Ministerial Council on HIV/AIDS

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Towards a Broader View of Health: Strengthening Inter-Ministerial Collaboration on HIV/AIDS in Canada

Section 6.0
Strategies for Successful Collaboration

This section discusses a number of strategies that can contribute to successful inter-ministerial collaboration at the federal level in Canada. These strategies emerged from (a) the lessons learned from existing collaborations and (b) the input of the key informants. The strategies have been divided into two categories:

• strategies to make collaboration happen; and
• strategies to make collaboration work.

Please note, however, that there is some overlap between the categories.

6.1 Strategies to Make Collaboration Happen

This sub-section looks at strategies that can help to get other departments and agencies involved in collaboration.

Obtain leadership and commitment at senior levels of government.

In the context of the fight against HIV/AIDS, the importance of political will should not be underestimated. A clear signal from the highest levels of the government and the bureaucracy - that HIV/AIDS is a priority, that it cuts across departmental barriers, that many departments and agencies are expected to be involved in the response to HIV/AIDS, and that they will be supported to do this work - would go a long way to making inter-ministerial collaboration happen.

In the context of the federal government as a whole, this leadership could come from the to the Prime Minister and from central agencies such as the Privy Council Office and Treasury Board.

Thailand In Thailand, in the early 1990s, the Prime Minister's office assumed responsibility for managing the HIV/AIDS programme and the Prime Minister himself chaired an inter-ministerial committee. As soon as he became involved, the level of participation on the committee rose and funding for HIV/AIDS was significantly increased. Responsibility for overall coordination of the response to HIV/AIDS shifted back to the Department of Health after two years, but the Prime Minister remains involved with the commitee.

In the context of individual departments and agencies, the leadership could come from ministers and deputy ministers. Public statements about HIV from ministers are very helpful. For example, when the Hon. Maria Minna, the Minister of International Development, added her voice to that of the Hon. Allan Rock, Minister of Health by speaking publicly on World AIDS Day in 1999, that sent an important signal that the response to HIV/AIDS extends beyond Health Canada.

Make inter-ministerial collaboration a priority within the Canadian Strategy on HIV/AIDS

The Canadian Strategy on HIV/AIDS stresses the importance of collaboration and partnerships, but does not specifically mention collaboration between federal government departments. If the Strategy were to identify inter-ministerial collaboration as a priority, this would help to facilitate such collaboration.

"When Health Canada identified the need for an HIV/AIDS training programme for customs and immigration officers several years ago, discussions with Citizenship & Immigration did not advance very far until the Deputy Minister of C itizenship & Immigration lent his personal support to the idea. After that, things went more smoothly." - Key informant

Obtain buy-in from other departments and agencies

For inter-ministerial collaboration to be successful, other departments and agencies have to buy in to the process. They have to own the issue. Inter-ministerial collaboration will be much more effective: (a) if departments and agencies understand why they should be involved and how they can help; and (b) if they decide they want to be involved (as opposed, for example, to simply following orders from a central agency).

Before buy-in can happen, the case for the involvement of individual departments and agencies needs to be clearly articulated. For most departments and agencies, this means explaining how the determinants of health affect HIV/AIDS and how the work of their departments and agencies relates to the determinants of health. It means showing how HIV/AIDS is relevant to the work of their organizations.

Buy-in will be much more likely to occur if Health Canada can identify a win-win scenario when it approaches other departments and agencies. Here are two examples of win-win scenarios:

• the involvement of these departments and agencies will benefit not only the Canadian Strategy on HIV/AIDS but also the organizations themselves; and
• a political problem has been identified that (a) can be solved by different departments and agencies working together or (b) will become a worse headache if not addressed now.

Work the system at different levels

To get departments and agencies on side, it may help to engage them at different levels of the bureaucracy. Simultaneous approaches could be made, for example, at the ministerial level, at the level of senior officials and at the branch level. If, during the course of making these approaches, it is possible to identify a champion - i.e., someone who will sell the concept within the department or agency - this will increase the chances of success.

