SUFA Initiative (2002)

Health Transition Fund

General Information
Department	Health Canada
Partners	Joint effort between the federal, provincial and territorial governments; led by a Federal / Provincial / Territorial Working Group on the HTF consisting of one representative from the federal government and each province / territory for a total of 14 members.
Effective Date	Announced in the February 1997 budget; Secretariat for the Fund was created in June 1997.
Expiry Date	March 31, 2002
Web Site	http://www.hc-sc.gc.ca/htf-fass
Purpose	To support innovations leading to a more integrated health system To support pilot and evaluation projects in four priority areas: home care, pharmacare, primary care and integrated service delivery; To provide evidence that will help identify feasible approaches for reform and improvement; To provide a basis for improving the delivery of health care services.
Roles and Contributions	The HTF operated as a joint effort between the federal, provincial and territorial governments through the F/P/T Working Group on the HTF. Recommendations for funding provincial and territorial projects were made bilaterally between the appropriate province or territory and the federal government. Funding decisions for national projects involved multilateral review and discussions among federal, provincial and territorial governments, and had to have, at a minimum, the support of the jurisdictions in which they took place and of the federal government. The HTF provided for up to 100% funding (i.e. no cost-sharing, however some projects did have other sources of funding). The federal / provincial / territorial partnership has been publicly communicated through a number of nationally-released documents (Information sheet, November 1997; call for proposals for National Projects, Spring 1998; HTF Brochure, August 2000; synthesis documents, June 2002); through a series of five regional workshops held in the spring of 2001; and through the HTF website. Public understanding and recognition of the federal government's role and contributions was not tracked as the program was a one-time initiative which ended in March 2002.

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Resources
Funding	1997-1998 Actuals 1998-1999 Actuals 1999-2000 Actuals 2000-2001 Actuals 2001-2002 Estimated Actuals Total O&M; $1,791.8 $2,696.8 $2,294.0 $1,677.7 $1,625.6 $10,085.9 G&C; $0 $22,138.8 $45,591.1 $10,555.5 $22,543.2 $130,828.6 Total $1,791.8 $24,835.6 $47,885.1 $42,233.2 $24,168.8 $140,914.5 Unspent funds of $9,085,500 consist of unused allocations; surpluses returned by approved projects; and an O&M; surplus. $30 M was allocated to national projects and initiatives, and $120 M was allocated to jurisdictions for provincial and territorial projects on an equal per capita basis. All HTF funding was from the federal government and may have been complemented in some projects by other sources.
Tracking and Reporting	Tracking and documenting of federal spending: provincial and territorial projects were selected bilaterally by the federal government and individual jurisdictions; national projects were selected multilaterally by the FPT Working Group on the HTF. Most projects received funding in arrears, following the submission of financial claims on a quarterly basis (a few projects received funding in advance and/or on a monthly basis) and monitoring by HTF staff to ensure that project activities were consistent with the approved work plan. Most projects submitted interim reports, and all projects submitted final reports. Public reporting: Information on project funding is posted on the HTF web site.

