Primary health care transition fund
(All funding allocations have been completed and no further funding is available.)
For further information/results on individual Primary Health Care Transition Fund (PHCTF) initiatives, please visit the Funded Initiatives page on this web site.
On September 11, 2000, First Ministers agreed that
"improvements to primary health care are crucial to the renewal of health services" and highlighted the importance of multi-disciplinary teams. In response to this agreement, the Government of Canada established the $800M Primary Health Care Transition Fund (PHCTF).
Over a six-year period (2000-2006), the PHCTF supported provinces and territories in their efforts to reform the primary health care system. Specifically, it provided support for the transitional costs associated with introducing new approaches to primary health care delivery. In addition to direct support to individual provinces and territories, the PHCTF also supported various pan-Canadian initiatives to address common barriers, and offered the opportunity for participation by health care system stakeholders. Although the PHCTF itself was time-limited, the changes which it supported are intended to have a lasting and sustainable impact on the health care system.
Collaboration among federal, provincial, and territorial governments was a key element of the PHCTF. An intergovernmental advisory group, with representation from all jurisdictions, provided advice on fund design and project selection from the outset and played an active role throughout the lifespan of the PHCTF. All governments agreed to the five common objectives of the PHCTF. All initiatives had to support at least one of these objectives.
The PHCTF consisted of five funding envelopes.
The provincial/territorial envelope directly supported provinces and territories in their primary health care reform activities. Funds were allocated on a per capita basis, and smaller jurisdictions (Prince Edward Island and the three northern territories) received an additional $4M each to ensure sufficient funding for initiatives on a significant and sustainable scale.
Initiatives were negotiated on a bilateral basis between each province or territory and the federal government, based on the unique circumstances of each jurisdiction and the common objectives of the PHCTF. All other PHCTF-funded activities complemented provincial and territorial activities.
The multi-jurisdictional envelope was available to provincial and territorial governments and offered the opportunity for collaboration among two or more jurisdictions in order to:
- realize economies of scale;
- encourage the sharing of strengths and experiences across jurisdictions;
- increase efficiency by avoiding duplication of effort; and
- overcome common barriers to primary health care reform.
In addition, all initiatives had to address one or more of the common objectives of the PHCTF, and complement provincial/territorial direction in primary health care reform. Multi-jurisdictional initiatives were selected by Health Canada in consultation with provincial and territorial governments.
The national envelope was open to federal, provincial, and territorial governments, and not-for-profit non-governmental organizations and supported initiatives of national significance in order to:
- create the necessary conditions on a national level to advance primary health care reform beyond what any single jurisdiction can achieve on its own; and
- address common barriers or gaps to primary health care reform.
In addition, all initiatives must have addressed one or more of the common objectives of the PHCTF, and complemented provincial/territorial direction in primary health care reform. Initiatives were selected by Health Canada in consultation with provincial and territorial governments.
The national envelope consisted of three elements:
National initiatives were national in scope or relevance but occurred primarily in local or regional settings. Many focussed on developing the skills and capacity of primary health care providers, and creating supports to facilitate greater collaboration.
National strategies maximized synergies and cost-effectiveness by developing collaborative approaches to key areas of renewal. Three areas were identified by governments: evaluation, awareness, and collaborative care. Each strategy consisted of several initiatives which were collectively addressing the common issue or barrier.
Tools for Transition focussed on change management for front-line providers and administrators. Initiatives were relatively small-scale and focussed on activities such as developing tools and facilitating opportunities for information-sharing. There were two streams within Tools for Transition:
- the Federal/Provincial/Territorial-directed Component, which supported initiatives identified as priorities by governments; and
- the Responsive Component, which supported workshops and similar activities on a cost-shared basis and was open to both governments and not-for-profit non-governmental organizations.
The Aboriginal envelope was open to federal, provincial, and territorial governments; First Nations and Inuit communities and health organizations; and not-for-profit non-governmental organizations. It responded to the needs of Aboriginal communities by:
- promoting more productive and cost-effective primary health care service delivery through the integration of existing services and resources;
- enhancing coordination of service delivery between Health Canada, provincial and territorial governments, and First Nations/Inuit communities and health organizations;
- enhancing the ability of federal, provincial, and territorial systems to be accountable to each other and to their publics through collaborative information development;
- improving the quality of services delivered to Aboriginal peoples, including cultural appropriateness; and
- improving linkages between primary health care services and social services.
In addition, all initiatives had to address one or more of the common objectives of the PHCTF, and complement provincial/territorial direction in primary health care reform. Initiatives were selected by Health Canada in consultation with provincial and territorial governments.
The Aboriginal envelope consisted of two components:
- health system renewal initiatives which were large-scale and intended to renew entire health systems; and
- health system enhancement initiatives which focussed on niche areas (such as telehealth) to improve the delivery of primary health care for Aboriginal peoples.
Official languages minority communities
The official languages minority communities envelope responded to the needs of French- an English-speaking minority communities within Canada by:
- improving information-sharing and networking among primary health care providers, governments, and official languages minority communities;
- developing training activities and tools for primary health care providers to improve the effectiveness of services delivered to official languages minority communities; and
- increasing providers' capacity to offer primary health care services to official languages minority communities in Canada.
In addition, all initiatives had to address one or more of the common objectives of the PHCTF, and complement provincial/territorial direction in primary health care reform.
Two consultative committees (representing Anglophones within Quebec and Francophones outside of Quebec respectively) advised the federal Minister of Health on the needs of official languages minority communities. These committees were responsible for identifying the not-for-profit non-governmental organizations which were eligible for funding under this envelope.
Synthesis and dissemination
Primary health care renewal requires fundamental changes to the organization and delivery of health care services. It is a long-term undertaking that began before the PHCTF and will continue well beyond it. Knowledge development is a critical component of this process, for although primary health care renewal has yielded some impressive results to date, its evidence base remains relatively modest. Therefore, dissemination of the results of PHCTF initiatives was a key element of the Fund.
Although PHCTF initiatives were time-limited, they were not pilot projects. Rather, they were intended to support the transitional costs of fundamental changes to primary health care delivery. Each individual initiative was required to include evaluation and dissemination activities, and received targeted funding to this end. In addition to these individual efforts, the PHCTF has developed and implemented a national dissemination strategy to maximize the usefulness and availability of results to provinces, territories, and health care system stakeholders. PHCTF dissemination activities included: the preparation of summaries and fact sheets, commissioning of synthesis reports, the development of this website, and holding a national conference in February 2007.
Health Canada's Departmental Performance Measurement and Evaluation Directorate is conducting a final program evaluation of the PHCTF to determine how effectively it met its objectives. A formative evaluation was conducted in 2004-05. A summative evaluation will be completed by fall 2007.
Objectives of the PHCTF
The five common objectives of the PHCTF are:
- to increase the proportion of the population with access to primary health care organizations which are accountable for the planned provision of comprehensive services to a defined population;
- to increase the emphasis on health promotion, disease and injury prevention, and chronic disease management;
- to expand 24/7 access to essential services;
- to establish multi-disciplinary teams, so that the most appropriate care is provided by the most appropriate provider; and
- to facilitate coordination with other health services (such as specialists and hospitals).
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