Evaluation of the Public Health Agency of Canada’s Maternal and Child Health Programs 2019-2020 to 2024-2025

Final Report - Executive Summary and Management Response and Action Plan
March 2026
Prepared by the Office of Audit and Evaluation
Public Health Agency of Canada

Note: The complete evaluation report is available upon request. Please send an email to oae-bae@phac-aspc.gc.ca.

Executive summary

Program description and context

The Public Health Agency of Canada (PHAC) provides national leadership on key maternal and child health promotion issues and conducts a range of activities, including providing funding for community-based programming, and fostering knowledge development and exchange. Maternal and Child Health (MCH) program activities are managed by the Division of Children and Youth (DCY) within the Health Promotion and Chronic Disease Prevention Branch (HPCDPB). DCY supports community-based programming through several initiatives. This evaluation is focused on the following two programs led by DCY and administered in collaboration with Regional Operations (RO) and the Centre for Grants and Contributions (CGC):

The Community Action Program for Children (CAPC), which promotes the health and development of children aged 0 to 6 years, who face challenges that may put their health at risk. Funding recipients develop and deliver a range of comprehensive and culturally appropriate early intervention and prevention activities aimed at improving health behaviours and overall general health and well-being. The program's grants and contributions (G&Cs) budget is about $51.5 million per year.
The Canada Prenatal Nutrition Program (CPNP), which supports the health of pregnant women and people and their infants who face challenges that may put their health at risk. Funding recipients deliver a range of programs and activities aimed at increasing healthy birth weights, promoting and supporting healthy nutrition during pregnancy and postpartum, promoting and supporting breastfeeding, as well as positive health behaviours and well-being. The program's G&Cs budget is about $27.2 million per year.

Together, these programs aim to reach participants who face challenges that may put their health at risk, in order to strengthen their knowledge and skills and support their overall health and well-being. The programs also aim to encourage funded organizations to collaborate with various sectors to support the needs of program participants.

CAPC is currently funding 415 recipients and CPNP is funding 241. Of these recipients, 121 have received funding from both programs. Up to 2025-2026, contribution agreements were amended on a regular basis, with a majority of funding recipients having received continuous funding for close to 30 years. In early 2025, as a step towards evolving the programs, CAPC and CPNP were merged into one program, the Community Action for Prenatal and Child Health Program (CAPCHP). This has created an administrative efficiency while maintaining the same total funding. Existing CAPC and CPNP funding recipients were then invited to apply to a targeted solicitation process for the new CAPCHP, except for Quebec's funding recipients, who will continue to be funded under the CAPC and CPNP until the end of March 2028.

Evaluation approach and scope

The evaluation reviewed DCY activities from April 2020 to March 2025, specifically those supporting community-based programming through CAPC and CPNP. The overall intent of the evaluation was to assess how the design and administration of CAPC and CPNP could be optimized. The evaluation considered program achievements, changes to be implemented, as well as the high-priority needs and health inequalities of pregnant women and people, families, and children experiencing vulnerabilities.

The evaluation questions explored the following themes:

Evolving needs and federal, provincial, and territorial responses;
Responses to population needs;
Achievement of program objectives and outcomes; and
Optimization of program design, management, and administration.

Overview of findings

Evolving needs and federal, provincial, and territorial responses

Key indicators related to inequities in the social determinants of health have shown slow and steady improvement over the last 30 years in Canada. This period overlaps with the introduction of CAPC and CPNP in the mid-1990s. Statistics show that the proportion of children under 18 living in poverty decreased from 24.2% in 2000 to 18.3% in 2023. The proportion of teen pregnancies also dropped from 5.4% in 2000 to 1.3% in 2023. In addition, breastfeeding initiation and duration have shown sustained progress. Despite improvements, there remain pockets of social and economic need that vary across regions. Funding recipients reported that program participants experience distinct needs related to food insecurity, isolation, and limited access to care, particularly among demographic groups like newcomers. Moreover, data from the Early Development Index (EDI) indicates that over a quarter of young children across Canada continue to be vulnerable in at least one of five domains of early childhood development.

