ARCHIVED - Integrated Strategy on Healthy Living and Chronic Diseases - Healthy Living Program Component
Introduction and Context
In 2005, the Government of Canada announced an investment of $300 million over five years in the Public Health Agency of Canada to implement the Integrated Strategy on Healthy Living and Chronic Disease (ISHLCD). Resourced in 2006-2007, the Healthy Living Program is a core component of this Strategy. The Healthy Living Program is composed of the following four core components: the Healthy Living Fund; the Intersectoral Healthy Living Network (IHLN); Knowledge Development and Exchange (KD&E); and Social Marketing. The strategy requires a formative evaluation at the program’s mid-point (2008-09).
The purpose of the Formative Evaluation of is to:
- assess program design and its implementation;
- assess early success/progress and ongoing improvement;
- assess performance measurement systems being used, including the Program Evaluation Reporting Tool (PERT);
- identify lessons learned; and
- make recommendations on key issues.
Data were collected from September 2008 through February 2009. The formative evaluation covered the period November 2006 to September 2008 and was formative in nature. An evaluation framework had been developed for this Program, the first step being the review and revision of the framework.
Main lines of evidence used in the evaluation included:
- a review of key documentation;
- PERT reports;
- key informant interviews with PHAC staff and management;
- key informant interviews with stakeholders; and
- an on-line survey with the Intersectoral Healthy Living Network E-Bulletin subscribers.
The evaluation concluded that the Healthy Living Program is relevant, necessary and generally well formulated. The Healthy Living Program is implementing its activities and outputs and making early progress towards many of the identified outcomes, with some adjustments indicated. Additional process improvements have been identified to increase the efficiency and effectiveness of activities.
Key Findings and Conclusions
The Healthy Living Program remains relevant, has been well designed and stakeholders clearly confirmed the ongoing need for the Program. The four program components were also found to be well aligned with the overall ISHLCD program.
The program outputs and activities are largely being delivered within revised timelines. While early successes are reported in the outcome areas, approaches for healthy eating and healthy weights, as well as addressing some target populations are not well integrated into the program.
The Healthy Living Fund has appropriate contribution agreements in place with signed bilateral agreements, however, the lengthy solicitation and approval process for the national fund and the delays in signing of the Bilateral projects have impeded the success of this component. KD&E is operating effectively within its outputs and results areas. The IHLN was slow to initiate activities however, these have begun to be implemented. There is a need to clearly define the IHLN and the HLIG. A number of Social Marketing activities have been implemented with evidence of a successful ParticiPACTION campaign.
Stakeholders expressed strong support and identified a continued need for the Healthy Living Fund, KD&E and the Social Marketing components. Stakeholders expressed mixed opinions as to the relevance of the IHLN.
No evidence of duplication across the four components was found; however, a need for increased integration across the components was identified.
Effective governance structures are in place within the ISHLCD for the Healthy Living Program. These generally ensure coordination and manage the potential for duplication within and between the Healthy Living Components and the Functional Components. Social Marketing is managed separately from the other components has created concerns about alignment with the other components.
The outputs and activities for the HLF, KD&E and Social Marketing have been broadly achieved as planned. On its current course, the IHLN will achieve many of its promised outputs but may not see progress in some of its key results areas.
Strategies to reach some target populations are not well integrated into the design of the four components; however, some specific initiatives are focused on the identified populations.
Partnerships are being formed as a result of the activities of the Healthy Living Fund, KD&E and some Social Marketing activities. While the IHLN is currently not effectively developing partnerships throughout its membership, a first layer of partnership has been established through the HLIG particularly in the F-P/T arena.
While information is thus far limited regarding the achievement of outcomes related to the Healthy Living Fund, interviewees report activities and outputs are aligned and likely to contribute to the identified outcomes. Progress has been made on KD&E outcomes. It appears that the IHLN has not yet achieved the desired outcomes. In Social Marketing, there is evidence of a successful ParticipACTION campaign, with concerns over inadequate social marketing efforts related to healthy weights.
One unintended outcome was generated as a result of the Healthy Living Fund’s lengthy approval processes within PHAC and the Provinces and Territories. This generated a negative impact on both project delivery and relations between PHAC, the Provinces and Territories, and funding recipients within the Healthy Living Fund (national and regional).
