Rural and Remote Health Innovations Initiative

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Population Health Fund: Guide for Applicants

April 1, 2000 

Table of Contents

• Rural and Remote Health Innovations Initiative
  • Background
  • Objectives
  • Priorities
  • Principles
• Population Health
• The Determinants of Health
• Funding Criteria
  • Eligible Applicants
  • Eligible Expenses
  • Ineligible Activities
• Proposal Development
• How Applications Will Be Assessed
• Project Administration
• Appendix A - Addresses for Health Promotion and Programs Branch
• Appendix B - Application for Funding
• Appendix C - Population Health Fund - Budget Addendum

Rural and Remote Health Innovations Initiative

Through this Initiative, Health Canada will provide project funding to support improved health in rural and remote areas and to increase community capacity for action on the determinants of health. Funded projects are intended to improve the health of communities and individuals living in rural and remote areas, provide models for use in other parts of the country, support the development of a national rural health strategy for Canadians, and have an impact on the health status of Canadians living in rural and remote communities.

Background

Rural and Remote Communities are broadly defined as communities of less than 10,000 population and removed from many urban services and resources. 

Thirty percent of Canadians live in rural and remote areas of Canada. Population shifts are changing the demand for rural health services. Youth are moving out to seek training and jobs not available in rural communities; this has in turn, increased the proportion of older persons in rural communities. Rural Canadians are increasingly voicing concern about differences between services and resources available in rural and remote areas and those in urban areas, and about ways to sustain health and healthy living in their communities. 

There are many underlying issues that affect health in rural Canada, including the recruitment and retention of health care professionals; access to specialized services; gaps in knowledge about rural health issues; a lack of coordination of services which can lead to duplication of effort, and barriers to care. Some of the health service restructuring has caused reductions or closure in services (often for a regional approach) and meant rural residents who require health services must move to communities with services or travel great distances for access to these services. As well, our changing world has created new challenges and opportunities to improving the health of Canadians. People living in rural and remote communities may not have sufficient access to resources to allow them to deal with these challenges or access the opportunities.

To address these concerns, the Federal Government has made a commitment to support Innovations for Rural and Community Health.

Objectives

Projects funded under the Rural and Remote Health Innovations Initiative must meet one or more of the following objectives:

• promote the integration and accessibility of a full range of health services in rural and remote areas, including primary and specialty care;
• explore ways to address workforce issues, including but not limited to gaps in the supply of health professionals; and
• explore system reforms to improve the delivery of health services in rural and remote areas.

Projects must provide models for improving the health of Canadians living in rural and remote communities which have implications beyond the community served by the project.

Projects must meet national and/or provincial and territorial priorities. Projects must demonstrate how they will serve the population, including official language minority communities, where appropriate. Please consult your local Health Canada office (see Appendix A) if you require additional information.

Priorities 

• developing and piloting solutions to rural health issues and problems related to access to health services;
• addressing issues of transportation to health services in rural and remote areas;
• addressing issues of recruitment and retention of rural health providers;
• developing models of integrated, multi-disciplinary teams to support rural health needs;
• examining the physical environments (natural and human made) in rural and remote communities which contribute to accidents or diseases;
• fostering intersectoral collaboration on rural health issues; and
• developing innovative models which address the determinants of health (see Population Health section, this page) as experienced by Canadians living in rural and remote areas.

Direct delivery of services will not be funded.

Projects may be local, regional, provincial or national in scope and must meet the objectives and priorities of the Fund. Successful applications for funding must address the following key elements in the project design, implementation and evaluation:

Principles

Projects submitted for funding under the initiative are required to respect the following principles in project development and implementation.

Promoting Participation 
Project activities must be relevant to the population being served. This is achieved by members of the population group including official language minority communities and key stakeholders taking an active role in developing, planning, implementing and evaluating the project, as well as in disseminating the results.

Intersectoral Collaboration
Key to the success of the Initiative is comprehensive and coordinated action by professional and voluntary sectors, in partnership with governments and the private sector. Strong collaboration at local, municipal, provincial and federal levels is necessary to mobilize resources for effective action and to create effective and co-ordinated activities. Partners may include volunteer and community groups, all levels of government, the business community, labour and professional organizations. As well, partnerships between the health sector and other sectors of the community are strongly encouraged.

