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Section II Analysis of Program Activities by Strategic Outcome

2.1 Strategic Outcome

The Agency's Strategic Outcome is healthier Canadians, reduced health disparities, and a stronger public health capacity. The following section describes the six program activities through which the Agency works to achieve the Strategic Outcome, and identifies the expected results, performance indicators and targets for each activity. This section also explains how the Agency achieved the expected results and presents the financial and human resources dedicated to each program activity.

2.1.1 Program Activity Health Promotion

Program Activity - Health Promotion

[D]

Financial Resources ($ millions)
2009-10
Human Resources (Full-Time Equivalents/FTEs)
2009-10
Planned
Spending
Total
Authorities
Actual
Spending
Planned Actual Difference
194.5 184.5* 180.9** 567.0 539.3 27.7***

*Total Authorities were less than Planned Spending mainly because funding was transferred to other Program Activities where the related expenditures were made. The overall Agency budget did not change as a result of these transfers.

**Actual Spending was $3.6M lower than Total Authorities mainly due to delays in staffing, internal reallocations to address corporate pressures such as H1N1, and delays in the solicitation process for Transfer Payments.

***Staffing delays caused lower utilization of Actual FTEs than Planned as a result of the Agency focus on responding to the H1N1 influenza pandemic and the difficulty in identifying and recruiting appropriately qualified public health professionals.

Program Activity Expected Results:

  • Canadians have increased awareness and knowledge of health and well being, the factors that influence these, and how they can play a role in improving and maintaining their health and that of their families and communities.
  • Canada has expert knowledge of the conditions that lead to inequalities in health among Canadians and has the infrastructure (e.g., policies, practices) to reduce them.
Performance
Indicator(s)
Targets Performance
Status
Performance
Summary
Knowledge, practice and policy documents produced and distributed to improve the health and well being of vulnerable groups (e.g., seniors, children, Aboriginal peoples) and/or support and inform healthy public policy and practice Establish baseline by March 31, 2010 Met all

Baseline is established at 204
PHAC disseminated 204 knowledge, practice and policy documents to individuals, health professionals, policy makers, researchers, educators, and families who contribute directly and indirectly to the creation of supportive environments and health promoting policies that enable Canadians to maintain and improve their health. These documents related to children and youth, family violence prevention, seniors, physical activity and the promotion of healthy weights, mental health promotion and mental health literacy, health inequalities, and the social determinants of health.
External cross-government and cross-sectoral collaborations to address health and public health, common determinants of health and/or social well-being Establish baseline by March 31, 2011 Somewhat met PHAC engaged in 108 national, inter-sectoral, government and international collaborations to improve public health, increase knowledge and understanding, and to develop coordinated and coherent approaches to address health equity, related determinants of health and/or social well-being.

Additional public health issues examined in cross-government and cross-sectoral collaborations included the prevention of family violence, promotion of mental health, and advancing knowledge related to seniors such as: building age-friendly communities; participating in the Federal Elder Abuse Initiative; falls prevention; older drivers; and emergency preparedness.

Further work will be undertaken to establish the appropriate baseline.
Canadians participating in health promotion programs, activities and initiatives Establish baseline by March 31, 2011 Somewhat met PHAC promoted health and healthy living directly and indirectly to reach over 660,000 Canadians.8 An estimated 37,000 parents, caregivers, and children six years of age and under facing conditions of risk participated in the Community Action Program for Children in a typical month. An estimated 18,000 pregnant and postnatal women participated in the Canada Prenatal Nutrition Program.9 Forty-five hundred children six years and under participated in 126 Aboriginal Head Start in Urban and Northern Communities sites. Six hundred forty-seven health and allied professionals participated in Fetal Alcohol Spectrum Disorder initiatives, including project development and training workshops.

 

Further work will be undertaken to establish the appropriate baseline.
Benefits for Canadians

Through its policies, programs, and activities, the Agency furthered knowledge development and built the evidence required to support health promotion strategies, so as to influence policy and action to reduce health inequalities and increase the overall health of Canadians.

In particular, PHAC's knowledge, tools, and resources help Canadians lead healthier lives by promoting topics such as physical activity and healthy eating; positive mental health; injury prevention and safety; children's health and well-being in Canada and abroad; and healthy aging/Age-Friendly initiatives across Canada.

Performance Analysis

PHAC continues to contribute evidence for policy and program decision-making on children's health and well-being in Canada and internationally by providing foundational tools and resources that can be used to assess new policies and programs from a child health and child rights perspective. The Agency is a national partner for link Aboriginal Head Start in Urban and Northern Communities (AHSUNC) National Strategic Fund (NSF). The AHSUNC NSF provided funding for an Inuit Early Childhood Education Conference, as well as cultural and nutrition products. Our Food, Our StoriesCelebrating our Gifts from the Creator10 includes nutritious recipes and pictures reflecting each culture and identity of nations, a holistic curriculum for a Traditional Aboriginal Parenting Program, and training on a National School Readiness Assessment Tool. This tool was used to measure school readiness in AHSUNC participants in the North West Territories and indicated that participants realize higher academic standing and greater social skills development. The tool has also shown that graduates maintain their progress and gains made during the AHSUNC program. It will be extended nationwide in September 2010.

PHAC Facts
link Evaluations of the CAPC and CPNP indicated that both programs were effective in promoting the health of at-risk pregnant women, infants and their families, Participants reported improved use of vitamin-mineral supplements, cessation of alcohol consumption, increased initiation and duration of breastfeeding, and decreased likelihood of low birth weight infants and preterm births along with improved child development outcomes, community capacity and personal parental improvement. Evaluations also indicated that CAPC continued to be relevant to the Canadian context and reaches the vulnerable populations (i.e., pregnant women, children and families living in conditions of risk), and contribute to their health and social development. Regional community based projects (CAPC, CPNP and AHSUNC) have been extended until March 31, 2012.

TheCPNP) and the link Community Action Program for Children (CAPC) provided funding to community-based groups and coalitions to develop and deliver comprehensive, culturally appropriate prevention and early intervention programs to promote the health and social development of pregnant women, infants, children (0-6 years) and their families facing conditions of risk. Five projects funded under the CPNP and the CAPC's link National Projects Fund focused on: developing resources and training to promote the mental health of mothers and reduce maternal depression, improving our understanding of the effects of exposure to toxic chemicals and other hazards in the physical environment on prenatal and child health, addressing childhood obesity, preventing injury in children, and helping mothers reduce or quit smoking.

Determining and communicating the risks to pregnant women and infants from the H1N1 vaccine became an important priority for the Agency during the pandemic. Progress in implementing the deliverables stemming from the 2008 Health and Environment Initiative and Consumer Safety Action Plan (enhancing national child health surveillance for congenital anomalies, developmental disabilities and disorders and product related injuries) was therefore delayed. Despite this delay, knowledge developed and experience gained from H1N1 will make important contributions to future maternal health and child health surveillance.

PHAC Facts
The built environment, (e.g., buildings, parks, schools, road systems, and other infrastructure), is a key determining factor to promote physical activity and prevent obesity. PHAC encouraged the use of health promoting features in land use and community planning with the release of its report in collaboration with the intersectoral Healthy Living Issue Group entitled link Bringing Health to the Planning Table: a Profile of Promising Practices in Canada and Abroad.

The Agency also contributed to the development of an evidence base of promising practices in community mobilization around Fetal Alcohol Spectrum Disorder (FASD), particularly for communities with scarce resources. It participated in the link Canadian Northwest FASD Partnership, an alliance of partners in the development and promotion of an inter-provincial/territorial approach on the prevention, intervention, care and support of individuals affected by FASD. PHAC worked in collaboration with the Partnership's Research Network to build the Canadian evidence base by developing and sharing tools for clinical practice, FASD prevention, and the interventions required to assist those living with FASD.

PHAC worked with provinces, territories, and other stakeholders to advance efforts on healthy living for Canadians and to reverse the trend towards childhood obesity. With its health portfolio partners, PHAC reviewed evidence and international approaches to determine priority areas for action to counteract overweight and obesity in Canada.

The HLF) made strategic investments to address the conditions that lead to unhealthy eating, physical inactivity and unhealthy weights. Projects supported aim to reduce health disparities by focusing on vulnerable populations and related settings for action. Several projects funded by the HLF took innovative approaches to reducing barriers to physical activity for children and youth. For example, link Canada Gets Active is a national community mobilization project that brings together community partners to provide free access to recreation facilities for Grade 5 students. The HLF also supported the development of environments that help make healthy choices easier ones to make, through such projects as the innovative link School Travel Planning project of Green Communities Canada, which is designed to increase active travel to and from school.