The federal government has made a number of investments since the mid-1990s to improve socio-economic conditions for children and families. These include the expansion of benefits and tax credits for families, temporary income support provided during the COVID-19 pandemic, as well as the introduction of provincial and territorial (PT) as well as Indigenous Early Learning and Child Care (IELCC) agreements. PHAC itself, and Health Canada before PHAC's creation in 2004, launched other early childhood health and development programs like Aboriginal Head Start in Urban and Northern Communities (AHSUNC), the Healthy Early Years (HEY) program, and programs addressing family violence. Furthermore, many provinces and territories (PTs) expanded their supports for children and families over this period, often building on the work of existing CAPC and CPNP funding recipients by providing additional funding or complementary programming, such as newborn screening, home visiting, and family support programs, and co-located early childhood hubs or family resource centres.

Responses to population needs

Supported by stable CAPC and CPNP funding for around 30 years, recipient organizations have built expertise, trust and familiarity with their local communities and partners. To provide programs and activities that meet the needs of local populations, which often go beyond the intent of CAPC and CPNP, many have adapted by collaborating with a multitude of partners and leveraging funds from other sources. Such collaborations have allowed them to offer wrap-around services to families, sometimes incorporating Indigenous or newcomer languages and cultural resources. It is estimated that CAPC and CPNP funding recipients leveraged a value of $44.6 million in 2022-2023 from other sources to support their activities, including $37.9 million from PT, regional, and municipal governments. A majority of funding recipients reported delivering six or more service types, such as enabling access to health professionals, information and communication technologies, nutrition supports, transportation and accompaniment.

Due to the capacity and reach of the funded organizations, PHAC has been able to leverage CAPC and CPNP to support a variety of other public health objectives and priorities, such as the dissemination of information related to COVID-19 and measles vaccination, as well as congenital syphilis prevention. In addition, community-based CAPC and CPNP funding recipients continue to act as service hubs and facilitate local and regional collaborations with public health authorities. These connections at the individual and organizational levels enabled funding recipients to contribute to emergency responses within their communities, such as the COVID-19 pandemic and environmental events like floods and wildfires.

Achievement of objectives and outcomes

Stable CAPC and CPNP funding and project implementation has enabled the programs to meet their objectives of building capacity, partnerships, and collaboration, as well as knowledge development and exchange. Over time, a network of over 600 funding recipients across Canada has been developed to support the health and well-being of pregnant women and people, infants, and children (0 to 6 years), as well as parents and caregivers. Eighty-one percent of these organizations have at least one partnership. Of those who reported any partnerships, many (68%) reported partnerships with four or more different types of organizations, such as those focused on public health, literacy, food security, and education. Networking among CAPC and CPNP funding recipients is supported by five nonservice delivery funding agreements that facilitate learning and sharing knowledge resources. The activities of CAPC and CPNP funding recipients have contributed towards building social cohesion, which is a factor in individual and community resilience. Participants reported that engagement in activities allow parents to connect with each other, reducing isolation and loneliness.

Performance data analysis showed that both programs continue to reach participants who face challenges like lone parenthood, low educational achievement, and poverty. However, the data also showed that program participation has been slowly decreasing over time, from a combined total of 271,521 participants in 2019-2020 to 232,234 in 2022-2023. This was due in part to funding limitations and the COVID-19 pandemic leading to fewer activities being offered. That said, 2024-2025 data showed early signs of increased uptake as the total went up to 252,523 participants. Over the years, participant surveys have shown consistently high levels (75% to 85%) of knowledge gained and strengthened health behaviours among parents and children. This is linked to the development of skills that support healthy pregnancies, parenting, and family health and well-being. Furthermore, in 2025, 88% of CAPC and 94% of CPNP respondents stated that they agreed or strongly agreed that their overall health and well-being had improved as a result of participating in the program. While there is no longitudinal data on how long these impacts have lasted, academic literature, including University of Toronto research on CPNP, highlights the value of ongoing investments in perinatal health and early childhood health and development to address vulnerabilities, promote well-being and reduce health and social costs throughout a lifetime.