Health Impact 
Project proposals must identify how they will improve access to needed health services or otherwise improve the health of communities and individuals in rural and remote areas. This could include expected benefits or impacts on the health or health status of individuals and communities, both directly or indirectly. The proposal should outline how these health impacts will be evaluated.
 

STOP If you have a project idea and are not a member of the population group affected by the project, do not proceed with a proposal until you have developed a partnership with those who are. They should be involved in all stages, starting now.

Population Health

The Rural and Remote Health Innovations Initiative is based on a population health model. This model focuses on the range of individual and collective factors that influence health and the way they act together in determining the health and well-being of Canadians. 

Using this approach, health is understood to be influenced by many factors. These factors are known as determinants of health and they continue to affect health and well-being throughout our life. Healthy development through the various life stages is the key to good health. 

Strategies and responses to these factors are based on conditions of risk and the benefits which will apply across an entire population, or to particular groups within that population.

In addition to acting on the determinants of health, the population health approach also endorses the concept of sustainable development. This concept looks at balancing environmental, economic and social considerations to achieve health for the present generation, without sacrificing the health, quality of life and well-being of future generations. Population health and sustainable development are mutually reinforcing concepts and are therefore embodied in the activities of the Rural and Remote Health Innovations Initiative.

The Determinants of Health

Determinants of health is the name given to the factors and conditions which have an influence on health. 

These determinants do not act alone or in isolation from each other; their complex interactions with each other have an even more important impact on health. The following is a brief description of each and some of the ways in which they affect health.

• Income and Social Status
  This is the single most important determinant of health. Health status improves at each step up in the income and social hierarchy. Higher income levels affect living conditions such as safe housing and ability to buy sufficient good food. The healthiest populations are those in societies which are prosperous and have an equitable distribution of wealth. 
• Social Support Networks 
  Support from families, friends and communities is associated with better health. The health benefits of the support of family and friends who provide a caring and supportive relationship may be as important as risk factors such as smoking, physical inactivity, obesity and high blood pressure.
• Education 
  Health status improves with level of education. Education increases opportunities for income and job security, and gives people more control over their lives - key factors which influence health.
• Employment and Working Conditions
  Unemployment, under-employment and stressful work are associated with poorer health. Those with more control over their work and fewer stress-related demands on the job are healthier.
• Social Environments 
  The values and rules of a society affect the health and well-being of individuals and populations. Social stability, recognition of diversity, safety, good relationships and cohesive communities provide a supportive society which reduces or removes many risks to good health.
• Physical Environment 
  Physical factors in the natural environment (e.g., air, water quality) are key influences on health. Factors in the human-built environment such as housing, workplace safety, community and road design are also important influences.
• Personal Health Practices and Coping Skills 
  Social environments that enable and support healthy choices and lifestyles, as well as people's knowledge, behaviours, and coping skills for dealing with life in healthy ways, are key influences on health.
• Healthy Child Development 
  The effect of prenatal and early childhood experiences on subsequent health, well-being, coping skills and competence is very powerful. For example, a low weight at birth links with health and social problems throughout a person's life.
• Culture
  Culture and ethnicity come from both personal history and wider situational, social, political, linguistic, geographic, and economic factors. Multicultural health issues demonstrate how necessary it is to consider physical, mental, spiritual, social, and economic well-being at the same time.
• Health Services 
  Health services, particularly those which maintain and promote health, prevent disease and restore health, contribute to population health.
• Gender 
  Gender refers to the many different roles, personality traits, attitudes, behaviours, values, relative powers and influences which society assigns to the two sexes. Each gender has specific health issues or may be affected in different ways by the same issues.
• Biology and Genetic Endowment 
  The basic biology and organic make-up of the human body are fundamental determinants of health. Inherited predispositions influence the ways individuals are affected by particular diseases or health problems.

Funding Criteria

Eligible Applicants

Canadian non-government, non-profit, voluntary organizations and educational institutions may be considered for funding. Multisectoral applications are strongly encouraged. Individuals are not eligible applicants under the Initiative. Requests for proposals (developed by Health Canada) may further limit which categories of eligible sponsors will be considered.

