Annual Report 2021-2022

ACTION THEN, ACTION NOW!

ANNUAL REPORT 2021–2022

40 YEARS OF BUILDING EQUITABLE FUTURES TOGETHER

Message from the Chair

Vision The best possible health and wellbeing for everyone living in Ontario.

Mission We champion transformative change to improve the health and wellbeing of people and communities facing barriers to health.

Values EQUITY: We champion an equitable, inclusive and respectful primary health care system.

LEADERSHIP: We challenge the status quo with integrity and transparency and are catalysts for system innovation.

COLLABORATION: We embrace community-driven cooperation and partner to influence change.

KNOWLEDGE: We act and learn from a communityinformed and evidencebased approach.

1960s-70s Street Clinics open across Toronto and Ottawa with funding from federal grants and community organizations.

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1982 PC Minister of Health Larry

1994 Ten Aboriginal Health

Grossman announces CHCs are an official part of mainstream health care services, and the Association of Ontario Health Centres (AOHC) is born with six CHCs as members.

Access Centres (AHACs) are created under Premier Bob Rae’s NDP government and become members of the Alliance.

This year, the Alliance for Healthier Communities celebrates its 40th anniversary. Founded in 1982 with six Community Health Centres as members, we have since grown to embrace a wide range on communitygoverned primary health care organizations across Ontario.

Today, the Alliance is more than 100 members strong and continues to expand, include new members and partners, and tackle new challenges and ideas.

The past four decades brought numerous internal transformations at the Alliance and external shifts in the provincial healthcare landscape. Through all these changes, one thing has remained unchanged: our collective commitment to improving the health and wellbeing for people and communities facing the biggest barriers in our province — those marginalized by poverty, isolation, racism, a lack of affordable housing, stigma and other social determinants. This commitment was officially declared in the Health Equity Charter adopted in 2012, and later reaffirmed when the refreshed Charter underwent a significant refresh and received overwhelming support at the 2020 Annual General Meeting.

This commitment is put into action every day as members work with the people and communities they serve to address their needs and deliver high-quality primary health care services all across the province: from large urban centres to small and remote rural communities. Members keep this commitment to health equity at the centre as they work with partners to transform our provincial health system through their local Ontario Health Teams. This commitment shone through during the last two years of the COVID-19 pandemic as members not only continued to serve their clients but also innovated to address emerging needs and advocated for an equitable response to the virus.

Here at the Alliance, we bring this same commitment to all facets of our work as we continue to serve as a strong provincial voice for community-governed primary health care

2009 Nurse Practitioner Led Clinics become part of the Alliance as Sudbury District Nurse Practitioner Clinic joins as a member.

and for people and communities facing barriers to health and wellbeing. Commitment to health equity is at the core of our advocacy efforts, the coalitions and partnerships we build, and the work we do to ensure members have access to the resources they need to fulfill their mandates. In this report, you will find highlights of the Alliance’s achievements of the last year. One of the most significant amongst them has been the fact that the term “health equity” is now readily embraced by partners, governments and broader society. It is the culmination of our collective work over the past 40 years — four decades defined by action to advance health equity through comprehensive primary health care.

As we celebrate these advancements and honour the incredible work of Alliance members, we are also looking to the future. With the new strategic plan, developed over the past year in consultation with members, partners and staff, and unwavering commitment to health equity, we are well positioned to continue our work building equitable futures for everyone in Ontario for decades to come. The struggles that Indigenous and Black communities in particular face in our province, in Canada and across the world is something that we will keep at the forefront of our work. The mass shooting in Buffalo, one of the many racist crimes and incidents we have witnessed recently on both sides of the border and around the world, is a reminder that racism in general, and anti-Black racism in particular, is real, is rampant and is not just a social evil but a serious danger to all of us. In our celebration of another difficult but successful year, let us remember those who have lost their lives, those who are in pain, those whose basic human rights and health and wellbeing continues to be impeded. We have achieved a lot in 40 years. We can do even more in the next 40 in building healthier communities.

Liben Gebremikael, Alliance Board Chair

2018 AOHC becomes Alliance for Healthier Communities.

2020 Alliance membership overwhelmingly approves the revised Health Equity Charter, originally adopted in 2012.

2022 The Alliance celebrates

1969 Centretown CHC opens

1989 First Aboriginal CHC, Anishnawbe

2006 Community Family

2017 Membership criteria

its doors as the Ottawa Street Clinic, operating out of a broom closet at the local YW-MCA.