PHAC Facts
An evaluation of the link Healthy Living Program (HLP) which includes the HLF indicated that it was relevant, necessary and generally well designed. The evaluation indicated that the HLP reached vulnerable populations, facilitated changes in knowledge and behaviour related to healthy eating and physical activity among target populations, and contributed to a reduction in specific barriers to physical activity and healthy eating in the community.

Key activities implemented to support comprehensive and coordinated actions to integrate equity (including sex- and gender-based analysis) into public health research, policy and action included: the development of link A Framework to Guide Public Health Agency of Canada Action to Reduce Health Inequities; equity-focused health impact assessment tools; and renewal of the multi-sectoral Canadian Reference Group on the Social Determinants of Health.

The Agency implemented the first cycle of the Innovation Strategy through funding of innovative and multi-sectoral interventions to address inequalities in mental health and related determinants. The development of the second cycle to address health inequalities through the promotion of healthy weights is currently underway. A key objective of the Strategy is to enhance practice-based evidence of effectiveness and disseminate this information to public health practitioners.

In addition, PHAC provided ongoing co-chair and secretariat support for the F/P/T link Indicators of Health Inequalities: A report from the Population Health Promotion Expert Group and the Healthy Living Issue Group for the Pan-Canadian Public Health Network. The indicators presented in this document can be used to measure the level of health inequalities in Canada and changes over time, and will form the basis of the first pan-Canadian report on health inequalities.

With respect to seniors, PHAC has been actively promoting the implementation of the Age-Friendly model throughout Canada. The Age-Friendly Communities project seeks to engage older Canadians and their communities in making communities better, healthier and safer places for seniors to live and thrive. Since embracing the Age-Friendly model, over 100 communities of varying sizes in Canada have embarked on Age-Friendly initiatives.

PHAC and the University of British Columbia's Injury Research and Prevention Unit supported the Canadian Falls Prevention Curriculum (Accredited) Project. A first of its kind in Canada, the Curriculum taught health professionals and community leaders how to design, implement, and evaluate fall prevention programs for vulnerable older persons. The Curriculum has been well-received across the country; license agreements have been signed with almost all provinces. The workshop version of the course has been offered over 70 times across the country to approximately 1,400 participants. The E-Learning version has also proven to be very popular, and was internationally recognized in 2009 with a link Brandon Hall Bronze Award for Best Custom Content.

Lessons Learned

There is a need for more comprehensive economic analysis to inform and influence healthy public policy. Recent evidence found that some upstream preventive health interventions with a focus on social determinants of health result in cost-saving for the health system and many others are cost-effective.11 Based on this evidence, the Agency plans to develop a framework and guidelines for assessing the cost effectiveness of upstream interventions in the next fiscal year.

Some areas of the Health Promotion Programs require improved processes for project management, monitoring and reporting. These include activities such as: setting program and funding priorities; renewing and amending ongoing projects; adequately overseeing and monitoring projects to minimize financial and non-financial risk to the Agency; and measuring and reporting the results of the projects and programs that PHAC supports.12 The Management Response and Action Plan of the link Health Promotion Audit outlines the actions taken to address these matters and to strengthen the Health Promotion contribution to healthy Canadians by improving efficacy and efficiency.

PHAC's activities benefit from early, consistent and meaningful collaboration with other government departments, provinces and territories, university-based researchers, health and social service professionals, non-governmental organizations (NGOs), the private sector and youth. Advancing public health goals requires participation from all sectors, and cooperation on youth health initiatives will mean reaching a larger audience and maximizing results. The association between youth participation, reduced risk behaviours, and improved health outcomes13 indicates that decision-makers need to take action to foster partnerships across sectors which support more meaningful engagement of youth, including the utilization of new technologies which play a greater role in the lives of today's youth.

2.1.2 Program Activity Chronic Disease Prevention and Control

Program Activity - Chronic Disease Prevention and Control

[D]

Financial Resources ($ millions)
2009-10
Human Resources (Full-Time Equivalents/FTEs)
2009-10
Planned
Spending
Total
Authorities
Actual
Spending
Planned Actual Difference
60.3 50.2* 47.8** 237.4 218.0 19.4***

*Total Authorities were lower than Planned Spending mainly because some authorities were transferred to other Program Activities where the related expenditures were made. The overall Agency budget did not change as a result of these transfers.

**Actual Spending was lower than Total Authorities mainly due to delays in finalizing or implementing collaborative arrangements such as the Memoranda of Agreement for the Childhood Cancer System and funding for the National Population Health Study on Neurological Conditions. Work in both of these areas is ongoing. Furthermore, the Agency experienced considerable difficulty in identifying and recruiting appropriately qualified public health professionals and reallocated resources to focus on the H1N1 response.

***Staffing delays caused lower utilization of Actual FTEs than Planned as a result of the Agency's focus on responding to the H1N1 influenza pandemic and the difficulty in identifying and recruiting appropriately qualified public health professionals.

Program Activity Expected Result:

  • Canadians have access to science-based, authoritative and timely information and tools to support informed decision-making on preventing chronic diseases and decreasing health risks.
Performance
Indicator(s)
Target Performance
Status
Performance
Summary
Diseases tracked and reported Establish baseline by March 31, 2010 Met all

Diabetes: 6.7 per 1,000 population (2006-07)14

Cancer: 400 per 100,000 population (2006)15

Hypertension: 22.1 per 1,000 population (2006-07)
In order to establish a baseline for tracking and reporting on diseases, the Agency collected, analysed, interpreted and reported data on trends for major chronic diseases cancer, diabetes and hypertension. PHAC issued the annual surveillance report on national diabetes trends and their public health implications; provided analyses of surveillance data for the annual report on national cancer statistics; periodically published comprehensive surveillance reports on specific diseases (e.g., heart disease); and published the biannual report on the performance of breast screening programs in Canada. As a result, the baseline incident rates (i.e., age-standardized new diagnoses) have been established for tracking and reporting those three diseases.

The development of chronic disease surveillance data is ongoing, and will contribute to the establishment of a national picture of chronic disease incidence. Future activities aim to improve tracking and reporting of other chronic diseases such as asthma, chronic obstructive pulmonary disease, arthritis and others.
Chronic diseases for which risk factors are established Establish baseline by March 31, 2010 Met all

In 2009, the:

self-reported prevalence of daily smoking is 18%;17

self-reported prevalence of physical inactivity is 47%;

self-reported prevalence of persons consuming less than five fruit and vegetable portions daily is 54%

self-reported prevalence of people responding that they experience quite a bit or extremely high stress is 31%

prevalence of obesity is 24%17
The Agency has started to track more than 20 chronic disease risk factors such as tobacco, physical inactivity, nutrition, stress, weight and obesity.18

A notable report published by the Agency was 19

In addition, PHAC scientists led the development of the link Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk report, released in April 2009, which received widespread Canadian and international media attention. The Expert Panel was the first to synthesize the evidence that concluded that active smoking was a risk factor for breast cancer and reconfirmed secondhand smoke as a risk factor for breast cancer.
Interventions listed on link Canadian Best Practices Portal (CBPP) 300 listed by March 31, 2010 Met all

316 interventions listed
As of March 31, 316 interventions or best practices were published on the CBPP. In addition, the range of resources (number of documents, types of documents) was increased. This increase gives decision-makers access to emerging best practice approaches to chronic disease prevention. CBPP additions included new interventions and resources for Injury Prevention, Family Violence, Gambling, Food Security, and Mental Health.
Benefits for Canadians

PHAC contributes to improving the overall health of Canadians by working to lower the number of Canadians who develop chronic diseases and enhance the quality of life for those living with chronic diseases.

The Agency also contributed to better collaboration among stakeholders for improved coordination and sharing of knowledge on common risk factors. The Agency provides public health practitioners with data, analysis, Web tools and technical advice to support policies, program development and public health interventions. As a result, public health decision/policy-makers and practitioners were supported in making well-informed decisions about what policies and programs work in order to reduce the burden of chronic disease in Canada.

Performance Analysis
PHAC Facts
PHAC committed $10M over 3 years to launch the link National Lung Health Framework, with emphasis on high-risk populations.

More accessible surveillance information has led to enhanced knowledge about chronic diseases and their risk factors. For example, in June 2009, PHAC released PHAC was created in 2004. In addition, the annual link Diabetes in Canada surveillance report was released in February 2010, and the Canadian Cancer Statistics report was released in May 2010. A report on standardized performance measurement for cervical cancer screening programs in Canada was also released in the spring of 2009. The Agency improved its understanding of cancer and chronic diseases among the Mtis population through data collection and linkages to provincial cancer registries, physician billing and hospitalization databases. The Agency's science publications, such as link Chronic Diseases in Canada, also promote better understanding of chronic diseases and their risk factors.

