canada

AR 3.1 not applicable^{Footnote 44}

Indigenous Services Canada

AR 3.2 Not applicable

Public Health Agency of Canada

AR 3.3 Not applicable^{Footnote 45}

Theme 4: Enforcement

Expected results

Health Canada

ER 4.1.1 Authorizations to perform legitimate activities with controlled substances and precursor chemicals are processed in a timely manner.

ER 4.1.2 Increased compliance and reduced risk of diversion of controlled substances, prescription drugs and precursor chemicals.

ER 4.1.3 Increased effectiveness in drug analysis.

ER 4.1.4 Data and research evidence on drugs and emerging drug trends are used by members of the federal Health Portfolio and their partners.

Canada Border Services Agency

ER 4.2.1 Increase awareness and capacity to gather information and intelligence to maximize interdiction of illegal drugs (as defined in the CDSA) at the border.

ER 4.2.2 Continue to inform enforcement activities by providing intelligence and analytical support to the regions.

ER 4.2.3 Continue to work with CDSS partner agencies to identify opportunities for cooperation, share information, and conduct laboratory analysis related to illegal drugs and other goods (e.g. precursor chemicals) governed by the CDSA.

Canada Revenue Agency

ER 4.3 30 audits of taxpayers involved in the production and distribution of illegal drugs resulting in (re) assessments of $2.0 million of federal taxes.

Correctional Services Canada

ER 4.4 Timely case preparation and supervision of provincial offenders with a drug offence (CDSA Schedule II).

Financial Transactions and Reports Analysis Centre of Canada.

ER 4.5 Given the importance of the CDSS initiative, FINTRAC will continue to work with law enforcement and intelligence agencies to ensure they receive financial intelligence related to drug production and distribution that is useful for further actions.

Global Affairs Canada

ER 4.6 In 2020-2021, GAC will increase capacity of port officials in selected countries in the Americas to intercept and seize illegal drugs smuggled via legal maritime containerized cargo. GAC will also work to build the capacity law enforcement of OAS member states to share and disseminate information and early warning alerts on New Psychoactive Substances (NPS), opioids, and other emerging drug threats.

Parole Board of Canada

ER 4.7.1 Conditional release decisions contribute to keeping communities safe.

ER 4.7.2 The timely exchange of relevant information with victims, offenders, observers, other components of the criminal justice system, and the general public.

Public Prosecution Service of Canada

ER 4.8.1 Provision of legal advice and litigation support, as well as the prosecution of drug offences in all provinces /territories regardless of which police agency investigates the offences, except Quebec and New Brunswick. In these provinces, the PPSC prosecutes only drug offences investigated by the RCMP.

ER 4.8.2 Provision of pre-charge legal advice and litigation support, as well as the prosecution of serious drug offences under the CDSA to which mandatory minimum penalties are applicable.

Public Safety Canada

ER 4.9 Coordinated enforcement action to address illegal drugs and substances.

Public Services and Procurement Canada

ER 4.10 Assist law enforcement agencies and prosecutors by providing forensic accounting services and expertise. These services assist in determining whether the assets identified were derived from criminal activities, thereby allowing the Crown to seize the assets and remove the financial incentives from the crime.

Royal Canadian Mounted Police

ER 4.11 The RCMP will focus its efforts to undertake investigations and initiatives focussing on the highest threats related to organized crime networks including those involved in the importation and trafficking of illegal drugs, including illegal opioids.

Performance indicators

Health Canada

PI 4.1.1 Overall percentage of High-Volume Regulatory Authorizations for controlled substances processed within service standards.

PI 4.1.2 Percentage of licensed dealers inspected that are deemed to be compliant with the CDSA and its regulations.

PI 4.1.3 Percentage of samples analyzed within service standards (60 days or negotiated date).

PI 4.1.4 Number of alerts issued to clients and to provincial and territorial health authorities on newly identified potent illegal drugs in communities.

Canada Border Services Agency

PI 4.2 Average dollar value of goods, shipments and conveyances seized attributed to Intelligence.

Canada Revenue Agency

PI 4.3 80% or more of audits resulting in (re) assessments

Correctional Services Canada

PI 4.4.1 Total number of provincial offenders convicted of a drug offence (CDSA Schedule II) supervised by CSC on a monthly basis during the year.

PI 4.4.2 Total number of provincial offenders convicted of a drug offence (CDSA Schedule II) with a residency requirement on a monthly basis during the year.

PI 4.4.3 Total number of case preparation reports (pre- and post-release) completed for all provincial offenders during the year.

Financial Transactions and Reports Analysis Centre of Canada

PI 4.5 Total number of FINTRAC disclosures of actionable financial intelligence made to regime partners, and the number of unique disclosures of actionable financial intelligence that relate to at least one drug-related offence.

Global Affairs Canada

PI 4.6.1 Number of illegal drug seizures made by GAC-financed/UNODC trained Port Control Units in beneficiary countries.

PI 4.6.2 Volume of illegal drug seized by GAC-financed/UNODC trained Port Control Units in beneficiary countries.

Parole Board of Canada

PI 4.7.1 Number and proportion of provincial offenders convicted of drug offences who successfully complete parole.

PI 4.7.2 Percentage of individuals (i.e., general public and victims) who are satisfied with the quality of the service.

Public Prosecution Service of Canada^{Footnote 46}

PI 4.8.1.1 Number of litigation files related to the prosecution of drug offences under the CDSA referred to the PPSC during the fiscal year.

PI 4.8.1.2 Number of files for which legal advice was provided by PPSC counsel.

PI 4.8.2.1 Number of litigation files related to the prosecution of serious drug offences under the CDSA referred to the PPSC during the fiscal year to which mandatory minimum penalties are applicable.

PI 4.8.2.2 Number of files for which legal advice was provided by PPSC counsel where mandatory minimum penalties are applicable.

Public Safety Canada

PI 4.9 Timely sharing of evidence-based knowledge and intelligence to support law enforcement actions against illegal drugs and substances.

Public Services and Procurement Canada

PI 4.10.1 Number of active CDSS files where the services of a forensic accountant were required.

PI 4.10.2 Number of Forensic Accounting Reports produced during the fiscal year.

Royal Canadian Mounted Police

PI 4.11.1 Number and percentage of Federal Serious and Organized Crime (FSOC) investigations with a transnational nexus.

PI 4.11.2 Number of drug-related charges laid by FSOC units.

PI 4.11.3 Number of drug seizures made by FSOC units, including amount of drugs seized.

Targets

Health Canada

T 4.1.1 90%

T 4.1.2 TBD^{Footnote 47}

T 4.1.3 95% of certificates of analysis issued within service standards or negotiated date.

