Public Record Of Meeting - Toronto, November 25, 26, 2001

Committee Reports

Executive Committee
Special Working Group on Aboriginal Issues (SWGAI)
Visioning Committee
Championing Committee
Communications Committee
Monitoring and Evaluation Committee (M & E)
FPT AIDS Update
Discussion on Annual MC Report
Ministerial Council Work Plan Development Discussion
CIHR Follow-Up to Dr. Bernstein's Presentation to Council
Additional Items - Presentations

EXECUTIVE COMMITTEE

It was mentioned that the committee had two teleconference calls since the last MC meeting in September.

It was noted that the issue of Gray Rocks II was discussed as a request to have a Council member sit on the Organizing Committee. The planning meeting is scheduled for December 13-14, 2001.

SPECIAL WORKING GROUP ON ABORIGINAL ISSUES (SWGAI)

A brief summary of SWGAI activities since the last Council meeting was provided.

It was mentioned that May Toulouse of First Nations and Inuit Health Branch (FNIHB) joined the SWGAI teleconference to respond to questions that the group had with regard to: a) accountability and reporting of $3.6 million in HIV/AIDS funds to Aboriginal people through FNIHB and CSHA, and, 2) how the two are integrated with respect to the Gray Rocks directions and CSHA goals.

SWGAI was told that a portion of FNIHB funds are used to support national projects such as the AFN National Action Plan and the National Aboriginal AIDS Strategy, and the remainder is distributed to the regions to distribute to the communities. All groups receiving funds are required to submit proposals and reports.

It was indicated that FNIHB reports out annually to the CSHA in terms of broad activities being done, but that a reporting and accountability framework for FNIHB regional work is under development.

It was outlined that SWGAI requested that a roll up of everything done at FNIHB be provided as a means of understanding how the $3.6 million is currently being spent.

It was noted that this is an important piece of work that needs to be done and requires increased funding for communities so that they can identify the gaps and then request additional funding.

It was mentioned that FNIHB will provide SWGAI with summaries on regional activities, financial allocations and community numbers for 2001-2002. SWGAI will review these documents and report to Council at the next meeting in March.

VISIONING COMMITTEE

It was reported that the new Visioning Committee met with the Communications Committee via teleconference.

It was noted that specific input was needed from Council prior to moving forward with the planning of a visioning day. It was suggested that a discussion take place to determine: a) what is meant by visioning; b) whether the "Vision" is focused on the MC or on the CSHA; c) a list of objectives/outputs for visioning day; and, d) the development of a process for that day.

Gray Rocks update and discussion

The Council was provided with a brief overview of the CSHA, the Direction-Setting and Work-Planning Model, as well as the Gray Rocks Direction-Setting Meeting.

The policy directions within the CSHA were discussed: (i) enhanced sustainability and integration, (ii) increased focus on those most at risk and, (iii) increased public accountability. It also touched on translating policy directions into action by way of Advisory/Coordinating Committees and Mechanisms and Processes.

The Direction-Setting and Work-Planning Model were outlined, indicating that there are:

(i) Guiding Principles

Centred around people living with HIV/AIDS and those at-risk of being infected with HIV/AIDS;
Respects the needs of First Nations, Inuit and Métis people;
Respects the needs of offenders/prisoners;
Sensitive to local/regional issues;
Based on wisdom, knowledge and evidence (a balance between quantitative and qualitative information);
Designed to strengthen existing partnerships and encourage the development of new ones;
Uses both existing and new structures/mechanisms to engage Strategy partners in all activities.

(ii) Goals, Objectives and Outcomes

Goals: Ensure a relevant response of the Strategy and its components to the HIV/AIDS epidemic in Canada using a coordinated, proactive and integrated approach to HIV/AIDS among Strategy partners.

Objectives: Establish common/shared priorities for Strategy partners and Develop integrated work plans for the Strategy.

Outcomes: Maximized national investment in HIV/AIDS activities; and Clear understanding of roles, responsibilities and reciprocal accountabilities.