Eligible Expenses

Funds can cover only those costs directly related to the project. These may include:

• personnel, for example, project staff salaries, contractor fees, and employee benefits, such as, Canada Pension Plan deductions.
• travel and accommodation, expenses for project activities such as private vehicle mileage, air, train or bus fares, project-related meals and accommodation costs are all eligible. Note: kilometre rates and living expenses must not exceed those allowed under federal Treasury Board regulations. A rate table is available.
• rent and utilities, for example, telephone, electricity, heating and office space (if not provided free of charge).
• materials and supplies, for example, office supplies, audio and video tapes, reference books.
• costs of services or equipment rental, such as photocopying, printing, postage, and rental or purchase office equipment.
• evaluation and dissemination of results, you can claim contract fees for a third party evaluation, data collection and analysis, and dissemination of results.
• other actual expenses related to the project that do not fit in the previous budget categories, for example, training, insurance, bank charges, translation (if required).

Capital costs, for example, purchase of land. buildings, or vehicles, are not eligible expenses.

Ineligible Activities 

The following activities are not eligible for support: 

• pure research, in any discipline; 
• profit-making activities;
• direct services which are part of other governments jurisdiction;
• costs of ongoing activities of your organization; or 
• survey studies, except those carried out to support objectives of the project (such as community assessments). 

Proposal Development

Project proposals will be solicited by Health Canada from eligible organizations and priority will be given to these proposals. 
 

The Initiative is delivered through the Regional Offices of the Health Promotion and Programs Branch (for regional, provincial or local projects) and the National Office of Rural Health (for national projects). Before developing a proposal, you should contact the appropriate regional or national office to discuss your project idea and the proposal process. (See Appendix A)

Projects may be funded for a maximum of 24 months, ending no later than March 31, 2002. 

The project applicant is responsible for all stages of the project, including assessing needs, designing and developing the project, conducting the project, evaluation and dissemination of results, as well as submitting progress and final reports. 

• The Federal Government "Fiscal Year" is April 1st to March 31st. Your application must also use these dates when outlining costs for each year. 

Your formal application must provide the following information and documentation:

• A signed application form (Appendix B); 
• A completed copy of the summary budget form in Appendix B and a detailed budget. Tell us if your organization or partners are already receiving funding from other sources; 
• A summary of the project. Use one page to briefly describe your organization and partners, project goals and objectives, a summary of the activities and intended outcomes. This information may be used as public information about your project; and 
• A detailed description of the project, no more than 15 pages long. Give information which is brief and to the point. This detailed project description must include the following: 

Your Organization

Describe your organization, including:

• mission/vision, philosophy/principles and goals/objectives; 
• accomplishments; services or activities now provided; 
• other funding you receive or will receive (include government and other); and 
• reasons your organization is able to sponsor the project, for example, skills, interest, credibility.

Project Description

• describe the issues to be addressed by the project. The following questions will guide you: what evidence are you using to define the needs? How will the project contribute to improving the health of the population? 
• describe the population with and for whom the project is being developed and how they are involved in designing, developing, carrying out and evaluating the project; and 
• explain the overall intended impact of the project on the population.

Determinants of Health

• identify and describe which determinants of health your project will address and how the project goals relate to these, including the relationship among the determinants addressed. 

Goals and Objectives

Goals are broad, general statements of what the project will try to do. In one or two sentences, tell us the overall purpose of the project. Tell us how this will meet the intended outcomes of the Rural and Remote Health Innovations Initiative. 

Objectives are step-by-step statements which show how you and your partners will achieve the goals. Objectives are time-limited, concrete, realistic and measurable. They should be listed one by one. 
Activities are specific actions to achieve the Objectives, and are listed in the Work plan. 

Activities are specific actions to achieve the Objectives, and are listed in the Work plan.

Work Plan

For each objective, the Work Plan must show:

• the activities you will carry out, and how these relate to the objectives; 
• the tasks for each activity; 
• how long each activity will take, with approximate start and end dates;
• what resources are needed for each activity, including space, people, equipment, skills, time and money;
• who is responsible for each activity (board members, staff, contract workers, volunteers, members of the applying organization); 
• what other community groups have offered to provide; and 
• training or support your staff volunteers and project participants will need. 

Partnerships and Intersectoral Collaboration 

Describe your partnerships by including: 

• who from the community will be involved; what activities will each partner be involved in; 
• how and what each partner will contribute towards reaching the goals and objectives of the project; 
• how links and collaborations with other community resources and groups will be made; 
• how you will promote the participation of those directly affected by your project activities; and
• how you will promote the participation of other sectors, not usually involved in health issues. 

