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Up-Front Multi-Year Funding

1. Name of Recipient: Canadian Health Services Research Foundation (CHSRF)

2. Start Date: 1996-1997

3. End Date: N/A

4. Total Funding: $151.5M

5. Description:

Total federal funding for the CHSRF is as follows (CHSRF's programs also receive funding from other sources): 

1996 - $66.5 M endowment (received over five years) to establish the CHSRF;

1999 - $25 M one-time grant to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health system restructuring (Nursing Research Fund or NRF); and a $35 M one-time grant to support the CHSRF's participation in the Canadian Institutes of Health Research (CIHR); and

2003 - $25 M one-time grant to develop a program to equip health service professionals and their organizations with the skills to find, assess, interpret and use research to better manage the Canadian health care system (Executive Training for Research Application or EXTRA) over a thirteen-year period.

CHSRF's mission is to support evidence-informed decision-making in the organization, management and delivery of health services through funding research, building capacity and transferring knowledge.

CHSRF's work contributes to Health Canada's aim of strengthening the knowledge base to address health and health care priorities. More specifically, CHSRF's programs further the development of health human resources, provide health managers with tools to improve primary and continuing care, and support nursing research from a health system perspective.

6. Strategic Outcome(s): Accessible and sustainable health system responsive to the health needs of Canadians

7. Summary of Results Achieved by the Recipient:

Research Granting and Commissioned Research
The Foundation continued with its Research, Exchange and Impact for System Support (REISS) grant competition, with five programs of research approved for funding as part of the 2008 competition. The total value of the funding was $4.8 million of which the Foundation's contribution was $1.9 million. The 2009 competition call for applications was launched in September 2008. The new research competition - Linking Evidence to Action on Decisions (LEAD) - was launched in September 2008. Ten applications were received, and the Foundation will fund up to three LEAD initiatives with a maximum contribution to each project of $250,000 over two years. Matched funding is required from the host organization and other co-sponsors.

In 2008, two commissioned research projects were completed, and two new projects were launched. Three projects were launched under the Foundation's (decision support and knowledge support) synthesis program.

As part of its work with the Foundation's partners around Listening for Direction III, the final LfD reports were disseminated broadly, beginning with their launch at the 2008 Canadian Association for Health Services and Policy Research (CAHSPR) conference.

With respect to the Nursing Research Fund (NRF), in 2008 the fund contributed $2,324,399 toward nursing research:

  • $748,275 to ongoing REISS Programs funded under the nursing theme; one additional nursing-focused REISS program was recommended in the 2008 competition, which began its funding in January 2009
  • $11,247 in development funds for invited teams to prepare nursing theme REISS full-scale applications
  • $216,078 in co-sponsorship funds for projects funded under the nursing theme of the Partnerships for Health System Improvement competition of the Canadian Institutes of Health Research; this includes funds for four ongoing and two new nursing-focused projects recommended in the 2008 competition
  • $169,168 for new and ongoing nursing-related postdoctoral awards; three new nursing-related awards were recommended in the 2008 postdoctoral awards competition
  • $610,250 for nursing-focused regional training centres
  • $473,200 for nursing-focused chair awards
  • $74,986 for the evaluation of the Nursing Research Fund award
  • $21,195 for other nursing-related projects and awards

The Foundation consulted with nursing stakeholders and opinion leaders throughout the year to communicate the wind-down of this program in 2009, and has been actively engaged with the nursing community to discuss next steps.

Building Research Capacity
The Foundation awarded nine CHSRF/CIHR Postdoctoral Awards in 2008. Three of these awards were funded from the NRF.

The Regional Training Centres (RTC) along with a number of other key participants, funders, decision makers, students and faculty, collaborated in a special issue of Healthcare Policy focusing on the experiences, successes, challenges and lessons learned in the RTC journey.

The Foundation presented its ninth annual Health Services Research Advancement Award. This award is presented annually to an individual, team or organization that has contributed significantly to the Canadian health services research community and to advancing evidence-informed decision-making.

A special project was launched by the Foundation to examine the experiences of junior and senior faculty working in applied health services and policy research in Canadian academic settings.

