The art and science of a strategic grantmaker: the experience of the Public Health Agency of Canada’s Innovation Strategy

Setting The Public Health Agency of Canada’s Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social innovation and systems change, the PHAC-IS was created as a national grantmaking program that funded the testing and delivery of promising population health interventions between 2009 and 2020. Intervention During its decade-long tenure, the PHAC-IS supported the development of innovative, locally driven programs that emphasized health equity, encouraged iterative learning to respond reflexively to complex public health problems (the art), while at the same time promoting and integrating population health intervention research (the science) for improved health at the individual, community, and systems levels through four program components. Outcomes PHAC-IS projects reached priority audiences in over 1700 communities. Over 1400 partnerships were established by community-led organizations across multiple sectors with more than $30 million of leveraged funds. By the final phase of funding, 90% of the projects and partnership networks had a sustained impact on policy and public health practice. By the end of the program, 82% of the projects were able to continue their intervention beyond PHAC-IS funding. Through a phased approach, projects were able to adapt, reflect, and build partnership networks to impact policy and practice while increasing reach and scale towards sustainability. Implications Analysis and reflection throughout the course of this initiative showed that strong partnerships that contribute sufficient time to collaboration are critical to achieving meaningful outcomes. Building on evaluation cycles that strengthen project design can ensure both scale and sustainability of project achievements. Furthermore, a flexible, phased approach allows for iterative learning and adjustments across various phases to realize sustained population and systems change. The model and reflexive approach underlying the PHAC-IS has the potential to apply to a broad range of public programs.


Introduction
Complex public health challenges require an approach that addresses social, economic, and environmental factors across multiple sectors and creates lasting impact at the population level. While investment in community-based projects has been a common approach within the field of health promotion and prevention, an opportunity exists to design programs to respond to the complexity of these challenges towards improved population health. Over a decade ago, the Public Health Agency of Canada designed an innovative funding model and approach that aimed to foster innovative and promising population health interventions that would have the potential to promote health at the individual, family, community, and systems levels.
The Public Health Agency of Canada-Innovation Strategy (PHAC-IS) was a national strategic program that supported the development of locally driven innovations between 2009 and 2020, while increasing the reach and impact of proven interventions towards long-term, sustained benefit. Drawing on theoretical underpinnings of social innovation, complexity thinking, and complex adaptive systems while incorporating a population health intervention research (PHIR) approach 1 , 1 PHIR refers to the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside the health sector and have the potential to impact health at the population level. This intervention research approach focuses on building knowledge about how the intervention process results in change and the context in which the intervention works best and for which populations. PHAC-IS investments 2 reached priority audiences in over 1700 communities and impacted 2,070,920 individuals 3 .
The PHAC-IS was designed to support multi-sectoral partnerships for intervention delivery, community engagement, and knowledge exchange aimed at impacting policy and systems. Over 1400 partnerships were established by community-led organizations across multiple sectors, including municipal, regional, and provincial/territorial levels and the philanthropic and private sector. Using an intentional partnership approach, projects leveraged over $30 million of supplementary funds, in addition to in-kind resources through their partnership networks. By the final phase of funding 4 , 90% of the projects and partnership networks had a sustained impact on policy and public health practice. At the conclusion of the PHAC-IS in 2020, 82% of the projects were able to continue their intervention through funding from other sources or by partially or fully integrating into existing systems through scale-up. While all projects demonstrated an increase in protective factors and/or a decrease in risk factors among primary audiences at the individual level, the emphasis of this article is on the program model and approach to support promising interventions that aim to impact multiple levels across the individual, family, community, and systems for sustained population health promotion.
This article outlines the model, approach, and outcomes 5 of the PHAC-IS as a way to contribute to dialogue and momentum for strategic grantmaking to promote population health. A combination of art and science guided the PHAC-IS model and approach across four program components, including a phased funding approach (grants and contributions), multi-level partnership development, knowledge development and exchange, and a focus on strengthening capacity and innovation (resources, methods, and tools). This article reflects on lessons learned, opportunities for improvement, and challenges identified along the way, punctuated with funding outcomes gained through rigorous performance monitoring and evaluation across three phases of funding. Learnings from the PHAC-IS model and reflexive approach, including emphasis on supporting partnerships, knowledge development and exchange, and scale-up aimed at impacting policy and systems to promote health, have the potential to apply to a broad range of public policies and programs.

