Message from the Chair It’s been more than a year since the COVID-19 pandemic entered our lives, reshaping the way we work, socialize and deliver services. And while the arrival of a global pandemic was in some ways unexpected, its disproportionate impacts on certain populations — Indigenous communities, Black and racialized people, those living in poverty, isolated seniors and people with disabilities, those experiencing homelessness, people who use drugs, migrant workers and people without a documented status, among many others — were not. From higher infection rates to loss of jobs and income to inequitable access to vaccination and supports — these impacts have been rooted in centuries of colonization, racism and systemic inequities. Over the past year, we saw many of the communities Alliance members serve having to deal with a wide range of barriers, exacerbated by the pandemic and combined with other intersecting crises, including overdose and drug poisoning crisis, homelessness, isolation and poverty. This has been a challenging year. As we acknowledge the loss and grief, I also want to recognize the incredible work of Alliance members. As always, they rose to the challenge and worked with their clients and communities to meet their long-existing and emerging needs, while also keeping health equity on the agenda at the Ontario Health Teams and other regional tables. Member surveys conducted by the Alliance research team over the past years revealed an impressive range of innovative, community-based approaches in the pandemic response: from quickly pivoting to virtual programming and service delivery, setting up mobile clinics and engaging community ambassadors, to distributing hot meals, food hampers and other necessities to their communities, initiating social check-ins and helping to bridge the digital divide.
Here, at the Alliance, we have been working to ensure members have timely and relevant information, resources and supports they need to do their work on the ground. Along with our partners in the Primary Care Collaborative, Community Health Ontario and other organizations, we have also been advocating for health equity-focused, community-based approaches to testing, wrap-around supports and vaccination. In this report, you will find the highlights of our work over the past year. For more, you can also refer to the last annual report that was released in November last year. As we move forward and start planning for the postpandemic future, the lessons we’ve learned over the past year, shifts in the external landscapes and growing awareness of pervasive health inequities, most importantly, our collective commitment to advancing health equity through comprehensive primary health care will serve as a foundation for building back better. I want to thank everyone — Alliance members, Board and staff — for your continuous efforts and dedication to improve the health and wellbeing of everyone living in Ontario and particularly those facing systemic barriers. Your work, innovative spirit and unwavering commitment to health equity is exceptionally inspiring.
Liben Gebremikael Board Chair, Alliance for Healthier Communities
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SUPPORTING MEMBERS THROUGH THE PANDEMIC
Pandemic Response: Supporting Members and Advocating for a Health Equity Approach The work of the Alliance over the past year has been dominated by the COVID-19 pandemic. Our focus was on supporting members with relevant information and resources as they worked to address long-stranding and emerging barriers and meet the needs of their clients and communities. Throughout the pandemic, the Alliance has been a fierce advocate for health equity approaches to testing, wrap around supports and vaccination. Our advocacy efforts have been aimed from the start at supporting those most impacted by the pandemic. We called for community-based testing and isolation supports, paid sick days and pandemic pay; for equitable vaccination roll-out and addressing barriers to vaccine confidence; and for healthcare expansion to include international agricultural workers. Recognizing the effects of systemic racism on inequitable COVID-19 outcomes, we continue to call for the collection of sociodemographic and race-based data to enable more equity in healthcare planning and delivery.
Coordinated bulk purchase of Personal Protective Equipment and distribution to members, including negotiating reduced rates and securing in-kind contributions for the sector. Offered 26 lunch and learns and 45 COVID-19 webinars to members. Provided daily communications, including guidance documents and other resources. Delivered webinars on digital health (e.g. TELUS health Virtual Visits & and the ThinkResearch platform). Negotiated a 70% discount for TELUS’ Virtual Visits. Redirected BIRT team development resources to build the COVID-19 datamart to meet the data collection needs of member centres. 3
Health Equity Charter receives overwhelming support from members Our collective commitment to health equity continued to guide our work throughout the year. This commitment was reiterated in the refreshed Health Equity Charter that takes a strong stance against white supremacy, Canada’s legacy
of colonization and slavery, racism against Black and Indigenous people, and outlines multiple intersecting inequities experienced by many communities in Ontario and beyond. After a year-long refresh process and multiple
consultations with Alliance’s priority populations and membership, the Charter was approved at the Annual General Meeting in November 2020. As we move forward, it will continue to guide our work in the years to come.
AGM RESOLUTIONS REFLECT OUR COLLECTIVE COMMITMENT TO ADVANCING HEALTH EQUITY AND ADDRESSING ANTI-BLACK RACISM
SAFER SUPPLY INITIATIVES AND SUPPORT FOR SAFER SUPPLY CONTINUE TO GROW WITHIN AND BEYOND OUR SECTOR.