T 4.1.4 Demand-driven

Canada Border Services Agency

T 4.2 9:1 ratio

Canada Revenue Agency

T 4.3 30 audits of taxpayers involved in the production and distribution of illegal drugs resulting in (re) assessments of $2.0 million of federal taxes.

Correctional Services Canada

T 4.4.1 43 (approximately)

T 4.4.2 27 (approximately)

T 4.4.3 596 (approximately)

Financial Transactions and Reports Analysis Centre of Canada

T 4.5 FINTRAC seeks to closely align its financial intelligence products with the needs and priorities of its investigative partners. As such, the Centre does not set specific targets for the number or types of drug-related case disclosures it produces in any fiscal year.

Global Affairs Canada

T 4.6.1 Illegal drug seizures are made in all beneficiary countries benefiting from GAC-financed/UNODC trained port control units.

T 4.6.2 At least 20 tons

Parole Board of Canada

T 4.7.1 100% of provincial offenders serving sentences for drug offences who are on parole are not convicted of a violent offence during their supervision period.

T 4.7.2 92% of individuals are satisfied with the quality of service. The PBC questionnaire was conducted in 2016-17 the next questionnaire is planned for 2022-23.

Public Prosecution Service of Canada

T 4.8 Targets are not applicable owing to the nature of the PPSC's workload and mandate.

Public Safety Canada

T 4.9 100% completion of planned coordination activities based on an integrated law enforcement work plan.

Public Services and Procurement Canada

T 4.10 The files are dependent on the projects law enforcement assign to PSPC and are based on the resource capacity of the three senior forensic accounts dedicated to work on CDSS files.

Royal Canadian Mounted Police

T 4.11 Targets are not applicable as these will vary by province/territory and is based on need.

Actual Results

Health Canada

AR 4.1.1 93%

AR 4.1.2 84%

AR 4.1.3 70.6%^{Footnote 48}

R 4.1.4 272

Canada Border Services Agency

AR 4.2 The CBSA made 32,094 drug seizures, valued at nearly $418 million. Of those seizures, nearly $173 million worth was seized as a result of intelligence.

The ratio of intelligence led seizures compared to non-intelligence seizures (in dollars) was 70:1^{Footnote 49}

Canada Revenue Agency

AR 4.3 14 cases resulting in $5.56M in Tax Earned by Audit (TEBA)

Correctional Services Canada

AR 4.4.1 39^{Footnote 50}

AR 4.4.2 16^{Footnote 51}

AR 4.4.3 535

Financial Transactions and Reports Analysis Centre of Canada

AR 4.5 2,046, including 692 unique disclosures^{Footnote 52}

Global Affairs Canada

AR 4.6.1 All beneficiary countries had drug seizures in 2020/2021

AR 4.6.2 At least 20 tons interdicted^{Footnote 53}

Parole Board of Canada

AR 4.7.1 100%

AR 4.7.2 89%^{Footnote 54}

Public Prosecution Service of Canada

AR 4.8.1.1 During the 2020-2021 fiscal year, 8,453 litigation files related to the prosecution of drug offences under the CDSA had been referred to the PPSC.

AR 4.8.1.2 PPSC counsel provided legal advice on 1,003 files during the 2020-2021 fiscal year.

AR 4.8.2.1 During the 2020-2021 fiscal year, 162 litigation files related to the prosecution of serious drug offences under the CDSA to which mandatory minimum penalties are applicable had been referred to the PPSC.

AR 4.8.2.2 Legal advice was provided by PPSC counsel on 12 litigation files where mandatory minimum penalties are applicable.

Public Safety Canada

AR 4.9 100% organized and participated in a range of national and international forums to share knowledge and advance best practices to reduce the illegal drug supply.^{Footnote 55}

Public Services and Procurement Canada

AR 4.10.1 77 open CDSS investigations in 2020-21 (opened with 70, added 23, closed 16)

AR 4.10.2 48 CDSS reports issued to clients in 2020-21

Royal Canadian Mounted Police

AR 4.11.1 6,995 RCMP drug production, import/export, and trafficking related occurrences with a transnational nexus; representing 33% of all total related occurrences^{Footnote 56}

AR 4.11.2 13,937 total drug related charges laid by RCMP units; by type (excluding cannabis), this represents 6,201 charges relating to possession; 4,065 charges related to trafficking; 78 charges related to production; 45 charges related to import/export; and 3,548 cannabis related charges.

AR 4.11.3 28,349 drug seizure-related occurrences reported by the RCMP^{Footnote 57}

Theme 5: Evidence base

Expected results

Health Canada

ER 5.1 Increased availability of data and research evidence on drugs and substances.

Canadian Institutes of Health Research

ER 5.2 Increased availability of data and research evidence on drugs and substances.

Public Health Agency of Canada

ER 5.3 Increase availability of national data and research evidence related to drugs and substances to support decision making.

Performance indicators

Health Canada

PI 5.1 Percentage of United Nations Annual Report Questionnaire completed with Canadian data.^{Footnote 58}

Canadian Institutes of Health Research

PI 5.2.1 Percentage of grant recipients producing policy-relevant knowledge products, such as research publications, policy briefs, guidelines for policies or practice, presentations to policy audiences, and media mentions.

PI 5.2.2 Percentage of health research publications related to problematic substance use.

Public Health Agency of Canada

PI 5.3 Percentage of provinces and territories reporting.

Targets

Health Canada

T 5.1 70%

Canadian Institutes of Health Research

T 5.2.1 75%

T 5.2.2 90%

Public Health Agency of Canada

T 5.3 100%

Actual Results

Health Canada

AR 5.1 not applicable

Canadian Institutes of Health Research

AR 5.2.1 100%

AR 5.2.2 86.7%

Public Health Agency of Canada

AR 5.3 not applicable

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 (PHAC)

Start date

2007-08

End date

2020-21

Description

Originally launched in 2006, the Chemicals Management Plan (CMP or "the Program") enables the Government of Canada to protect human health and the environment by addressing substances of concern in Canada.

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 also enables use of the most appropriate management tools among a full suite of federal laws, which include the Canadian Environmental Protection Act, 1999 (CEPA), the Canada Consumer Product Safety Act (CCPSA), the Food and Drugs Act (F&DA), the Pest Control Products Act (PCPA), and the Fisheries 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 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 the 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 for CMP (e.g., CMP Performance Measurement Strategy, the CMP contribution to the Federal Sustainable Development Strategy, etc.).

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 funding planned spending to date (dollars)

$1,308,179,400^{Footnote 59}

Total federal actual spending to date (dollars)

$1,266,704,760 (includes Phases I, II and III)

Date of last renewal of initiative

October 2014

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

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

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

$493,286,450

Total actual spending since last renewal

$490,619,612

Fiscal year of planned completion of next evaluation

2024-25^{Footnote 60}

Performance highlights

Summary

In 2020-21, Health Canada (HC) and Environment and Climate Change Canada (ECCC) assessed and managed the potential health and environmental risks from priority existing substances. Screening Assessment Reports and Risk Management Strategies were published, and risk management measures were developed, implemented, tracked and monitored. Departmental officials assessed notifications for new substances within their mandated timelines, and developed risk management instruments within mandated timeframes, as required for substances considered harmful to human health and/or the environment.