Background and setting
When the PHAC-IS was established in 2009, there was a paucity of information about how grantmaking models and initiatives could support social innovation and systems change. During that time, it was also recognized that integrating a population health approach to address the complexity of underlying determinants of health was extremely important and that a paradigm shift from a narrow focus on individual behavioural change to complex interventions that could effectively and equitably sustain impact at population and policy level was required (Butler-Jones, 2009;Hawe & Potvin, 2009;Hawe & Shiell, 2007;Nutbeam, 2001;Resnicow & Page, 2008). The literature also pointed to a need for diverse structural funding mechanisms that could support research agendas to mobilize knowledge gained from these interventions, including the scale-up of pilot projects into long-term funding programs and knowledge sharing across jurisdictions (CIHR-IPPH, 2010;Bégin, 2009).
In response, the PHAC-IS focused on social innovation and systems change within a PHIR approach. Social innovation has been described by Broadhead (2010) as "a complex process of introducing products, processes or programs that profoundly change the basic routines, resources and authority flows or beliefs of the social system in which they arise." A nested theory within the PHAC-IS model was that of complex adaptive systems change and the notion that difficult public health challenges require a robust and multifaceted response that interacts with and promotes health at the individual, family, and community levels (Resnicow & Page, 2008). The PHAC-IS was also informed by a concept of strategic grantmaking that had gained momentum in private and philanthropic sectors since the 1990s, in part because of its ability to jump-start innovation and its emphasis on broad impact and long-term goals (Orfield et al., 2015). This concept emphasized that greater intentionality and strategic processes contribute to a strong theory of change (Easterling & Metz, 2016).
Additionally, in 2006, an Independent Blue Ribbon Panel on Grants and Contributions called for greater accountability across government departments at the federal level while improving both efficiency and access. The Blue Ribbon Panel recommended increased focus on the design of strategic programs as well as innovation and the importance of identifying intended results at the outset (Treasury Board Secretariat of Canada, 2006). In response, PHAC initiated a process to design a model that would address barriers encountered by funders and grant recipients such as limited resources and lack of capacity to generate evidence as well as lessons learned from successful interventions (PHAC, 2015). A priority-setting exercise with federal departments, provincial and territorial ministries, and key nongovernmental organizations and stakeholders identified the need for evidence-based population health interventions within two priority streams, Equipping Canadians: Mental Health Throughout Life (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) and Achieving Healthier Weights in Canada's Communities (2011-2020. By design, the PHAC-IS model enhanced a culture of innovation and learning within population health interventions to reduce health inequities and effectively address priority public health problems and their underlying factors. In order to remain responsive, a combination of art and science guided the PHAC-IS model. The "art" refers to a reflexive, partnership-driven model with a focus on continual improvement to foster innovation and adapt to complex population health challenges operating alongside the "science" of PHIR and the four components of the model: phased funding approach (grants and contributions), partnership development, knowledge development and exchange, and strengthening capacity and innovation (resources, methods, and tools). Two overarching objectives guided the iterative aspects of the PHAC-IS: supporting the development, adaptation, implementation, and evaluation of promising innovative population health interventions to address priority challenges and their underlying factors, and supporting knowledge development and exchange based on the systematic collection of data across three phases (Table 1).

Review and evaluation methods
The PHAC-IS operated for approximately 11 years using an analytical and structured reflection process that was integrated into its delivery to foster a culture of innovation and learning (Cook & Bradley Dexter, 2021). The findings in this article are drawn from this process and include highlights related to the four components of the program. To capture these highlights, an analysis of project and program sources was completed, including independent consultant reports at the project and program level, project knowledge products, PHAC-IS reports, and PHAC corporate evaluations. year time frame and project performance evaluation and reporting forms completed at the time captured only information from the first year of implementation, many projects could not yet respond to this question. Either projects had not attempted to directly improve health practices, skills, or outcomes at this stage or this had not yet been sufficiently measured to conclusively confirm a change had occurred † This figure represents behaviour change only for phase 2 projects funded through the Achieving Healthier Weights in Canada's Communities stream; 55% (6/11) projects reported a change in protective factors among participants. Additionally, 45% (5/11) of projects reported improved well-being among participants In addition, rigorous performance monitoring captured the outcomes of PHAC-IS funding across the four components. Performance measurement tools and processes developed for evaluation reviews 6 of funded projects (Boileau-Falardeau et al., 2021) as well as program-level performance measurement informed the analysis. Although qualitative examples of projects are provided to illustrate components of the funding model, this article does not include an overview of specific outcomes from the funded projects.