Health, and first Francophone CHC, Centre Francophone de Toronto, open their doors.

Health Teams become part of the Alliance as Tilbury Family Health Team joins as a member.

are expanded to organizations that are committed to delivering interprofessional comprehensive primary health care.

ALLIANCE FOR HEALTHIER COMMUNITIES

40 years of advancing health equity in Ontario together with members and partners.

ANNUAL REPORT 2021–2022

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Health Equity at the Centre THE ALLIANCE COMPLETES AN ANTI-BLACK RACISM AUDIT Last year, the Alliance for Healthier Communities completed an anti-Black racism audit of the organization. The audit led by Hawa Y. Mire of HYMIRE Consulting resulted in a set of recommendations and a work plan aimed at developing clear understanding of equity, anti-racism and anti-Black racism at every level of the organization, addressing gaps in policies and procedures, and building a positive work culture that adequately addresses the needs of Black staff.

The audit findings and recommendations were shared with staff, leadership team, the Alliance Board and the Black Health Committee. A multi-year work plan has been finalized to implement the recommendations, including: • Creating an explicit internal policy statement on antiBlack racism • Increasing team specific training and time for training • Building a common lexicon and foundation setting for all staff

GOVERNING FOR HEALTH EQUITY BUILDS MEMBER BOARDS’ CAPACITY TO BE HEALTH EQUITY LEADERS The events of the past two years have put into a sharp focus the need to advance health equity, to champion diversity, anti-racism and anti-oppression and to build inclusive and integrated organizations and institutions. To support members and other community-centred health care and community services organizations’ boards in their journey to be leaders for health equity and for a just, equitable and integrated health system for everyone in Ontario, the Alliance for Healthier Communities developed the Governing for Health Equity Training. This online, self-paced training includes five modules helping Boards understand how they can put into action, through governance practices, the core concepts of diversity, equity, meaningful inclusion, anti-racism and antioppression. Since its launch in November last year, more than 35 organizations have already registered for the training.

NATIONAL SAFER SUPPLY COMMUNITY OF PRACTICE CONTINUES TO GROW

• Training for leadership team to understand how to better support racialized, Black staff and the resources available for them.

• Setting up clear and consistent feedback loops that account for race-based issues • Creating a safe and confidential mechanism for staff to bring forward issues of race without reprisal • Increasing HR capacity to support rewriting relevant policies and culture change Some of the work is already underway. The Anti-Black Racism Statement has been developed in consultation with staff and leadership. The Leadership Team has been participating in anti-Black racism coaching. The Alliance is now in the process of hiring an HR consultant with antiBlack racism expertise to assist with creating and updating policies and procedures.

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ALLIANCE FOR HEALTHIER COMMUNITIES

A collaboration between the Alliance, London Intercommunity Health Centre, and the Canadian Association of People who Use Drugs, the National Safer Supply Community of Practice (NSS-CoP) is a two-year project funded by Health Canada to support the scale up of safer supply programs in Canada. Launched last year, NSS-CoP focuses on a medical model delivered from a harm reduction and public health approach, while supporting advocacy for non-medical models and decriminalization.

The project offers a consultation line for clinicians, a bilingual website (nss-aps.ca) with a growing resource library, working groups on a wide variety of topics, an informal weekly drop-in meeting, webinars, presentations, and workshops, a monthly newsletter, regional meetings, an email discussion list, knowledge products, and more. At the end of its first year, this interdisciplinary, cross-Canada community comprised 747 pharmacists, prescribers, nurses, social care providers, advocates and activists, people who use drugs, researchers, policy makers, and others. In total, 2,286 participants enjoyed 89 learning opportunities.

DIGITAL EQUITY STRATEGY GAINS MOMENTUM

Seniors Online program at Unison Health and Community Services helps its participants build their digital literacy skills.

Over the past year, the Alliance worked with members to create a Digital Equity Examples Diary. This online resource also includes the Digital Equity Playbook, Digital Equity Partner Scorecard and accompanying workbook.

We launched the Digital Equity Champion Spotlight that highlights the digital equity work our members are doing in their communities. The first two articles spotlighted the work of a Francophone and rural member and a session focused on the unique digital equity challenges faced by Black and other racialized communities.

As part of the Digital Equity Strategy, the Alliance applied for and received $600,000 in funding for devices and data plans. This, along with the funding received from United Way accounts for close to 2,000 prepaid devices made available to members for clients in need.