HC continued to develop and publish drinking water quality guidelines. Federal, provincial and territorial jurisdictions in Canada use these guidelines as the basis for establishing their drinking water requirements.

Research and monitoring programs continued over the reporting period. Due to the COVID-19 pandemic, laboratory and field work progressed at a slower pace, while data analysis and reporting (e.g., publication of manuscripts) was conducted at a higher pace than usual.

HC and ECCC collaborated to develop and deliver compliance promotion strategies and enforcement plans for CMP substances.

The Healthy Home social marketing campaign on chemicals and pollutants in and around the home continued to reach Canadians through social media, search engine marketing, web content, national media (print and radio) and virtual events across the country. The Healthy Home website makes it easy 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 2020 program evaluation found that the CMP had made progress in all functional activity areas. 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 for some substances for which risk management measures have been in place for several years. For example, the performance measurement evaluation for the toxic substance DEHP concluded that the risk management tools are meeting their intended goals. Biomonitoring data collected from 3 cycles (2007 to 2017) of the Canadian Health Measures Survey (CHMS) shows that Canadians' exposure to DEHP has progressively decreased since risk management tools were implemented.

Performance Details

Risk Assessment/Risk Management

Over the course of 2020-21, the Program continued to assess the safety of existing substances under the CMP. Since its launch, the Program has assessed approximately 91% (3,974 substances) of the Program's original total planned assessments.

In 2020-21, ECCC and HC published 24 Draft Screening Assessment Reports (dSARs) (representing 84 substances), 20 Final Screening Assessment Reports (fSARs) (representing 153 substances), and 1 Science Approach Document (SciAD).

In December 2020, ECCC and HC also published the results of their 2019 Identification of risk assessment priorities (IRAP) review, recommending 85 substances for further scoping.

The spring publication of HC's Pest Management Regulatory Agency annual 5-year Re-evaluation and Special Review Work Plan was delayed as a result of the COVID-19 pandemic and was later published in September 2020. For 2020-21, the Re-evaluation and Special Review Work Plan was exclusively focused on priority pesticide reviews. Approximately 30% of pesticide re-evaluations currently on hold are past the standard of 4.2 years for completion of a re-evaluation. In 2020-21, HC completed 21 proposed re-evaluation decisions (PRVDs) and 15 final re-evaluation decisions (RVDs) as per the Re-evaluation and Special Review Work Plan. The special reviews of 3 additional active ingredients were completed with a final decision that was not scheduled in the 2020-21 work plan.

In 2020-21, HC and ECCC published targeted risk management activities for substances deemed harmful to human health and/or the environment In total, there were 14 risk management instruments put in place to manage more than 160 toxic substances, including 3 proposed risk management instruments and 11 final risk management instruments. 11 risk management scope documents and 5 risk management approach documents were also published, covering more than 39 substances.

A final order adding mitotane to the List of Toxic Substances on Schedule 1 of CEPA was published and a proposed order adding chlorhexidine and its salts to the List of Toxic Substances on Schedule 1 of CEPA was published.

In 2020-21, ECCC and HC collaboratively published 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. 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 2020-21, the Program published 7 performance measurement evaluation reports (BPA – ecological component; PBDEs; lead; mercury; isoprene; pigment red 3; and butanone oxime (MEKO)).

In 2020-21, 319 new substance notifications were received pursuant to section 81 of CEPA and theNew Substances Notification Regulations (Chemicals and Polymers)and 296 were assessed. For new substances, 4 Notices were published applying the Significant New Activity (SNAc) provisions to 4 substances and one was varied (i.e., it was a modification to a SNAc that was already in force); and 11 Ministerial Conditions came into force on 8 new substances and 1 was varied. For existing substances, 4 SNAc Notices of Intent (NOIs) were issued for existing substances on a total of 6 substances. 3 SNAc Orders were published applying the SNAc provisions to 27 existing substances.

During 2020-21, 70 notifications of new animate products of biotechnology were received and 60 were assessed under the New Substances Notification Regulations (Organisms). One Ministerial Condition came into force on 1 new living organism.

HC also contributed to risk management activities related to drinking water quality in 2020-21, publishing 7 final and 9 draft Guidelines for Canadian Drinking Water Quality online. These are used by all jurisdictions in Canada to inform their regulatory requirements.

HC's Consumer Product Safety Program (CPSP) continued to manage potential risks related to chemicals in consumer products and cosmetics. Program risk assessors and risk managers drafted 2 dSARs (Sucrose Acetate Isobutyrate and triclocarban) and co-authored 1 fSAR (talc) that were published in 2020-21, as well as 2 fSARs (Lotus Corniculatus and parabens) that will be published in 2021-22. The CPSP provided cosmetic notification data to support the assessment for a number of CMP substances. Restrictions and public health measures related to the COVID-19 pandemic led to the intermittent closure of the CPSP's Product Safety Laboratory and limited the ability of regional inspectors to carry out inspections on-site. This caused delays in the completion of compliance verification projects and test method development. Off-site inspections, sampling and testing were initiated on compliance verification projects for lead and cadmium in children's jewellery and selected cosmetic ingredients once it was possible to do so. Other projects were deferred to 2021-22. In addition, the Product Safety Laboratory completed the development and validation of a new test method for the dermal migration of flame retardants used in foam, and completed a series of tests to assess the dermal migration of flame retardants from polyurethane foam products once the laboratory reopened.

HC's Health Products and Food Branch continued to provide information to support the development of CMP screening assessments, as well as to 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 or main source of exposure.

HC continued to develop Human Health Soil Quality Guidelines to support the development of the Canadian Council of Ministers of the Environment Canadian Soil Quality Guidelines for the Protection of Environmental and Human Health. 9 Soil Screening Values for a suite of energetic substances were finalized.

Stakeholder Engagement and Public Outreach

Stakeholder engagement activities delivered in 2020-21 focused on targeted stakeholders, such as the Assembly of First Nations and the Canadian Network for Human Health and the Environment, in order to facilitate information sharing. The CMP Stakeholder Advisory Council (SAC) held its final virtual meeting in 2020-21. The objective of this meeting was to reflect on an evaluation of the experiences of SAC members throughout the current mandate, as well as seek insight on some forward-looking considerations for the future of stakeholder engagement under CMP.

The CMP Science Committee continued to provide a strong science foundation to CMP, by enabling external science professionals from national and international sources to share their expertise with HC and ECCC.