The Foundation, in collaboration with the U.S. Commonwealth Fund, supported the eighth Harkness Associate Award competition which selected two Canadian Harkness Associates. CHSRF also organized (and prepared the briefing book for) the annual Canadian Harkness Policy Briefing Tour for all fellows.

Decision Maker Capacity Building, Knowledge Exchange and Transfer
In 2008, the Executive Training for Research Application (EXTRA) program welcomed a new cohort of 28 fellows including five interdisciplinary teams and four fellows from government ministries. For the first time, the cohort included four policy fellows approved from Health Canada. Since EXTRA's inception in 2003, three cohorts of fellows have graduated. EXTRA's 2008 CEO Forum attracted 20 chief executivesfrom across Canada and the United Kingdom. The forum focused on issues and opportunities related to mandates for access and quality. In 2008 the EXTRA program began work on publishing a book that will share the knowledge and experience of the EXTRA program and present some early results in improving decision-making in Canada's healthcare system. A team was also commissioned to do an EXTRA/SEARCH Canada (SEARCH - Swift, Efficient Application of Research in Community Health) case study evaluation.

Over 150 decision makers, researchers, healthcare professionals, students, and patients participated in a teamwork workshop - a two-day session of frank and open dialogue about strategies, tools, challenges, and tips for improving teamwork and interprofessional collaboration in healthcare.

Five sessions of Researcher on Call - a series of interactive teleconference calls that bring researchers and decision makers together to discuss timely and interesting topics relevant to Canada's health system -were held in 2008.

In 2008, the CHSRF produced and released two Mythbusters publications. Information reflected in this series was presented at two international conferences, and one issue of Mythbusters was translated into Spanish for the Madrid Public Health Agency. Two issues of the Mythbusters companion piece, Evidence Boost, were published in 2008. One of these issues was reprinted in the Canadian journal Healthcare Policy. CHSRF completed its Mythbusters Teaching Resource - a tool to help instructors teach summary-writing to their students. A professor with Dalhousie University's master's program in community health and epidemiology developed with the Foundation's assistance a Mythbusters assignment for its health services systems course. The Foundation launched the first-ever Mythbusters Award, open to students of Canadian universities. This award is designed to provide students with the opportunity to prepare a user-friendly summary of the research evidence behind some of today's major debates in Canadian health services management and policy.

Twenty-one issues of Insight and Action, a digest that aims to share knowledge about knowledge exchange, were produced this year.

Four new installments of the Promising Practices in Research Use series were produced in 2008. The series highlights healthcare organizations that have invested time, energy, and resources to improve their ability to use research.

Foundation staff published four columns in Healthcare Quarterly in 2008.

Leveraging of Federal Investments in CHSRF
The total amount of CHSRF funds spent on partnership eligible programming in 2008 was $5.47 million. This includes payments made towards ongoing multiyear activities as well as new activities for which 2008 payments were made. The total amount of partnership contributions on these same activities was $7.36 million. In other words, for every $1 of Foundation funding spent, $1.35 was contributed by partners. When considering partnership contributions from an overall CHSRF funding envelope perspective, the leverage is even more impressive. Considering that total CHSRF program spending was $20.5 million, and total partner contributions were $7.4 million, the CHSRF's net draw on the endowment of $18.9 million yielded a leveraged ratio of 1:1.08; that is, $1.08 was spent on the Foundation's objectives for every $1 spent from the Foundation's capital in its endowment. The CHSRF partnered with 44 direct partners in 2008 and entered into 24 new partnership agreements in 2008 with an additional 14 under negotiation at the end of the year.

Five-Year Strategic Plan
Throughout 2008 the Foundation transitioned into its four strategic priorities that were guiding CHSRF's core programming activities at the Foundation. At the 9 December 2008 board meeting, trustees approved the 2009-2013 strategic plan which was developed based on the board's input and staff consultations with key stakeholders across the country. This resulted in the following revised vision, mission and strategic priorities:

Our vision
Timely, appropriate and high-quality services that improve the health of all Canadians

Our role and mission
The Canadian Health Services Research Foundation works to improve the health of Canadians by:

  1. Capturing the best evidence about how healthcare and other services can do more to improve the health of Canadians.
  2. Filling critical gaps in evidence about how to improve the health of Canadians, by funding research and evaluation.
  3. Supporting policymakers and managers to develop the skills necessary to apply the best evidence to improve the health of Canadians.