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Measurement and Reporting
Outcomes	Outputs: increased information and knowledge about the design and delivery of health care services through: final reports from each of the individual projects; project fact sheets; synthesis reports for each of the four priority areas and five additional theme areas, and a synthesis report addressing the overall results of the HTF projects; dissemination activities by individual projects; the HTF web site; face-to-face briefings and presentations by the HTF Secretariat; and a series of five regional HTF workshops in the spring of 2001 Planned outcomes: short-term outcomes include: health care decisions based on new evidence; ongoing research and identification of areas which merit further study; medium-term outcome is improved delivery of health care services; long-term outcome is maintenance and improvement of the health of the people of Canada. The final evaluation of the HTF (see below) will address this issue of whether the initiative achieved its planned outputs/outcomes.
Indicators	Measurement The outputs of the HTF may be measured in terms of the number and quality of: project final reports and dissemination activities (e.g. project fact sheets and newsletters) - final reports were received from all but two projects (these are pending); factsheets were prepared and web-posted for all but these two projects (these will be completed when the reports are received); individual projects reported on their own dissemination activities, which were extensive and varied; priority area / theme synthesis reports and overall results - ten documents were prepared by subject-area experts and released in June 2002 (one for each priority area, one overall, and five additional themes (Aboriginal health, rural health / telehealth, seniors’ health, children’s health, and mental health); and HTF dissemination activities (e.g. HTF and non-HTF organized workshops and/or conferences - the HTF sponsored five regional events in the spring of 2001; some larger projects held their own conferences and workshops (i.e. Alberta Primary Health Care Project Showcase Conference, November 2000; British Columbia Primary Care Demonstration Project Conference, October 2001; le colloque Jean-Yves-Rivard (November 2001) devoted a session to HTF projects in Quebec). In measuring project outcomes, individual projects evaluated models of care or approaches to service delivery based on an evaluation framework developed by the HTF. This framework included the quality of services provided (satisfaction, technical appropriateness of intervention, appropriateness of health care provider); the accessibility of health services (waiting times, culturally and linguistically sensitive services, accessibility by gender, geographic location, and/or ethnic group); integration with other parts of the health system (mix of services, sharing information, evidence of mechanisms for integration / co-ordination); the health impacts on the service / target population (changes in morbidity, population perspective on changes to health status, and unanticipated results), cost-effectiveness, and transferability or generalizability of the model or program. Individual projects were also required to develop project-specific indicators for factors they are measuring. To measure the longer term outcomes of the HTF, it is necessary to determine the extent to which HTF project results are influencing decisions on the health care delivery system, and thus on the health of Canadians. Benchmarks and indicators will be developed as part of a final (impact) program evaluation of the HTF to measure the HTF's outcomes. It is anticipated that the final evaluation will be completed in 2004. Assessment Project-specific evaluations were mandatory and have been completed for each project. Health Canada's Program Evaluation Division in the Information, Analysis and Connectivity Branch (IACB) is coordinating an evaluation of the HTF program. This evaluation involves two stages: an interim evaluation which focused on project selection, processes and lessons learned to date (April 2002); and, a final impact evaluation of the HTF model of collaboration and the extent to which HTF project results are influencing decisions related to health care delivery and, therefore, the health of Canadians (to be conducted in 2003-04). The HTF was audited by the OAG as part of the audit of the Federal Support of Health Care Delivery (Report of the Auditor General of Canada - November, 1999, chapter 29). The audit dealing with the HTF was relatively small, and focused on compliance with the program's terms of reference as approved by the Treasury Board of Canada. To ensure that funds were used in the approved manner, the HTF conducted an initial series of compliance audits in 2000-01. A second series was initiated in 2001-02 and will be concluded shortly. Generally speaking, the audits have revealed good compliance with program guidelines; no major issues have been encountered.
Evaluation / Thrid Party Assessments	Evaluation methods proposed in the draft framework for the impact evaluation will incorporate the perspectives of third parties into the response to the evaluation issues. In particular, the methods proposed that will provide third party assessments are the stakeholder interviews, expert interviews and the case studies.
Shared Information and Best Practices	Information was shared through the HTF's National Synthesis and Dissemination Strategy and continues to be available on the HTF website. Individual projects were responsible for sharing their own results; at a national, aggregate level, the HTF Secretariat undertook various activities including publications, events and analytical syntheses of project results. Outcomes will be addressed by the final evaluation of the HTF as a program.
Public Reporting	As noted above, individual projects were responsible for disseminating their results. All HTF publications were distributed by mail-out to key stakeholders and are available on the HTF website. Hard copies may also be requested from Health Canada Publications. Information arising from the evaluation of the HTF as a program is available through the usual channels for such products.

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Involving Canadians
Provisions for Citizens to Participate in Developing Social Priorities and Reviewing Outcomes	Opportunities for citizen engagement include(d): 1) the two major conferences held by the HTF in 1998; 2) five regional workshops currently being held across the country; and 3) project information distributed by mail or via the web-site. Also, a consultation process was conducted to inform the design of the dissemination strategy.
Feedback Mechanisms to the Public	At the individual project level, many initiatives involved public consultations and were designed accordingly. At the aggregate level, public consultations informed the national synthesis and dissemination strategy.

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Service Commitments
Public Availability of Eligibility Criteria	Program criteria are posted on the HTF web site (http://www.hc-sc.gc.ca).
Existence and Availability of Service Commitments	Most of the HTF's contacts were with the organizations to which it provided funding, rather than to the general public. Mutual responsibilities and obligations were set out in a standard contribution agreement, including procedures for dispute resolution. The HTF's website is its main vehicle for communicating information generated by the program to the public. The website includes a feedback survey.
Measurement and Public Reporting	Not applicable

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Appeals and Complaints
Existence, Availability and Communication of Mechanisms	With regard to HTF project proponents - see above regarding dispute resolution mechanism in the HTF contribution agreement. With regard to public complaints - any complaints regarding access and service or unfair administrative practices can be lodged through the federal minister / deputy minister's office, provincial / territorial governments or through direct contact with the Primary Health Care Division (which subsumed the HTF Secretariat in May 2001) by telephone, fax or email and would be addressed accordingly. The dispute resolution mechanisms of the HTF contribution agreement were never invoked. When areas of concern arose with individual projects, they were dealt with on a bilateral basis. When issues of general application were identified, the HTF Secretariat communicated them to all proponents - for example, in August 1999 a "mid-term communication" was sent to all recipients clarifying issues to do with financial reporting, etc. With regard to public feedback on the website - as of the termination of the program, it has been very positive and did include suggestions for changes etc. In the event of such changes being proposed, they would be give due consideration.
Tracking and Public Reporting	Not applicable - to date there have been no formal complaints lodged.

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Mobility
Existence of Measure	Not applicable - eligible recipients for HTF funding were provincial / territorial governments, federal departments and other organizations such as universities, researchers, health districts / authorities, etc. and not individual persons receiving health services.