The Program managed a rigorous posting schedule for the chemical substances content on Canada.ca to ensure the public had the opportunity to participate in the CMP during the public comment periods following publications in the Canada Gazette.

The Healthy Home campaign was featured in social media posts (Facebook,Twitter and LinkedIn) and served to provide Canadians with practical tips on how to protect their families from chemicals and pollutants within the home. An advertising campaign, which featured paid social media (Facebook and Instagram) and search engine marketing, helped to promote messaging by directing Canadians to the website. 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. Messaging was further distributed through a series of illustrated, plain-language articles that were published by local, regional and national media outlets throughout the year.

HC conducted virtual public outreach activities (e.g., virtual exhibitions, presentations, workshops and Train-the-Trainer collaborations) across the country throughout 2020-21. These ongoing activities are designed 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. Outreach activities targeted intermediary groups such as caregivers, early childhood educators, health care providers and parents/guardians. This enabled delivery of information to subpopulations that may be more vulnerable to chemicals or have greater exposure, such as Indigenous communities, new Canadians, seniors, pregnant persons, children and youth.

Research

Research at HC continued to address CMP3 priorities identified under the following themes:

1. Nanomaterials;
2. Integrated hazard characterization and exposure assessments for CMP3 priority chemicals, mixtures or CEPA substances;
3. Monitoring and surveillance of CMP priority chemicals; and,
4. Methods and tools development for the assessment of CMP3 priority chemicals, mixtures or CEPA substances.

In 2020-21, HC conducted 27 research and monitoring and surveillance projects to support CMP3 priority substances 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 4 DSARs and 5 FSARs.

At ECCC, research projects initiated in 2019-20 continued in 2020-21, but at a slower pace than expected due to the COVID-19 pandemic and related suspension of laboratory and field work. However, significant progress was made in terms of data analysis and reporting (e.g., publication of manuscripts). The newly analyzed results will 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, phthalates (DEHP), PBDEs, benzophenones and nanomaterials.

Monitoring and Surveillance

HC and ECCC continued to conduct monitoring and surveillance, although at a slower pace due to the COVID-19 pandemic. This monitoring will be used to address existing and emerging chemicals of concern, and to inform risk assessment needs and risk management activities.

At ECCC, there were limited monitoring and surveillance activities conducted in 2020-21 due to the COVID-19 pandemic and related suspension of laboratory and field work. For some environmental media (e.g., air, wildlife), field and laboratory activities have occurred since they were conducted by external collaborators and contractors. Overall, there was significant progress made on data analysis and reporting (e.g., publication of manuscripts) for many CMP priority substances and/or groups of substances monitored in fresh water, sediments, fish, bird eggs, ambient air, municipal wastewater and biosolids.

At HC, the Maternal-Infant Research on Environmental Chemicals (MIREC) Research Platform continued the assessment of prenatal exposure to chemicals and established national estimates of maternal and fetal exposures. A follow-up study called MIREC-ENDO is studying the effects of prenatal exposure to environmental chemicals on puberty and metabolic function in the child, as well as maternal health. In 2020-21, researchers completed participant recruitment, data collection and laboratory analysis of collected biospecimens for Phase 1 of MIREC-ENDO. The MIREC-ENDO participant recruitment plan was revised due to the COVID-19 pandemic. The revised plan is questionnaire-based and can be completed at home, without in-person visits. 437 families were recruited in Phase 1, while 307 families have indicated interest. Phase 2 planning and preparation will continue through fall 2021 and will be launched in winter 2022 with recruitment continuing using the at-home questionnaire.

In summer 2019, HC conducted a study to generate biomonitoring data from DEET personal insect repellents used by children in a camp setting. DEET is a common name for N,N-Diethyl-m-toluamide. This study complements other HC studies that measure chemical exposures in children from typical use. It will provide a better understanding of children's exposure to DEET in Canada, and will inform any future recommendations. Data was analysed in 2020-21 and results are expected to be published in 2021-22.

In December 2020, HC released the first "Report on Human Biomonitoring of Environmental Chemicals in Pooled Samples - Results of the Canadian Health Measures Survey Cycle 1 (2007–2009), Cycle 3 (2012–2013), Cycle 4 (2014–2015) and Cycle 5 (2016–2017)". This report presents the first set of pooled serum data from the national biomonitoring program collected as part of the CHMS and is the first nationally representative dataset in blood for these specific 90 persistent environmental chemicals. The data advances our understanding of Canadians' exposure to chemicals, including measurements of persistent organic pollutants, and contributes to performance measurement activities for these chemicals.

Through the CHMS, HC obtained nationally-representative biomonitoring data to monitor the levels of over 250 chemicals in the general Canadian population, then applied trend analysis to examine the change in chemical concentrations in Canadians over 10 years (2007 to 2017). Levels of several chemicals declined significantly over this period, including a 33% decrease for lead, 32% for bisphenol A (BPA), 31% for triclosan, and 75% for the plasticizer DEHP. Monitoring trends in the level of chemicals in Canadians will be used as a key performance indicator for evaluating the effectiveness of recent risk management actions intended to reduce chemical exposures.

Both ECCC and HC contribute to the Northern Contaminants Program (NCP) led by Crown-Indigenous Relations and Northern Affairs Canada. 5 human biomonitoring and health project proposals were funded in 2020-21 under the NCP. HC co-edited the overall assessment and led the biomonitoring component of the 2021 Artic Monitoring and Assessment Programme Human Health Assessment Report presented to the Arctic Council Ministerial meeting in May 2021.

Information Gathering

HC and ECCC continued to conduct information gathering activities with industry to understand commercial use, import and manufacture of chemical substances, which will 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 2020-21, HC conducted a targeted voluntary data request for turpentine and turpentine oil (part of the terpenes and terpenoïds Group 1: Acyclic, monocyclic, and bicyclic monoterpenes) to inform risk assessment and risk management activities.

Additionally, the Program published a CEPA section 71 information gathering notice in the Canada Gazette for perfluorohexane sulfonic acid, its salts and its precursors, and published open data summaries of data received from these past section 71 notices:

• Notice to provide information for the risk management of 1,4-benzenediamine, N,N′-mixed phenyl and tolyl derivatives (BENPAT);
• Notice with respect to certain quaternary ammonium compounds in Canadian commerce — Phase 1; and
• Notice to provide information for the risk management of certain coal tars and their distillates

Compliance and Enforcement

Compliance promotion activities for this initiative 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. In 2020-21, compliance promotion activities were carried out for regulatory and non-regulatory instruments related to CMP substances. A total of 16,143 known or potential regulatees received compliance promotion awareness materials, and 3,186 stakeholders contacted compliance promotion officers for clarification of regulatory requirements and/or additional information. These activities aimed to increase voluntary compliance with regulatory and non-regulatory instruments, thereby mitigating consequential enforcement actions. ECCC continued to enforce CMP instruments based on its risk-based approach that defines enforcement priorities based on risks to human health and the environment, and targets the most serious forms of non-compliance. ECCC conducted 755 inspections related to CMP regulations and issued 213 enforcement measures in 2020-21.