PHAC Facts
By 2011, 2.6 million Canadians will have a diabetes diagnosis - a 7 percent average annual increase. Through the link Canadian Diabetes Strategy, the Agency invests $18 million annually to prevent diabetes and its complications and provide information to Canadians who are at a higher risk of diabetes.

In addition to surveillance information, the Agency helped to build the scientific evidence base by contributing to several reports and plans, including the Report on Vitamin D and Calcium Intakes20 related to disease prevention; and the summary of the symposium link Journal of Applied Physiology, Nutrition and Metabolism.

PHAC fostered innovation in developing and assessing models for chronic disease prevention at the provincial, territorial, and community levels through interventions, screening, and preventive health care. For example, the Agency disseminated risk assessment tools, such as the PHAC leveraged the Canadian Partnership Against Cancer's investment to support the creation of the link Coalitions Linking Action and Science for Prevention; PHAC is currently funding projects that will help accelerate chronic disease prevention in Canada with a focus on northern and Aboriginal communities. It also supported community initiatives such as the development of the National Aboriginal Health Organization's television broadcast health series on Inuit health to include content on gestational diabetes and type 2 diabetes prevention. This has allowed the Agency to accelerate cancer and chronic disease prevention in northern and Aboriginal communities as well as raise awareness of risk factors for diabetes and the public health implications of obesity.

PHAC Facts
In June 2009, PHAC, in collaboration with the link National Study on Neurological Diseases. This 4 year national population study will develop important knowledge about neurological disease prevalence, risk factors, health service use, and economic cost today and over the next 20 years. The federal government will provide $15 million over 4 years to fund the design of this study, working closely with the stakeholders.

Through the PHAC supported breast cancer networks working at the national and P/T level to address the information and support needs of Aboriginal, rural and remote communities as well as the needs of young women with breast cancer. Also, PHAC has provided support to cancer organizations to develop and share best practices, community-based innovations, or approaches that address underserved and rural populations. In addition, the Agency provided evaluation and decision support tools to help Canadians make informed choices such as the link Breast Cancer Screening Decision Aid. A Compendium of Best Practices to Engage Seldom or Never Screened Women in Cancer Screening has been developed, collecting more than 60 best practices which will be shared nationally with cancer stakeholders and public health organizations.

With the launch of the link Canadian Task Force on Preventive Health Care, the Agency responded to the needs of primary health care providers for evidence-based preventive health care guidelines that support the adoption of prevention in practice. In November 2009, PHAC supported, in collaboration with the Canadian Institutes of Health Research, the establishment of an Evidence Review and Synthesis Centre, to ensure rigorous systematic reviews of scientific evidence to inform the development of innovative practice guidelines and recommendations.

PHAC Facts
PHAC continues its participation as Canada's representative to the link Global Alliance against Chronic Respiratory Diseases (GARD). GARD is a voluntary alliance of 40 nations, as well as international organizations, institutions and agencies, which supports WHO in its commitment to reduce the global burden of chronic respiratory diseases.

The Agency collaborated internationally to advance chronic disease prevention and mitigation. PHAC is a WHO) Collaborating Centre on Non-communicable Chronic Disease Policy and works with the WHO as well as the Pan American Health Organization to develop, monitor and evaluate frameworks to advance the link Global Strategy for the Prevention and Control of Non-communicable Diseases. In addition, the Agency collaborates with the Organisation for Economic Co-operation and Development to conduct economic analysis of interventions to prevent chronic diseases linked to unhealthy diets, sedentary lifestyles and obesity in Canada. Experts from local, national and international organizations emphasize the importance of considering multiple policy approaches to reduce the burden of chronic disease.

PHAC has demonstrated leadership in chronic disease prevention through its membership in the link WHO's Global Noncommunicable Disease Network (NCDnet) International Advisory Committee.21 PHAC has also been involved in the development of NCDnet's Monitoring and Evaluation Strategy. The strategy will provide a logic model for monitoring all stages of planning, operations and implementation to ensure readiness for an evaluation of the impact of NCDnet in 2012-13.

Lessons Learned

A key lesson learned from a 2004 evaluation of the Canadian Diabetes Strategy was the need to capture what has been learned from the community-based projects and communicate those lessons to future projects.22 This lesson was also reflected in more recent evaluations in 2009, which identified a similar requirement to disseminate project-level evaluation findings and lessons learned to improve future projects aimed at preventing and mitigating diabetes.23 Work has begun to synthesize and evaluate the outcomes from diabetes community-based projects in order to determine the effectiveness of diabetes prevention and management strategies. These lessons are being applied to other chronic disease programming where project-level data is being collected. An important component of this work involves the timely dissemination of these findings to relevant organizations in order to inform future diabetes programming.

Since the link Canadian Breast Cancer Initiative was launched, the cancer landscape has changed and new stakeholders and networks have emerged. Their work has contributed to cancer prevention and control efforts at the local, regional and national levels. The 2008 evaluation of the Canadian Breast Cancer Initiative24 noted that planning for action on breast cancer should involve those directly affected by this chronic disease. PHAC has a role to play to ensure that the breast cancer community continues to have a forum to network, and those opportunities are created for their participation in the larger cancer community.

2.1.3 Program Activity Infectious Disease Prevention and Control

Program Activity - Infectious Disease Prevention and Control

[D]

Financial Resources ($ millions)
2009-10
Human Resources (Full-Time Equivalents/FTEs)
2009-10
Planned
Spending
Total
Authorities
Actual
Spending
Planned Actual Difference
261.3 747.2* 529.3** 831.9 992.0 (160.1)***

*The Total Authorities were higher than Planned Spending mainly due to new funding for the H1N1 vaccine and other costs of the pandemic response, for the vaccine fill line, and for initiatives in response to lessons learned from the Listeria outbreak.

**PHAC received funding for the H1N1 vaccine and other costs based on the best available information in the summer. However, by fall, the containment of the outbreak was effective which resulted in lower than anticipated costs. Funding Authorities for a new influenza vaccine fill line and the Canadian HIV Vaccine Initiative were moved to future years, which resulted in lower Actual Spending in 2009-10.

***The variance between Planned and Actual FTE utilization is mainly due to hiring for H1N1 response activities and successful staffing of new employees through a recruitment drive.

Program Activity Expected Results:

  • Reduced incidence of infectious diseases of public health importance in Canada.
  • Improved response to infectious disease outbreaks in Canada both in the health care and community settings.
Performance
Indicator(s)
Target Performance
Status
Performance
Summary
Incidence of tuberculosis, viral hepatitis, sexually transmitted infections (STIs), West Nile Virus (WNV), and HIV among Canadians Establish baseline by March 31, 2011 Somewhat met25

Tuberculosis (TB) baseline:
4.8 per 100,000 (2007)

TB target:
3.6 per 100,000 by 2015
The 2007 incidence rate of 4.8 per 100,000 was the lowest TB rate ever reported in Canada, and represents good progress toward the Canadian target of 3.6 per 100,000 by 2015. Provisional data for 2008 indicates that the incidence rate would remain unchanged from 2007. Much work remains to be done to decrease the high rate of TB in the Aboriginal population.

The prevention and treatment of STIs is a significant public health challenge in Canada. Between 1998 and 2007, the reported rate of chlamydia increased by 4%, with approximately 74,000 cases reported in 2007. The number of reported cases is an underestimate of the true incidence and burden of infection due to the high proportion of asymptomatic cases that remain undiagnosed. Due to underreporting, comprehensive incidence rates are not available at this time. Gonorrhea and syphilis pose similar concerns.26

The Enhanced Hepatitis Strain Surveillance System (EHSSS) measures the incidence of hepatitis B and C in select Canadian jurisdictions (covers 40% of the Canadian population). Diagnoses of acute hepatitis B declined from 0.74 per 100,000 people in 2008 to 0.56 per 100,000 people in 2009. Diagnoses of acute hepatitis C declined from 2.40 per 100,000 people in 2008 to 1.88 per 100,000 people in 2009. Given the complexities associated with the symptomatic /asymptomatic proportions of hepatitis B/C, there is no established baseline for these diseases as of yet. Compared to other countries, Canada has low rates of hepatitis B (3.3 per 100,000 in 2007) and C (2.2 per 100,000 in 2008). Incidence rates are considerably higher among Aboriginal populations and other at-risk groups, where improved vaccine coverage and other infection control measures would be of benefit.27
WNV baseline and target range:
0.025 - 7.06 per 100,000 (2009)
WNV risk and incidence of human cases are significantly influenced by factors such as weather and climate leading to wide inter-annual variations in human case incidence. National human WNV case surveillance data are obtained in a timely manner (weekly during WNV season) from all provinces and territories, and have been collected from 2002-2009 to establish baseline data and variations from this baseline.