Intervention and outcomes
As noted, the PHAC-IS emphasized four components: phased funding approach (grants and contributions), partnership development, knowledge development and exchange, and strengthening capacity and innovation (resources, methods, and tools). These components were informed by a PHIR approach that acknowledged intersectoral partnership development, multiplicity, and intervention implementation quality as a subset of PHIR and as key objective, knowledge exchange (Riley et al., 2015). Each component was developed, implemented, monitored, and evaluated to advance the PHAC-IS objectives in an iterative way through complementary work at the project, project cohort, and program levels. To provide a robust picture of the PHAC-IS, outcomes are framed along the four core components ( Fig. 1 and Table 1). The components were also influenced by cross-cutting principles, including social innovation, multi-level and multi-sectoral action, cultural safety, health equity, and evidence-based decision-making.
(1) A phased approach to social innovation and systems change (grants and contributions) The PHAC-IS approach acknowledged that high-quality innovative population health interventions must be developed, tested/piloted, and assessed during a multi-year development cycle. Originally conceived with two phases, it was observed that a third phase would provide effective interventions with the opportunity to move towards scale-up to increase reach and impact systems change . Phase 1 supported the initial design, development, and testing of an intervention; phase 2 focused on full implementation to additional sites alongside rigorous evaluation; and finally, phase 3 provided funding for scale-up for extended reach and sustained impact 7 . A three-phased approach to long-term funding Fig. 1) allowed for and supported the lengthy processes involved in social innovation and systems change that traditional shorter models of funding were unable to address.
In line with the Treasury Board's Blue Ribbon Panel recommendations on grants and contributions, the PHAC-IS's phased approach (Text Box 1) was competitive and provided a way for projects to receive funding for up to 9 years, though application to subsequent phases was voluntary and at the discretion of the project . This approach facilitated a stable funding framework to develop lasting partnerships and to implement, test, and adapt work while performing high-quality research that focused on scale-up and longer-term impact. Exit interviews with funded projects revealed that the phased application process focussed the host organization to intentionally design their partnership network and intervention expansion with consideration for scale-up and systems change. 6 Each of the funded projects completed the following documentation and various data sources were used to compile these findings, including: (1) the PHAC-IS's annual reporting tool (ISART) (formerly called the Performance Measurement and Evaluation Reporting Tool [PERT]) which was completed by projects annually to monitor project activities and to assess the impact of interventions on the health of participants and their communities; (2) the final report template (which was submitted in lieu of the ISART in the final year of each phase); (3) evaluation research reports produced by funded projects; and (4) end of funding interviews carried out 3 to 6 months after funding ended. Text Box 1 The PHAC-IS phased approach to funding • Phase 1: Initiation and development focused on the early design, development, testing and delivery of population health interventions over an initial period of 12 to 18 months (budgets from $150,000 to $250,000 per year). Phase 1 supported the development of vested partnerships and networks among public, non-profit, community, academic and private sectors.
• Phase 2: Delivery and evaluation supported full implementation, adaptation and evaluation of comprehensive population health interventions across multiple populations, communities (in at least three different jurisdictions) and settings over a period of up to four years (budgets from $300,000 to $750,000 per year). Phase 2 created and distributed evidence on community and cultural context compatibility, implementation readiness and the measurable impact of population health promotion interventions.
• Phase 3: Scale-up successes supported efforts to expand the reach and impact of successfully evaluated population health interventions (budgets up to $500,000 annually). This funding was available for a three-year period to build capacity and create opportunities to scale up the reach to additional populations and policy impact of proven interventions to sustain the measurable impact.
In phase 1, applicants were assessed based on requirements that reflected a population health approach combined with early predictors of their capacity to develop, deliver, evaluate, and build partnerships. By the end of phase 1, funded interventions had reached over 60,000 individuals affected by specific risk conditions or factors, with some already demonstrating changes in health outcomes and risk/protective factors within an 18-month time frame (Table 1). During phase 2, projects developed evaluation plans and expanded, reaching over 1000 communities across all provinces and territories. In phase 3, applicants were assessed based on the capacity of their intervention to scale up. Assessment criteria were derived from PHAC-IS research and analysis to identify predictors of success in scale-up for population health interventions. These domains included: intervention evidence and evaluation, reach and scale, organizational capacity, partnership development, system readiness, community context, cost factors, and knowledge development and exchange .
As noted, by the completion of phase 3, 82% of projects were able to sustain all or part of their intervention activities after PHAC funding had completed. In addition, there were 44 instances across 90% of the projects in phase 3 of policy and practice change, spanning a range of local, regional, provincial, and territorial jurisdictions. Through the phased approach, projects were able to adapt, reflect, and build additional partnership networks to impact policy and practice while increasing scale towards sustainability .
(2) Partnership development A strong partnership approach supported funding to build capacity for delivery, knowledge mobilization, and policy development in several domains. While many funders support and monitor partnership development, the PHAC-IS recognized this as a foundational component of scale-up and eventual systems change. Partnership development and collaboration with practitioners, researchers, policy makers, and community organizations was embedded in project planning and collaborations spanned local governments, municipalities, regional health authorities, and provincial/territorial governments, as well as private sector organizations. By phase 2, almost 40% of the over 1400 partnerships developed among the 20 funded projects had been sustained for 3 or more years. As the funded projects scaled up in phase 3, the average number of partnerships per project remained steady above 50% and over half (58%) were maintained for 3 or more years. This time, investment to build and nurture partnerships was an essential feature for projects that were able to work well within the communities that they served, scale with purpose, and ultimately change systems. An excerpt from a recent PHAC-IS evaluation report highlights this in a project spotlight from two phase 2 funded projects (Text Box 2).

