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Hepatitis C Prevention, Support and Research Program
Health Canada

Get the Facts: Mid-term evaluation report

Action Plan

Evaluation Conclusion: Overall Assessment

The contaminated blood tragedy was the genesis of the Hepatitis C Program. Three years into its mandate, the Program has been successful in the implementation of numerous program activities to strengthen the Canadian response to hepatitis C. Surveillance data, however, show high hepatitis C rates among populations such as Aboriginal peoples, street youth, inmates and drug users. Addressing the multiple health determinants and disease challenges of diverse populations demands a coordinated strategy that promotes a multi-disciplinary approach, linkages and partnerships.

Evaluation Recommendation(s)

1.   In the context of federal government priorities, it is recommended that continued federal leadership be considered in the broad areas of capacity building, research, surveillance and project/model evaluation. The knowledge generated from these activities will set the foundation for a coordinated, multi-disciplinary approach to hepatitis C that is able to meet the diverse needs of people infected through the blood supply and marginalized populations.

Program Response

Current Status	Action Required	Time Line	Lead
The Program is developing a rationale and plan for Program renewal.	In current Program cycle: Integrate the findings of the mid-term evaluation into the renewal and the strategic planning processes of the Division.	Work in progress. Jan 2003 and ongoing	Director Mgr, Policy and Evaluation Mgr, Program

Evaluation Conclusion: Generation of Knowledge in the Area of Hepatitis C

The findings of the evaluation demonstrated the Program’s ability to leverage funds from the Canadian Institutes of Health Research (CIHR) for research mainly in the areas of biology, pathogenesis and treatment of the disease. More is required to support behavioural and social science research. Research worthy of international presentation and publication has been encouraged and funded through the Program.

Evaluation Recommendation(s)

2.   With regard to research, it is recommended that

• Hepatitis C research continue to be a major focus of the Program.

• The Program continue to monitor the joint Health Canada/CIHR research initiative on hepatitis C and guide CIHR to include an increased focus on behavioural and social science research while maintaining its current support for clinical/biomedical research.

• The Program retain a portion of research funds within the Hepatitis C Division to fund directed research for the purpose of answering those research questions critical to the development of effective hepatitis C policies and programs.

• The Program and CIHR work together to resolve the problem of mismatched funding cycles, communication and decision-making.

Program Response

Current Status	Action Required	Time Line	Lead
The Program has an allocation of $14.1 million in research funds over 5 years. Of that amount, $12.25 million is transferred to CIHR under a special research initiative on hepatitis C. This initiative is funded on a cost shared basis, with CIHR contributing $6.125 million over 5 years. Findings from the consultation process conducted between October 2002 and January 2003 indicate that there is strong support for research in areas of treatment, prevention, and behavioural and social science.	In current Program cycle: Continue funding hepatitis C research through present Memorandum of Understanding (MOU) with CIHR. Program to exercise stronger role in the management of the MOU through improved financial and progress reporting and multi-disciplinary discussions on research priorities.	Ongoing	Director Mgr, Program Research Coord.
	The CIHR and HC initiative on hepatitis C research targeted a call for proposals on prevention, and care and treatment in September 2002.	Ongoing	Research Coord.
	Study on knowledge, attitude and behaviour of physicians dealing with hepatitis C.	Ongoing	Research Coord.
	Support increased links with international researchers through attendance at international symposia and sharing of research findings.	Ongoing	Research Coord.

Evaluation Conclusion: Partnerships

The outlook for the continued development of effective partnerships and collaborations is good. The evaluation reported evidence of continued efforts and work with a broad spectrum of partners at all levels of programming within each of the program components. The relevance of partnership with some organizations needs to be re-assessed, and other partnerships need to be strengthened (e.g. at risk populations).

Evaluation Recommendation(s)

3.   It is recommended that the Program be more strategic about partnership development at the inter-governmental, national, regional and community levels as identified below:

• Re-examine the current funding relationship with the national NGOs in terms of relevance, responsiveness, accountability and intra-organizational linkages.