The incidence rate for HIV has remained essentially unchanged for the past five years. There has been an increase from 8.8 per 100,000 in 2007 to 9.9 per 100,000 in 2008, and Canada ranks in the mid-range among developed countries.28
Agreements with provinces and territories on information management during outbreaks where there is a federal role 40% of P/Ts have agreements for improved information sharing by March 31, 2011 Mostly met All F/P/T Ministers of Health signed two memoranda of understanding on link Provision of Mutual Aid in Relation to Health Resources During an Emergency Affecting the Health of the Public.

A Multi-lateral Information Sharing Agreement (MLISA) on infectious diseases is currently under development through a PHAC-supported F/P/T task group. This agreement will include biological substances, a generic main body on infectious disease, and technical schedules dealing with specific infectious diseases and public health events.
Benefits for Canadians

The Agency contributes to reducing both the risk of acquiring and the burden of infectious diseases in Canada. The Agency's surveillance and public health assessment activities work to improve access to key data and reduce the impacts of infectious disease outbreaks. The Agency's science and innovation activities develop leading-edge methods of assessment for monitoring and evaluating public health risks.

Through application of the legislative and regulatory provisions of the link Quarantine Act and other public health measures including the provision of quarantine officers at major ports of entry, the Agency contributes to the protection of Canadians against the importation of infectious diseases which pose a threat to public health. It collaborates with key partners such as the Canadian Border Services Agency to contribute to heightened screening by asking additional health questions and through public health messaging by distributing Health Alert Notices handouts, on-board messaging and posters at international airports.

Performance Analysis

Outlining future directions for a renewed public health response to address hepatitis C, the Agency released its link Strategic Framework for Action in June, 2009. The renewed Hepatitis C Program, through inter-sectoral collaboration and partnerships, funded 48 projects across Canada addressing three key themes:

  • research and surveillanceprojects under this theme centred on contributing to better treatments, innovative technologies, more effective public health responses and new evidence-based policies as well as better surveillance and epidemiology data collection and analysis tools;
  • care and awarenessthis theme's projects focused on capacity-building opportunities for health and social services professionals, researchers and community-based organizations and strengthened models of care and treatment for vulnerable and under-served populations; and
  • prevention and community-based supportinvestment in these projects aimed at creating, enhancing and sustaining linkages between co-infection with other infectious diseases, populations and health determinants, common risk factors and population health/health promotion approaches, as well as increasing community-based capacity to ensure relevant programmatic responses to localized prevention needs and/or priorities.
PHAC Facts
The Agency's support and funding of the Pacific AIDS Network (PAN) (a provincial network of over 55 community-based organizations devoted to the care, treatment and support of persons living with HIV/AIDS, co-infected with HIV or at risk) provided the stimulus for its new focus on professional development and capacity building for member agencies. In April 2010, PAN's Executive Director was awarded the BC Persons with AIDS Society link ACCOLAIDS Award honouring her role in Social/Political/Community Action.

In the battle against HIV, the Agency's link National HIV and Retrovirology Laboratories (NHRL) continue to provide highly specialized diagnostic services for provincial, national and international stakeholders. It manages a range of laboratory quality assurance and monitoring programs for patient care and treatment. The NHRL is accredited to the ISO 15189 Standard (i.e., Medical Laboratories Particular Requirements for Quality and Competence) and is the sole Canadian lab to be accredited to this standard.

Knowledge of the factors that contribute to the spread of HIV infection was advanced through augmented HIV and risk behaviour surveillance programs and through reporting on current surveillance data, research, current responses, emerging issues and gaps for at risk populations. Targeted epidemiological studies were developed and enhanced. Work continued with provinces and territories to enhance link HIV surveillance and reporting, and memoranda of agreement were developed to support the province-based work of Field Surveillance Officers and the tracking of HIV strain and drug resistance in Canada.

HIV/AIDS sentinel surveillance programs continue to be established and implemented among at-risk populations in order to develop targeted studies to address issues arising from case-reporting surveillance. The surveillance information provides statistical support for HIV/AIDS modelling efforts to assess the hidden epidemic and produce national HIV estimates.

PHAC Facts
The Government of Canada Assistant Deputy Minister Committee on HIV/AIDS hosted the first link Interdepartmental Policy Forum on the Determinants of Health and HIV/AIDS. Fourteen federal government departments and agencies forged linkages and a shared understanding of  potential synergies across federal mandates, target populations and priorities. The results of the Forum include the identification of common barriers to horizontal collaboration; strategies to overcome the barriers; and consensus to build an all-of-government approach to address the broader social and economic determinants of health.

The construction of a pilot-scale manufacturing facility for the production of a safe, effective, affordable and globally accessible HIV vaccine did not move forward as planned. An open and transparent selection process for a Not for Profit Corporation to build and operate a pilot scale clinical trial lots manufacturing facility was completed; however, none of the applicants were found to be successful in meeting pre-established criteria. link The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility given a shift in landscape which demonstrated that there was sufficient manufacturing capacity. Subsequently, in July 2010 the Government of Canada and the Bill & Melinda Gates Foundation announced the renewal of the Canadian HIV Vaccine Initiative, with the establishment of a new Research and Development Alliance as its cornerstone.

Canada was alert to the risk of an emerging respiratory infection from Mexico (H1N1) and detected the early cases in Canada. Within days, clinical guidance and infection control documents were posted on the Agency Web site. In consultation with P/Ts and professional groups, the Agency developed 44 clinical guidance documents over the course of the pandemic and weekly media briefings led to high levels of preparedness and confidence in the government response. Highlights of the Agency's activity with respect to H1N1 were the partnerships that emerged and the high level of collaboration among all the stakeholders. Canada was known internationally as having one of the best vaccine contracts and highest vaccination rates in the world.

The Canadian Network for Public Health Intelligence continues to be a key technology platform for the Agency's national surveillance, real-time alerting and response, and delivered two new applications as part of the F/P/T response to the H1N1 outbreak. One, an interactive Web-based platform for real-time interpretation and analysis of laboratory test results to support analysis and reporting during the H1N1 outbreak, and two, a platform for rapid real-time surveillance and monitoring of pandemic influenza associated pneumonia and risk factors using primary care electronic medical records.

PHAC Facts
The H1N1 outbreak provided an opportunity to examine the antiviral drug management and supply strategy. Based on lessons learned as identified by the Clinical Care and Antiviral Task Group following the pandemic, the Agency is in process of re-examining the composition and quantities of antiviral stockpiles.

Fulfilling the commitment to develop leading-edge methods of evaluating the health risk of emerging pathogens, the Agency created real-time polymerase chain reaction (Q-PCR) platforms to detect the H1N1 virus and identify H1N1 drug-resistant strains. The implementation and use of Q-PCR platforms played a significant role in the Agency-wide response to the H1N1 outbreak by providing rapid, more accurate assessments of confirmed cases and facilitating more informed decision making at F/P/T levels.

The Agency conducted economic and social impact analyses of the H1N1 influenza pandemic on Canadians; modelling studies on the spread of the H1N1 outbreak are ongoing. The evergreen Canadian Pandemic Influenza Plan formed the basis of the H1N1 response; this year four annexes were updated.

In June 2009, the Agency launched an information campaign for new parents called link A Parent's Guide to Immunization in 10 languages, which covers vaccine safety, the importance of on-time immunization, information on the 13 serious diseases that can be prevented by vaccines, and provides parents with information to help them understand what they should expect when their child gets immunized. As of March 31, 2010, over 56,000 copies of the guide have been ordered through 1-800-O-Canada.

The Agency has taken positive steps regarding vaccine safety surveillance. Contributing to this effort is a strengthened sentinel hospital surveillance system which shares more detailed information regarding children with serious vaccine-associated adverse events. One trade-off associated with the focus on H1N1 is the maintenance, as opposed to enhancement, of current activity in vaccine preventable disease surveillance.

PHAC Facts
The link Canadian Nosocomial Infection Surveillance Program and other blood safety surveillance programs continue to monitor infectious diseases, their risk factors, and determinants of health. A new program, the Cell, Tissue, and Organ Surveillance System is in its pilot stage.