Text Box 2 Project spotlight: Partnerships
Equipping Canadians: Mental Health Throughout Life The Towards Flourishing: Mental Health Promotion for Families project, led by the University of Manitoba, formed partnerships with a wide variety of stakeholders, including provincial ministries of health, regional health authorities, the Assembly of Manitoba Chiefs and the First Nations Advisory Group. Partners brought a wide range of experience, knowledge and skills to the project and contributed to improving and promoting the mental well-being of parents and their families. These strong partnerships ultimately led to this project being delivered through the Province of Manitoba to support the Towards Flourishing strategy across the province. An analysis of "vested partnerships" within the PHAC-IS highlights characteristics of a robust partnership approach towards systems change. Vested partnerships have diverse partners, a clear public sectoral agenda, demonstrated collaborative value, often a pooling of both human and financial assets, and a commitment to alignment and dialogue, along with a collective approach for collaborative systems change (Lee & Kavanagh Salmond, 2021). Although partnership development was anticipated in phase 2, early learnings indicated that more time was needed to develop meaningful connections at the project level. Significant time and funding were also required to conduct outreach, meet with partners, and establish ongoing, meaningful, and sustained relationships.
This shifting emphasis on capturing the vestedness of partnerships also has implications for performance monitoring efforts which should aim to capture the movement of the collaborative effort, including agenda setting, rather than the number, or reach, of partners in a network. In light of this, the PHAC-IS offers the duration of partnerships as a limited proxy for vestedness, as well as an introspective commentary around the challenges of collecting and contextualizing information for performance and evaluation measurement purposes (Boileau-Falardeau et al., 2021).