Our strategic priorities

  1. Engaging and supporting citizens
  2. Accelerating evidence-informed change
  3. Promoting policy dialogue

14. Program Activity:
($ millions)
8. Actual
Spending
2006-07

Jan 1 '06 to
Dec 31 '06

9. Actual
Spending
2007-08

Jan 1 '07 to
Dec 31 '07

10. Planned
Spending
2008-09

Jan 1 '08 to
Dec 31 '08

11. Total
Authorities
2008-09

Jan 1 '08 to
Dec 31 '08

12. Actual
Spending
2008-09

Jan 1 '08 to
Dec 31 '08

13. Variance(s)
$0 $0 $0 $0 $0 $0

15. Comments on Variance(s): The conditional grant was paid to CHSRF in instalments prior to the 2008-2009 reporting period.

16. Significant Evaluation findings by the recipient during the reporting year and future plan:

A CHSRF-commissioned independent evaluation of the NRF was completed in 2008. The final report, incorporating the Foundation's response, was posted on the Foundation's web site. The evaluation includes important lessons and results that are of direct interest to the wider nursing community (including researchers and decision makers), the original sponsors of the NRF (the Government of Canada and Canadian nursing leadership), and the Foundation. The evaluation team noted the many successes and positive outcomes of the investments made through the NRF, as well as identifying areas that could be improved.

(http://www.chsrf.ca/nursing_research_fund/documents/Evaluation_of_the_NRF_ENG_Final.pdf)

The EXTRA Program Summative Evaluation Report was received in March 2009, marking the halfway point of the ten-year program launched in 2004. Evaluation results indicate that EXTRA Fellows have increased their level of research evidence use over the period of the two-year fellowship and the data clearly show that EXTRA Fellows acquire new skill sets and competencies in finding, using and applying research evidence in their work. As well, the evaluation data indicate that EXTRA Fellows have significantly increased the level of research evidence use in their organizations, including: effecting a change in the organizational culture, developing strategies for colleagues to use and apply evidence, engaging in change management strategies based on the intervention project, improving the diffusion and use of research evidence tools, and increasing the awareness of evidence based decision-making and its value in the host organizations.

17. Significant Audit findings by the recipient during the reporting year and future plan:

The final recommendations from the 2005 internal controls review and the 2007 audit of funded projects were implemented in 2008. In addition, the Foundation undertook an internal controls review of its information systems in 2008 which showed that the Foundation's information systems were sound and secure. The recommendations from this internal controls review will be implemented in 2009.

The 2008 external financial and pension plan audits showed no major concerns, with the auditors reporting clean audits with no evidence of fraud or illegal acts.
(http://www.chsrf.ca/about/ga_accountability_financial_e.php)

In Health Canada's Audit and Accountability Bureau 2008 audit report, the Foundation received high praise for its sound management and investment frameworks.

The Foundation will continue to conduct its internal controls reviews as outlined in its five-year Internal Audit Plan. In 2009, it is anticipated that the Foundation will conduct an internal controls review of purchases, investments, insurance policies, and capital assets.

18. URL to Recipient's Site: www.chsrf.ca

See also:

1. Name of Recipient: Mental Health Commission of Canada -- Conditional Grant to support Research Demonstration Projects in Mental Health and Homelessness

2. Start Date: April 1, 2008

3. End Date: March 31, 2013

4. Total Funding: $110M

5. Description:

In Budget 2008, the federal government announced its intent to provide $110 million in funding to the MHCC to support five research demonstration projects in mental health and homelessness over five years (2008-2013). These research demonstration projects will focus on developing best practices and a broader knowledge base with respect to mental health and homelessness, and will strive to make real improvements in the lives of Canada's most vulnerable.

Expected results of this initiative will be:

  • the development of a knowledge-base accessible to all jurisdictions;
  • the identification of effective approaches to integrating housing supports and the Basket of Necessary Services or other "prerequisites";
  • the development of Best Practices and Lessons Learned; produce data that is reflective of mental health issues among Canada's homeless population;
  • the identification of unique problems and solutions for diverse ethno-cultural groups within this population;
  • and support improvements at each project site to address fragmentation through improved system integration and support.