The Agency's CNISP) has provided early detection of novel influenza viruses and monitoring of severe morbidity/mortality during a pandemic through link FluWatch since 2005. In a repeat point prevalence survey for healthcare-associated infections (HAIs), the CNISP reported that 12.4% of patients admitted to Canadian acute-care hospitals had one or more HAI. The prevalence of HAI increased 11.7 percent from 2002 to 2009. The increase was seen primarily in adults in whom the prevalence increased by 17.1 percent, whereas in children, the prevalence decreased by 6.6 percent.29

Collaboration to develop modelling capacity to predict West Nile virus is ongoing and Agency research related to infection prevention and control of influenza in healthcare settings was completed. Results will be available in 2010-11.30 The Agency's link Special Pathogens Program began development of a new platform to test human or animal serum samples for up to 10 different biosafety level 4 viruses at one time per sample. Tests were developed for detecting novel vector-borne pathogens to assist scientists in identifying new mosquito-borne viruses and to issue alerts to P/T public health labs and health departments. As well, Agency science activities at the human-animal-environment interface have been published in 60 national and international journal articles this past year.

PHAC Facts
In October 2009, the Agency's National Microbiology Laboratory was granted full entry into the Global Polio Laboratory Network and given formal accreditation as a Pan American Health Organization/World Health Organization Polio Regional Reference Laboratory.

The Agency also worked to establish a more holistic approach to disease prevention and population risk characterization with a view to include determinants from agriculture and the environment for the benefit of humans and animals. Satellite technologies were used to collect global information about factors that can affect public health and to enhance surveillance methods. Newly developed Agency tools of geospatial information systems were also used to track the spread of H1N1 in order to develop the appropriate outbreak response. And building on lessons learned in 2008-09, the link Centre for Food-borne, Environmental and Zoonotic Infectious Diseases is collaborating with the CFIA and other partners to develop an Integrated Risk Assessment (IRA) capacity to strengthen our ability to evaluate and respond to zoonotic disease threats. Continued work in the area of emerging pathogens resulted in the National Microbiology Laboratory developing high capacity tools for identifying and classifying potential threats to public health in Canada and monitoring the evolution of these threats over time.

The Agency continued to develop innovative approaches to mitigate the incidence of infectious and chronic diseases based on the analysis of human genetic risk. Novel genetic biomarkers are under development that will lead to earlier detection, enhanced monitoring and action through identification of vulnerable subpopulations that can be targeted for risk prevention.

Lessons Learned

Although Canada remains a leader in immunization and generally compares favourably with other Organisation for Economic Co-operation and Development countries, research and analysis indicates that there is room for improvement. The 2007 Interim Evaluation of the National Immunization Strategy (NIS) identified four gaps relating to: 1) lack of public health research; 2) less than optimal coordination between the Canadian Immunization Committee and the National Advisory Committee on Immunization; 3) insufficient attention to special populations (mobile populations, immigrants, Aboriginal peoples); and 4) lack of sustainable funding models. Building on the Interim Evaluation of the NIS, policy research and analysis is being carried out to further substantiate and determine lessons learned, as well as any necessary corrective action to strengthen the NIS. Options and recommendations are under development.

The H1N1 response demanded timely reporting of hospitalizations and deaths. There is a need for the Agency to develop a common, reliable and accurate electronic system to link epidemiological and laboratory information to support laboratory handling of emerging pathogens, and an information strategy to efficiently distribute clinical guidance to front-line health care providers. The Agency undertook a surveillance project that successfully established an additional set of conceptual and analytic tools and expertise concerning the spread of H1N1, the results of which are being prepared for publication. The project noted that the receipt of data defining the extent of illness and ready integration of surveillance data with epidemiological modelling is critical to predict and assess pandemic risks. Work related to this modelling is ongoing.

As per its federal obligations, PHAC undertook a link Summative Evaluation of the Blood Safety Contribution Program (BSCP), covering the period of 1998 to 2008. The Agency has accepted and taken action on all the report's recommendations. Highlights of progress against the recommendations include: the Transfusion Transmitted Injuries Surveillance System which now covers 83 percent of the red blood cell transfusion activity in Canada; the Transfusion Error Surveillance System which provides an improved characterization of transfusion errors; and the piloting of the Agency's new Cell, Tissue and Organ Surveillance System. PHAC's response to the evaluation demonstrates its continued commitment to maintaining the confidence of Canadians in the safety of the national blood supply.

Major findings of the May 2009 link Federal Initiative (FI) to Address HIV/AIDS in Canada Implementation Evaluation Report identified that the FI is in an advanced stage of implementation and that key outputs aligned with outcomes. Findings and recommendations focused on opportunities to strengthen performance measurement, information management systems and horizontal management. The Management Response and Action Plan developed to address the recommendations is on track.

2.1.4 Program Activity Emergency Preparedness and Response

Program Activity - Emergency Preparedness and Response

[D]

Financial Resources ($ millions)
2009-10
Human Resources (Full-Time Equivalents/FTEs)
2009-10
Planned
Spending
Total
Authorities
Actual
Spending
Planned Actual Difference
32.3 67.8* 39.2** 200.2 199.6 0.6

*The variance between Planned Spending and Total Authorities is mainly due to additional funding received for H1N1 response and security for the Vancouver 2010 Olympics.

**Actual Spending was lower than Total Authorities mainly due to the H1N1 influenza pandemic being less severe than originally forecasted, resulting in lower laboratory costs and pandemic response requirements.

Program Activity Expected Result:

  • Canada is prepared to respond to public health risks caused by natural and human-caused emergencies including infectious disease outbreaks, hurricanes, floods, earthquakes, Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies and to recover from the aftermath of these emergencies.
Performance
Indicator(s)
Target Performance
Status
Performance
Summary
Extent to which events and exercises are useful in enhancing the Agency's management of emergencies Lessons learned are carried out for 100 percent of events and exercises Met all

Events and multipartite exercises have been instructive in identifying gaps related to the Agency's overall management of emergencies. For example, H1N1 and the 2010 Olympic Winter Games in Vancouver tested the ability of the Agency to manage multiple public health events. These experiences suggest that:

Canada has the capacity for public health interventions including emergency response;
the Agency enhances the ability of public health organizations to carry out core public health responsibilities;
Canadian public health workers and first responders have the competencies required to carry out effective public health functions;
there is improved inter-operability and response capacity among relevant pan-Canadian agencies;
public health risk reduction and management plans establish clear roles and responsibilities and are managed in a timely manner; and
there is enhanced collaboration among F/P/T, international and NGO public health partners.

Opportunities for improvement in emergency preparedness at the Agency exist with respect to planning, equipment, training and preparation.

Percentage of implementation of the International Health Regulations in Canada Meet compliance obligation 100% by 2012 Exceeded Canada completed a self-assessment of the ability of existing F/P/T structures and resources to meet the minimum core capacity requirements of the International Health Regulations (IHR). Canada already meets the minimum requirements; however, 10 areas could be strengthened. An action plan to address these areas has been approved by F/P/T IHR Champions. A Pan-Canadian Capacity Assessment Report: Process, Findings and Action Plan will be published in the fall of 2010.
Benefits for Canadians

Ensuring Canada's regulation development and compliance, and emergency response protocols and capacity reduce the potential harm to Canadians and increase the nation's recovery speed from a public health event is an ongoing effort requiring continuous improvement and attention. Threats to the health and security of Canadians are mitigated during international public health emergencies; risks are identified, planned for, and managed during international and domestic mass gatherings; and 24/7 health emergency response and quarantine capability and capacity contribute to the health and safety of Canadians. An all hazards approach31 is ongoing.

To this end, the Agency: delivers and implements the highest quality national regulation taking into account international standards and obligations; maintains a stockpile of medical supplies for use as required anywhere in Canada; screens for and contributes to the containment of potential threats to public health at all points of entry to Canada; and provides ongoing services, inspection and expertise to enhance the safe handling and security of human pathogens and toxins.

Performance Analysis

Central to the Agency's Emergency Preparedness and Response capacity is the Health Portfolio Operations Centre (HPOC). It serves as the main communications access point for stakeholders and manages the joint response of Health Canada and the Agency to public health events. Operating 24/7 during the response to the H1N1 influenza pandemic and the Vancouver 2010 mass gathering event, HPOC produced and disseminated to national and international stakeholders the Fusion Report32 and ensured that Canada was International Health Regulation (IHR) compliant in its ability to respond to inquiries and to communicate information on events of international public health concern.

