Ministerial Council on HIV/AIDS

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

The Way Ahead: Recommendations

This section presents recommendations for how to strengthen inter-ministerial collaboration on HIV/AIDS at the federal level in Canada. It is divided into four sub-sections:

• the recommended overall approach;
• recommendations for recruiting new departments and agencies;
• recommendations for enhancing collaboration with existing departments and agencies; and
• other recommendations.

In the last section, a number of strategies for successful collaboration were presented. These were based on lessons learned from existing collaborations in Canada and in other countries. All of them are important and should be considered in any plan to expand collaboration in Canada. But what needs to happen now in Canada to strengthen inter-ministerial collaboration on HIV/AIDS at the federal level? How should Health Canada and the Minister of Health proceed? Below, the authors present a possible road map.

7.1 Overall Approach

Health Canada should consolidate its relationship with departments and agencies already involved in inter-ministerial collaboration.

Health Canada should expand inter-ministerial collaboration among new departments and agencies. It should adopt an incremental approach and select only the most likely candidates for an initial round of inter-ministerial collaboration expansion. Given the competing priorities, given the demands on people's time (both in Health Canada and in other departments and agencies), and given that inter-ministerial collaboration on HIV/AIDS is not an easy sell in some departments and agencies, this is the approach that is most likely to succeed in the long run. Please see Section 6.0 Strategies for Successful Collaboration for a discussion of the advantages of the "start small" approach.

As this incremental approach builds success, more and more departments and agencies will become involved in HIV/AIDS work. Ultimately, this will permit the federal government to adopt a government-wide, coordinated approach to HIV/AIDS, one that takes into account all of the determinants of health.

Health Canada should ensure that any plan it develops to expand inter-ministerial collaboration at the federal level in Canada includes three strategies that are critical to successful collaboration:

• Obtaining leadership and commitment at senior levels. Ministers and senior officials in all of the participating departments and agencies need to lead the way and need to send out the right signals. Attempts should be made to get the Prime Minister to speak publicly about the importance of HIV/AIDS issues and the need for a response that cuts across departmental lines. Consideration needs to be given to how best to involve the central agencies in HIV/AIDS. For some others issues, they are at the table (e.g., Canada's Drug Strategy Working Group, Sustainable Development Network) and play an ongoing advisory role. This helps to ensure that they are kept current with the issues. It also provides the collaborating departments and agencies access to the expertise and the broader government experience of the central agencies.
• Obtaining buy-in from other departments and agencies. Inter-ministerial collaboration will have a much greater chance of success if other departments and agencies share ownership of the issue.
• Facilitating the participation of community-based HIV/AIDS organizations. Community-based organizations are uniquely positioned to promote the involvement of other departments and agencies and to assist these organizations in planning and implementing their HIV/AIDS programmes.

All three strategies are discussed in more detail in Section 6.0 Strategies for Successful Collaboration.

7.2 Recruiting New Departments and Agencies

The following specific activities are recommended:

1. Make inter-ministerial collaboration a priority in the Canadian Strategy on HIV/AIDS.

The Strategy guides the response to HIV/AIDS at the federal level in Canada. It should clearly identify inter-ministerial collaboration as a policy direction.

2. Make inter-ministerial collaboration a greater priority among the responsibilities of staff in the HIV/AIDS Division at Health Canada.

Inter-ministerial collaboration is more likely to happen if staff and management recognize that they have a responsibility to make it happen. One possibility is to assign the responsibility for negotiating and coordinating inter-ministerial collaboration to one staff person in the division. It may make more sense to assign the responsibility to several different staff persons based on their areas of responsibility. Or, it may be possible to combine these two approaches (one person with overall responsibility and other persons reaching out to specific departments and agencies). Health Canada should consider providing additional funding to allow this expansion of responsibilities to occur without disrupting existing programmes.

3. Select the departments and agencies to be targeted initially.

Health Canada should consult with the Ministerial Council on HIV/AIDS and community-based organizations concerning the selection of departments and agencies to be targeted. The choice should be based on the following criteria:

• Which departments and agencies have the greatest impact on HIV/AIDS and related determinants of health?
• Which departments and agencies are most likely to be receptive, given their own priorities and needs?

4. Build the case for the involvement of the targeted departments and agencies.

It is important to do the groundwork and research, and to have a solid case before approaching the departments and agencies that have been selected. The case for each department and agency will be different.

5. Identify funding for these inter-ministerial collaborations.

The funding should be in addition to what is already in the Canadian Strategy on HIV/AIDS funding envelope.