Since people have different ways of learning about issues and becoming engaged, approaching them on a personal level can be very effective. It can help people understand the reality of HIV/AIDS beyond the statistics. Perrin Beatty, who was Minister of Health when the first National AIDS Strategy was developed, knew someone who was living with HIV/AIDS; this personal knowledge helped him cut through the issues. Collaboration is more likely to succeed if ministers and other officials are provided with the opportunity to meet and hear the perspectives of people living with HIV/AIDS.

Be prepared to invest time and resources

Making collaboration happen will require an investment of time, people and money.

Collaboration does not happen overnight. It takes time to convince a department or agency to get involved, and then to work with that organization to develop a plan of action.

Within Health Canada, resources will need to be devoted to making collaboration a reality. It may make sense to designate a staff person to be responsible for negotiating and establishing collaborative initiatives with other departments and agencies. As these initiatives become established, and more and more working groups are formed, it may be necessary to provide secretariat support for these working groups from within Health Canada.

Finally, it is unlikely that many departments and agencies will be interested in doing collaborative work on HIV/AIDS without some dedicated funding.

Provide assistance to community-based organization to enable them to engage other departments and agencies

Health Canada has benefited throughout the epidemic from the expertise that community activists have brought to the table. As was pointed out in Section 5.0 Potential Barriers to Inter-Ministerial Collaboration, community-based organizations have not interacted significantly with other departments and agencies, with the exception of Correctional Service Canada. These departments and agencies are more likely to become involved in collaborative efforts if community-based organizations are prodding them to do so, and if the community-based organizations are prepared to work with the departments and agencies to educate them on the issues and to assist them with the development of appropriate responses. It is unlikely that the community-based organizations will be able to take on this work within existing resources.

Also, some work may be required to help other departments and agencies connect with community-based HIV/AIDS organizations and to help these organizations identify the right people in the departments and agencies.

Start small and build from there

In Canada, meaningful inter-ministerial collaboration on HIV/AIDS at the federal level has so far involved only a handful of departments and agencies. Employing an incremental approach to getting other departments and agencies involved might be an effective strategy. This approach would be advantageous for several reasons:

• Health Canada could select only the most likely candidates for an initial round of inter-ministerial collaboration expansion. This would increase the chances that these initial collaborations will be successful. Success would build Health Canada's credibility and could then be used to entice other departments and agencies to become involved.
• If there are limited resources that can be applied to inter-ministerial collaboration expansion, either in terms of people's time or in terms of dedicated budgets, it makes sense to start with a limited number of departments and agencies.
• By doing a few new collaborations first, Health Canada would learn from experience what works and what does not work, and could then apply these lessons to later collaborations.

Test A key informant shared the test he uses to help determine whether particular departments and agencies should be involved in inter-ministerial collaboration on a given issue: Is it going to improve health outcomes? Will lives be saved? Will it be worth the money? (Will it be worth the trees cuts down for the paper it will take?) Will it be worth the time invested?

Encourage the establishment of a non-partisan parliamentary group on HIV/AIDS

The presence of a non-partisan parliamentary group on HIV/AIDS could promote greater collaboration among departments and agencies. There are two reasons for this:

• The work of the committee could help to raise the profile of HIV/AIDS.
• The non-partisan nature of the committee would reinforce the notion that HIV/AIDS is a shared priority and concern.

This approach has been tried in Australia and the United Kingdom with some success. In Canada, there was an ad-hoc parliamentary group in the early 1990s. It was followed in 1995 by a more formalized group that was disbanded in 1997. These groups provided a parliamentary forum for the discussion of HIV/AIDS issues. Whether or not this would work in the current Canadian context, or whether this would be considered a priority at this time, are questions that may require further reflection.

6.2 Strategies to Make Collaboration Work

This sub-section looks at strategies that can help make collaboration work once it has been established.

Appoint liaison persons and work one-on-one or in small groups.

