Under the Canadian Strategy on HIV/AIDS (CSHA), which existed from 1998-2004, the AIDS Community Action Program (ACAP) did not have specific program goal/goals defined. ACAP was designed to contribute to CSHA goals 1, 4, 5, and 6:

1. prevent the spread of HIV infection in Canada;

4. ensure care, treatment, and support for Canadians living with HIV/AIDS, their families, friends, and caregivers;

5. minimize the adverse impact of HIV/AIDS on individuals and communities;

6. minimize the impact of social and economic factors that increase individual and collective risk for HIV.

The Federal Initiative on HIV/AIDS in Canada (FI), launched in January 2005, is the federal government’s renewed strategy to address HIV/AIDS. ACAP delivers the front-line HIV/AIDS response in Canada in the form of grants and contributions to community-based organizations.

ACAP contributes to the following three FI goals:

1. prevent the acquisition and transmission of new infections;
2. slow the progression of the disease and improve quality of life;
3. reduce the social and economic impact of HIV/AIDS.

These three goals are used in the ACAP logic model and evaluation framework and make clear the connection the program has with the FI. The Public Health Agency of Canada (PHAC) will review and revise, as deemed appropriate, the statement of purpose to ensure it clearly communicates how ACAP contributes to the FI as well as the Program’s important role in supporting a community-based response to HIV/AIDS.

July 2007

The CSHA was coordinated by Health Canada. Under the CSHA, the five ACAP principles were identified as:

• health promotion
• population health
• community development
• partnerships and
• collaboration
• evaluation.

Under the CSHA, ACAP did not have a performance measurement system. The Program had neither a logic model nor an evaluation framework, and ACAP outcomes were not identified.

PHAC was created in September of 2004 and is responsible for the overall coordination of the FI. PHAC will revise the ACAP principles, both in the context of the program operating within the newly launched Agency, and within the new national HIV/AIDS strategy.

To further ensure alignment with the FI, PHAC will also review the four ACAP funding approaches: prevention, health promotion for people living with HIV/AIDS, creating supportive environments, and strengthening community-based organizations.

PHAC will finalize the ACAP evaluation framework, including the logic model and outcomes.

July 2007

May 2007

September 2007

Under the FI, PHAC will continue to encourage community-based organizations to support the direct involvement of people living with HIV/AIDS and those vulnerable to the epidemic in the planning and implementation of their projects.

PHAC will review the Greater Involvement of People Living with HIV/AIDS (GIPA) principles and will determine how these principles can be reflected by ACAP.

PHAC will distribute information and guide discussions on GIPA among ACAP staff and funded groups.

July 2007

March 2008

Under the CSHA, community groups funded by ACAP were supported to meet and exchange information, knowledge and skills at annual network/skills-building meetings.

Under the CSHA, PHAC staff shared best practices and did some strategic planning through the Regional HIV/AIDS Network (RHAN).

Under the CSHA, the regional offices maintained some flexibility in the delivery of ACAP. The HIV/AIDS epidemic varies in different parts of Canada; one of the strengths of ACAP has been and continues to be its ability to adapt to the different epidemics and regional differences.

Under the FI, ACAP-funded community-based organizations continue to participate in knowledge development and exchange activities at local, regional, and national levels.

ACAP-funded groups will be encouraged to participate and contribute to activities funded through the Knowledge Exchange Fund. Launched under the FI, the Knowledge Exchange Fund is a national PHAC funding program with a mandate to strengthen the response of front-line organizations involved in the delivery of prevention, diagnosis, care, treatment, and support to people living with and at risk for HIV/AIDS by incorporating an active and continuous exchange of HIV/AIDS-related knowledge.

Integration is an important policy direction of the FI. PHAC is working to enhance linkages among HIV/AIDS programming and other infectious disease programs and activities, including those related to hepatitis C and sexually transmitted diseases.

PHAC will revise existing tools used for solicitations, etc., that ensure consistency across all regions, consideration of integration, and the meaningful involvement of vulnerable populations.

PHAC will offer learning opportunities to PHAC staff related to strengthening support for vulnerable populations and promoting integrated approaches.