• Strengthen linkages at the national level with the Office of Canada’s Drug Strategy, the Canadian Strategy on HIV/AIDS, Correctional Service Canada and, in particular, develop a strategic partnership with First Nations and Inuit Health Branch to ensure that programming is seamless for Aboriginal peoples on and off reserve.

• In order to strengthen and coordinate the federal, provincial and territorial response, the Program should establish a Federal/Provincial/Territorial coordinating mechanism (e.g. Working Group on hepatitis C).

Program Response

Current Status	Action Required	Time Line	Lead
The evaluation and the discussions arising out of the November 2002 National Program Meeting identified the need to review and clarify the role of the national organizations and their regional chapters. As well, the national NGO operational funding applications must be examined for relevance to prevention in at-risk populations.	In current Program cycle: National office to determine reporting, funding and support mechanisms (e.g. development and sharing of generic resource materials) between national organizations and their chapters.	March 2003 onwards	Prog. Consultant Mgr, Program
	Review and reassess partnerships with national NGOs to ensure that prevention activities are conducted at the national level. This will be done in the review of NGOs 2003-2004 work plans.	March 2003 onwards	Prog. Consultant Mgr, Program
The evaluation results highlighted the need to foster a stronger and broader response to the disease. The Program should particularly look to partners working with populations at greatest risk of HCV. The November 2002 National Program Meeting supported a stronger relationship with FNIHB and Correctional Service Canada (CSC). Past efforts have been limited to collaborative surveillance and/or research studies. An MOU is currently being developed between the Community Acquired Infections Division and CSC to enable collaboration on training, surveillance and prevention of infectious diseases. The membership list for F/P/T Heads of Corrections Working group on Infectious Diseases has been shared with regions.	To encourage a coordinated approach between PPHB and FNIHB the Program will:
	a) engage in systematic discussions with FNIHB. Issues of mobility on and off reserve make it important to coordinate funding and programming to best meet the needs of Aboriginal peoples.	April 2003 onwards	Mgr, Program Regions FNIHB
	b) share materials and information related to hepatitis C and involve FNIHB in project review committees.	April 2003 onwards
	To support collaborative work in Corrections the Program will:
	a) Develop stronger links with CSC and provincial/territorial correctional staff.	Ongoing	Chief, TB & Bacterial Respiratory Diseases Mgr, Program Regions
	b) Document regional initiatives in Corrections and promote these initiatives with other regions.	May - Sep 2003	Regions
	c) Maintain membership on F/P/T Heads of Corrections Working Group on Infectious Diseases and continue to invite Corrections to collaborate on common issues of interest and relevance.	Ongoing	Mgr, Program
The need was identified for a stronger level of cooperation and coordination between federal and provincial/ territorial governments to address the prevention and care needs of persons infected with and at risk of HCV. The Program has made ad hoc presentations to the Federal/ Provincial/Territorial Advisory Committee on AIDS (F/P/T AIDS). There is no equivalent for hepatitis C.	The Program will engage in discussions with F/P/T representatives to determine the interest in establishing an F/P/T collaboration mechanism.	January 2003 onwards	Director Mgr, Program Policy Analyst
	The P/T consultation held January 9 2003 identified interest in a P/T infectious disease working group.	Ongoing	Mgr, Program Policy Analyst Mgr, Policy and Evaluation
	In the absence of a working group or other collaborative mechanism, the Program will continue to consult with P/Ts in an ad hoc manner on issues of mutual interest and will enhance the role of regions in these ongoing consultations.		Various Prog. Consultants Regions

Evaluation Conclusion: Building Capacity

The outlook for the further development of hepatitis C capacity is favourable as a result of significant efforts made to date in the Community-based and Care and Treatment Support components of the Program. Community capacity is essential to sustain the early successes of community groups and organizations involved in serving populations infected with/affected by or at risk of hepatitis C.

Evaluation Recommendation(s)

4.    It is recommended that the Program support community groups for continued capacity building.

5.   It is recommended that the Program continue to support community development through its regional offices, and support initiatives aimed at disseminating lessons learned, especially as they relate to interventions with marginalized populations.