It was indicated that the Direction-Setting Meeting had objectives: (i) to launch an annual collaborative planning and direction-setting process for the CSHA, and, (ii) to identify broad strategic directions to guide the CSHA in fiscal year 2001-02. The meeting also had outcomes of: (i) the 10 Strategic Directions, (ii)a sense of positive energy and healthy skepticism about the process, and, (iii) willingness to engage in collaborative work-planning.

It was mentioned that one of the lessons learned along the way was that working with a multi-stakeholder task group is a good idea when trying to develop a broad-based consultative process. It was stated that this broad-based consultation proved to be do-able and useful.

The Direction-Setting and Work-Planning Task Group Recommendations were outlined: (i) that a communication strategy be created to transmit the messages coming out of Gray Rocks and to encourage broader participation in the direction-setting process, (ii) that Health Canada begin to move forward on an implementation process for the 10 Directions, and, (iii) that a broad collaborative work-planning process be designed for 2002-2003. It was also indicated the need to communicate about Gray Rocks and follow-ups via the website, brochures and updates.

It was stated that the 10 Directions are a key mechanism to ensure that the CSHA remains relevant to the changing epidemic in Canada. It was also indicated that Health Canada is committed to moving this process forward and to realize the directions.

It was noted that the objectives of Gray Rocks II are: i) integration of the 10 Directions into strategic collaboration across the CSHA, ii) defining the process for continued collaborative thinking and workplanning, iii) an opportunity to think strategically about the epidemic, iv) an opportunity to further expand our thinking about our response to the epidemic, and, v) an opportunity to develop networks.

The four components of the planning process were discussed: i) the new task group will be essential in building on successes and lessons learned from the previous group, ii) the environmental scan will clearly be part of the planning process and its content will depend on what needs to be accomplished, iii) the collaborative work-planning project is critical to follow-up on the directions, and, iv) the communication and engagement strategy will ensure that the right amount of information is getting out.

CHAMPIONING COMMITTEE

The Council were provided with an update of Championing's activities. The members were advised that both Rick Marchand and Louise Binder will serve as co-chairs for the committee, alternating who will table the reports from one meeting to another. It was also noted that many of the current issues being looked at by Championing have been on its agenda since its inception.

a) Correctional Service of Canada (CSC)

It was indicated that Championing met with the new commissioner several months ago and a subsequent letter was written to the MoH suggesting that he meet with the Solicitor General. It was stated that the meeting has yet to be scheduled.

(b) UNGASS

It was noted that the letter that Championing was to draft and send to the Prime Minister,(copying the MoH and CIDA, thanking him, yet advising of Council's disappointment in Canada's financial contribution to the Global AIDS Fund), is still in draft form, but will be going out soon.

(c) National Reference Group for Women

The Council was advised that a letter to the MoH seeking reinstatement of the group was sent on November 16. It recommends reinstating the NRG to oversee the implementation of its recommendations before the group is disbanded. Championing is awaiting a response from the MoH.

(d) Determinants of Health Paper - Joint project with FPT

The Council was notified of an upcoming conference call to review the draft paper.

(e) Valuing Gay Men's Lives - Gay Men's National Reference Group

It was indicated that Health Canada is working on the policy strategy and guiding principles to be ready by January 2002. It was noted that the policy strategy and guiding principles will support the future National Advisory Committee in the development of the gay men' HIV prevention framework to be used by Health Canada HIV/AIDS Division. The framework for gay men's HIV prevention is expected to be ready by March 2002.

(f) Mother to Child Drug Surveillance Registry

It was mentioned that the committee was provided with background material by way of the Canadian Perinatal Exposure to Antiretroviral Surveillance (PEARS).

(g) Immigration

It was reported that a letter was sent October 18 inviting a meeting between Minister Caplan, staff and the Council. Minister Caplan has responded that she could meet with the co-chairs and a staff person from her office.

After consideration of the issue and a brief discussion, Council agreed that a face to face meeting between Minister Caplan and the co-chairs will be the best course of action at this point.