March 2008

Ongoing

July 2007

October 2008

An ACAP evaluation framework, including a logic model, is under development by PHAC. The ACAP evaluation framework is aligned with the FI logic model. The ACAP logic model clearly outlines how Program activities contribute to the outcomes of the FI. The ACAP evaluation framework includes a description of expected outcomes and provides measurable indicators of the Program’s achievements and impact.

ACAP is participating in the pilot phase of the Program Evaluation Reporting Tool (PERT) that was developed to collect information from across all population health funding programs. The PERT tool contains specific questions for each program, including ACAP.

PHAC will ensure that the performance measurement systems under development allow for the collection of data related to strategic issues such as strengthening support for vulnerable populations and promoting integrated approaches for addressing HIV/AIDS.

PHAC will ensure that evaluation results are shared publicly and are used for continuous program improvement.

September 2007

Ongoing

September 2007

Ongoing

Under the CSHA, the sharing of information among Health Canada’s regional offices and the national HIV/AIDS Division was an important consideration. The physical separation of staff in regional offices and the national headquarters made shared planning and decision making a challenge. A variety of communication methods and vehicles for working between regions and the national HIV/AIDS Division was utilized with varying degrees of success over the history of ACAP:

• For many years, there was a HIV/AIDS Policy, Coordination and Programs Division staff person assigned to assist with the coordination of RHAN. This practice was suspended in 2003.
• Representatives from the HIV/AIDS Division were invited to provide updates on RHAN calls and at meetings on an ad hoc basis.
• A few RHAN working groups, including the ACAP Evaluation Working Group, included staff members of the national HIV/AIDS Division.
• Representatives from RHAN were sometimes invited to participate in particular planning processes and events hosted by the HIV/AIDS Division.

To foster productive working relationships, PHAC will determine an appropriate level of linkages and involvement for regional ACAP staff in activities led by the national HIV/AIDS Division by applying the Regional Lens (February 2006) to program planning under the FI. The Regional Lens is a guide for determining the role and function of PHAC regional offices in relation to Agency program and policy development. For example, PHAC will define how regional ACAP staff and national HIV/AIDS Division staff can meaningfully and mutually contribute to such initiatives as the development of status reports for vulnerable populations, the Accountability Working Group, and the national HIV funds’ development, review, and monitoring.

PHAC will also ensure appropriate communication mechanisms are in place between regional offices and the Surveillance and Risk Assessment Division (SRAD) to strengthen the inclusion of epidemiology and surveillance data in ACAP decision-making processes.

Also under the FI, a new position, the Pan Regional HIV/AIDS Evaluation, Accountability and Coordination Analyst, will be in place. This position will be responsible for developing and sustaining strong collaborative working relationships with various stakeholders, including across the Agency.

March 2008

January 2008

September 2007*
*(delayed)

Under the CSHA, the determinants of health were a key aspect of the ACAP funding guidelines. Community groups were asked to demonstrate how their proposed project activities addressed the determinants of health in all ACAP proposals. Also, one of the ACAP principles is population health, which has at its core the determinants of health.

Under the CSHA, ACAP had developed a set of key program guidelines and program tools. However, over the years, some tools had been revised by individual regions; as a result, some inconsistent messaging related to the determinants of health may exist across regions.

Under the CSHA, the only mechanism for reporting on ACAP was through the annual World AIDS Day Report and the Departmental Performance Report.

Under the FI, ACAP will continue to support the determinants of health and examine new ways to strengthen this support. In particular, through the FI Assistant Deputy Minister Committee, horizontal linkages to address HIV/AIDS are being strengthened across departments, allowing for discussion on intersectoral policy issues.

PHAC will ensure that a common set of program tools exists for consistent messaging related to the determinants of health across regions. New and revised tools, including solicitation and evaluation templates, will ensure clear explanation of the determinants of health and how these can be addressed by community-based projects.

PHAC will complete the ACAP evaluation framework. This framework will recognize the importance of the determinants of health; long-term outcomes of the Program will be closely aligned with the determinants of health, and these outcomes will be linked to shorter-term outcomes and project activities in the ACAP logic model.

PHAC will also provide training to staff and funded community organizations related to supporting the determinants of health within ACAP.

