Results at a glance - Evaluation of the Territorial Health Investment Fund 2014-15 to 2016-17

About the Territorial Health Investment Fund

• The Government of Canada introduced the Territorial Health Investment Fund (THIF) in 2014-15.
• THIF was a three-year contribution agreement that aimed to support territorial governments’ efforts to innovate and transform their health care systems, and ultimately ensure that Northerners have access to necessary health care services.
• THIF replaced the Territorial Health System Sustainability Initiative (THSSI), a grant program introduced in 2005 that had the overall objective of building capacity by investing in territorial health care systems, supporting health promotion activities, and improving access to health care services.
• THIF committed $70 million between 2014-15 and 2016-17 to Canada’s three territories. THIF provided proposal-based funding through the Territorial Stream ($4.33M each year), the Pan-Territorial Stream ($2M each year), and the Medical Travel Stream ($12M in 2014-15, declining to $5M in 2016-17).

What the Evaluation Found

• The THIF contribution agreement addressed a need to support initiatives that addressed high health care costs and lower health outcomes in the territories.
• Although territorial governments are responsible for administering health care for most residents within their jurisdiction, a federal subsidy for increased health care costs in the North is consistent with the Government of Canada’s role under the Canada Health Act principle of ‘accessibility.’
• Funding through this contribution agreement enabled some systems-level changes, which are expected to improve the ability of territorial governments to manage their health services within existing resources.
• Territorial governments used THIF funding to invest in training for medical professionals and community health workers, and to fund projects using innovative health care technology. These projects contributed to improved access to health care services for residents.
• Due to the short timeframe of this initiative, it is too early to assess changes to health outcomes that may have resulted from investments in health care delivery.
• The design of the THIF contribution agreement introduced additional reporting requirements that created an administrative burden for both Health Canada and territorial governments. The design of a new THIF grant is expected to improve efficiency by removing some reporting requirements in order to allow for more flexibility on the part of funding recipients.
• Further investments in innovative service delivery methods and technologies are expected to increase the availability of routine health care services, such as screening and diagnostic services in communities. This could increase the need for medical travel in the short term, as more residents in remote communities are connected to existing treatment options in urban areas or out of territory. In the long term, however, investments in innovative health care solutions may improve the ability of territories to more efficiently connect clients with care options.
• As THIF continues to evolve, consideration may be given towards longer-term funding agreements to address high rates of staff turnover associated with short-term projects, and to facilitate longer-term strategic planning.

Recommendations and responses

The THIF contribution agreement was replaced with a new time-limited THIF grant in 2017-18. The grant design contains changes to the objectives of the funding program. As a result, this evaluation does not provide any recommendations related to the THIF contribution agreement.

About the evaluation

This evaluation satisfies a commitment made to the Treasury Board Secretariat to evaluate the THIF contribution agreement. The evaluation assessed the relevance and performance of THIF over the three-year period in which it was operational, from 2014-15 to 2016-17. The evaluation included a document review, key informant interviews, and a review of financial data.