(h) Intravenous Drug Use (IDU)

It was mentioned that Championing had been charged with writing a letter to MoH on a list of issues related to IDU. Following a teleconference, the committee agreed that too many issues in one letter will not be an efficient way to deal with them. As such, the committee decided that two letters will be drafted. The first letter will focus on the follow-up to the Canadian HIV/AIDS Legal Network report on IDU, the update from FPT Ministers Meeting in Newfoundland and will thank the MoH for his leadership in this matter. The second letter will focus on the funding for Canada's Drug Strategy and the issue of safe injection sites.

On the issue of the second letter to the MoH, it was agreed that Championing will wait until after the task force meeting, and the issues have been discussed at committee level. Once done, Championing will report back to Council for discussion on further steps to be taken.

(i) Community-Based Research (CBR) update

A brief summary on the issue was provided, notably that October 1, 2001 was the start date for the review process and the anticipated completion date is March 31, 2002. The review will be done in 4 phases: 1) electronic discussion group, 2) review of models for CBR and funding, 3) draft discussion paper for circulation and comment, and, 4) key informant interviews and focus groups in every region.

(j) CIHR Discussion

It was stated that letters have been sent out to the MoH and there is a recommendation of the creation of an Office of HIV Research in the CIHR structure.

It was mentioned that many issues related to CIHR, including 1) community based research, 2) vaccine research, 3) research coordination, and 4) consultation with stakeholders, all need to be reviewed/discussed by Council.

(k) Vaccines

The Championing committee is still at the "gathering information" stage and has no recommendations yet. It was indicated that the committee is trying to understand any links for CIHR possibilities and also trying to understand the US National Institute of Health structure. It was reported that Championing is also gathering information on CIDA investment in vaccine research.

(l) Trade Negotiations and Drug Access

It was mentioned that Championing discussed the fact that the World Trade Organization is planning to hold its next meeting in Qatar.

It was indicated that the committee questioned whether the MC should inform and make recommendations to the MoH, as well as to other Ministers (e.g., P. Pettigrew, Minister for International Trade, J. Manley, Min.of Foreign Affairs, and B. Tobin, Min. of Industry). Committee members agreed that Council needs to first be informed of the issue before putting any recommendations forward.

The committee is still at the information gathering stage on this matter and members are trying to brief themselves on the details of these negotiations.

(m) Drug Review and Cost effectiveness

The Council was briefed on the latest developments with regard to the drug review issue. Members were advised that at the last Ministers of Health Meeting in Newfoundland, an agreement to improve pharmaceutical management was reached. The agreement includes: (1) the establishment of a single, common review process for coverage of new drugs, (2) the support of best practices in drug prescribing and utilization, and, (3) the establishment of a national prescription drug utilization information system. It was noted that these pertain more to the approval for reimbursement processes than to drug review.

Serious concern was expressed with the new advisory panel to be set up at the Branch level as it might not be in a position to do effective work on this issue since members will not be up to date and may have other priority issues. It was also indicated that the lack of resources to do reviews in a timely manner has resulted in huge backlogs in new drug reviews.

It was indicated that Championing will also monitor the following issues: blood borne pathogens, development of the "aide-mémoire" from the MoH to his colleagues on inter-departmental co-operation, research on women in prisons and the work plan from Health Canada.

COMMUNICATIONS COMMITTEE

a) World AIDS Day

Members were provided with a brief summary of activities surrounding the preparation of the MC's input into the key messages that were to be included in the MoH's speech on World AIDS Day.

It was indicated that information received from Council was used to formulate the message from Council to be included in the WAD report, but very few ideas were actually used and Health Canada essentially re-wrote the entire report. It was indicated that effective communication, planning and working in collaboration with Health Canada is crucial in putting forward the type of message that Council recommended at its last meeting in September.