Design and Delivery
Overall, the healthy eating and healthy weights themes of the Healthy Living Program are not well integrated into the design of the Program or into its individual components. A number of specific gaps have been identified at the component level.
Among lessons learned to date: strategic investments can be leveraged effectively; and timely release of funding is critical to ensuring the success of projects.
PERT has been implemented to monitor the Healthy Living Fund and KD&E projects and appears effective with regular monitoring. Relevance of some PERT questions has been queried by funding recipients. The IHLN with no current monitoring plan, will be implementing a plan through the HLIG in 2009. Social marketing is being monitored in an ad hoc manner with some effective monitoring of specific campaigns.
The funding processes for the Healthy Living Fund are well-documented and operate in a transparent manner. Process improvements for the Fund are indicated primarily in terms of improving timeliness and efficiency. The KD&E component is well managed through carefully nurtured relationships with key stakeholders. The IHLN through the activities of the HLIG is well managed and operating effectively. The Social Marketing activities are managed separately from the other components, and planning and reporting mechanisms display weaknesses.
There are opportunities to enhance program effectiveness and outcome achievement. The following recommendations are offered:
Healthy Living Program
Increase integration across the four components of the Healthy Living Program.
- Develop collaborative work plans across all four components of the HLP to ensure maximum impact and to avoid any risk of duplication.
- Establish Memorandum of Agreements with agencies outside the Healthy Living Unit responsible for components of the Healthy Living Program, including Office of Nutrition and Policy Promotion (ONPP) and PHAC Communications.
Increase emphasis on target populations. The Healthy Living Program should take a strategic approach to targeting a small number of well-resourced initiatives to improve healthy living behaviours among vulnerable populations. This approach should include:
- consistent definition of target populations;
- annual prioritization of targets;
- directed funding to organizations equipped to address identified targets; and
- intermediary approaches to the support work of identified targets.
Increase alignment with Healthy Eating. The Healthy Living Program must ensure better alignment of strategic efforts to increase healthy living behaviours through physical activity and healthy eating. This should include:
- joint planning activities with the ONPP at Health Canada; and
- identification of joint priority initiatives and activities.
Implement process improvements for the Healthy Living Fund.
- Continue to identify and implement process improvements for the Healthy Living Fund. Specific areas for consideration include:
- adjust timing for the national solicitation process to not be carried out exclusively in the December timeframe;
- modify, communicate and respect approval timelines for the national stream to allow for project commencement on April 1st;
- provide project funding for multiple years to facilitate outcomes and better project delivery;
- consider a staggered letter-of-interest process to call for innovative and collaborative projects in vulnerable population groups;
- improve timeliness of approvals for funding under the bilateral process;
- include approval commitment timelines for partners within the bilateral agreements; and
- refine the PERT to improve Healthy Living outcomes reporting and better align with target populations.
Develop learning and knowledge exchange and transfer strategies and tools to build on successful programs identified from the HL Fund Program.
- Identify promising practices within the Healthy Living Fund’s community projects as part of KD&E operations to enable further study regarding their effectiveness and transferability.
Develop and implement terms of reference (TOR) for the IHLN and ensure their alignment with the existing TOR for the HLIG to provide seamless planning for the entire network.
- Strengthen the HLIG with financial and secretariat resources needed to carry out the leadership, strategic policy initiatives and priorities identified to ensure the success of the HL Program.
Improve alignment and delivery of Social Marketing activities:
- Ensure alignment of priorities, activities and accountabilities for social marketing activities between the Communications Unit and the Healthy Living Unit through:
- joint planning processes;
- memoranda of agreement for resource allocations and management of resources; and
- monitoring and evaluation of campaign outcomes.
- Consider establishing long-term strategic partnerships with NGO(s) and other stakeholders to deliver certain components of the physical activity component of the HL Social Marketing program. It would be essential that this include:
- clearly defined target populations;
- clearly defined performance deliverables;
- a secure resource base and term; and
- clearly defined expectations regarding NGO social marketing financial sponsors.
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