Ongoing

July 2007

September 2007

March 2008

ACAP Past Status for Recommendations 9-11

Under the CSHA, ACAP Regional Operational Funding was only available to local, provincial, and territorial community-based organizations whose principal mandate was HIV/AIDS. Local, provincial, and territorial community-based organizations whose principal mandate was not HIV/AIDS, but which address specific HIV/AIDS issues, may have been eligible for ACAP time-limited project funding. Under the CSHA, operational funding was considered instrumental in supporting a strong community-based response to HIV/AIDS across the country.

Under the CSHA, ACAP evaluation was limited and roll-up of project evaluation data across regions was not possible due to inconsistent tools and approaches.

Implementation Plan for Recommendations 9-16

Recommendations 9-16 indicate that PHAC does not have sufficient evidence to make significant changes to the current ACAP operational and time-limited project funding policies, including those related to eligibility. While PHAC believes there is intrinsic value in operational funding and time-limited project funding, it is recognized that better evidence is needed to make funding decisions. Under the FI, the outcomes of operational and time-limited project funding will be better understood through research and evaluation.

The ACAP evaluation framework is being developed, and it will include analytic tools which address the outcomes of operational and time-limited project funding related to HIV/AIDS and co-morbidity with other blood borne pathogens.

Furthermore, PHAC will commission a study to

• better understand the longer-term outcomes of time-limited project and operational funding;
• better understand how operational and time-limited project funding streams reach vulnerable populations;

September 2007

April 2008

• provide stronger evidence for determining allocation formulas for time-limited project and operational funding.

As a first step in the research, PHAC will undertake a mapping exercise to describe and better understand the community-based organizations which are currently receiving the different types of ACAP funding as well as the target populations these organizations are reaching to ensure alignment with the seven vulnerable populations included in the FI. The study will involve a comprehensive literature review, including epidemiological data, related to operational and time-limited project funding. The results of the mapping exercise will be used to make decisions related to time-limited project and operational funding allocations.

PHAC will develop a common set of program tools, including solicitation documents, and ensure these contain consistent messaging related to ACAP funding types and eligibility guidelines.

May 2007

July 2007

Under the CSHA, ACAP evaluation was limited. Contribution agreements were assessed on an individual basis but there were no integrated performance measurement systems in place, i.e. logic model, evaluation framework etc.

Standard Operating Procedures (SOP) were implemented in 2004 across PHAC to assist in ensuring consistent administrative procedures related to contribution agreements, monitoring, etc.

See also the implementation plan for Recommendations 9-16.

SOP have already been implemented across PHAC to enhance consistency of administrative procedures. It is important to note that some administrative procedures have been set by Treasury Board and are, therefore, outside the scope of this review.

See also the implementation plan for Recommendations 9-16.

Under the FI, there are five national HIV/AIDS funds: Non-Reserve Fund; Specific Populations HIV/AIDS Initiatives Fund; National HIV/AIDS Voluntary Sector Response Fund; Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund; National HIV/AIDS Knowledge Exchange Fund. Another national program, the National HIV/AIDS Demonstration Fund, is not yet launched. Regional offices administer ACAP.

To strengthen complementarity and alignment with national HIV/AIDS funds, PHAC will work toward a common menu approach for all HIV/AIDS funding programs. This menu approach will be featured on the main PHAC web site, regional PHAC web sites, and in program tools such as solicitation documents.

Information and updates will be provided to regional and Division staff to enhance knowledge of all the HIV/AIDS funding programs. SOP are being used by national and regional offices to guide administrative procedures.

March 2008

Ongoing

Under the CSHA, local, provincial, and territorial community-based organizations whose principal mandate was not HIV/AIDS, but which addressed specific HIV/AIDS issues, may have been eligible for ACAP time-limited project funding. Organizations were required to demonstrate how they were well-suited to carry out the work described in their proposals.

Under the CSHA, ACAP evaluation was limited. Contribution agreements were assessed on an individual basis but there were no integrated performance measurement systems in place, i.e. logic model, evaluation framework etc.

See also the implementation plan for Recommendations 9-16. Evidence gathered through research and evaluation will be used to inform program planning.

Time-limited project funding is recognized as an important mechanism for supporting action to address priority populations, integration, and emerging issues and trends. Over 2006-2009, all community-based organizations, including AIDS service organizations, will continue to be eligible for time-limited project funding.