It was noted that each year on WAD, the Minister holds a public event and releases Canada's Report on HIV/AIDS, which provides a snap shot of the HIV/AIDS epidemic in Canada, as well as the response to the epidemic by the CSHA. This year, a new approach was implemented by the HIV/AIDS Division in collaboration with the Departmental Program Evaluation Division to develop Canada's Report on HIV/AIDS 2001. Whereas in previous years Health Canada prepared a report for Treasury Board and the separate public report on HIV/AIDS, this year one report was prepared and used for both purposes. The approach involved interviews with 25 key departmental officials and key national stakeholders. An editorial board was also convened to help finalize the report. Coordination with other departments (CIDA, CSC, CIHR) was a key element of the approach to ensure common messages are used in all WAD communications activities.

b) Implementation of MC Communication Strategy - Discussion

The issue of promoting the Council's public profile was discussed and it was noted that there seems to be confusion about what the Council is. It was mentioned that many stakeholder groups do not know what the MC is and what it does. It was questioned whether the message can get out there since it appears that the website does not answer questions for people. It was suggested that the Communications Committee prepare a presentation to promote the Council, show transparency and how it prioritizes issues.

c) Managing Incoming Information

The Council was advised that a procedure for the management of incoming information needs to be developed. It needs to articulate the exact process used by the MC in managing incoming and outgoing information, including for example, the type of issues that Council considers, where materials or requests should be sent, in what format (letters or emails) while at the same time ensuring that Council does not become the clearing house for HC. The letters should go to the Secretariat first, and will then be distributed to the appropriate MC committee.

MONITORING AND EVALUATION COMMITTEE (M & E)

It was indicated that the committee reviewed the refinement of Council Objectives developed at the September meeting. It was subsequently approved by the committee for recommendation to Council with a few minor adjustments. It was mentioned that in Role # 1 the words "regarding HIV/AIDS" were added so that it reads "To ensure that current and emerging issues regarding HIV/AIDS are being adequately addressed". It was also mentioned that the roles were re-ordered to reflect the optimal chronological sequence.

Council agreed with the revised wording in Role # 1 and the re-sequencing of all three roles.

Members were advised that the current CSHA resource allocations were developed in late 1997 based on recommendations of the National Stakeholder Group and the national consultation process for the renewal of the CSHA. As part of that renewal, Health Canada committed to Treasury Board to develop an ongoing process for reviewing CSHA allocations. To this end, a resource allocation framework has been developed and was distributed to CSHA partners in mid-June 2001 for review. M & E did provide feedback and now the allocation framework has gone to peer review.

FPT AIDS UPDATE

It was mentioned that FPT AIDS had a very successful meeting in November. It was noted that the committee had a presentation on multi-drug resistant HIV and the implications for testing and treatment policies.

It was indicated that the main outcomes of the meeting, (which will have significant cost implications for FPT) included:

i) Agreement on the work to be completed by March 2002:

• finalizing the health determinants paper in collaboration with the MC
• updating Partner Notification Guidelines
• organizing a meeting of key FPT, regional and local experts on the issue of persons unwilling / unable to prevent HIV transmission
• completing a discussion paper on the issue of access to HIV drugs

ii) Agreement on certain areas of activities for 2002-2003 which will be submitted for approval by the Conference of Deputy Ministers of Health (CDMH) at the end of November, including:

• a strategic planning process to develop medium term directions for the Advisory Committee
• a workshop on the issue of persons unwilling or unable to prevent HIV transmission
• a blue print for an HIV/AIDS related action plan in response to the FPT-IDU report Reducing the Harm Associated with Injection Drug Use (approved at the November meeting)
• policy advice to address jurisdictional barriers to strategically provide HIV/AIDS treatment and care within the Aboriginal populations
• a policy framework to address issues related to multi-drug resistant HIV
• a panel of experts to share the findings from the HIV and Health Determinants literature review. This would be a joint initiative with the MC

It was indicated that the FPT AIDS is proposing that the MC considers the following joint initiatives:

• Translation, printing and distribution of the HIV and Health Determinants literature review.
• Convening a think tank to share the findings from the HIV and the Health Determinants literature review and brainstorm methods to overcome barriers to inter-governmental collaboration on HIV/AIDS related health determinants.