Over the past year, a growing Black Lives Matter movement in Canada and across the world, as well as disproportionate impacts of COVID-19 on Black and racialized communities have laid bare the pervasive nature of anti-Black racism in all systems and its negative impacts on the health and wellbeing. Our sector’s commitment to confront anti-Black racism is reflected not only in the Health Equity Charter but also in the resolutions approved last year: Addressing Anti-Black Racism and Addressing Harms Linked to Policing by Reallocating Funds. The Alliance has been working to advance these important issues while also supporting a coalition of Black Health leaders in their work to develop the Black Health Strategy.
The Alliance is supporting safer supply prescribers and programs through a community of practice (SOS CoP) co-led by Alliance, staff from our sector, the Canadian Mental Health Association (CMHA), and Addictions & Mental Health Ontario (AMHO). This CoP has been approved for external funding from Health Canada to expand and sustain its work. In response to a letter the Alliance wrote with partners, the College of Physicians and Surgeons of Ontario (CPSO) is updating their guidance on safer supply to eliminate barriers for clinicians taking on this work in their practice.
The resolutions put forward last year touched on many issues that affect the people and communities Alliance members serve, including CommunityBased Testing during COVID-19, Right to Housing, Commitment to Data Collection, and Advancing Health Equity in Rural, Remote and Northern Communities, among others. Since November, we have made some progress on a few of these files, including continuous advocacy for appropriate funding and supports for COVID-19 communitybased testing and vaccination and establishment of the Rural, Remote and Northern working group.
THE NEWLY ESTABLISHED PRIMARY CARE COLLABORATIVE BECOMES THE VOICE FOR PRIMARY CARE IN ONTARIO. Working with five other primary care associations, the Alliance has developed and signed onto the terms of reference for the Primary Care Collaborative (PCC). This amalgam of associations will be a powerful force in advancing primary care in Ontario and ensuring that comprehensive primary health care is the foundation of the health system and health system transformation. The Ministry of Health and Ontario Health routinely meet with the PCC to seek input on policy, directions and decisions with the goal of improving the health and wellbeing of people living in Ontario.
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Alliance members adopt the EPIC Learning Health System 2020 was a year of significant progress towards becoming a true learning health system (LHS): • EPIC Committee: The Performance Measurement Committee (PMC) renamed itself the Equity, Performance, Improvement and Change (EPIC) Committee. EPIC became the brand of our LHS. • Practice-based learning network (PBLN): The EPIC PBLN was formed in the summer of 2020 and is now one of seven PBLNs within the Primary Care Ontario Learning and Research (POPLAR) Network. • EL Network Endorsement: The EPIC LHS was formally approved by the Alliance’s Executive Leaders’ Network in October. • EPIC News: The monthly newsletter of the EPIC LHS was launched in November. Although the COVID-19 pandemic delayed some steps, it also became a driver of sector-based research and learning. From the outset, Alliance staff conducted research within our sector in order to understand how our members were responding to the crisis within our communities. As the pandemic has triggered a massive shift towards virtual delivery of primary healthcare programs and services, the Alliance and our research partners have undertaken numerous funded studies to understand the impact, barriers, and enablers of virtual care. The Alliance is currently collaborating on 30 different research projects. While COVID-19 is a major topic, other research projects that align with Alliance priorities continue as well, including evaluation of Rx: Community and TeamCare projects, primary care for individuals with severe mental illness (PRiSMI), advancing knowledge of homelessness and optimizing Canada’s healthcare for refugees.
CARING THROUGH THE CRISIS: MEMBER SURVEY HIGHLIGHTS
98% made check-in social calls to clients they identified as being at risk of social isolation.
54%
visited people in their homes.
38% visited people
By the end of May 2020, of members were offering group programs virtually, including cooking classes, exercise groups,social groups, and chronic disease management groups.
79%
in shelters. By the end of May 2020, all Alliance members were providing some primary care remotely. were offering virtual appointments for chronic disease management.
85%
Nearly all members were providing onsite prenatal & perinatal care; in-person support for chronic disease management; childhood & infant immunizations; and on-site wound care.
Many increased material supports: delivering hot meals to people’s homes; handing out tents and sleeping bags to people experiencing homelessness. of members distributed food hampers and grocery gift cards, often supplementing hampers with other necessities, as well as “love gifts”, like knitted teddy bears and painted flower pots, made by social prescribing groups.