The Agency established the Pan Regional H1N1 Task Force Working Group. Regional Health Portfolio staff were trained in all Regions to work in Regional Emergency Coordinating Centres and implemented the federal health response to local emergencies in cooperation and partnership with F/T/P public health officers. Together with the establishment of a Regional Liaison Officer role these activities ensured a comprehensive and consistent emergency response across the nation. PHAC's Regional Offices have completed the H1N1 Pan-Regional After Action Reportand are acting on lessons learned.

PHAC Facts
The Agency supplemented its link National Emergency Stockpile System as part of its on-going modernization strategy. Over 400 ventilators, including those with pediatric capabilities, were added. A new mini clinic was developed and deployed for use during mass gatherings.

The Agency also supported F/P/T Health Emergency Response Networks such as the Council of Emergency Social Service Directors, Council of Health Emergency Management Directors, Council of Emergency Voluntary Sector Directors, the National Municipal Emergency Social Services Network and the National Emergency Psychosocial Advisory Consortium. All groups were active and maintained ongoing communication, producing deliverables such as Psychosocial Fact Sheets to enhance the H1N1 response.

Fundamental to the effective implementation of public health preparedness and capacity strategies are plans. The Agency: completed the Health Portfolio Emergency Response Plan; implemented an Emergency Preparedness and Response Plan with Standard Operating Instructions within the Incident Command System (ICS) utilized at the 2010 Olympic Winter Games; applied the laboratory component of the link Canadian Pandemic Influenza Plan during H1N1, improving communication and collaboration; and implemented the pan-Canadian Health Incident Management System, which wasused during the second wave of the F/P/T H1N1 response from October-December 2009. The Agency also implemented a mass gathering health emergency response plan for the Vancouver 2010 Winter Olympics and Paralympics in partnership with stakeholders. Twenty-one physicians, nurses and respiratory therapists from the Agency's Health Emergency Response Team were part of the medical team that staffed the Mobile Medical Unit during the 60-day medical operational period. To help ensure sufficient capacity at a time of crisis, the Agency has initiated discussions with regulatory bodies on inter-jurisdictional licensing of health professionals.

PHAC is also collaborating on an ICS for improved coordination and capacity during foodborne illness outbreaks with Health Canada and the Canadian Food Inspection Agency. Rooted in the link Foodborne Illness Outbreak Response Protocol, one of many initiatives underway to link improve food safety.

The Agency's emergency contracting plan was instrumental in our response to the H1N1 outbreak. The plan allowed the Agency to quickly increase the number of staff members and ensure they were ready to maintain open lines of communication and to secure timely approval for critical purchases. The Agency's procurement staff were able to work from anywhere at any time to purchase required medical supplies on behalf of all provinces and territories.

The Agency continues to build emergency preparedness capacity across Canada. As part of the Royal Canadian Mounted Police-led Integrated Security Unit, the Agency successfully commissioned and deployed the Microbiological Emergency Response Team (a mobile lab-truck and lab-trailer) to the 2010 Vancouver Winter Olympics. These advanced laboratory assets are now a key part of the Agency's capacity to enhance security at major international events, with PHAC scientists providing rapid in-field detection and assessment of high-risk pathogens.

PHAC Facts
The Agency continues to expand its human resource capacity. In 2009-10 the Agency trained 800 health care professionals across Canada in public health emergency preparedness and response including CBRN response. Three hundred federal employees were trained to respond to a public health emergency. Ongoing emergency training exercises refresh and update their training and ensure readiness for future public health events.

Regulation is a key component for protecting Canadians from public health emergencies and mitigating the impact should they occur. The passing of the link Human Pathogens and Toxins Act (HPTA) in June 2009 established the legislative framework for ensuring enhanced safety and security in the handling and management of imported and domestically acquired human pathogens and toxins. The Agency has a detailed five-year project plan outlining activities, timeframes and human resources required to implement the necessary program and regulatory framework of the HPTA in consultation with the provinces and territories.

Canada has contributed to several international initiatives in support of global emergency preparedness and response. With respect to IHR, the Agency has surpassed the commitment to achieve compliance by 2012 and has constructed an action plan to go beyond compliance. The Agency assisted the WHO in the development of guidance documents and training courses required for the international implementation of the IHRs. Through the link Global Health Security Action Group the Agency supported rapid information exchange during the H1N1 influenza pandemic and encouraged cooperation among member states.

An outstanding commitment of the Agency from 2009-10 is the finalization of the Quarantine Service Framework for Cooperation document with provinces, territories and local health authorities. The target for completion of the document is December 2012.

Lessons Learned

In order for the Agency to respond to future outbreaks like H1N1, critical human resource skills and competency shortfalls will need to be addressed. It will be vital for the Agency's future operations to ensure all employees have access to emergency preparedness training. Renewed efforts must be made to further define and deliver practical learning programs to employees to ensure surge capacity for outbreak management. Multipartite simulation exercises identified some minor gaps and opportunities for improvement in planning, equipment, training and preparation of Agency personnel to better react to public health events and emergencies.

The experience of H1N1 also identified the need for a tiered planning approach to pandemic response. Not all pandemic outbreaks will require 100 percent capacity to contain and manage; response plans should be developed for mild, moderate and severe pandemics.

The complexity of the interfaces and interplay among F/P/T health organizations during the H1N1 influenza pandemic revealed a greater than anticipated communication challenge. Cooperative action enabled all organizations to adapt individual emergency response systems. Clarity on the roles and responsibilities in pandemic response was enhanced, strengthening the Agency's ability to respond to future public health events.

Despite the successful passing of the HPTA, statements made by witnesses who appeared throughout the parliamentary process indicated that the level of stakeholder consultation in the preliminary drafting of the legislation was insufficient. Robust and meaningful stakeholder consultations will occur in subsequent phases in accordance with the principles outlined in the Cabinet Directives on Streamlining Regulations. Pre-consultations with provinces, territories and key stakeholders will inform a consultation plan that will be followed throughout the program and regulatory development process.

2.1.5 Program Activity Strengthen Public Health Capacity

Program Activity - Strengthen Public Health Capacity

[D]

Financial Resources ($ millions)
2009-10
Human Resources (Full-Time Equivalents/FTEs)
2009-10
Planned
Spending
Total
Authorities
Actual
Spending
Planned Actual Difference
31.1 37.8* 35.5** 222 170.8 51.2***

*The variance between Planned Spending and Total Authorities is mainly due to new funding received for Listeria and collective bargaining.

**The variance between Actual Spending and Total Authorities is mainly due to delays in staffing as a result of the Agency's focus on responding to the H1N1 outbreak. Also, the new Listeria funding was not fully utilized, though all work continues.

***The variance between Planned and Actual FTE utilization is mainly due to staffing delays resulting from the Agency focus on responding to H1N1.

Program Activity Expected Result(s):

  • Canada has the public health workforce, information, laws and ethical frameworks needed to meet Canada's public health needs.
Performance
Indicator(s)
Target Performance
Status
Performance Summary
Public Health Capacity Index Baseline by March 31, 2012 Not available As part of the development of the 2010-11 Performance Measurement Framework (PMF), consultation with program experts led to a decision to use the PMF indicators to report progress on strengthening public health capacity instead of the PH Capacity Index. An internal working group has been struck to establish, validate and monitor public health capacity indicators. Alignment of approaches to further develop public health indicators is in progress through the pan-Canadian Public Health Network Expert Groups.
Benefits for Canadians

Canadians benefit from a public health workforce with the skills and knowledge to enhance Canada's ability to detect and take action on major health issues. The Agency helps to build this skills and knowledge base by: identifying learning needs and requirements for the public health workforce; providing learning opportunities; establishing professional development tools and programs; and developing workforce measurement tools to guide public health human resource planning.

Performance Analysis

Over the last year substantial advances have been made on the path towards a competency-based Learning Framework for the Agency. These include the establishment of PHAC's Learning Council in June 2009, which is a critical first step in the development of the Learning Framework. Achievements of the Learning Council include: establishment of a network of subject matter experts; endorsement of a EC) classification; the Emergency Preparedness and Response Branch's Learning Framework; a pilot for automated Performance Discussion Process/Personal Learning Plan (PDP/PLP); and improved sharing of information regarding learning across disciplines. Other progress in this area includes: a pilot development program for physicians entering PHAC; an link internship program for public health master's students; and a community medicine residents' program designed to strengthen collaborative relationships with schools of medicine across Canada.

An operational review was completed for the link Canadian Field Epidemiology Program (CFEP) and a restructuring of the program was implemented. A formal evaluation of CFEP will be carried out within the larger Agency review of its Field Services.

Complete establishment of the Canadian Public Health Service Program faced significant challenges including staffing in remote locations, and an extremely high volume of responses to the call for applications.