PUBLIC ORAL HEALTH CARE ADVOCATES CELEBRATE AN IMPORTANT MILESTONE WITH FEDERAL FUNDING Advocates for public oral health care in Ontario and across Canada have reason to smile widely. In April, after years of relentless research, advocacy and policy proposals, the Alliance and members learned that the federal government, with strong support from the federal NDP, would include in the 2022 Budget “$5.3 billion to provide dental care for Canadians with family incomes of less than $90,000 annually,

starting with under 12 years-olds in 2022, expanding to under 18 years-olds, seniors and persons living with a disability in 2023, with full implementation by 2025.” Congratulations to all the oral health advocates in Ontario, led by the Ontario Oral Health Alliance, Alliance members’ staff; public health advocates; and especially, to the people who shared lived experiences of what having access to public oral health care means to their lives and wellbeing, as well as the challenges of not having it. While there is still work ahead to ensure health equity in the implementation and delivery of public oral health programs in Ontario, this is a moment to celebrate a milestone of major success for community advocacy to change policy in support of health equity.

STRATEGY TO ADVANCE BLACK HEALTH IN ONTARIO LAUNCHED In April, the Black Health Committee, comprised of Black Executive Directors and Chief Executive Officers of Community Health Centres across Ontario, launched the first Black Health Strategy.

The strategy lays out a bold approach and roadmap to improve Black health in Ontario. Drawing from critical lessons learned from intersecting pandemics, HIV and COVID-19, and Canada’s colonial history, which continues to negatively shape the quality of life and health outcomes, these proven tools and approaches aim to address the unmet health needs of Black communities. Embedded in the Afrocentric community-focused approach that recognizes antiBlack racism as a critical determinant of ill-health and disparate health outcomes for Black communities in Ontario, the strategy presents the measures, actions, and targets to prioritize Black communities and their health needs. As we move ahead with the Black Health Strategy implementation, the Black Health Committee looks forward to sharing supplementary resources to support members and other organizations in bringing the strategy to life.

To learn more about the Black Health Strategy, click the QR code.

ANNUAL REPORT 2021–2022

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Comprehensive Primary Health Care as the the Ontario CoP. The project is working with physician and student champions across Canada to engage and educate clinicians, other health professionals, and to raise social prescribing awareness in academia.

PRIMARY CARE COLLABORATIVE LEADS ADVOCACY FOR THE PRIMARY HEALTH CARE SECTOR

Costume Walkathon at Active Adult Centre in Mississauga: The Links2Wellbeing project brings together 10 CHCs and 39 SALCs to facilitate referrals for older adults.

LINKS2WELLBEING: SOCIAL PRESCRIBING FOR OLDER ADULTS PROJECT ESTABLISHES A HOLISTIC SOCIAL PRESCRIBING MODEL In 2021, the Alliance partnered with the Older Adults Centres’ Association of Ontario (OACAO) to develop the Links2Wellbeing: Social Prescribing for Older Adults (L2W) project. The L2W project has enabled health care providers from Community Health Centres (CHCs) and other health organizations to refer older adult clients to Seniors Active Living Centre (SALC) programs, with the support of trained Designated Centre Contacts and Volunteer Link Ambassadors. Ten CHCs and 39 SALC programs representing a range of urban and rural communities across Ontario have committed to participating in Links2Wellbeing.

Two L2W Communities of Practice (CoPs) convene cross-sectoral practitioners, researchers, government representatives, and other stakeholders to share knowledge and lessons learned. Close to 120 participants are currently registered for the Canadian CoP and over 70 participants for 6

ALLIANCE FOR HEALTHIER COMMUNITIES

In last year’s report, we were excited to share with you that the Alliance had helped to convene, with five other primary care associations in Ontario, the Primary Care Collaborative (PCC), as a collective force for advancing primary care and comprehensive primary health care as the foundation of Ontario’s health system. Since PCC formed, the collaborative has continuously advocated for the primary health care sector to Ontario Health, the Ministry of Health, and the Ontario government. Efforts have included calling for equitability in vaccination rollout, more supports for essential workers during the pandemic, as well as a collective statement in support of training and other steps to take to create safer spaces and change for Indigenous health and wellbeing on National Truth and Reconciliation Day.

SUPPORTING MEMBERS THROUGH THE COVID-19 PANDEMIC Over the past year, the Alliance has continued to monitor and share the latest information, new resources, and guidance changes. Through regular COVID-19 update webinars, as-needed information sessions on topics such as employer support, pediatric vaccination and engagement with Ontario Health, daily Situation Reports and resource update, and EL Communiques for priority issues, the Alliance has been making every effort to ensure that members are kept up-to-date as government directives, clinical best practices, and public health responses continue to evolve. We are also engaging with all our health system partners, including Ontario Health and the Primary Care Collaborative, to ensure we stay focused on working together as a system through this urgent time, and advocating for equity-informed policies, guidance, and supports our members need to serve their communities.