It was mentioned that a significant part of FPT's activity this coming year will be on a strategic planning process. He added that anything for public release or that has financial implications must be routed through CDMH for approval.

DISCUSSION ON ANNUAL MC REPORT

There was a discussion on an annual MC report to go to the MoH, which could be used to help bolster arguments for additional funding.

Members agreed that an annual report is required.

MINISTERIAL COUNCIL WORK PLAN DEVELOPMENT DISCUSSION

There was a discussion on Council's priority issues for future meetings. The need for medium and long-term strategic planning for the Council was stressed. It was noted that a strategic planning exercise (Visioning Day) is required to determine the MC's strategic directions for the next few years.

CIHR FOLLOW-UP TO DR. BERNSTEIN'S PRESENTATION TO COUNCIL

A discussion was led and members were reminded that concerns were raised from the presentation made by CIHR representatives at the last meeting. The issue of Community-Based Research, the recommendation to have an Office of HIV/AIDS within CIHR and the question of decision making with regard to the funds allocated to CIHR from CSHA were discussed

Attention was drawn to the letter that was recently sent to Dr. Bernstein and one to Minister of Health requesting an Office for HIV/AIDS within CIHR and reiterating concerns already expressed about the apparent lack of experience and interest within CIHR regarding community-based research.

It was indicated that there is serious underfunding of basic research and there should be more emphasis on clinical research. It was noted that having another meeting with Dr. Bernstein will be a good start, but pointed out that even if he is on board, it may be difficult to get others on-side.

Business Arising

Next MC meeting set for Montréal on Friday and Saturday March 8 and 9, 2002.

Additional Items

Social Justice Framework Presentation and Discussion

Review of the UNGASS Declaration

Health Canada Report

Interdepartmental collaboration

It was noted that following the events of September 11th, 2001, departmental resources have been refocused and prioritized to protect the health security and preparedness of Canadians in response to the threat of bio-terrorism.

World AIDS Day 2001

It was stated that plans for World AIDS Day (WAD) are on schedule and that a speech, as well as information kits for WAD events, are being prepared.

The kits will be distributed to MPs, Senators, Media, National Partners, Ministerial Council members, FPT AIDS Committee members and to the Canadian HIV/AIDS Clearinghouse and key strategy Partners for broader distribution on November 29, 2001.

It was mentioned that this year, HC combined its Annual Report to Treasury Board with the WAD Report.

Community-Based Research (CBR)

A detailed overview of the activities that have taken place since the last update given in September was provided. As requested by Council, a document entitled "Funded Community-Based Research (CBR) and Aboriginal Research (AR) Proposals under the CSHA" was distributed.

It was mentioned that the review process for the NHRDP March 2001 Call has been completed. Five projects have gone forward for Ministerial approval (3 CBR and 2 AR). With the addition of these five proposals the total number of currently funded research projects will be fourteen (9 CBR and 4 AR).

It was strongly felt that the process developed by the Steering Committee and Health Canada to renew the CBR Program will ensure consultation with a wide range of stakeholders, and will result in a program that is responsive to community needs.

Continuously emerging Anti-Retroviral Drug resistant HIV

A document prepared by Health Canada that summarizes the drug resistance issue was briefly discussed. It was noted that the document will be revised slightly for dissemination on World AIDS Day. The a formal report on the strain and drug resistance surveillance program, with updated data, should be released in January 2002.

National Aboriginal Council on HIV/AIDS

It was mentioned that the NAC held its first face-to-face meeting in Vancouver from September 30 to October 2, 2001 and indicated that its raison d'être was to provide advice on the CSHA to HC.

It was noted that the meeting was an opportunity for the group to meet each other, find out what brought the individuals to the work of the NAC, and to select co-chairs from the caucuses. It was explained that letters were sent to the 10 Métis members who wanted to participate in the NAC, but that a decision had been made to bring only three members to sit on the NAC. It was reported that the process is moving forward in unity and with full representation. It was also pointed out that for the balance of the meeting, the NAC finished developing its Terms of Reference based on input collected at the last National Aboriginal Summit of May, 2001.