Public Health Agency of Canada

During 2020-21, 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.

96% of conveyance and facility operators successfully met public health requirements during, or in response to, 98 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 response to the COVID-19 pandemic. 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 pandemic.

Contact information

Health Canada
Kathleen Buset
Director
Healthy Environments and Consumer Safety Branch
kathleen.Buset@hc-sc.gc.ca
613-415-9402

Environment and Climate Change Canada
Thomas Kruidenier
A/Executive Director, Program Development and Engagement
Science and Technology Branch
Thomas.kruidenier@ec.gc.ca
613-697-4854

Christina Paradiso
Executive Director, Chemicals Management Division
Environmental Protection Branch
Christina.Paradiso@ec.gc.ca
613-797-3612

Performance information

SO-AR1: Over the life of the CMP, significant investments have been, and continue to be, made towards measuring the final outcome in a meaningful manner. Specific to 2020-21, and building on the biomonitoring surveillance data collected as part of the CHMS, a retrospective public health-focused pilot project was developed with Statistics Canada. The pilot project will begin in 2021-22 with the goal of identifying potential relationships between chemical exposures and disease outcomes by linking biomonitoring data from the CHMS with critical health and diagnostic information from provincial medical records. Preliminary analysis of the association between levels of 4 priority substances measured over 10 years and cancer diagnoses from the Canadian Cancer Registry is expected to be completed by end of the 2021-22 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 2020-21, a Performance Measurement Strategy for the risk management of toxic substances and a new performance measurement landing page to centralize performance information were published online,. To date, risk management performance evaluations have been published for Bisphenol A, Polybrominated Diphenyl Ethers (PBDEs), Lead, Mercury, Isoprene, Pigment Red 3, Butanone oxide (MEKO) and DEHP (human health component). Risk management performance evaluations have also been conducted for Dioxins and Furans (human health component) and DCM (human health component). A rolling workplan for current and upcoming performance work was also published online.

Theme 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 Percentage of dietary exposure assessments and/or hazard characterizations completed for substances for which Chemicals Management Plan assessments have identified food as the contributing / main source of exposure
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 actions taken in a timely manner to protect Canada's environment from substances found to be a risk 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%^{Footnote 61}
T 1.1.4 100%
T 1.1.5 80%
T 1.2.1 100%^{Footnote 62}
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%^{Footnote 63}
T 3.1.2 100%
T 3.2 100%^{Footnote 64}
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 94%
AR 1.1.4 100%
AR 1.1.5 89%
AR 1.2.1 100%
AR 1.2.2 92%
AR 1.3 88%
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 94%
AR 3.1.2 70%
AR 3.2 87.5%
AR 3.3 100%
AR 3.4 100%
AR 3.5 16,143
AR 3.6 83%

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)

Canada Border Services Agency
Public Health Agency of Canada
Public Safety Canada
Royal Canadian Mounted Police

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

Start date

April 1, 2017

End date

March 31, 2022

Description

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 initiative is designed to follow through on the Government's key objectives of protecting public health, safety, and security. More specifically, the initiative aims to prevent young persons from accessing cannabis, to protect public health and public safety by establishing strict product safety and product quality requirements and to deter criminal activity by imposing serious criminal penalties for those operating outside the legal framework.

Federal partner organizations implement 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 continues to support a robust governance structure to facilitate whole-of-government coordination in implementing and administering the 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; 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. Supporting F/P/T working groups and committees also facilitate ongoing engagement in key priority areas, including public education and awareness, data development and information sharing, national inventory tracking and implementation. In addition, existing F/P/T bodies are also considering the implications of cannabis legalization and regulation, including F/P/T Deputy Ministers Responsible for Justice and Public Safety, and F/P/T Ministers Responsible for Finance.

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

$546,807,456

Total federal funding planned spending to date (dollars)

$424,998,366

Total federal actual spending to date (dollars)

$380,177,454

Date of last renewal of initiative

Not applicable

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

Not applicable

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

Not applicable

Total actual spending since last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Performance highlights

The federal government continued to support the effective implementation of the cannabis framework in 2020-21, working with provinces, territories, Indigenous governments, federal partners, regulated industry, municipalities, non-governmental organizations, academics, law enforcement, international partners, and communities to meet its objectives. The objectives of the Cannabis Act are to protect the public health and public safety of Canadians, particularly youth, while providing adults with legal access to regulated cannabis and reducing illicit activities.

More specifically, the following progress and achievements have been made in 2020-21:

Public Health

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. Health Canada led two cannabis public education campaigns, one launched in December 2020 targeted at pregnant women, and the second in March 2021 targeted at young adults aged 16 to 24 focusing on the risks and harms to mental health associated with cannabis use. In collaboration with partners, educators, and health professionals, the Public Health Agency of Canada (PHAC) continues to support the Government of Canada's efforts to reduce substance-related harms through a variety of efforts. This includes supporting the Chief Public Health Officer as a leading voice on public health in Canada and developing tailored public education resources on substance use for various audiences, such as school communities, older adults, and postsecondary students. PHAC has also engaged with partners and stakeholders to mobilize knowledge on upstream approaches to the prevention of substance use and related harms in youth. Through investments in public education in 2020-21, the Government has helped Canadians make informed choices and better understand the risks associated with cannabis use. In 2020, 77% of Canadians strongly or somewhat agreed that they had access to enough trustworthy information about the health risks of cannabis to make informed decisions in comparison to 71% in 2019 (Canadian Cannabis Survey 2020).

Health Canada also provided scientific advice, conducted health risk assessments; and monitored, assessed, and communicated on adverse reactions, contributing to regulatory amendments, compliance and enforcement activities, and public education, with the goal of protecting public health. In 2020-21, Health Canada conducted four health risk assessments, more than 400 risk-related consultations, and screened 176 unique cases of adverse reactions^{Footnote 65} with cannabis products, of which 33 involved hospitalization. The Department also made presentations on adverse reaction reporting and the vigilance framework for cannabis products to various stakeholders across Canada and internationally. Health Canada published the Cannabis Adverse Reaction Reporting Guide to inform federal licence holders on their mandatory reporting obligations as well as an Infowatch article to raise awareness of harmful cannabis-warfarin interactions. Additionally, to help monitor compliance with regulatory requirements, the Cannabis Regulations require federal licence holders to provide advance notice of their intent to introduce new cannabis products into the market. Health Canada reviewed a total of 23,905 notices of new cannabis products and followed up on 3.5% of the notices due to potential non-compliance with the regulations or because or potential safety concerns.