The Agency continued to support the ongoing operations of the link Public Health Human Resources Task Group by establishing critical paths for two public health priorities that were identified for increasing capacity: quality graduate public health education; and public health enumeration.

In collaboration with the University of Manitoba and the Federal Student Work Experience Program and Cooperative Education Programs, PHAC continues to provide training programs under the supervision of National Microbiology Laboratory (NML) scientists to post-doctoral fellows from around the world, local post-graduate medical fellows, graduate students and undergraduate students from across Canada. Over 180 individuals worked at NML in internship placements ranging from several months to several years in duration.

The Agency's Laboratory Liaison Technical Officer Program is in place with memoranda of agreement with seven participating provinces. During the H1N1 outbreak, these positions supported the laboratory portion of the link Canadian Pandemic Influenza Plan and strengthened the coordination of the pan-Canadian response.

PHAC led negotiations with Ministre de la Sant et des Services sociaux and other provincial departments with regard to the launch of new programs and initiatives, as well as all agreements including intergovernmental agreements, contributions, and grants for all PHAC centres in order to ensure compliance and effective F/P/T relations.

PHAC Facts
During the H1N1 outbreak, the Agency responded by protecting Canadian points of entry through the deployment of staff, collaborating with key partners to increase screening, and through public health messaging. The Agency implemented an approved Data Quality Framework, and developed an Integrated Framework for Surveillance and a Risk Management Standard for surveillance activity and tools.

Another area of focus is strengthening the Agency's surveillance function and surveillance coordination. PHAC has taken positive steps towards understanding the implications of managing privacy in its surveillance activities. The Agency has developed a Privacy Management Framework which includes, for example, the employment of a Web-based tool for Privacy Impact Assessment with the Agency and a Policy on the Collection, Use and Dissemination of Public Health Data, currently under implementation.

The Agency has taken a leadership role in the adoption of next generation technologies for surveillance case management data and information (e.g., pilot deployment of a Web-based single national component of the Panorama case management tool) in order to improve the collection and analysis of health information and for the coordination of federal, provincial, and territorial responses to disease outbreaks including foodborne illnesses. PHAC is also a member of link Canada Health Infoway's pan-Canadian Standards Collaborative enabling the Agency to lead in the development of data and terminology standards for public health.

With links to Agency priorities such as surveillance and compliance with the International Health Regulations (IHR), the Agency is working through the link Information Sharing During a Public Health Emergency and link Provision of Mutual Aid in Relation to Health Resources During an Emergency Affecting the Health of the Public.are in place and form the initial building blocks for more detailed agreements. A formal multi-lateral information sharing agreement is under development by the relevant expert groups of the Network. Detailed negotiations are taking place to determine the public health circumstances under which information will be shared, what information and with whom it will be shared, and through which mechanisms it will be shared. The development of this multi-lateral information sharing agreement is integrated into the pan-Canadian IHR action plan.

The Agency's continuing efforts to facilitate decision-making include:

  • establishing a team to support the corporate population health and epidemiological information needs by providing a focal point for population health assessment, one of six core public health functions;
  • supporting the National Collaborating Centres for Public Health by completing the funding renewal process in March 2010 (up to five years between 2010 and 2015) for workplans focused on bridging the gaps between research, policy and practice in public health;
  • enhancing ethics considerations in research through the link Research and Ethics Board. This partnership between Health Canada and the Agency was implemented on April 1, 2010 and formalizes the ethics review process; and
  • developing additional modules with provincial and territorial partners as part of the link Canadian Network for Public Health Intelligence (CNPHI) (e.g., a Web-based tool for real-time interpretation and analysis of laboratory test results).
PHAC Facts
PHAC Executive has recently approved the implementation of its Public Heath Ethics Advisory Committee to provide advice and guidance to the Agency. Additionally, a national ethics framework will be explored through discussion with Health Portfolio members and appropriate P/T fora. These activities will benefit the health of Canadians by ensuring there is a national ethics framework for decision-making in place before a public health event occurs.

The management of science is another aspect of strengthening public health capacity. H1N1 proved an effective testing ground for new decision-making models. The Chief Public Health Officer's H1N1 Flu Virus Science Advisory Committee anchored PHAC's decision-making in science, ensuring the most effective and appropriate precautions protected Canadians throughout the H1N1 influenza pandemic.

For the long-term, the Agency is establishing a Science and Research Strategic Plan to align science, program and policy development. Championed by the Chief Public Health Officer, ongoing work in this area will result in an Agency-wide policy framework for the development and integration of science-based knowledge. It is expected to be completed in the spring/summer of 2011.

Lessons Learned

The successful implementation of cross-Agency mechanisms and the establishment of a collaborative culture to coordinate PHAC's surveillance function require ongoing commitment at all levels of the organization to support the goals, objectives and governance structure of the Agency's Surveillance Strategic Plan.

Two waves of pandemic H1N1 have demonstrated the need to ensure that all PHAC employees have access to critical public health knowledge and emergency preparedness training. In addition to the establishment of a secretariat office which coordinates surge capacity under the Foodborne Illness Outbreak Response Protocol, renewed efforts are required to further define and deliver practical public health learning programs to Agency employees in order to ensure appropriate surge capacity for multi-jurisdictional outbreak management. Greater numbers of employees with the necessary technical skills to manage outbreaks are needed across the country.

2.1.6 Program Activity Internal Services

Financial Resources ($ millions)
2009-10
Human Resources (Full-Time Equivalents/FTEs)
2009-10
Planned
Spending
Total
Authorities
Actual
Spending
Planned Actual Difference
74.0 114.9* 111.5** 376.4 438.4 (62.0)***

*The variance between Planned Spending and Total Authorities is mainly due to transfers from other Program Activities to increase the capacity of the Agency's financial and administrative infrastructure. Total Authorities were adjusted to reflect expenditures that were incurred by Internal Services on behalf of other Program Activities.  For example, costs of communication services increased significantly due to the need to communicate with Canadians during the H1N1 pandemic. Also, funding for an addition to the Canadian Science Centre for Human and Animal Health (CSCHAH) is included in Internal Services.

**The variance between Actual Spending and Total Authorities is mainly due to delays in construction on the JC Wilt laboratory, CSCHAH expansion, and planned renovation projects.

***The variance between Planned and Actual FTE utilization is mainly due to hiring for H1N1 response activities, additional staffing required for new projects (e.g., Human Pathogens), and internal reallocations requiring realignment from other program activities.

Program Activity Expected Results:

  • The communications, service operations and programs of the Agency comply with applicable laws, regulations, policies and/or plans and meet the diverse needs of the public.
  • Strategic Allocation and prudent use of resources among programs, processes and services.
  • Information technology and management that supports government priorities and program and service delivery.
  • Assets are acquired and managed in a sustainable and financially responsible manner, throughout their lifecycle, to support cost-effective and efficient delivery of government programs and services.
Performance Indicator(s) 33 Target Performance
Status
Performance
Summary
Compliance with the statutory time requirements of the link Access to Information Act and Privacy Act A rating (95% and above) Mostly met PHAC achieved a compliance rate of 83.1%. This compares to a federal department average of only 48% within the 30-day statutory timeline and 66% compliance with allowable timeline extensions reported for 2008-09.34
Compliance with the link Government of Canada Communications Policy 100% Met all Activities in relation to risk communications are compliant with the Government of Canada Communications policy.
Compliance with the link Government of Canada Official Language Act 100% of executives meet the language profile of their position

Number of active official languages complaints is zero
Somewhat met 85% of executives meet the language requirements of their position. Human Resources is actively supporting the remaining executives (15%) in their efforts to achieve required language levels within designated time frames.

