Results at a Glance: Evaluation of Health Canada’s Territorial Health Investment Fund 2017-18 to 2022-23

Program context

The Territorial Health Investment Fund (THIF) delivers funding through grant agreements to each of the three territories in recognition of the unique challenges of delivering health care in the North. Structured as two streams (Innovation Funding and Medical Travel streams), THIF funding supports access to health service and territorial initiatives to build sustainable health care systems.

• The Innovation Funding stream is directed at strengthening health systems and improving health outcomes through health system innovation. The fund supports a maximum of four projects per year in each territory.
• The Medical Travel stream is used to offset eligible medical transportation costs, and may include transportation, accommodation, meals for patients as well as for eligible escorts.

Funding: $108 million over four years from 2017-18 to 2020-21 and $54 million over two years from 2021-22 to 2022-23.

Evaluation approach

This evaluation examined the relevance and performance of THIF from April 2017 to September 2022 and used multiple data collection methods, including the following:

• Document review;
• Data analysis;
• Interviews; and
• Financial data analysis.

What the evaluation found

THIF funding has enabled the territories to respond to local health needs and has been used differently by each territory to fund the planning, development, and execution of a variety of health services and initiatives. This funding flexibility enabled territories to innovate their health system and service delivery without negatively affecting existing services. Except for medical travel, which is also funded by other federal and territorial programs, identified health care needs were addressed by THIF through innovative system changes and projects. Other unmet needs related to the social determinants of health, such as housing, drinking water, and food security, were outside of the scope of THIF.

THIF has been successful in achieving its short-term outcome of improving Northerners' access to health care services, and it allowed territories to offer direct health care services, recruit and train staff and adopt new technologies to improve service delivery. Challenges remain in attracting and retaining qualified personnel, which has led to delays in THIF activities. There has not been sufficient data and elapsed time for THIF's long-term outcome to be achieved.

Although THIF did not require territories to respond to the Truth and Reconciliation Commission of Canada's Calls to Action nor the Inuit Nunangat Policy, multiple examples of alignment were found between THIF's funded projects and those key guiding documents. THIF has enabled each territory to plan and execute system-wide initiatives to improve Indigenous health on multiple fronts, including the development and provision of cultural competency and anti-racism courses, and the hiring of Indigenous health care professionals. Early and ongoing engagement with Indigenous stakeholders, including at project inception, will continue to be essential to ensure advancements in addressing Indigenous peoples' health needs.

Recommendations

1. Maintain THIF's flexibility in addressing the unique needs identified by the territorial governments.
2. Support each territory to develop context-specific performance measurement strategies that would be of most value for both the territories and Health Canada.