As a means of continuous improvement of the regulatory framework for cannabis, Health Canada consulted with and sought feedback from Canadians on a number of topics, including: a notice of intent on a proposal to provide the cannabis industry with financial relief amid the COVID-19 pandemic; a proposal to regulate non-therapeutic research under the Cannabis Act; the manner that public possession limits are calculated for different types of cannabis products; packaging and labelling requirements; COVID-19 measures; micro class licensing; and draft guidance related to the personal and designated production of cannabis for medical purposes.

The federally regulated production of cannabis continued to expand and diversify over the past year. From April 2020 to March 2021, the Department granted an additional 302 licences for cultivation, processing, and/or sale of cannabis for medical purposes and 596 licences for research, analytical testing, cannabis drug and/or industrial hemp. Health Canada also worked closely with Indigenous leaders, organizations and communities across the country to assist interested Indigenous groups in participating in the regulated cannabis sector. As of March 31, 2021, there were 249 engagement sessions with First Nations, Metis and Inuit leaders, organizations and communities. From April 2020 to March 2021, there were an additional 14 Indigenous-owned or -affiliated businesses located across Canada that received a Health Canada licence to cultivate or process cannabis for a total of 28 Indigenous businesses licensed, including two located on a reserve.

From a compliance and enforcement perspective, Health Canada is responsible for regulatory oversight of the legal industry, while law enforcement agencies are responsible for enforcing the criminal prohibitions associated with cannabis (such as the illegal production, distribution or sale or cannabis). The Department continued to engage with applicants, associations, industry representatives and regulated parties to increase knowledge of, and compliance with, regulatory requirements. Health Canada conducted 208 inspections and 185 compliance verifications with an overall industry compliance rate of 93% in 2020-21. There was one licence revocation, one licence suspension and two licence reinstatements as a result of compliance activities.

The impacts of cannabis legalization and regulation has been monitored closely through ongoing population-based surveys and other evaluation, research and monitoring activities. 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) to advance cannabis research priorities.

Public Safety

Results show that a diverse competitive legal cannabis industry has captured a significant proportion of the cannabis market. The proportion of cannabis spending in the legal market has grown from 9% in Q3 2018 to 58% in Q1 2021 (representing over $3.8B in annual legal spending from Q2 2020 through Q1 2021).

Public Safety Canada (PS) worked closely with federal, provincial and territorial partners and other key external stakeholders to displace the cannabis illicit market, including disrupting illicit online sales of cannabis. In 2020-21, PS led several initiatives and advanced partnerships through the implementation of the Online Illicit Cannabis Sales Action Plan. Activities focused on: increasing public education and awareness for consumers, and increasing information-sharing, resources and collaborative approaches among partners to support enforcement of cannabis legislation and regulations, as well as conducting outreach with third-party entities on ways to disrupt illicit activities. In addition, PS established a national sub-working group to monitor trends/patterns of the illicit cannabis market across the country.

To strengthen knowledge sharing of law enforcement practices among key stakeholders, PS and Health Canada held a Cannabis Compliance and Enforcement Symposium. This virtual symposium, held over three sessions on January 28, February 17 and March 25, 2021, brought together federal, provincial and territorial government officials, as well as law enforcement agencies, to discuss the main challenges as well as promising practices relating to cannabis enforcement.

Public Safety Canada also continued public education and awareness activities in 2020-2021 with the Don't Drive High campaign, to provide Canadians, and in particular, young Canadians aged 16 to 24, with information on the legal implications and laws associated with cannabis use and driving. Don't Drive High's fourth year featured a successful digital advertising campaign which took place in January and February 2021, where ads were delivered over 64M times across Canada on Instagram, Snapchat, TikTok, YouTube, and websites, with 20.7M completed views of a new animated video ad. As part of the Online Illicit Cannabis Sales Action Plan and to raise awareness of the dangers/risks of consuming cannabis purchased from illegal online sources, in February and March 2021, articles, radio spots, and a new animated video were delivered to Canadians over 4.5M times.

In 2020-21, the Royal Canadian Mounted Police (RCMP) continued to investigate cannabis-related violations, as well as engage with partners and stakeholders to address illicit online cannabis sales and organized crime-related activities. It also continued to support cannabis-related training and capacity development for Federal Policing employees and focused on new classes of cannabis as well as changes to the Excise Act 2001.

Since March 2020, Criminal Intelligence Service Canada (CISC) established a National Intelligence Working Group of federal, provincial and municipal law enforcement partners to enhance information sharing on organized crime group involvement in the illicit cannabis market. In the future, CISC will use the National Intelligence Working Group to publish six intelligence reports annually on organized crime group-related trends and to inform its operational counterparts on the most important threats.

During the reporting period, the RCMP continued updating its internal policies related to the enforcement of the Cannabis Act. Revisions to RCMP policy included additional guidance and resources for investigations related to the Act.

The RCMP also updated the organization's approach to enforcement of the Cannabis Act in Indigenous communities. Some First Nations communities have asserted their authority to regulate cannabis-related activities. The RCMP continues to employ a measured approach regarding enforcement of the Act in Indigenous communities, while national-level discussions with Indigenous stakeholders and communities continue. The measured approach is the deliberate employment of pro-active engagement, communication, mitigation and facilitation measures by police. The RCMP continued to support the federal government's approach to engage in trilateral discussions with provinces, territories, and Indigenous communities around these issues.

In fiscal year 2020-21, the RCMP's National Youth Services (NYS) delivered several training sessions to RCMP officers who work with youth, which covered a variety of topics including the Youth Criminal Justice Act and cannabis. NYS also launched engagement sessions and educational materials for youth and those who work with this population. RCMPTalks – a talk show format presentation where NYS staff and a guest speaker present on a topic and answer questions directly from youth was delivered to approximately 1,000 students from 41 schools. The National Youth Advisory Committee also hosted several Facebook Live interactive panel discussions to better engage youth about the impact and trends of cannabis use in their communities.

NYS also launched the Botvin Lifeskills Training (BLST) pilot project, which was delivered in communities in Alberta, Manitoba and New Brunswick. The BLST is a youth drug prevention and lifestyle program that focuses on providing youth with social and substance resistance skills, as well as personal self-management skills. The pilot was delivered over the second half of the 2020-2021 school year, and will start again in September 2021 for a full 18 months.