Of the 17 official language complaints, six have been closed with the Office of the Commissioner of Official Languages (OCOL), seven have been sent to OCOL for closure, and four remain active.
Compliance with the link Government of Canada Employment Equity Act Aboriginal People 3.3% Met all PHAC Representation April 1, 2009
Aboriginal Peoples: 3.5%
Persons with Disabilities 4.3% Persons With Disabilities: 4.3%
Visible Minorities exceeds 12.9% Visible Minorities: 13.1%
Women 61.8% Women: 69.4%
% growth of critical shortage occupational groups35
PE: 29
MD: 46
EC: 612
EG: 261
SE: 59
Mostly met Indeterminate Employees

  April
2009
April
2010
April
2010
% growth
PE: 29 32 10.3
MD: 43 41  -4.7
EC: 577 650 12.7
EG: 217 225 3.7
SE: 58 60 3.4
% Year-end Agency variance of planned vs. actual expenditures 5% variance or less Not met Operating (Salaries, Conversion Factor and O&M) 5.6%
Not met Capital Expenditures 18.1%
Met all Grants and Contributions 1.5%
Compliance with the link Government of Canada Common Look and Feel (CLF) 2.0 100% Somewhat met In the fall of 2009 TBS conducted a government wide review of Websites to verify the level of CLF 2.0 compliance. Each page of content on the Web is required to go through a 131-point checklist toward compliancy. The TBS review revealed shortfalls in compliance in all government Websites but smaller departments/agencies with large page volumes were shown to be even less compliant. The Agency continues to work toward full compliancy to meet CLF 2.0 standards.
% of major capital assets with completed asset condition reports 100% Somewhat met The Agency enhanced oversight and control over its material assets through the implementation of its first Asset Management Policy by completing asset condition reports for capital assets with an acquisition value over $50,000 after being delayed due to the Agency's response to the H1N1 outbreak.

The Agency completed 62% of the asset condition reports for the identified capital assets (208 of 336). Remaining assets will be addressed in 2010-11.
Benefits for Canadians

Internal Services supported the needs of programs and corporate obligations, and helped to align resources with government priorities. This enabled the efficient and effective delivery of programs and ensured that the Agency had sufficient resources to operate successfully through H1N1 and that matters of administration, human and capital resources were addressed. In addition, Internal Services provided advice and recommendations on matters relating to corporate risks, strategic planning, change management and improvements to the internal management of the organization. It evaluated and developed strategic plans, implemented Government of Canada policies and practices, strengthened corporate risk management practices and developed business continuity plans and facilitated enhanced and expanded skills sets by training employees.

Performance Analysis
PHAC Facts
In 2009-10, the Agency trained 99 staff on the Strategic Risk Communications Framework over 8 sessions while 26 staff trained via specialized workshop for staff working on Information Sharing Agreement Project.

Human resource capability and capacity is the greatest influence on the quality and quantity of work achieved. The Agency is committed to the continuous improvement and streamlining of Human Resource strategies, policies and practices. The results achieved are threefold. New staffing policies dealing with acting appointments and choice of appointment processes were approved in July 2009; amendments to the Chart of Delegation Authorities were approved; and a Values and Ethics Framework and Action plan was approved in February 2010. In addition, conflict of interest and post-employment guidelines were approved. In April 2010, the Agency endorsed a People Management Framework that provides a strategic and coherent approach for people management. Moving forward, the Agency will implement a three-year strategic approach to advance human resource priorities and objectives.

PHAC Facts
The completion rate for the 2008-2009 Performance Discussion Process/Personal Learning Plan (PDP/PLP) exercise was 93%. PHAC continues to improve this process. An automated application of the PDP/PLP process has been developed, piloted and is to be implemented Agency-wide in 2010-11.

Corporate-wide activities have been developed to meet the needs identified by employees in the 2008 Public Service Employee Survey. The results demonstrated a solid foundation of skilled, dedicated and committed employees who are satisfied with their jobs, and have access to learning opportunities to perform their work. Areas that need improvement include work-life balance, workload, communication and the need to address harassment and discrimination. The Agency has held workplace wellbeing (WWB) conferences and delivered anti-harassment workshops to address these issues and continues to work to establish conditions to generate high levels of employee engagement in support of WWB. Co-champions of WWB were appointed and a WWB action plan was approved in May 2010.

PHAC Facts
As one of the federal departments selected to work closely with TBS in the Business Solutions pilot project, PHAC is actively participating in the Government of Canada common services roll-out.

The Agency continues to identify learners and monitor completions related to required training as per the TBS Policy on Learning, Training and Development. Finance and the learning team work in collaboration to ensure compliance with the policy and requirements to obtain financial delegation. In addition, PHAC's Learning Council supports the establishment of a vibrant learning culture at PHAC as discussed in Section 2.1.5.

Contributing to the Privy Council Office's PHAC has hired 57 indeterminate post-secondary recruits (including seven visible minorities) as of December 2009 and 20 more will join the agency in 2010-11. The Agency also hired 98 post-secondary students for co-op positions, placed 71 students in the link Federal Student Work Experience Program, employed five students in the link Research Affiliate Program, and coordinated the placement of about 50 masters-level students in related fields of study. The Agency has made progress in all of the identified Renewal priority areas. Under the 2009 Economic Action Plan, the Agency fully utilized the Treasury Board allocation of $177,021 and hired an additional 24 students in the regions. As well, in recognition of the students' contributions, PHAC held appreciation events in the NCR and Winnipeg in August 2009.

A proposed Policy Suite Framework (PSF) was developed internally and approved within the Agency to address the need for standards and compliance with TBS requirements for policy monitoring and auditing mechanisms. The PSF was developed to provide clear guidance and define responsibilities, expectations, processes and level of approval requirements without creating an increase in rules governing the Agency. The implementation of the PSF will be completed once resources have been identified.

Risk management is crucial to the effective delivery of Agency services to Canadians. Increased use of the Strategic Risk Communications Framework (SRCF) involved training of Health Portfolio communications, program and policy staff through regular interactive sessions throughout the year. The Agency developed a risk communications strategy to guide how the Agency shares information with the public. Originally developed in response to the Listeriosis outbreak to address foodborne illnesses, new approaches identified in the strategy such as the innovative use of social media networks and audio-video Webcasts by the Chief Public Health Officer were instrumental in communicating with Canadians during H1N1. The Agency also developed and approved an Integrated Risk Management Standard and drafted the associated tools and criteria for its implementation.

The Agency's revised 2010-11 PAA and 2010-11 PMF were approved by Treasury Board and Treasury Board Secretariat on May 28, 2009 and July 31, 2009, respectively. PHAC will stabilize its PAA and continue to improve the PMF to ensure that the Agency's expected results, outputs and performance indicators are relevant and measurable.

While the PHAC Public Involvement Framework was delayed during the pandemic H1N1 response, the draft Framework and Handbook were used in the planning for the H1N1 vaccine prioritization consultation activities. The workplanwhich includes tools, ongoing training and a Web presenceto finalize the Framework and Handbook has resumed and is targeted for a March 2011 completion date.

Lessons Learned

The 2007-2012 Strategic Plan mid-term assessment was a useful exercise which identified concerns and issues regarding the advancement of 28 priorities. The assessment resulted in senior management discussion of each of the 28 priority areas. This was beneficial, as it identified challenges and issues to focus on when moving forward despite requiring a significant time investment from the Agency.

The Agency completed a majority of the Asset Condition Reports despite the challenge of re-allocating human resources to support H1N1 efforts. By standardizing both the timing of the annual process and the information gathered, the asset review process was simplified.

Integration of the SRCF training with other ongoing Agency training opportunities is a best practice. To maintain this momentum, it is important for the Agency to create a community of practice for sustaining the promotion of best practices related to the SCRF in contrast to one-off training sessions.

A November 2009 Audit Report on information and records management (IM) found that PHAC's IM practices were in the early stages of development. The Agency's IM function is decentralized and requires further improvement to ensure that information and records management practices in PHAC are in full compliance with Treasury Board policies and directives. To address these challenges, the Agency has recently developed an information framework as well as policies, protocols and training for the IM function. 

2.2 Canada's Economic Action Plan

Due to a lack of physical space, an expansion of the Canadian Science Centre for Human and Animal Health (CSCHAH) was approved by Treasury Board in April 2009 as part of Canada's Economic Action Plan to support the effective and efficient movement of specimens and goods within the CSCHAH. Forecasted spending for the project was $3.5M in 2009-10 and $20.6M in 2010-11. Actual spending in 2009-10 was $2.9M. The $600K variance between the actual and forecasted spending is due unforeseen administrative delays including de-scoping of work post-tender and municipal construction permit delays.

Despite these administrative delays, progress to date has been good. Initial start-up activities are complete, demolition commenced in December 2009 and construction activities began in April 2010.

A performance management framework for the Agency's Economic Action Plan project was established in the 2010-11 Report on Plans and Priorities. It is highlighted by the three expected results and performance indicators below. Information included in the Performance Summary is the best available information at the time of writing.

Expected
Results
Performance
Indicators
Performance
Summary
Increased pathogens diagnosing capacity # of specimens processed by period of time Not available until expansion is complete. A baseline will be established in 2010-11 for comparison.
Faster response to health emergency situations Response time of diagnostic once sample is received Not available until expansion is complete. A baseline will be established in 2010-11 for comparison.
Job Creation # of jobs created It is anticipated that the services of approximately 75 local tradespersons will be required during the construction phase.