Past Status for Recommendation 15-16

Under the CSHA, local, provincial, and territorial community-based organizations whose principal mandate was not HIV/AIDS, but which addressed specific HIV/AIDS issues, may have been eligible for ACAP time-limited project funding.

Under the CSHA, all regional offices maintained some minimum degree of time-limited project funding. While an agreement in principle had been reached by RHAN to ensure that 70% of funds were for operational projects and 30% of funds were for time-limited projects, some regional offices adjusted the amounts to reflect regional realities.

See also the implementation plan for Recommendations 9-16.

Under the FI, the outcomes of time-limited project funding will be better understood through research and evaluation.

Time-limited project funding is recognized as an important mechanism for supporting action to address priority populations, integration, and emerging issues and trends. PHAC will encourage all regional offices to maintain some minimum degree of time-limited project funding capacity through 2006-2007. However, PHAC understands that regional differences exist in terms of other funding bodies and arrangements, and these may impact on the ability of regional offices to provide time-limited project funding.

March 2008

Under the FI, the outcomes of time-limited project funding will be better understood through research and evaluation. See implementation plan for Recommendations 9-16.

Based on the results of evaluation and research, PHAC will develop a set of guidelines to be used by regional offices in determining the operational/timelimited project funding allocations.

March 2008

Under the CSHA, ACAP had common features across regions, including funding approaches and principles. Common solicitation documents were created, but over the years, these were adapted by different regions. A common evaluation framework and reporting tools were not available.

The HIV/AIDS epidemic varies in different parts of Canada; one of the strengths of ACAP has been its ability to adapt to different epidemics and regional differences. Regional offices have always maintained flexibility in the delivery of ACAP. For example, each region conducts priority-setting exercises prior to launching solicitations for new proposals to ensure funding is directed to address the most important target populations and issues for the particular region.

Under the FI, PHAC will continue to support regional flexibility. Furthermore, PHAC will continue to use epidemiological, surveillance, and other types of evidence to support its decision making.

PHAC will develop a common set of plain language program tools, including solicitation documents, which will be used by all regional offices.

To ensure common reporting tools for ACAP, PHAC will implement the ACAP evaluation framework, and the PERT will be used to collect core performance data.

July 2007

April 2008

Under the CSHA, ACAP had common features across regions, including funding approaches and principles. Common solicitation documents were created, but over the years, these were adapted by different regions. A common evaluation framework and reporting tools were not available.

Under the CSHA, each region conducted priority-setting exercises prior to launching solicitations for new proposals to ensure funding is directed to address the most important target populations and issues for the particular region. Priority-setting exercises usually involved consultations with stakeholders as well as some form of environmental scan, including a review of available epidemiological and other data.

March 2008

Under the FI, program evaluator positions are now created in all regional offices and provide support to the evaluation of ACAP.

The creation of the Pan Regional HIV/AIDS Evaluation, Accountability and Co-ordination Analyst position will assist in the coordination of regional contributions to the FI reporting requirements.

PHAC will complete the ACAP evaluation framework, ensuring continued consistency and alignment with the FI logic model. Also, ACAP is participating in the pilot of PERT, the common tool for data collection across population health funding programs.

The Accountability Working Group has been established to develop the collective response to the FI’s performance measurement, evaluation, and reporting requirements. The Working Group is made up of one representative from each of the Federal Responsibility Centres that receive funding under the FI (including ACAP) and reports to the Federal Responsibility Centre Committee.

September 2007* * (delayed)

September 2007

Ongoing

Under the CSHA, ACAP evaluation was limited. Contribution agreements were assessed on an individual basis but there were no integrated performance measurement systems in place, i.e. logic model, evaluation framework etc.

Under the CSHA, ACAP funded work to support people living with HIV/AIDS. It was not possible, however, to capture the lived experience of people living with HIV/AIDS and the sentinel activities of community-based organizations in any consistent manner.

Under the FI, PHAC will continue to fund work that supports people living with HIV/AIDS.

Under the FI, the HIV/AIDS Division is working on the development of eight separate status reports, one for each of the identified priority populations: people living with HIV/AIDS, gay men, injection drug users, Aboriginal people, federal inmates, youth, women, and people from countries where HIV is endemic. The purpose of the status reports will be to provide point-in-time snapshots of these populations to guide program planning. The lived experience of each population will be an important component of these status reports.