In 2020-21, the Canada Border Services Agency (CBSA) continued to advance initiatives that support the identification and interception of high-risk people, goods and conveyances that pose a threat to the security of Canadians with respect to the illegitimate cross-border movement of cannabis. Mail and courier volumes have reached high levels due to the rapid rise of online shopping, and in fiscal year 2020-21, this has been exacerbated by the COVID-19 pandemic. In this fiscal year, 90% of cannabis interdictions occurred in the postal/courier environments as opposed to 10% in the traveller stream. The total number of border enforcement actions involving cannabis was 24,761 and the total quantity of cannabis interdicted was 11,808 kg. There were 4,750 seizures and 20,022 forfeitures. There were 11 enforcement actions where both a forfeiture and a seizure was administered, involving 6,974 kg of cannabis seized and 4,834 kg of cannabis forfeited. In fiscal year 2020-21, the CBSA acknowledged 89% of the appeals received within 10 calendar days and decided 72% of the Enforcement and Trusted Traveller appeals within 180 days. Moreover, CBSA implemented the Personal Administrative Monetary Penalty (AMP) Regime for contraventions of the Customs Act involving cannabis offences at the border on March 29, 2021. Since the coming into force of the Cannabis Act in 2018, the CBSA laboratory analyzed or partially analyzed 70% of the suspect cannabis samples received from ports of entry and 70% of the samples analyzed tested positive for cannabis. Although the CBSA published communication (i.e. social media and website) in the fiscal year 2019-20 reminding the public that unauthorized purchases from outside Canada (online or other) will be confiscated at the border and may lead to arrests and/or criminal prosecution, international postal centres continued to experience a high volume of e-commerce shipments containing unauthorized cannabis or cannabis and hemp-derived products.

Contact information

Health Canada

John Clare
Director General
Controlled Substances and Cannabis Branch
John.Clare@hc-sc.gc.ca
613-941-2045

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

Horizontal Initiative Overview

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 federal licence holders who indicate they have access to information to help them 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%

Actual Results

Health Canada

AR 1.1.1.1 1,746

AR 1.1.1.2 Not available

AR 1.1.2 Not available

AR 1.1.3 93%

Royal Canadian Mounted Police

AR 1.2 99.6%

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 youth.

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 Chief Public Health Officer's Health Professionals Forum member organizations 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 Not applicable

Public Health Agency of Canada

T 2.2.1 200,000

T 2.2.2 75%

Public Safety Canada

T 2.3.1 22%

T 2.3.2 51%

Actual Results

Health Canada

AR 2.1.1 7%

AR 2.1.2 86%

Public Health Agency of Canada

AR 2.2.1 189,763 as of January 2021

AR 2.2.2 Not available

Public Safety Canada

AR 2.3.1 19%

AR 2.3.2 31% - legal storefront and 17% - legal online sales

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 Targets achieved in fiscal year 2019-20

AR 3.1.2.1 Not available

AR 3.1.2.2 30

AR 3.1.2.3 3

AR 3.1.3 0%

AR 3.1.4 Not available

Royal Canadian Mounted Police

AR 3.2.1.1 38%

AR 3.2.1.2 348

AR 3.2.2.1 33%

AR 3.2.2.2 90%

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 Percentage or 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 or percentage 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 Not applicable

T 4.1.2.1 TBD by December 31, 2022

T 4.1.2.2 3

T 4.1.3 80%.

T 4.1.4 100%.

Actual Results

Royal Canadian Mounted Police

AR 4.1.1 23

AR 4.1.2.1 Not applicable

AR 4.1.2.2 19

AR 4.1.3 63.8%

AR 4.1.4 81.3%

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 Percentage of appeals received that are acknowledged within 10 calendar days.

PI 5.1.5.2 Percentage of Enforcement and Trusted Traveller appeals received that are decided within 180 calendar days.

PI 5.1.5.3 Percentage of Trade related appeals – Tariff Classification – that are decided within 365 calendars days (for cases never held in abeyance).

PI 5.1.5.4 Percentage of cannabis-related complaints for which the CBSA contact the complainant within 14 calendar days after a written complaint is received.

PI 5.1.5.5 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.

Targets

Canada Border Services Agency

T 5.1.1.1 Achieved March 31, 2019

T 5.1.1.2 Achieved March 31, 2019

T 5.1.2 Achieved March 31, 2019

T 5.1.3 10% reduction (+/- 5% variance) to baseline of 20,933

T 5.1.4 90%

T 5.1.5.1 85%

T 5.1.5.2 70%

T 5.1.5.3 70%

T 5.1.5.4 85%

T 5.1.5.5 90%

Actual Results

Canada Border Services Agency

AR 5.1.1.1 100%

AR 5.1.1.2 100%

AR 5.1.2 100%

AR 5.1.3 22,845 (9% increase from baseline)

AR 5.1.4 10%

AR 5.1.5.1 89%

AR 5.1.5.2 72%

AR 5.1.5.3 Not applicable

AR 5.1.5.4 81%

AR 5.1.5.5 100%

Up-front multi-year funding

Canadian Foundation for Healthcare Improvement

General information

Recipient information

Canadian Foundation for Healthcare Improvement formerly the Canadian Health Services Research Foundation.^{Footnote 66}

Start date

1996-97

End date

Not Applicable

Link to Departmental Result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems

Link to department's Program Inventory

• Program 1: Health Care Systems Analysis and Policy

Purpose and objective of transfer payment

When the Canadian Health Services Research Foundation 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, the organization was renamed the Canadian Foundation for Healthcare Improvement (CFHI) in 2012. The organization aims to: find and promote health care innovators and innovations; drive rapid adoption of proven innovations; enable improvement-oriented systems; and, shape the future of healthcare.

Up-front multi-year funding included:

• 1996-97: A $66.5 million endowment established the Canadian Health Services Research Foundation.

Additional federal grants were provided 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).

Subsequent funding has been delivered through contribution funding rather than up-front, multi-year funding.

Audit findings by the recipient during 2020-21, and future plan

CFHI's financial records are reviewed and audited annually by independent external auditors. The 2020-21 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 2020-21, 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 from 2014 to 2019, in 2019-20 to examine the relevance, effectiveness and efficiency of its work. The results were released in late June 2020 and showed the organization demonstrated good alignment with the priorities and requirements of its stakeholders; 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.

CFHI is expected to release an annual report for fiscal year 2020-21 in Fall 2021.

Summary of results achieved by the recipient

The Canadian Health Services Research Foundation, and later the Canadian Foundation for Healthcare Improvement, facilitated 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 did so by finding and promoting innovators and innovations; driving rapid adoption of proven innovations; enabling improvement-oriented systems; and, shaping the future of healthcare.

As its designated successor, Healthcare Excellence Canada will assume ownership of the remaining up-front multi-year funding, which is being held in reserve to address potential staffing and pension liability costs. There are no new results associated with the up-front multi-year funding to report for 2020-21.

