Snapshots of charitable support in 2009 have produced two very different pictures for nonprofit health-care institutions in the U.S. and Canada, according to the Association for Healthcare Philanthropy (AHP). The association's annual Report on Giving indicated donations dropped $944 million in the U.S. last year from 2008 levels, while rising $56 million in Canada.

Members of AHP direct fundraising programs on behalf of more than 2,000 nonprofit health-care facilities. In fiscal year 2009, their efforts yielded $7.644 billion in the U.S. and $1.124 billion in Canada, compared with $8.588 billion and $1.068 billion the previous year.

"Whether the recession ended in 2009 is for economists to debate, but its ripple effect certainly continued to curtail the ability of donors to give," says William C. McGinly, the association's president and CEO. "It means fundraisers will have to work harder and smarter."

In the U.S., the largest declines were experienced in cash donations, down $818 million from 2008, and secured pledges, which declined $97 million. Amounts donated per dollar-spent to raise them also went down, from $3.51 in 2008 to $3.19 last year, a 9 percent decline.

"This downward trend is a very serious problem in the U.S.," says Gregory Pope, chairman of the AHP board and vice president of philanthropy at Saint Thomas Health Services Foundation, in Nashville, Tenn. "It comes just as some in Congress want to make it difficult for taxpayers to earn deductions for their donations, and as health-care reform puts new pressure on nonprofit hospitals to serve more patients."

More than four out of five contributors in the U.S. were individuals, and most of them had a direct relationship with the health-care facility to which they gave, including patients, employees, physicians, and board members. Other major donors were businesses and foundations, who together accounted for about 12 percent of all donors and 28 percent of the funds raised.

There was little change over the year in the allocation of funds raised. U.S. nonprofit health-care facilities devoted much of their donated money to construction and renovations (27.3 percent) and new equipment (18.4 percent). Eighteen percent of donated dollars went to fund charity care and community benefit programs, and 15 percent supported general operations. Other uses for the funds included endowments (6.5 percent), research and teaching (5.1 percent), and hospice and long-term care (4 percent).

In Canada, fiscal-year 2009's increase of 5.2 percent in donations to hospitals and health-care systems partially moderated a 13 percent drop in 2008. Some of that improvement, however, came about because most hospitals ended their 2009 fiscal year in March 2010, which included a high-growth January through March quarter for Canada's economy. The AHP survey showed that giving picked up, but only to the level reached in 2006, and remained $200 million less than amounts raised in 2007.

"Foundations that support Canadian hospitals are working to improve their productivity," says Nancy Hewat, regional director of AHP for Canada and executive director of the Grand River Hospital Foundation, in Kitchener, Ontario. "Achieving a better return on investment will be especially important for fundraisers who help support academic and community-based hospitals."

Most of the 2009 increase in Canada came from cash contributions, which, at $869 million, were up $147 million over 2008.

As in the U.S., individuals comprised about four of every five Canadian donors, contributing almost $6 of every $10 raised. More than 27 percent of individual donors were patients, physicians, board members, or other staff of the hospitals to which they gave, while community supporters unaffiliated with the institution accounted for over half of all individual donors.

Businesses in Canada contributed more than one of every four dollars given to health-care philanthropy, representing nearly 15 percent of all donors. Foundations made up 3 percent of the donors, and they contributed 5.8 percent of donated funds.

The Association for Healthcare Philanthropy is a nonprofit organization whose more than 4,700 members direct philanthropic programs in 2,000 of North America's nonprofit health-care providers.