(3) Knowledge development and exchange
Knowledge development and exchange (KDE) was directed at developing strategies to share evidence-based knowledge products, activities, and lessons learned to impact future public health practice, program, and policy development. The combined emphasis on partnership and knowledge exchange resulted in over 400 examples from phase 2 projects of how knowledge generated by their intervention work was applied, and over 78% of these examples directly informed or led to the implementation or adaptation of a practice, policy, or program.
In phase 3, greater emphasis was placed on the effective uptake of knowledge among internal and external partners and other stakeholders (potential knowledge users who were external to the project) rather than the quantity of knowledge products. Projects continued to create and deliver thousands of knowledge products and activities, and a greater number of these were designed to influence policy, practice, and programming. Projects cited over 200 examples of how the knowledge generated by their intervention work influenced policy, practice, and/or programs. As outlined in Text Box 3, phase 3 projects were able to work with their partners to influence policy change at regional, provincial, and territorial levels and adapt public health programming. The PHAC-IS influenced a range of sectors, including: municipal transportation plans to encourage physical activity, regional plans to support local food security, and school districts adopting social and emotional learning curricula. The creation of KDE plans was stipulated as part of the work plan, and this led to dedicated time and resources allocated to the KDE process at the project level. The longterm funding of up to 9 years combined with partnership development and KDE allowed projects to redesign their approach through each phase and continue to maximize the uptake of knowledge/evidence into practice and policy decisions that effected change within complex public health issues.

Text Box 3 Project spotlight: Knowledge development and exchange
Equipping Canadians: Mental Health Throughout Life Knowledge development and exchange initiatives of the Fourth R: Healthy Relationships project led by the Centre for Addiction and Mental Health (CAMH) and Western University supported the inclusion of a Safe Schools graduate course for teacher candidates at the University of Calgary and the University of Lethbridge. This project also informed the development of anti-bullying policies and legislation in the Northwest Territories.

Achieving Healthier Weights in Canada's Communities
The Expanding the Impact and Reach of Community Food Centre Model project led by Community Food Centres Canada provided access to knowledge, training and resources to community food security organizations across the country through its Good Food Organizations program. The Good Food Organizations program is helping community food security organizations change their programmatic or organizational policies. An annual assessment of the program demonstrated the following examples of internal policy change in member organizations: • 49% of the Good Food Organizations created or deepened a healthy food policy that guides purchases and menu choices; • 93% broadened their food programming to serve multiple objectives in the area of food access, food skills, and community engagement; and • 73% increased material supports to enable low-income and marginalized people to participate in their programs.
The Healthy Start / Départ Santé Project (HSDS): A Multi-Level Intervention to Increase Physical Activity and Healthy Eating Among Young Children (3-5) Attending Early Learning Programs project led by Réseau Santé en français de la Saskatchewan (RSFS) implemented knowledge development and exchange (KDE) teams to deliver training and information sessions to early childhood educators and administrators of child care centres. Through the promotion of best practices, individual champions and booster training sessions, several opportunities for training and support were made available. As an early indication of knowledge uptake, after training, 94% of centres were using the physical activity materials and 95% were using the nutrition resources at least two times per month.
Our Food NL project led by Food First Newfoundland implemented an innovative Community-Led Food Assessment (CLFA) model. A CLFA helps a community to identify gaps and strengths to access healthy and culturally appropriate food, so they may initiate effective solutions to local food security challenges. This effort brought together a broad range of partners at the community, regional, provincial, and national levels to address serious food security challenges facing communities. The CLFA model has had a lasting impact on policy and programming in several communities in Newfoundland and Labrador. For example, the CLFA led to concrete changes in the availability and diversity of fresh produce offered in community stores. In Rencontre East (accessible only by ferry), a local storeowner created a successful points system where customers accumulate points by purchasing fresh fruits and vegetables, and at the end of the month, the customer with the most points receives a prize. In response to the CLFA findings, this private business began offering single portions of fruits and vegetables to respond to feedback from seniors (Our Food NL, 2018).
Measuring the use of the knowledge products and activities by other stakeholders was challenging for projects; however, by phase 3, all projects were able to identify how knowledge generated through their work impacted policy and practice 8 . Despite the relative successes of KDE by projects, the ability to impact systems change requires a responsive and adaptive audience. KDE also requires expertise, time, and resources to build the links between the research and evaluation agenda of an intervention to the knowledge needs of a program designer or policy maker. For future iterations of this model, an interactive, external platform for KDE is expected to provide capacity building to the projects to support the design of evaluation plans with an integral KDE plan, alongside facilitating the uptake of knowledge by developing a community of practitioners and policy makers as knowledge brokers and users.
(4) Strengthening capacity and innovation (resources, methods, and tools) The PHAC-IS supported projects by creating or supplementing many resources, methods, and tools to strengthen capacity and access to information on a variety of topics, including implementation science, knowledge mobilization, collective impact, policy change, and scale-up. These were often delivered in partnership and made available to wider audiences (e.g., webinars with the National Collaborating Centre for Methods and Tools) or through formalized connections between the PHAC-IS and project partners (e.g., PHAC-IS technical presentations to project advisory boards). In addition, the PHAC-IS team organized annual multi-day workshops for funded projects to meet with experts in various fields and exchange structured lessons learned on topics related to implementation science, partnership development, scale-up, and evaluation. These themes were identified by projects to respond to specific capacity-building needs, and by phase 3, projects led the development, facilitation, and content creation of the annual workshops.
A gap in capacity for evaluation was identified during phase 1 and the majority of projects partnered with a university or researcher to provide the rigour to evaluate their intervention and collect sufficient data for PHIR. In addition, PHAC-IS supported the development of several evaluation resources and engaged an evaluation expert to support projects with return on investment analysis, the evaluation of policy influence, and one-on-one support for tailored evaluation plans. Projects were very diverse in context, population served, and intervention approach; as a result, a tool kit or generic resource for PHIR often was not as effective as oneon-one approaches. Within future iterations of the funding model, tailored capacity building and supports will be built into the funding model starting in phase 1 and further integrated and supported through an external knowledge development and exchange hub. It was also difficult to capture the impact of capacity-building tools, and future iterations of the funding model will link this component to the KDE and partnership work towards systems change.

