ARCHIVED - Population Health Fund Evaluation 2008 Final Report

4. CONCLUSIONS

4.1 Ongoing relevance

The PHAC strategic plan clearly identifies action on the determinants of health to improve the health of the population and to reduce health disparities as an area of importance for the Agency. The Minister’s message says:

It emphasizes the importance of addressing the determinants of health and reducing health disparities, and underscores the importance of recognizing linkages between the environment and our collective health (page 1).

The Chief Public Health Officer’s message indicates:

we actively promote health and work with our partners to improve and strengthen the very social foundations that underpin not just our health as individuals, but the health of our society, and persistent health disparities must be reduced and eventually eliminated (page 3).

The importance of work on the determinants of health is also referenced in the body of the report:

Public health has a key role to play in mobilizing efforts across sectors in order to address these determinants of health. With this in mind, the Agency will continue to place a high priority on action on health disparities, in collaboration with other governments, sectors and partners (page 13).

This indicates that the PHF’s objectives, with its emphasis on determinants of health, health inequities, and collaboration, are still relevant to the mandate of the PHAC. Clearly, the issues the PHF addresses are current issues.

4.3 Effectiveness

There is good evidence that the PHF has achieved the immediate and intermediate outcomes specified in the Logic Model. There are 116 projects that have been completed between October 1, 2005 and the present. Almost all of them developed knowledge and/or models, and documented and disseminated these to others. Almost all developed partnerships, and a large majority (86%) had intersectoral partnerships. Most adhered to the PHF principle of target group participation.

There is some evidence that immediate project outcomes were evaluated. About three-quarters of the files had some evidence of change in the target population, but most reported changes were changes in knowledge. Only a little over one-quarter documented changes in behaviour, and less than 10% documented changes in determinants of health or health status.

The evidence for the final outcome is somewhat weaker. Most respondents reported ongoing use of materials and models developed, and most said that other organizations were also using them. However, we have no direct information about the extent or intensity of use of the materials/models by other organizations.

Case studies do suggest that projects often continue, sometimes long after the PHF funding ends. Some get funding from elsewhere. Others incorporate the initiatives into their ongoing operations.

4.4 Success

We have no direct measures of community capacity. The assumption underlying the logic model is that access to community-based knowledge and models will increase the capacity of communities to act. Seven in ten of the partnerships established continued after the end of the project. It is reasonable to assume that this also enhances community capacity to take action on the determinants of health.

Evidence from interviews and case studies indicating that sponsoring organizations continue the work that was started with the PHF suggests that capacity was built in those organizations to sustain action.

4.5 Cost Effectiveness

The nature of this program makes a formal cost effectiveness evaluation difficult. However, there are some indicators that the PHF gets a good “bang for its bucks.”

Over a quarter of the sponsoring organizations had partners who supplied funding in addition to the PHF monies to the project. Over a half had partners who contributed in-kind resources. Four in ten projects had volunteers involved in the project. Some respondents mentioned that their projects were continuing with funding from others. Evidence from the case studies shows that some projects continue doing the work in the community that was started during the project after PHF funding has ceased.

All of this suggests that the PHF funding can be viewed as “seed” money. PHF can get things started and the projects then “take on a life of their own,” as some PHF consultants have said. This is summed up by a comment from one of the respondents: “So much gets done with such a small financial investment!”