The NAC will be convening again December 12 to 15 in Ottawa. The purpose of this next meeting will be to review past and existing collaborative mechanisms between the CSHA and Aboriginal peoples, and to identify priorities in each element of the CSHA for the NAC to engage in as they develop a workplan for the balance of this fiscal year.

International Affairs Directorate

The members were provided with a brief summary of three documents published in the fall of 2001 by the International Affairs Directorate. The documents were distributed at this MC meeting. The documents are:

1. The UNGASS Report, a reference document for the work done at UNGASS and beyond, which contains key documents from the Special Session as well as reports on Canada's participation in this historic and unprecedented event. These include the Declaration of Commitment, the final outcome document of UNGASS, the address by UN Secretary General Kofi Anna, and the Report on the Canadian Consultation Meeting on UNGASS. It also contains information on where to find copies of other relevant UNGASS documents.

2. The Report on HIV/AIDS: What Canadians can do Internationally: Report of the International Issues Satellite, summarizes the salient proceedings, discussion and outcomes of the session. The Satellite, co-sponsored by HC's International Affairs Directorate, the Canadian AIDS Society and the Interagency Coalition on AIDS and Development, was held on July 6, 2001, and preceded the third Canadian HIV/AIDS Skills-Building Symposium that took place in Montreal. The event attracted participants from across Canada and around the world.

3. Taking Stock, September 2001, is an HIV/AIDS newsletter produced by the International Affairs Directorate. This document summarizes key events and news reviews related to HIV/AIDS at the international level. The newsletter which is produced occasionally, is intended to keep partners and collaborators informed and build awareness and support for greater participation in international efforts to address HIV/AIDS issues.

CSHA Year Three Evaluation

It was reported that the draft Year Three Evaluation report and the draft technical reports were reviewed on November 14, 2001 by a peer review panel organized by HC's Departmental Program Evaluation Division (DPED), which is leading the evaluation process.

It was indicated that the Year Three Evaluation is an important tool to ensure that the CSHA remains relevant and responsive to the changing dynamic of the HIV/AIDS epidemic in Canada. The review focussed on the soundness of the evaluation study's methodology, findings, conclusions and recommendations, and provided advice to guide the Year Five Evaluation. It was also mentioned that the peer review panel recommendations will be used by DPED to determine the next steps to complete the evaluation study.

It was noted that DPED will be working to complete the Year Three Evaluation and provide a next-to-final version to Council and other stakeholders in early 2002 and begin planning the Year Five Evaluation.

Population and Public Health Branch / Grants and Contribution Programs

It was mentioned that HC has been notified that there are a number of weaknesses in the Branch's project management practices. It was indicated that specific deficiencies were noted in the HIV/AIDS Community funding programs. In response, a review of all current PPHB grants and contribution files under the CSHA is being undertaken. The review will encompass all steps in the project management cycle, including project solicitation and selection, approval, monitoring and evaluation. The review will include ways in which HC can improve how it does business and will show how to undertake these changes.

Second Quarter CSHA Financial Report

The financial status report was tabled for the second quarter for 2001-02, along with the complementary template that Council requested for a more detailed breakdown of line items.

ADDITIONAL ITEMS - PRESENTATIONS

Social Justice Framework Presentation and Discussion

Presentation was done by a Health Canada representative. The establishment of a social justice framework has been initiated to guide the CSHA (Direction 9 from the direction setting meeting held in Gray Rocks). The topic of the presentation was "Social Justice and Population Health: A Rights-based Approach". The full presentation is available from the Secretariate. Highlights from the presentation included:

• Origin of the movement linking health and human rights to the work of the late Jonathon Mann, and its consistency with international standards such as UNAIDS;
• The common links between the determinants of health and the broad range of human rights, especially around marginalized groups, social and economic disadvantage and health inequalities;
• Discussion on application of the law as a structural intervention to work toward long-term health outcomes, and also as a more proximate intervention to address effects of inequality as one part of a multi-disciplinary, cross jurisdictional approach;
• The need for an integrated strategy;
• Social justice challenges and potential benefits to the traditional approach to public health; and,
• Brief discussion of potential implications of a shift to a social justice framework to stakeholders (including Health Canada, public health, CBAOs and vulnerable populations).