Implications
The PHAC-IS model has informed the design of other funding initiatives provided by the Canadian Institutes of Health Research-Institute of Population and Public Health (CIHR, 2016a;CIHR-IPPH, 2010)  There are a number of important lessons learned during the PHAC-IS journey that are useful to those administering and managing strategic funding programs for health promotion at the individual and system levels. First, strong, vested partners were key to the delivery, implementation, scale-up, and sustainability of projects in both funding streams. These partnerships led to a valuable two-way exchange of knowledge that improved practice toward systems change. Analyses of vested partnerships offered the need to capture the collective movement and shared agenda (Lee & Kavanagh Salmond, 2021). Exit interviews from phase 3 projects also highlighted the advantage of time and space to build out partnerships as a means to focus efforts upstream towards systems change. Therefore, flexibility and support for partnership and, ultimately, relationship development and shared agenda-setting activities have the potential to create scale-up and sustainability in programming.
Second, incorporating evaluation expertise in each funded project ensured that interventions were tested to better understand the impact of their activities, which added to the evidence base on effective approaches. The PHAC-IS provided support to enhance understanding of what was meant by "scale-up"  and how to move towards policy and systems change. As a result, projects were able to take the necessary steps to expand their interventions and enhance sustainability.
Third, the PHAC-IS phased approach built in flexibility that allowed the program and projects to identify and learn from what worked and what did not at the end of each phase. This resulted in course corrections that would improve overall success.
Finally, the length and potential for prolonged funding across the three phases was seen as especially vital for this type of program, since projects were trying to create long-lasting system-level changes that can only be achieved through years of committed investment (Office of Evaluation, Health Canada and the Public Health Agency of Canada, 2019).
Challenges were also revealed throughout this iterative process. While the PHAC-IS supported projects that sought to address health inequities, it was sometimes difficult to capture impact in a meaningful way, in part because of the complexity and diversity in the context at the project level. Future iterations of this funding program will incorporate opportunities and methods at the start of the funding cycles to capture information on how projects approach and impact health inequities.
In addition, despite the relative success of integrating KDE at the program level for continued learning, the depth and range of work presented challenges. Subsequent iterations of the PHAC-IS model are exploring additional resources for an external organization that will support projects to develop rigorous evaluation plans, and facilitate collaborative partnership experiences, shared learnings and knowledge exchange among and outside of funded projects to advance a more enabling environment for social innovation towards systems change.

