| Summary: | Multi-Service Accountability Agreements (MSAAs) have been put in place to hold Community Sector Service (CSS) agencies to account for services receiving public funding in Ontario. The MSAA seeks to support financial and performance accountability, requiring CSS agencies to report on their performance quarterly. The MSAA is an expenditure policy tool that has undergone several iterations, each informed by negotiations between the Ontario Ministry of Health and Long-Term Care (MOHLTC), the province’s regional authorities—known as Local Health Integration Networks (LHINs)—and organizations/associations representing CSS agency interests. This approach to accountability is consistent with a broader focus on the government role as ‘steering’ service delivery rather than ‘rowing.’ The MSAA offers a standardized, politically acceptable approach to accountability. However, the MSAA relies heavily on performance indicators that may not adequately reflect quality care. The MSAA exemplifies the tension between the need for strong standardized accountability requirements for publicly-funded health service providers and the need for services that meet the needs of their communities.
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