Foundation of Ontario’s Health System COMMUNITY VACCINATION PROMOTION PROJECT IMPROVES VACCINE CONFIDENCE AND UPTAKE In April 2021, the Alliance received funding from the Public Health Agency of Canada’s Immunization Partnership Fund to implement the Community Vaccination Promotion (CVP-ON) project. Twelve Alliance members were funded to advance vaccine promotion communication and

outreach initiatives rooted in an equity-informed approach, community leadership, and trusted relationships. Activities have included door-to-door outreach with community ambassadors, transportation to vaccination clinics, information-sharing events in faith-based or cultural spaces, and vaccination during local community events.

CVP-ON PROJECT BY THE NUMBERS Connected with

19,734 individuals and families through phone, text and door-to-door visits

Reached

241,890 individuals through social media and local advertising

Held

104 online or in-person public events

14,581 people booked vaccine appointments or were vaccinated directly as a result of these initiatives

ANNUAL REPORT 2021–2022

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The EPIC Learning Health System The EPIC learning health system was launched in 2020 with the promise of ensuring that practice data and research findings would be made meaningful for the sector and result in action that would ultimately improve health equity, quality, and outcomes.

To learn more about the EPIC Learning Health System, click the QR code.

Learning Health System Accomplishments 2021-2022 SUPPORTING PERFORMANCE MANAGEMENT

TELLING OUR STORY AND DEMONSTRATING THE EFFECTIVENESS OF OUR MODEL

Numerous resources were developed or are currently in development to help Alliance members measure and report their performance and plan improvement activities:

At the end of the 2021-2022 fiscal year, our research team: • was leading or contributing to 26 active CIHR-funded research collaborations;

• Redesigned practice profiles to make them more accessible and useable as a tool for quality improvement;

• had completed 3 member-driven virtual care studies;

• Collaborative QIP webinar held with over 200 attendees;

• had published 5 new journal articles in 2021-22;

• Indigenous-led OHT attribution data was developed and approved by the Ministry of Health; • Work on the population grouper, a new tool that will help us more accurately measure health; complexity, is underway in partnership with the Centre for Health Information (CIHI).

• was contributing sector data to 28 ICES projects;

LEARNING AND GROWING TOGETHER: LEARNING COLLABORATIVES AND COMMUNITIES OF PRACTICE Our inaugural Learning Collaborative: Improving Your Cancer Screening Rates ran from September 2021 through March 2022. Its formal conclusion was recognized with a capstone event in April, but the work at participating centres continues. Planning has begun for the second learning collaborative, which will focus on improving sociodemographic data collection.

• had 6 more journal articles submitted and under review;

Other communities of practice:

• is working on a follow-up to our 2020 paper on Alliance member response to COVID-19.

• National Safer Supply Community of Practice (NSSCoP), formerly the Safer Opioid Supply Community of Practice — a joint, PHAC-funded project of the Alliance, the London Intercommunity Health Centre, and the Canadian Association of People Who Use Drugs.

Additionally, many Alliance member organizations have their own research programs.

Click the QR code to access our research library, where you can check out published research from the Alliance, our members, and our partners.

LHS FOUNDATIONAL ACTIVITIES Data-sharing agreements have been completed and signed with POPLAR, and a data governance structure has been created. POPLAR has received funding through 2027.

A revised job description and title have been created for the role formerly known as Regional Decision Support Specialists (RDSS); from now on, they are known as Quality Improvement & Performance (QIP) Leads. An MOU has been approved by the QIP Leads’ host sites. This change in title and job description reflects a shift in their work towards active QI coaching and practice facilitation.

10 Issues of EPIC News were published, with a 35% open rate and a 57% increase in readership.

• Two communities of practice — one Ontario-based, and one Canada-wide — supporting the scale and spread of social prescribing.

• Community Vaccination Promotion — Ontario (CVP-ON).

• PS Suite EMR Users, Data Management Coordinators, and JReports users (supported by the IMS and BIRT teams).

Click the QR Code to learn more about Alliance Communities of Practice.