Optimization of program design, management, and administration

CAPC and CPNP design and funding levels have remained unchanged for 30 years. This has led to a 45% decline in budget value due to inflation, significantly reducing purchasing power and straining the ability of funding recipients to meet the objectives of the programs. In addition, the emergence over the last 30 years of other federal, PT MCH initiatives to address needs has created instances of overlapping program objectives. In addition, there is an absence of coordination mechanisms among the various players. Moreover, access to CAPC and CPNP funding has historically been limited to the original recipient organizations, thus restricting broader participation and reducing PHAC flexibility to respond to demographic shifts and emerging needs, especially among equity-deserving populations like urban Indigenous populations, official language minority communities, newcomers, and refugees.

Following the evaluation of CAPC and CPNP in 2021, PHAC explored alternative delivery models through stakeholder consultations. Efforts to shift toward an open and competitive funding solicitation raised concerns about funding loss, particularly for organizations serving small, rural, or remote communities. To date, incremental changes have been slowly implemented to streamline reporting requirements and lower administrative burden. At the same time, DCY continues to explore promising policy options to maximize the impact of investments. Finally, while the current shared management model for the CAPC and CPNP draws on the valuable expertise of DCY, RO, and CGC, many internal interviewees noted that the approach could benefit from further refinement. While there is a program charter in place that outlines respective roles and responsibilities, there is room for further clarification of roles for some internal partners, strengthening accountabilities and improving communication practices.

Recommendations

Recommendation 1: Use lessons from the 2026 CAPCHP renewal to develop a revised funding approach that better positions PHAC to address priorities and emerging child health needs.

The program delivery model has not been significantly updated in over 30 years, despite changing needs and the emergence of other federal, PT initiatives with similar goals. This presents a challenge to the sustainability of both CAPC and CPNP, particularly since inflation has diminished the value of the investment over the years.

Recommendation 2: As PHAC develops the revised funding approach, consider how CAPCHP's community capacity work can support PHAC's broader strategic priorities.

One of the key achievements of CAPC and CPNP is the stable community capacity built across Canada, with most funding recipients having developed partnerships that allow them to act as a hub for a broad range of services to families. Recipients have also built trust over time within their local communities, which allows them to act effectively as welcoming places for intended populations. This type of community capacity has enabled the Agency to reach a variety of populations with public health information on topics such as COVID-19 and measles vaccination as well as congenital syphilis prevention. Moving forward, as PHAC develops a revised funding approach there is an opportunity to explore ways to maintain and leverage these program strengths to further advance PHAC's broader strategic priorities.

Management Response and Action Plan

Recommendation 1

Use lessons from the 2026 CAPCHP renewal to develop a revised funding approach that better positions PHAC to address priorities and emerging child health needs.

Management response

Agree

Table 1: Action plan for Recommendation 1
Action Plan	Deliverables	Expected Completion Date	Accountability
1. Develop a revised approach to funding based on PHAC's mandate and strategic direction, lessons learned from 2026 CAPCHP program renewal, and updated demographic data. This renewed approach will align with and inform PHAC's work on Grants and Contributions modernization.	1.1 Internal lessons learned document Document (approved by Executive Director) describing lessons learned from the CAPC and CPNP programs and the CAPCHP invitation to submit a funding request process.	December 30, 2026	Director General - Centre for Health Promotion and Chronic Disease Prevention
	1.2 Internal report (approved by Executive Director) on PT demographic data from 2021 Census Updated PT demographic data and data tables based on 2021 census (e.g., % of children in low income households, % of children living with immigrant parents, % of children living with a lone parent).	April 30, 2027
	1.3 Internal document (approved by Director General) outlining a proposed revised CAPCHP funding approach which aligns with PHAC's work on Grants and Contributions modernization Document proposing revisions to the CAPCHP funding approach based on an overview of findings from 1.1 and 1.2 and a review of PHAC's mandate and strategic direction.	April 30, 2027

Recommendation 2

As PHAC develops the revised funding approach, consider how CAPCHP's community capacity work can support PHAC's broader strategic priorities.

Management response