Large inter-departmental committees have not been very successful (see Section 4.0 Case Studies). Experience in Canada and in other countries reveals that collaboration is more effective when the lead department is working with individual departments and agencies one-on-one, or where small working groups are formed to deal with specific issues. The one-on-one approach is useful when dealing with an issue that really only affects one department or agency. Working groups can be set up when there is an issue that affects two or three departments and agencies. Working groups are most effective when the participants have sufficient authority to make decisions or have ready access to people who can make decisions.

Departments and agencies that have agreed to become involved could appoint liaison persons to work with Health Canada and to participate in the working groups. It may make sense to hold periodic meetings of the liaison persons for the purpose of exchanging information.

Be prepared to involve other stakeholders (where warranted)

Where working groups are established to deal with specific issues, it may sometimes make sense to include representation from the provinces and territories, or from community-based organizations.

Be realistic about what can be accomplished

Over time, collaboration is more likely to be successful if expectations are kept in check. If a department or agency is getting involved in HIV/AIDS for the first time, it is a good idea to be pragmatic about what can be accomplished. In dealing with other departments and agencies, Health Canada will need to remember that it does not control the agenda and that it may need to be prepared to compromise.

Involve other departments and agencies in the planning process - strategically

It is important to ensure that departments and agencies that are doing HIV/AIDS work are involved in the planning process for the Canadian Strategy on HIV/AIDS. For collaboration to be successful, these departments and agencies must be seen as partners in the process.

However, it is also important to be strategic about how the departments and agencies participate. If a particular department is involved in only one or two specific initiatives, it may have no interest in sending someone to a four-day Strategy planning session. It may, however, be happy to participate in a short meeting that focuses more on (a) how the department's initiatives can contribute to the Strategy and (b) what changes to the Strategy the department might like to suggest.

Make collaboration proactive (not just reactive)

Much of the collaboration on HIV/AIDS that has occurred in the federal government has been reactive - i.e., departments and agencies reacting to events. An example of this is the work that was done by the Department of Justice around HIV testing in cases of sexual assault (see Section 4.0 Case Studies). Good collaboration is also proactive. Departments and agencies could identify potential problems (and emerging issues) and act to resolve them before they turn into crises. An example of proactive collaboration would be the Department of Justice producing recommendations on ways to ensure the confidentiality of records of HIV/AIDS clients kept by social workers and psychologists.

Proactive collaboration requires that good planning systems be in place. Health Canada (and other stakeholders) will need to work with departments and agencies to identify which issues need to be addressed.

Build in accountability mechanisms

It is important to ensure that the departments and agencies that participate in inter-ministerial collaboration on HIV/AIDS are held accountable for their actions.

One way to do this is for Health Canada to develop a memorandum of understanding with each department and agency. The memorandum would spell out exactly what work the department or agency has agreed to undertake, when the work will be performed, and what the funding mechanisms and reporting requirements are. The memorandum could be used to ensure that the department or agency involved remains accountable for its actions. This approach proved successful in Québec (see Section 2.0 Background). The potential advantages of this approach need to be weighed against the time and effort required to implement it.

Another option is for Health Canada to obtain commitments from participating departments and agencies and then make these commitments public. This approach has been adopted in British Columbia for inter-ministerial collaboration on HIV/AIDS in that province. Participating ministries were asked to make commitments and were told that their commitments would be made public in a report. British Columbia has also promised to produce follow-up reports.

Design systems to ensure good communications

Sharing information on HIV/AIDS programming can help build collaboration. There are two broad categories of information that are relevant to this discussion:

• information on HIV/AIDS programmes in Health Canada that would be of interest to other departments and agencies; and
• information on HIV/AIDS programmes in other departments and agencies that would useful to share.

The challenge will be to ensure that the information is presented in a useful format and that the volume of information is not overwhelming.

As frequently happens with HIV/AIDS, there are programmes that are developed with HIV/AIDS funding that have an impact on other diseases and programmes. For example, Correctional Service Canada recently prepared a computer learning module on infectious diseases (how they are spread, how to take precautions); this module could be shared with other departments and agencies.

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