75%
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THE WORK TO ADVANCE DIGITAL EQUITY GAINS MOMENTUM A shift to virtual programming and service delivery over the past year exposed the need to advance digital equity and digital inclusion. The Alliance took on the work early in the pandemic. Since then, a Digital Equity Strategy has been developed and endorsed by the Executive Leaders Network. The Digital Equity Strategy resource package was launched and is designed to help members develop and implement work towards digital equity with their partners. In December 2020, the Alliance received a $20,000 grant from the United Way of Greater Toronto to support the Digital Equity Strategy. The Alliance purchased 41 cellphones with 12-month data plans and distributed them to Alliance members in the Greater Toronto Area, focusing on priority populations from the LGBTQ2S+, Indigenous, French and Black communities. This is in addition to the 600 cellphones with prepaid data plans from TELUS Health that were distributed in the spring of 2020, demonstrating progress in our digital equity strategy.
THE PS SUITE EMR IMPLEMENTATION NOW COMPLETED Ninety-one existing and new members transitioned to the Alliance Electronic Medical Records (EMR) Master agreement. This includes the five Francophone centres that were using the Purkinje system and that now have an OntarioMD-certified, fully bilingual EMR with PS Suite (PSS). It was a long four-year journey to educate TELUS Health around the unique EMR needs of Alliance members. We are now focused on meaningful use to improve data collection and more importantly, client outcomes. Early member meaningful use survey results show a 40% improvement in PSS EMR use over Nightingale on Demand (NOD).
BY THE NUMBERS PRIVACY AND SECURITY TRAINING Privacy and Security training for member centres exceeded last year results.
614 privacy consultations offered —
47%
28 phishing exercises were completed with
1780
increase from last year
individuals taking the online security training module
2,089
3,840
took the staff online privacy training course
staff were trained through live video sessions
CYBERSECURITY Due to the rise in cyber risk, the Alliance secured two free resources to assist members. The first allows the Alliance to scan members for security vulnerabilities and share the results for remediation with them. The second will enable automation of sophisticated phishing campaigns to build awareness and cyber resilience of both member and non-member staff.
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Financial Report Alliance for Healthier Communities has a solid financial picture, with total revenues of $6.8 million. Total revenue of approximately $2 million contributes to our core operations: advocacy, policy, communications, and resource and policy support for our members. This revenue was earned from membership fees, meeting registrations, learning events, and funding from special projects. Additional revenue of $4.8 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 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. As of March 31, 2021, the Alliance’s fund balances totaled $436,630. • General Fund: $30,460 was transferred to our general reserve. The balance in the General Fund is $256,611. • IMS Fund: $30,000 was transferred to our IMS reserve. The balance in the IMS Fund is $180,019. Audited statements are available upon request.
Board of Directors 2020-2021 We want to thank outgoing governors — Cate Melito, Dale McMurchy and Micheal Hardy — 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. LIBEN GEBREMIKAEL, Chair Executive Director of TAIBU Community Health Centre
CATE MELITO, Director Executive Director of Grand Bend Area Community Health Centre
DALE MCMURCHY, Director Board member at Kawartha North Family Health Team
MARIETTE SUTHERLAND, Vice-Chair Committee member of Noojmowin Teg Health Centre
ANIKO VARPALOTAI Board member at Central Community Health Centre
FRANÇOIS SEGUIN, Treasurer Board Chair of l’Équipe de santé familiale communautaire de l’Est d’Ottawa
MICHEAL HARDY Executive Director of Anishnawbe Mushkiki Aboriginal Health Access Centre
CLIFF LEDWOS, Director Associate Executive Director and Director of Primary Health Care at Access Alliance Multicultural Health and Community Services
MARC BISSON, Secretary Executive Director of Centre de santé communautaire de l’Estrie
MIKE BULTHUIS Board member at Centretown Community Health Centre
CLAUDIA DEN BOER, Director CEO of Canadian Mental Health Association — Windsor-Essex County Branch
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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
STRATEGIC DIRECTIONS 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 community-informed and evidence-based approach.
Champion health equity and population needs-based planning, and challenge systemic inequities to achieve improved health outcomes. Advance people-centred, high quality primary health care as the foundation of the universal and publicly funded health system to increase access to appropriate services, especially for populations facing barriers. Demonstrate the value and impact of the Model of Health and Wellbeing on the improved health outcomes and experiences of people and communities. Advocate for appropriate policies, processes and resources to ensure members are equipped to operate healthy organizations and realize their potential as effective catalysts in system transformation.
500-970 LAWRENCE AVENUE WEST TORONTO, ON M6A 3B6 416-236-2539 WWW.ALLIANCEON.ORG ALLIANCEON @ALLIANCEON