Evaluation Plan

An evaluation plan is required, and must relate to the project's goals and objectives. For information on how to develop an appropriate evaluation, please contact your Health Promotion and Programs Branch Office. The project evaluation will be considered in the assessment of your proposal. 

When planning an evaluation, take into consideration:

• an overall evaluation strategy for your organization and your partners; 
• what information will be gathered, including process, outputs, outcomes and impacts; 
• how information will be gathered (for example, surveys, interviews, project records); 
• who the information will be collected from; 
• who will collect the information (for example, an applicant member or organization, a consultant, an evaluation committee); Note, an external evaluation may be required in some cases. 
• how evaluation information may be used to change and improve the project as it is carried out; 
• when this will be done; 
• how you will know if your project is a success (what indicators will you use); 
• what data will be recorded throughout the project; and
• role of the partners in evaluation.

Evaluation is an important part of the Rural and Remote Health Innovations Initiative
Project sponsors will be required to participate in information-gathering activities for the overall evaluation of the Initiative. More information can be obtained from a Program Consultant. role of the partners in evaluation.

Estimate

• costs of developing the evaluation plan; 
• estimated costs for continuing collection of information; 
• cost of having a contractor do the evaluation, if appropriate; and
• total cost (if required) for evaluation. 

Plan For Sharing Results of The Project

• who will benefit from the results of the project; 
• how the project results will reach these groups; and 
• how your partners will be part of the dissemination plan. 

Project Sustainability Plan, If Applicable

Where the applicant intends the project to continue after Initiative support ends, the proposal must outline how the project will become self-sustaining. 

Budget

A contribution, either financial or in kind, from the applicant and partners, is expected.

• complete the Budget section of the Application for Funding form in Appendix B of this guide; 
• explain the various budget items in relation to project activities;
• clearly outline any contributions, whether financial or in kind, made by the applicant or a partner; 
• provide details about any support the project has received, or will receive, from other sources, including money, services, or office space; and 
• include costs for project evaluation, dissemination of results, and translation ( if required). 

Letters of Commitment

You must send us: 

• an official letter from your organization, agreeing to sponsor the project;
• name, address and telephone number of the contact person for your organization (on the application form appendix B); 
• letters of commitment from other persons or organizations supporting the project and your organization as applicant; and 
• letters from your partner organizations, describing their role. 

To be meaningful, letters must be written about your project (not photocopied form letters), show a real understanding of what you will do and identify how the organization is supporting your project.

Service to the Public

Recipients of public funds are reminded that they must respect the spirit and intent of the Official Languages Act when serving the public if services are offered to a public composed of members of both official language communities. For more information, please refer to the Treasury Board Secretariat policy under Chapter 1-4 Grants and Contributions.

How Applications will be Assessed

Additional information may be requested during the review process. 

Proposals will first be reviewed to make sure the application is complete, and fits with priorities and eligibility criteria of the Rural and Remote Health Innovations Initiative. 

Your application will then be assessed by a review committee which may include federal, provincial and community representatives. This committee may also consult with other communities or experts as part of the review process. 

The following questions will be used to review your application: 

• Does it fit?
  How well does the project meet the objectives and priorities of the Rural and Remote Health Innovations Initiative.
• Is the problem identified clearly?
  Does the application show what the issue or issues which are being addressed? Does it provide information on how this issue affects populations? 
• Are the goals and objectives reasonable?
  Are the goals sensible? Would accomplishing the objectives lead to the desired results?
• Are members of the population group affected involved?
  Does this include involvement at every phase of your project, from initial development and preparation of the proposal to the actual implementation and evaluation of the activities? Is this involvement meaningful? 
• Will the project serve official language minority communities, where appropriate? 
• Are the activities realistic? 
  Do the project activities relate to the problem, the goals and the objectives? Can they be carried out by that number of people, with that training, in that time frame?
• Can the organization do it?
  Will the goals be reached by working with community groups, agencies and the at-risk population? Is the organization able to do the activities and administer the project? 
• How does it fit in the community?
  Do the proposed activities add to and work with existing community supports and activities?
• Are intersectoral partners involved?
  Does the proposal include appropriate partnerships from both the health and other sectors, and at various levels?
• Does it have wider applicability?
  How will this project serve as a model? Will the results be useful to other groups, or in other regions of the country?
• Is the budget realistic?
  Do the budget items relate to the project goals and objectives? Are the estimated amounts reasonable? Has everything been included?
• Can the results be measured?
  How clear and measurable are the goals and objectives? How realistic are the outcomes? Can an evaluation be developed for this project?
• Will the results be spread to others?
  Is there a plan to share the results? Is there funding or other resources to support this?
• Are the activities sustainable?
  Is there a plan to carry on with the activities? Is there a need for further funding, and if so, is the source of that funding identified?