PHAC will examine the ability of the ACAP evaluation framework and the common tool, PERT, to collect information on the lived experience of people living with HIV/AIDS and the sentinel activities of community-based organizations. Furthermore, PHAC will develop a mechanism to roll up information provided by funded groups specific to the lived experience of people living with HIV/AIDS. This information will be reported publicly, including through the HIV/AIDS Division status reports described previously.

April 2007, and ongoing

September 2007

Under the CSHA, program administration was governed by the Treasury Board Policy on Transfer Payments (currently under review).

In December 2001, the Office of the Auditor General released the findings of an audit of grant and contribution programs administered through the Population and Public Health Branch (PPHB). The findings revealed a number of weaknesses; specific deficiencies were noted in the CSHA community funding programs. To address these weaknesses, PPHB launched a review of transfer payment files as well as program funding guidelines used by PPHB to administer CSHA funding programs. The overall purpose of the review was to ensure effective management of HIV/AIDS grants and contributions funding programs by promoting accountability in the use of public funds. In response to the recommendations of the review, SOP were implemented in 2004 across PHAC to assist in ensuring consistent administrative procedures related to contribution agreements, project monitoring, and reporting.

Under the FI, PHAC is committed to follow all Treasury Board requirements for administrative and reporting procedures.

SOP are used across all regions to ensure consistent administrative procedures. ACAP program consultants participate in the SOP Network, through which they can share ACAP best practices and influence the evolution of standard administrative procedures.

ACAP is participating in the pilot phase of the PERT. This tool was developed to collect information on project outcomes from across all population health funding programs, using a common template. Therefore, groups receiving funding from more than one funding program will be using the same reporting tool.

PHAC will assess the burden placed on community-based organizations as a result of the implementation of PERT and SOP and other administrative procedures over time.

Ongoing

Ongoing

Ongoing

March 2009

While the Voluntary Sector Initiative’s A Code of Good Funding Practice is recognized as an important tool, this recommendation is beyond the scope of ACAP and the FI to implement.

PHAC will offer training to staff on the Voluntary Sector Initiative’s Code.

March 2008

As a result of PERT and the ACAP evaluation framework, common ACAP evaluation data are expected to be available from all regional offices starting for the 2008-9 fiscal year.

PHAC will consider the development of an annual ACAP report beginning in 2008-9. An ACAP annual report would function to highlight PHAC’s role in supporting community-based organizations and approaches, as well as activities that are specific to the eight priority populations identified in the FI.

Furthermore, PHAC will investigate the possibility of an annual Federal Initiative Annual Report to which ACAP could contribute, allowing a comprehensive report on federal HIV/AIDS funding programs and initiatives.

The creation of two new positions will support the creation of annual reports. A PHAC communication officer will be in each of the regional offices. Also, the Pan Regional HIV/AIDS Evaluation, Accountability and Co-ordination Analyst will contribute to better reporting on pan-regional activities and outcomes.

March 2009

December 2008

December 2008

September 2007

Under the CSHA, O&M resources directed to ACAP were limited. The lack of O&M affected the ability of the regional offices to dedicate appropriate resources for planning and coordination across the country. For example, resources were not available to plan and conduct evaluations of ACAP in a consistent manner. Other evidence-gathering activities, including regional environmental scans, were also limited.

However, even without dedicated O&M resources, regional ACAP staff have always been involved in activities outside the delivery of the funding program. For example, staff have participated in various partnership activities with provincial and territorial governments, researchers, and community-based organizations on strategic policy, knowledge development and exchange activities, research, and evaluations. Due to the disparity in O&M compared to other funding programs, ACAP was usually subsidized by other programs in each of the regional offices.

Under the FI, ACAP has been allocated increased resources for O&M, allowing for better planning and coordination. For example, regional offices are now better able to conduct regional scans for priority setting. Also, each regional office has been given funding to support 0.5 FTE of an evaluation consultant. These new positions are supporting the planning and implementation of PERT and the ACAP evaluation framework.

Under the FI, another new position, the Pan Regional HIV/AIDS Evaluation Accountability and Co-ordination Analyst, is being created. This position will contribute to better coordination and reporting on pan-regional activities and outcomes.

Ongoing

September 2007* *(delayed)