Program Response

Current Status	Action Required	Time Line	Lead
The evaluation identified a common request for provision of funding to support ongoing operations and infrastructure of local community groups (rather than project funding). Currently, operational funding is limited to national NGOs and is not provided at the local level.	In current Program cycle: Continue funding of local and community- based projects to encourage partnerships at the local and P/T levels.	Ongoing	Mgr, Program
	Investigate with other federal programs and with Treasury Board Secretariat the feasibility of supporting infrastructure needs of organizations in future.	March 2003 onwards	Mgr, Program Mgr, Policy and Evaluation
Regions benefit from funding to hold priority setting/capacity building workshops in each respective region. Themes covered include evaluation, proposal writing, lessons learned and strategic planning.	The program is planning to support similar workshops in 2003-2004. The Program will share lessons learned through the dissemination of the evaluation case studies and other initiatives developed in the regions.	March 2003-2004	Prog. Consultant Regions

Evaluation Conclusion: Program Monitoring and Evaluation

Measurement of success was not possible for all program outcomes. It is advisable that key initiatives be appraised and the extent of their effectiveness measured. Strategic action plans and evaluation tools will need to be developed and are likely to improve the Program’s ability to chart the Program’s success and ability to achieve objectives.

Evaluation Recommendation(s)

6.    It is recommended that the Program design awareness activities with priority populations and measure the impact of these initiatives.

7.    It is recommended that implementation of the care and treatment guidelines that have been developed through funding by the Program be measured to determine the extent to which they are being adopted.

8.    As the Program moves forward, it is recommended that

• strategic directions and action plans be developed that clearly link Program components and funding to Program objectives

• progress toward objectives be reported annually in a streamlined, standardized manner

• the Evaluation Logic Model and Data Collection Matrix be modified, and

• Program outcomes and impacts be identified that can 1) be measured, 2) be attributed to the Program, and 3) be reasonably expected to occur within the five-year time period.

Program Response

Current Status	Action Required	Time Line	Lead
The Program has baseline data on some of its outcomes: an environmental scan (2000); two public opinion polls(99/01); and a research agenda drafted in 1999. The data collected as part of the evaluation will form the baseline for measurement of progress for outcomes where no previous data existed.	Develop plan and strategy for the collection and analysis of data and measurement of program outcomes for final evaluation due in 2004.	April 2003-June 2003	Policy Analyst
	Develop strategy to measure use and uptake of care and treatment guidelines and effectiveness of planned awareness initiatives:	Feb 2003 onwards	Prog. Consultant Policy Analyst
	a) In the short term, develop survey to evaluate co-infection guidelines developed with the Canadian Infectious Disease Society.	Completed
	b) Explore ways to expand current evaluation of physician practice-based learning module to other training initiatives.	March-June 2003	Prog. Consultant Policy Analyst
Work plans have been developed since 2000 although not consistently for each program area. Recent integration of the Hepatitis C Program with the Sexual Health/STI and tuberculosis areas will require a coordinated set of strategic directions.	Division work planning session took place April 2003. Coordination is ongoing.	April 2003 and ongoing	Director Mgr, Program
A standardized reporting format was developed for the 150 funded community- based projects. Year 2001 was its first year of implementation. The mid-term evaluation looks at years 1,2,3 for all program areas.	Progress in the Community-based support component of the Program is tracked annually through the project progress reports. Explore the development of similar annual or bi-annual reporting mechanism for other areas of the Program. Review and ensure consistent application of reporting requirements across regions.	April 2003	Policy Analyst
The initial Program evaluation framework had five logic models, one for each program component. A simplified version was developed for the purposes of the evaluation.	Engage in discussions with the Departmental Program Evaluation Division (DPED) to perform modifications to the Logic Model, program indicators and Data Collection Matrix. (A logic model is a work in progress and it is good practice to revisit a model as a program evolves.) Then implement data collection process and analytical strategy.	June 2003	Mgr, Policy and Evaluation Policy Analyst

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