Conclusion
Strategic and responsive grantmaking programs have the potential to support innovative and locally grown solutions to tackle complex public health issues. The PHAC-IS model supported creative local action to promote positive and sustainable change in systems and jurisdictions in Canada's communities and beyond. The PHAC-IS model accomplished this by using a phased approach with an emphasis on partnership development, knowledge development and exchange, and strengthened capacity and innovation. Across the four core components of the PHAC-IS model, evidence from innovative local solutions to complex challenges influenced and informed policies and practice across sectors and throughout jurisdictions. PHAC-IS reflections and funding outcomes are offered here to encourage more dialogue about health promotion grantmaking and programming among multiple levels of government and community organizations that seek to reduce risk factors, promote protective factors, and address their underlying determinants of health through population health interventions.
Achievements at the program and project levels through longer-term, phased funding supported design, delivery, and eventual scale-up, as well as strong and vested partnerships that were key to knowledge exchange that improved practice and supported health-promoting policies. The PHAC-IS combined the art of innovation and continuous improvement with the science of sound public health implementation as an intentional basis to guide the strategic design of a funding model to tackle the complex public health challenges in Canada's communities.
L'art et la science de la subvention stratégique: l'expérience de la Stratégie d'innovation de l'Agence de la santé publique du Canada Introduction Les défis complexes de santé publique exigent une approche tenant compte des facteurs sociaux, économiques et environnementaux dans de multiples secteurs et générant une incidence durable au niveau de la population. Bien que l'investissement dans des projets communautaires soit une approche courante dans le domaine de la promotion de la santé et de la prévention, il est possible de concevoir des programmes qui répondent à la complexité de ces défis en vue d'améliorer la santé de la population. Il y a plus de dix ans, l'Agence de la santé publique du Canada a conçu une approche et un modèle de financement novateurs visant à favoriser les interventions novatrices et prometteuses en matière de santé de la population qui pourraient promouvoir la santé au niveau des individus, des familles, des communautés et des systèmes.
Enfin, la durée du financement et la possibilité de financement prolongé au cours des trois phases ont été considérées comme particulièrement essentielles pour ce type de programme puisque les projets tentaient de créer des changements durables dans le système, ce qui nécessite des années d'engagements en matière d'investissements (Office of Evaluation, Health Canada and the Public Health Agency of Canada, 2019).

Conclusion
Les programmes de subventions stratégiques et adaptables pourraient soutenir des solutions novatrices et locales pour s'attaquer à des problèmes complexes de santé publique. Le modèle de la SI de l'ASPC a appuyé l'action locale créative afin de favoriser des changements positifs et durables dans les systèmes et au sein des administrations des communautés du Canada et d'ailleurs. Le modèle de la SI de l'ASPC y est parvenu en utilisant une approche progressive mettant l'accent sur l'établissement de partenariats, le développement et l'échange de connaissances et le renforcement des capacités et de l'innovation. Pour les quatre éléments de base du modèle de la SI de l'ASPC, les données probantes provenant de solutions novatrices locales à des défis complexes ont influencé et orienté les politiques et pratiques dans divers secteurs et l'ensemble des administrations. Les réflexions tirées de la SI de l'ASPC et les résultats du financement sont présentés dans le présent document pour encourager davantage de dialogue sur l'octroi de subventions et les programmes en matière de promotion de la santé entre différents paliers de gouvernement et des organisations communautaires qui cherchent à réduire les facteurs de risque, à promouvoir les facteurs de protection et à influer sur leurs déterminants sous-jacents de la santé au moyen d'interventions en santé de la population.
Author contributions SBD, MC, EDR, and KKS wrote initial draft of the manuscript; LP performed data analysis and contributed to the writing; KKS and SM contributed significantly to multiple drafts; SBD had primary responsibility for final content. All authors have read and approved the final manuscript.
Funding The Special Issue on the Public Health Agency of Canada-Innovation Strategy was funded by the Public Health Agency of Canada.
Data availability All data, reports, and materials were made available from the PHAC-IS funding program and project-level-completed reports.
Code availability N/A.

Declarations
Ethics approval and consent to participate N/A.

Consent for publication
Publication of this article has been confirmed by the Director of the Division of Mental Health and Wellbeing at PHAC.

Conflict of interest Government of Canada employees completed this work.
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