Michael indicated that a research/discussion paper will be circulated prior to Gray Rocks II. He asked members what kind of consultation they thought will be needed post Gray Rocks II.

Review of the UNGASS Declaration

The presentation provided Council with a review of the UNGASS Declaration.

It was noted that leadership, commitment and concrete actions are required to move the UNGASS Declaration forward. There is 11 areas in which commitments were made and targets set:

• leadership for an effective response
• prevention as the mainstay of the response
• care, support and treatment as fundamental elements of the response
• realization of human rights and fundamental freedoms for all is essential to reduce vulnerability
• reducing vulnerability (including vulnerable groups, women, children/youth)
• providing special assistance for children orphaned and made vulnerable by HIV/AIDS
• alleviating social and economic impacts
• further research and development
• recognition of how conflicts and disasters contribute to the spread of HIV/AIDS
• recognition that the challenge cannot be met without new, additional and sustained resources
• follow-up to maintain momentum and monitor progress

Here a list of specific areas of interest/concern in the Canadian context:

a) Leadership

• assess the CSHA in light of the UNGASS Declaration
• development planning, integrating HIV/AIDS
• Canada's role in various UN fora

b) Prevention

• time-bound national targets - re: reducing HIV prevalence
• workplace
• migrant/mobile workers
• universal precautions
• wide-ranging prevention programs - access to info/goods; includes harm reduction; education/skills for prevention; prevention of Mother to Child Transmission(MTCT) of HIV

c) Care, support and treatment

• strengthen health care systems, including access to drugs and health personnel
• address issues of global differential pricing, health infrastructure
• collectively realizing human right to the highest attainable standard of health
• address pharmaceutical policy
• strengthen community care

d) Human rights aspect

• discrimination against PHAs and vulnerable groups persists... CSHA response?
  • ensuring access to health care and services, treatment, info, .
  • privacy and confidentiality protections
  • anti-stigma/social exclusion strategies
• incorporating gender dimensions/perspective in CSHA

e) Reducing vulnerability

• does CSHA address factors underlying vulnerability?
• education for youth reflected in CSHA?

f) Children

• de-stigmatizing children orphaned and made vulnerable
• international funding... role for Canada.. focus on children?

g) Alleviating social and economic impact

• correlation between CSHA and poverty reduction... "social justice" framework
• health care costs

h) Research and development

• Canadian funding.. domestic and international

i) Conflict/Disaster affected areas

• peacekeepers... what is Canada doing?

j) Resources

• Canada's Official Development Assistance (ODA) level
• Global Fund contribution
• implementing the Heavily Indebted Poor Countries (HIPC) Initiative
• investment in research
• CSHA funding

The Council would need to keep two dimensions in mind when considered the following questions for discussion: i) implementing Declaration commitments in Canada, and, ii) supporting their implementation elsewhere

• How can the MC best monitor Canada's implementation of its commitments in the Declaration and its progress toward the agreed-upon targets?
• What are Health Canada (IAD, HIV/AIDS Division) and DFAIT (CIDA) doing to implement Canada's commitments, to champion the commitments vis-à-vis other departments, and to monitor progress? What kind of information does Council want from them? Ex: UNAIDS is designing a monitoring strategy and template for regular reporting by countries. Will Canada be providing input? Will MC provide recommendations re this?
• What are others in Canada doing to follow-up on UNGASS commitments?
• Is there a role for Ministerial Council to collaborate with others in achieving the targets set out in the UNGASS Declaration?
• What are the implications for Council's communications strategy?