6. Strategic Outcome(s): Accessible and sustainable health system responsive to the health needs of Canadians

7. Summary of Results Achieved by the Recipient:

Since submitting their Project Précis to Health Canada in October 2008 which outlined the projects principles, objectives, community engagement and project design, the Commission has engaged host cities of Montreal, Moncton, Toronto, Vancouver, and Winnipeg. in the planning of each site. The Request for Applicants (RFA) closed on January 31, 2009 and feedback has been provided to the site applicants prior to finalizing contracts and grants. The Commission plans to have all five projects in place by 2009/10, with evaluations planned for 2011/12.


14. Program Activity: Canadian Health System
($ millions)
8. Actual
Spending
2006-07
9. Actual
Spending
2007-08
10. Planned
Spending
2008-09
11. Total
Authorities
2008-09
12. Actual
Spending
2008-09
13. Variance(s)
$0 $0 $110M $110M $110M nil

15. Comments on Variance(s): N/A

16. Significant Evaluation findings by the recipient during the reporting year and future plan: As per the terms and conditions of the funding agreement, the Commission must carry out an Independent Evaluation within 5 years and 180 days to measure the Commission's overall performance in achieving the purpose of the Grant funding. It is expected that this initiative will be included as part of the overall performance evaluation for the Commission which is scheduled for 2010-2011.

17. Significant Audit findings by the recipient during the reporting year and future plan: As outlined in the funding agreement, the Commission must engage an independent auditor to conduct a full audit of its financial statements each Fiscal Year. The 2008-09 audited financial statements have now been completed and were presented at the Board Meeting for approval on May 31, 2009.

18. URL to Recipient's Site: http://www.mentalhealthcommission.ca/Pages/index.html

1. Name of Recipient: Canada Health Infoway (Infoway)

2. Start Date: March 9, 2001

3. End Date: N/A

4. Total Funding: $1.6B*

*Infoway received $1.2 B as lump-sum grants between 2001 and 2004. The $400 M allocated in 2007 was subject to new conditions - these funds flow to Infoway on an as-needed basis.

5. Description:

Canada Health Infoway Inc. (Infoway) is a federally funded, independent, not-for-profit corporation with a mandate to foster and accelerate development and adoption of electronic health information communication technologies with compatible standards on a pan-Canadian basis.

Since 2001, the federal government has committed the following funding allocations: $500 million in 2001 in support of the September 2000 First Ministers' Action Plan for Health System Renewal to strengthen a Canada-wide health infostructure (with the electronic health record - EHR - as a priority); $600 million in the First Ministers' Health Accord of February 2003, to accelerate implementation of the EHR and Telehealth; $100 million as part of Budget 2004 to support development of a pan-Canadian health surveillance system; and $400 million as part of Budget 2007 to support continued work on EHRs and wait times reductions.

It is anticipated that Infoway's approach, where federal, provincial and territorial (F/P/T) governments participate as equals, toward a goal of modernizing the health information system, will reduce costs through coordination of effort and avoidance of duplication. For example, in 2008-2009 Infoway and 11 jurisdictions jointly issued a national request for proposals for telehealth video conference equipment from which six manufacturers were chosen.

6. Strategic Outcome(s): Accessible and sustainable health system responsive to the health needs of Canadians

7. Summary of Results Achieved by the Recipient:

Investment Strategy - Infoway is a strategic investor, with a funding formula covering up to 100% of territorial and 75% of provincial project development and implementation costs. Infoway provides a portion of system development costs and supports project oversight while P/T partners are responsible for actual system development, implementation and overall funding, including ongoing operational costs. In 2008-2009 Infoway approved $136.5 million in new projects, bringing its cumulative value of investments to $1.576 billion. By the end of the year, 138 projects had been completed and 145 were under way, for a total of 283 projects since Infoway's inception.

Electronic Health Records - Infoway's goal for EHRs, endorsed by all jurisdictions is that: "by 2010 every province and territory and the populations they serve will benefit from new health information systems that will help transform their health care systems.  Further, by 2010, 50% of Canadians and by 2016, 100% of Canadians will have their electronic health record available to their authorized health professionals." Infoway estimates that as of March 31, 2009, the core components of an EHR were in place for 17% of Canadians.