With ongoing contribution funding now in place, most recently provided through a new agreement that provides annual funding from 2021-22 to 2025-26. CFHI has been considering how to best use its remaining up-front multi-year funding (approximately $11 million). Addressing issues in the Long Term Care sector and other challenges brought to light by the pandemic are being considered.

Canada Health Infoway

General information

Recipient information

Canada Health Infoway (Infoway)

Start date

March 31, 2001^{Footnote 67}

End date

March 31, 2015^{Footnote 68}

Link to Departmental Result(s)

• Core Responsibility 1: Health Care Systems
• Result 1: Canada has modern and sustainable health care systems
• Result 2: Canadians have access to appropriate and effective health services

Link to department's Program Inventory

• Program 6: Digital Health

Purpose and objective of transfer payment

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 EHR as a priority; $600 million in 2003 to accelerate implementation of the EHR 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 (fully expended); and $500 million in 2010 to support continued implementation of EHRs, implementation of electronic medical records (EMRs) in physicians' offices, and integration of points of service with the EHR system (fully expended). 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 2020-21, 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 2020-21, and future plan

Infoway pursued ongoing internal evaluative and measurement work of its activities and reported its results through its website and annual reports.

Summary of results achieved by the recipient

Results associated with Infoway's legacy activities funded via Up-Front Multi-Year Funding (2001 to 2010) include the following initiatives and activities^{Footnote 69}.

Closing the Circle of Care First Nations Expansion Project^{Footnote 70}

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, 2021, this initiative was serving 317 communities in 7 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 71} in Quebec had more than 739,000 registered users as of March 31, 2021.This is a 34% increase from the same time last year when there were 551,000 enrolled users.
• Due to rapid uptake during the pandemic, Sunnybrook Hospital's MyChart (Ontario) achieved a significant milestone with more than one million users.
• 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. More than 565,000 residents were using the service as of March 31, 2021, up from 141,000 the previous year.
• All patients in Saskatchewan now have digital access to health information such as laboratory results, medical imaging results and clinical visit summaries through MySaskHealthRecord. More than 220,000 residents were using the service as of March 31, 2021, up from 42,000 the previous year.

Telehomecare

In 2020-21, Infoway continued to support telehomecare projects for individuals with chronic conditions such as chronic obstructive pulmonary disease and congestive heart failure. There was a significant increase in the uptake of telehomecare services due to the pandemic. For example, Infoway funded a remote patient monitoring program to support patients in British Columbia with chronic diseases and those with respiratory symptoms who were quarantined at home due to COVID-19. In 12 months, this program provided remote patient care to more than 16,000 patients. Telehomecare has been shown to reduce hospitalizations and trips to emergency rooms as well as improve patient's ability to manage their health conditions.

The use of virtual care, including services such as provider-to-patient e-visits, experienced significant growth in 2020-21. There were just over 1.4 million visits offered in 2019-20; in 2020-21, there were approximately 4 million visits, an increase of approximately 186%. The increase in the use of virtual care during 2020-21 had significant positive impacts on the environment saving Canadian patients an estimated 90 million hours in travel time, and resulting in a reduction of CO2 emissions by approximately 286,000 metric tonnes. More than 97,000 Canadians have enrolled in telehomecare programs since 2010, with 41,459 enrolling in 2020-21.

Pan-Canadian Leadership in Digital Health Knowledge and Collaboration

In 2020-21, 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. Throughout the year, Infoway hosted events designed to engage with Canadians and health care providers to understand their experiences and expectations. Infoway's cornerstone event, the annual Partnership Conference, was held virtually in 2020-21, with sessions in September, October, and November. These sessions featured presentations and discussions about a variety of topics such as, the impact of the COVID-19 pandemic; the keys to sustainable virtual care; e-mental health; and, artificial intelligence and its application to health care. Across all three sessions, there were almost 1,100 attendees.

In 2020-2021, Infoway completed a review of pan-Canadian digital health governance and standards products. Infoway hosted 30 sessions with more than 160 people from across Canada, who provided valuable insights about the roles and responsibilities for stakeholders involved in digital heath standards governance, and the potential opportunities for Infoway standards and services. Infoway intends to use these insights to help it collaborate with provinces and territories to advance digital health interoperability in Canada. Infoway also collaborated on standards to support the fight against COVID-19. Infoway worked with our provincial/territorial and national partners (Health Canada, Public Health Agency of Canada and Canadian Institute for Health Information) to create coded terminology to track COVID-19 testing, diagnosis, surveillance and vaccinations.

Response to parliamentary committees and external audits

Response to parliamentary committees

There were no parliamentary committee reports requiring a response in 2020-21.

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)

2020 Fall Reports of the Commissioner of the Environment and Sustainable Development to the Parliament of Canada

Departmental Progress in Implementing Sustainable Development Strategies – Safe and Healthy Communities

This review, conducted by the Commissioner of the Environment and Sustainable Development (CESD), focused on whether federal departments and agencies contributed to the goal of safe and healthy communities in the 2016–2019 Federal Sustainable Development Strategy. This goal includes improving air quality, protecting Canadians from harmful substances and preventing environmental emergencies or mitigating their impacts.

CESD examined the 2017–2020 sustainable development strategies of 12 federal departments and agencies that contribute to this goal. CESD also reviewed the progress these organizations reported in the supplementary tables of their 2018–19 departmental results reports on the federal goal of safe and healthy communities.

Overall, the organizations reported activities that largely supported the actions set out for this goal in the government's Federal Sustainable Development Strategy. However, the organizations' reporting was at times unclear or incomplete, making it difficult for parliamentarians and Canadians to gain a clear sense of overall progress against the goal.

To achieve the goal of safe and healthy communities, the strategy lists 10 contributing actions. Through their departmental actions, the departments and agencies responsible are expected to collectively help achieve all 10 federal contributing actions.

Recommendation:

Departments and agencies responsible for helping achieve the goal of safe and healthy communities should collectively ensure that their departmental sustainable development strategies support all contributing actions in the Federal Sustainable Development Strategy.

Health Canada's response:

Although Health Canada does not contribute to the contributing actions that were identified as missing under the safe and healthy communities goal, the department will continue to ensure that its departmental sustainable development strategy links to the contributing actions in the Federal Sustainable Development Strategy that the department's mandate supports.

The report was tabled on October 27, 2020.

Environmental Petitions Annual Report

This year's Annual Report of the Commissioner of the Environment and Sustainable Development indicates that 16 petitions, addressing a wide range of issues, were received between July 1, 2019 and June 30, 2020 and seven of these were directed to Health Canada. Canadians petitioned Health Canada for information regarding their concerns related to pollution from plastics (two petitions), wolf reduction programs (one petition), genetically modified salmon (one petition) as well as toxic substances in the environment (three petitions).

There were no recommendations in this report.

The report was tabled on October 27, 2020.

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

There were no audits in 2020–21 requiring a response.