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ALLIANCE FOR HEALTHIER COMMUNITIES

ANNUAL REPORT 2021–2022

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Information Management Program Provides Foundation for Learning Health System Although pandemic protocols were still in place, the Information Management (IM) Program continued to provide support and deliver high-value education and capacity-building programs and services. We focused on leveraging the wealth of high-quality data to support meaningful use, improving access to care, and support strategic decision-making based on value and quality.

DIGITAL HEALTH FUNDING

CAPACITY BUILDING AND MEMBER SUPPORT

BY THE NUMBERS OHT Digital Health Workshop with TELUS —

82% attendee satisfaction

ONTARIO HEALTH • Online Appointment Booking – $215,000 • Virtual Care – $226,000 • Digital Equity: Devices with Data Plans Loan Program – $600,000 UNITED WAY • Digital Equity: Devices and Data plans - $20,000

PRIVACY AND SECURITY Privacy and security continue to be important parts of the IM Program work. Our comprehensive privacy outreach program is designed to assist Alliance members in a constantly changing privacy and security landscape.

This work continues to be guided by a growing Privacy Community of Practice for Chief Privacy Officers and informed by PHIPA and the data sharing needs of OHTs. We expanded our education and capacity-building efforts and also provided a new Vulnerability Assessment service to help members better secure their networks and data.

BUSINESS INTELLIGENCE The Alliance continued working diligently with TELUS to remediate and load missing data in the Business Intelligence Reporting Tool (BIRT). This included developing new solutions to add the missing data seamlessly into BIRT with minimal downtime. We also successfully integrated the EMR data from three new Indigenous organizations into BIRT. The BIRT Team collected member COVID data and reported results on a dashboard.

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ALLIANCE FOR HEALTHIER COMMUNITIES

Knowledge Management Professional Learning Event (PLE) —

90% attendee satisfaction Inaugural Risk Management PLE —

90% attendee Value for Money Privacy PLE —

90% attendee satisfaction

Financial Report 2021-2022 Alliance for Healthier Communities has a solid financial picture, with total revenues of $8.7 million.

Total revenue of approximately $3 million contributes to our core operations: advocacy, policy, communications, and resource support for our members. This revenue was earned from membership fees, meeting registrations, learning events, and funding from special projects.

Additional revenue of $5.7 million contributes to our Performance and Information Management Program.

This revenue was earned from IMS participation fees and from Privacy and Security Training conducted with member organizations. $2.4 million of IMS fees are a direct flow through to vendors and the rest of the funding was used to support PSS migration and BIRT.

Grant funding in the amount of $2.2 million was received from the Public Health Agency of Canada, Links2Wellbeiing Social Prescribing, Ontario Health, Healthcare Excellence Canada and Queen’s University.

The majority of the grant funding was distributed to participating member centres.

As of March 31, 2022, the Alliance’s fund balances totaled $517,090.

• General Fund: $30,460 was transferred to our general reserve. The balance in the General Fund is $287,071.

• IMS Fund: $50,000 was transferred to our IMS reserve.

The balance in the IMS Fund is $230,019.

Audited statements are available upon request.

Alliance Board 2021-2022 LIBEN GEBREMIKAEL, CHAIR Executive Director of TAIBU Community Health Centre MARIETTE SUTHERLAND, VICE-CHAIR Committee member of Noojmowin Teg Health Centre FRANÇOIS SEGUIN, TREASURER Board Chair of l’Équipe de santé familiale communautaire de l’Est d’Ottawa MARC BISSON, SECRETARY Executive Director of Centre de santé communautaire de l’Estrie ANIKO VARPALOTAI, DIRECTOR Board member at Central Community Health Centre CLAUDIA DEN BOER, DIRECTOR CEO of Canadian Mental Health Association — Windsor-Essex County Branch

We want to thank outgoing governors — Claudia den Boer and Crystal Pirie — for their dedicated service on the Alliance Board, commitment to our mission, vision and values, and outstanding contributions to advancing healthy equity through comprehensive primary health care.

CLIFF LEDWOS, DIRECTOR Associate Executive Director and Director of Primary Health Care at Access Alliance Multicultural Health and Community Services CRYSTAL PIRIE, DIRECTOR Board Vice-President of Anishnawbe Mushkiki Community Health and Wellness Aboriginal Health Access Centre

FLORENCE NGENZEBUHORO, DIRECTOR Executive Director of Centre francophone du Grand Toronto KIRSTEN WOODEND, DIRECTOR Board Chair of Peterborough 360 Degree Nurse Practitioner-Led Clinic MIKE BULTHUIS, DIRECTOR Board member at Centretown Community Health Centre ANNUAL REPORT 2021–2022

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