Projects recommended by the Review Committee will be sent to the Federal Minister of Health for final approval. Do not assume any commitment on the part of the Department until ministerial approval has been obtained.

We will notify you in writing as soon as your application is approved or rejected. 

The entire review will likely take three to six months before a decision is made.

Project Administration

If your project is approved, funding will be provided through a Grant or a Contribution Agreement. An agreement (contract) will be prepared for your project, containing conditions and requirements for your organization and for Health Canada. This must be signed before any payments are made. In most cases, funds will be paid on an advance basis as you need them to operate your project. You must regularly report on your spending and your activities. 

A Program Consultant will be available to provide assistance, advice and support as you operate your project. 

If approved, you should talk with your Program Consultant about: 

• your project as it has been approved (sometimes, not all elements of a proposal will be approved); 
• the operating period and dates of the project; 
• your budget and cash flow forecasts; and
• terms and conditions in the Agreement. Note: Health Canada will make public announcements of approved projects and services from time to time. 

The availability of funding after the first fiscal year depends on Parliamentary approval of continued funding for the Rural and Remote Health Innovations Initiative. 

All projects approved under the Rural and Remote Health Innovations Initiative are subject to the Terms and Conditions approved by the Treasury Board of Canada.

Project funding under the Rural and Remote Health Innovations Initiative does not imply any commitment, financial or otherwise, by any provincial, territorial or federal government department or agency beyond the approved funding period.

Appendix A

Health Canada Offices

For further information, please contact your regional or the national office, Health Promotion and Programs Branch

For projects national in scope, contact: 
Population Health Directorate Health Canada 
8th Floor, Room # B 845 
P.L. 1908C1 
Jeanne Mance Building 
Tunney's Pasture
Ottawa, ON 
K1A 1B4 
Tel: (613) 946-5100 
Fax: (613) 952 - 5310 

For projects regional in scope, contact: 

Appendix B

Application for Funding

• Application form (print friendly)

Appendix C

Population Health Fund - Budget Addendum 

As the budget is an integral part of the application, and is given careful scrutiny by the review committee, you must ensure that your figures are accurate and that each item is fully justified and in accordance with the project activities and timelines.

In addition to page 2 of the application for funding, a detailed budget is required. To further assist you, we have outlined the requirements for some of the budget category, and have provided a sample budget to illustrate this. The budget must be presented to reflect the federal government's fiscal year (April 1 - March 31).

Personnel: 
Clearly indicate salary (including benefits) and time commitment (ie., What percentage of the staff person's time will be spent on the project activities?) for all project staff. The roles and responsibilities of each should be described on a separate sheet.

Project funds cannot be used for the management or supervisory tasks involved in the ongoing, everyday operational functions of the organization, e.g., Executive Director's salary.

An employee may not receive pay from two sources for the same work period. If, for example, an employee of the sponsoring organization works 2 days per week on the project and 3 days per week for the sponsor, he/she may not receive a full week's pay from the sponsor plus 2 days per week from PHF.

Travel:
You must include calculations showing how the costs were estimated e.g., the purpose, # of people travelling and the destination(s). Mileage rates and meal allowances may not exceed Federal Government Treasury Board rates (copy available upon request). 

Rent and Utilities:
Only a portion of the rent and utilities will be considered (if not provided in-kind or free of charge); e.g., it is not acceptable for the project sponsor to charge rent for office space that is already paid from other sources. It is expected that sponsors, as part of their contribution to the project, will give project staff access to their office space and utilities. 

Evaluation and Dissemination:
Cost of the evaluation is approximately 10% of the total project cost. Please provide full budget details such as: cost for staff, of conducting the specific evaluation activity, cost of preparing and disseminating the information. 

Other:
GST should be included in all budget expenses, not as a separate item in this category. 

Ineligible Costs

• on-going costs of an organization
• hospitality
• administration or overhead fees
• entertainment
• miscellaneous or unforeseeable expenses
• gifts, honoraria
• annual conferences
• international travel