6. Use an individualized, strategic approach to the targeted departments and agencies.

The approaches should be made at different levels in each organization - for example, from Minister of Health to the minister of the target organization; from assistant deputy minister in Health Canada to his or her counterpart in the target organization; and from senior policy advisors and programme officers in Health Canada to people at their level in the target organization. Health Canada should build on existing relationships wherever possible. Personal contacts in the target organizations will be very helpful.

7. Obtain the assistance of community-based HIV/AIDS organizations.

The community-based organizations can help to persuade the targeted departments and agencies to buy in. Health Canada should provide support and guidance to the community-based organizations to enable them to fulfil this role. This activity should be coordinated with activity #6.

8. Secure buy-in at the highest levels.

If a targeted department or agency does agree to participate, Health Canada should make sure that buy-in is obtained at the highest level of the targeted organization.

9. Ensure that liaison persons are appointed in the participating departments and agencies.

These are the people who will liaise with Health Canada on the file, so they will be critical to the success of any collaborative efforts.

10. Set objectives for each collaboration and develop workplans with the participating departments and agencies.

Health Canada and the departments and agencies concerned should jointly establish objectives for each collaboration. Once the objectives are established, workplans can be developed.

11. Build in accountability and evaluation mechanisms.

Two ways of building in accountability are to make the workplans public or to negotiate memoranda of understanding with the participating departments and agencies. Evaluation mechanisms will help ensure accountability and will also be useful in monitoring both outcomes of the collaboration and the actual process of collaboration.

12. Establish working groups (where appropriate).

Working groups may make sense when there are several players involved in a specific issue - for example:

• more than one other department or agency;
• different branches in the same department or agency;
• one other department or agency and a community-based organization;

or some combination of the above.

13. Include the participating departments and agencies in future planning for the Canadian Strategy on HIV/AIDS.

The participating departments and agencies should be involved in the direction-setting process and the workplan process.

7.3 Enhancing Existing Collaborations

The existing collaborations are assumed to be those involving the Canadian International Development Agency (CIDA), Correctional Service Canada (CSC), and the Department of Justice.

Some of the specific activities recommended above for recruiting new departments and agencies (or variations of these activities) should be applied to the existing collaborations. These include the following:

• Ensure staff of the HIV/AIDS Policy, Coordination and Programs Division are given appropriate support to maintain and enhance current working relationships.
• Identify any funding needed to enhance current inter-ministerial collaborations.
• Help to strengthen the relationship between these departments and community-based organizations.
• Ensure that mutual goals and plans with these departments are reviewed and accountability mechanisms are clear.
• Maintain communication at senior levels to support ongoing collaboration at programme levels.

The following additional specific activities are recommended:

1. Conduct an evaluation of the existing collaborations.

The existing collaborations should be evaluated in terms of both outcomes and process. The evaluation of each collaboration should also include a process to identify new and emerging issues for that department or agency (with assistance from the Ministerial Advisory Council on HIV/AIDS and community-based groups) and to determine which of these issues would be best addressed through collaborative activities.

Health Canada should arrange for the consultation to be done externally - i.e., by people from outside Health Canada and the departments and agencies concerned.

2. Analyze the results of the evaluations and make changes where appropriate.

Each of the three existing collaborations is quite different and will likely require different approaches.

The collaboration with CSC is well established. CSC is the only other department or agency receiving funding directly under the Canadian Strategy on HIV/AIDS. Nevertheless, the evaluations may reveal that changes are required to the way Health Canada and CSC work together or to the substance of the HIV/AIDS work done at CSC.

CIDA is somewhat of a special case. Although it has been doing HIV/AIDS work for many years, its funding does not come from the Strategy, and it is only in the last few years that CIDA has begun liaising with Health Canada on the HIV/AIDS file. It is very important that the two organizations strengthen their collaboration on international HIV/AIDS issues. The evaluation and the subsequent analysis of the results should help to determine how they can best work together.

In the past, collaboration with the Department of Justice has been fairly successful. As has been pointed out in this report, however, the department could and should become more proactive.

7.4 Other Recommendations

• Health Canada should integrate HIV/AIDS into other programmes within its own department (e.g., programmes that deal with family violence, mental health and children). This would facilitate collaboration with other departments. (For a more detailed discussion of this point, see Section 5.0 Potential Barriers to Collaboration.)
• Health Canada should provide training on HIV/AIDS issues (as required) to people in other participating departments and agencies.
• Health Canada should consider developing an educational campaign on population health and the determinants of health, in order to familiarize other departments and agencies with these concepts. It would be useful if such a campaign could be implemented prior to approaching other departments and agencies with respect to collaboration. Another option is to integrate education on population health and the determinants of health into the actual approaches.

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