ARCHIVED - Population Health Fund Evaluation 2008 Final Report



1.1 Background

The Population Health Fund (PHF) is a grants and contributions program established in 1997 under the auspices of the Health Promotion and Programs Branch (later reorganized and named the Population and Public Health Branch) of Health Canada. The first projects were funded in 1997/98. It funds voluntary not-for-profit organizations and educational institutions to carry out projects related to population health. These organizations support services for a variety of beneficiary populations. A substantial proportion of projects funded were aimed at addressing determinants of health issues among marginalised populations.

The program design was premised on the accumulating evidence, reported in Strategies for Population Health: Investing in the Health of Canadians, that attributes of the economic, social, and physical environments affect the health status of the Canadian population.Footnote 1 Collectively, these attributes are referred to as determinants of health. There was also evidence that some groups of Canadians have significantly lower health status than others, "associated primarily with their very low income, socioeconomic status, lack of education and other unfavorable living conditions." The document also noted that improving the overall health of the population was not just the responsibility of the health sector, but required the involvement of other sectors.

The PHF was designed to encourage communities to develop knowledge and program models to address the determinants of health. Two principles were to guide project implementation: intersectoral collaboration and participant involvement.

Implementation of the program has taken place through both the national and regional offices, with solicitations occurring at both levels. Projects in the North are currently managed by the Northern Secretariat within Health Canada. Most project proposals were responses to broad solicitations, though occasionally groups were invited to submit a proposal. In recent years, there have been some directed projects at the national level in support of national priorities. The PHF administers planned transfer payments of approximately 12.1 million dollars per year, divided equally between national and regional programs.

With the establishment of the Public Health Agency of Canada (PHAC) in 2004, responsibility for the PHF moved from the former Population and Public Health Branch within Health Canada to PHAC. At about the same time, the Terms and Conditions for the Promotion of Population Health Grants and Contributions were renewed.

In 2005, the Results-Based Management and Accountability Framework (RMAF) for the PHF was developed. The RMAF identifies three streams of activity that contribute to the attainment of the intermediate and long-term outcomes: Delivery Management, Management of the Funding Environment, and Program Leadership. Because the latter two streams were not clearly differentiated, they will be referred to collectively as Program Leadership through the rest of this document.

Delivery Management includes soliciting proposals from eligible recipients, reviewing those proposals, and selecting proposals for funding. The output of these processes is grants and contribution agreements.

When the funding is in place, consultants provide ongoing monitoring and support for the implementation of the projects. The immediate outcome of these activities is expected to be "completed projects that generate community knowledge, build community models, and increase community partnerships."

PHF staff activities in Program Leadership include: coordinating between the national and regional activities and with other programs; consulting with recipients in the interest of building recipient skills; offering expertise and sharing knowledge; analysing lessons from completed projects; and promoting the population health approach. The outputs of these activities are networks, collaborations, program and evaluation reports, consultation reports, training workshops, and conference and community presentations.

These activities and outputs are expected to have the immediate outcomes of providing "more skilled and informed recipients, and greater understanding of program design and outcomes," and "supportive environments for collaborative action on the determinants of health."

Completed projects in the context of skilled recipients and supportive environments were designed to produce two intermediate outcomes: "Community-generated knowledge for program and policy development on the determinants of health is more broadly accessible", and "Community-based models to act on the determinants of health are more broadly accessible."

Once projects were completed it was expected that recipients would take responsibility to communicate their successes to others. These activities were designed to extend the project's effects beyond the immediate project participants stated as a Final outcome: "Increased use of community-generated knowledge for program and policy development and increased application of community-based models to act on the determinants of health."

1.2 Evaluation Context and Objectives

The evaluation is being carried out to respond to the requirement for a summative evaluation in the PHF Results Based Management and Accountability Framework (RMAF), an annex to the 2004 Promotion of Population Health Grants and Contributions RMAF. It is intended that the results will provide PHAC senior management with a summative assessment of the PHF’s activities to date and inform the analyses of the program staff and their community partners of their work.

Evaluations of the PHF were completed in 2003 and 2006. The 2003 evaluation was based on a review of 420 funded projects that were completed by September 30, 2002. The 2006 evaluation reviewed 213 projects completed between October 1, 2002 and September 30, 2005.

Both evaluations concluded that:

  • the Population Health Approach (PHA) fit well with the way the sponsoring organizations worked;
  • processes for implementation of the PHF were generally reasonable, and the support provided by the consultants was perceived as good to excellent;
  • projects were successful at gaining intersectoral collaboration in the implementation of the project;
  • most projects had members of the target population involved in the design and/or implementation of the project;
  • a wide variety of resources were developed, and extensive efforts at dissemination through multiple channels were made; and
  • resources were generally used on an ongoing basis by the sponsoring organization and other organizations.

Between 2003 and 2006, there was:

  • an increase in the targeting of vulnerable populations; and
  • an increase in the extent to which knowledge, attitude, and behavior change was documented as a part of project evaluation.

The objective of the current evaluation is to document the extent to which the PHF is achieving the desired outcomes specified in the RMAF. It will also document the recipients’ views of the relevance of the PHA to their work, and the quality of support they received from PHAC consultants.

The evaluation issues being addressed include:

  1. Relevance: To what extent is there a need to continue taking action on the determinants of health for the population?
  2. Implementation: How has the program approached the design and delivery of programs? What has worked well, what has not?
  3. Effectiveness: To what extent has the PHF contributed to the achievement of outcomes identified in the logic model?
  4. Success: To what extent are PHF projects successfully influencing community capacity to take action on the determinants of health? How has the PHF program contributed to positive changes in community capacity to take action on the determinants of health for the population?
  5. Cost-effectiveness: What evidence is there that the human and financial resources have been used in the best way possible to produce positive outcomes and experiences?
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