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Accountability and Performance Management

The Simcoe Muskoka District Health Unit is accountable to its provincial and municipal funders, as well as to the public, for the work it does to protect and promote public health and to prevent disease and injury.

The health unit monitors its performance using a number of tools, including:

  • Accountability Agreements – These agreements, drawn up by the Province of Ontario, specify performance expectations for boards of health and require public health units to demonstrate compliance with the Ontario Public Health Standards.
  • Balanced Scorecard – The health unit uses its scorecard to measure progress as it works toward the goals in its strategic plan.
  • Financial Reports – Audited financial statements are made available to the public, as required by the Ontario Public Health Organizational Standards.

In 2016 we made good progress on almost all our Balanced Scorecard strategic directions as well as achieving targets or showing improvement in all 14 Accountability Agreement indicators.

Performance management

Performance management is one approach we use to achieve excellence in public health service. We set priority standards, build tools to measure our success, and report the results. Ultimately, these methods help to build a process of continuous quality improvement.   

The graphic below presents the four critical components of our performance management cycle:

Performance Standards diagram
Accountability Agreement
The first provincial Accountability Agreement came into effect January, 2011. The intent of the Accountability Agreement is to move all boards of health toward improved performance in key areas of health protection and health promotion. The Agreement includes performance indicators based on the Ontario Public Health Standards. Since 2012, the health unit is required to report to the MOHLTC twice, at mid-year and year-end, on our progress towards achieving Accountability Agreement targets.

2016 Year-end Accountability Agreement Results*


*subset of all indicators – only includes those requiring year-end reporting in 2016. 


The MOHLTC sets targets for achievement which all Ontario health units are expected to achieve.  If targets are not achieved, health units may be required to submit a performance report, outlining the cause of the issue and the steps that the Board of Health plan to undertake in order to improve performance. Some simple icons give a quick indication of the state of progress in achieving targets.


  Performance target is being achieve.

Yellow Arrow  Health unit's performance has been improving, nearing target achievement.

Balanced Scorecard
SMDHU introduced the BSC in 2008, coinciding with our first Strategic Plan.

The BSC is divided into quadrants that balance internally and externally driven strategies and outcomes:
  • Health Status. Health status indicators—the markers that gauge the overall health of the population—tend to change slowly over time and therefore it is not realistic to expect to see change within one year. Where there are positive changes in health status, it is hard to attribute the improvements to public health action, as other influencing factors must first be ruled out.

  • Community Engagement. Outreach and advocacy have resulted in positive change as a result of our efforts to raise awareness of important public health issues (community water fluoridation, infection prevention and control, and determinants of health) and to work with community partners to address these issues.

  • Integration and Responsiveness. In 2014 the health unit completed its Business Continuity Plan and incorporated the Health Equity Impact Assessment into many of our programs. This has resulted in stronger external partnerships, and has enhanced our capacity to respond quickly to changing needs and emerging issues.

  • Resources and Services. We have made progress on strategic priorities where we have focused energies and resources. Having staff specifically assigned to move initiatives forward contributes significantly to our success in meeting identified outcomes. However, resource limitations are expected to increase over the next few years, making it progressively more challenging to recruit and respond to rising demands for service.
Each quadrant contains key performance indicators that are reported annually for the duration of the strategic plan. Teams use these indicators to create a balanced scorecard for each of the current strategic directions or activities they are leading.


The following table describes the colour coding used to show progress on each indicator.

2015 Balanced Scorecard Results

strat plan blanced scorecard 2012-2015
​The agency’s BSC for the Strategic Plan reflects an aggregate of the measures for each strategic direction.

Strategic Plan graph

Financial Reports

In accordance with S. 59(2) of the Health Protection and Promotion Act, the Simcoe Muskoka District Health Unit annually produces financial statements and as required by the Ontario Public Health Organizational Standards, these annual reports must be made available to the general public.

Current and past financial statements include:

Financial Statements for the year ended December 31, 2016 (pdf)

Financial Statements for the year ended December 31, 2015 (pdf)

Financial Statements for the year ended December 31, 2014  (pdf)

Financial Statements for the year ended December 31, 2013 (pdf)

Financial Statements for the year ended December 31, 2012 (pdf)

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