Telehealth - Infoway is working to implement solutions that facilitate the delivery of health information and services between patients and providers over distance, with a focus on Aboriginal, official language minority, northern and remote communities. Telehealth strategic plans are in place in most jurisdictions, and, in 2008-2009, Infoway approved $20.6 million in new telehealth projects, bringing cumulative telehealth project approvals to $97.56 million.

Public Health Surveillance - Canada Health Infoway continues to support development and implementation of a pan-Canadian Public Health Surveillance System (Panorama). Panorama will facilitate identification, management and control of infectious diseases that pose a threat to the public's health by providing public health professionals with software tools to manage cases, outbreaks, immunization, materials/vaccine inventories, notifications and workload. In 2008-2009, Infoway approved $12.6 million in public health surveillance projects, bringing cumulative approvals to $132.4 million. The first production release of Panorama is scheduled to be complete and available to jurisdictions on June 30, 2009. A second release of the product is currently targeted for completion by the late fall of 2009.

Patient Access to Quality Care (PAQC) - As a result of the 2007 budget, Infoway created a new, $50 million investment program. PAQC supports investments to demonstrate how technologies can improve access to care and reduce wait times when deployed in an integrated manner. In 2008-2009 funding for the new program began to flow to jurisdictional demonstration projects. In 200-2009, new project approvals totaled $28.2 million, bringing cumulative approvals to $28.7 million.


14. Program Activity: Canadian Health System
($ millions)
8. Actual
Spending
2006-07
9. Actual
Spending
2007-08
10. Planned
Spending
2008-09
11. Total
Authorities
2008-09
12. Actual
Spending
2008-09
13. Variance(s)
$0* $38.7M $122.99M $122.99M $122.9M 0

15. Comments on Variance(s): The federal government has invested $1.6 billion in Infoway to date, $1.2 billion of which was provided as lump-sum grants between 2001 and 2004. As part of Budget 2007, $400 million was earmarked in the fiscal framework for 2006-2007. These funds were payable on passage of the Budget Implementation Act 2007 and Royal Assent, authorizing the Minister of Health to make a statutory payment directly from the Consolidated Revenue Fund. Payment is made on an as-needed basis, on receipt of Infoway's annual Cash Flow Statement. In 2008-2009, one payment was made for $122.99 million out of the $400 million.

* The pace at which funding is expended is at the discretion of Infoway and is largely driven by the rate of progress of its P/T partners. Total annual spending in relation to all federal allocations (i.e. 2001, 2003, 2004, 2007) is as follows:
  • $117.8 M in 2005-2006
  • $174.6 M in 2006-2007
  • $271.7 M in 2007-2008
  • $251.76 M in 2008-2009

16. Significant Evaluation findings by the recipient during the reporting year and future plan:

In March 2009, Infoway released an independent performance evaluation of its public health surveillance system investment program. The evaluation found that Infoway has met, or is expected to meet, the majority of the expected outcomes.

Infoway also released an independent evaluation of the emerging benefits as a result of its diagnostic imaging investment program. The evaluation found that efficiencies and cost-savings as a result of investments to date are increasing productivity of the health care system.

In fiscal year 2009-2010, Infoway is expected to release an independent third-party evaluation to measure its performance in achieving objectives of the 2007 funding agreement.

17. Significant Audit findings by the recipient during the reporting year and future plan:

In 2008-2009, Health Canada's Audit and Accountability Bureau (AAB) conducted an audit of Transfer Payments to Infoway, which encompassed allocations totaling$1.6 billion under the 2001, 2003, 2004 and 2007 funding agreements. The audit report found that Infoway was in compliance with the terms and conditions of the funding agreements and did have an effective management control framework in place.Annual financial and compliance audits were completed by independent third parties. Financial auditor Ernst and Young stated that the financial statements fairly represented Infoway's financial position, and the results of its operations and cash flows. The annual compliance report was carried out by Mallette and the auditor stated that Infoway complied in all material respects with the key terms and conditions of funding agreements.

18. URL to Recipient's Site:www.infoway-inforoute.ca