Evaluation of the Hepatitis C Prevention, Support and Research Program 1999/2000 – 2005/2006

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6.2 Lessons Learned

The Five-Year Program Review detailed a comprehensive set of lessons learned that helped to shape the Program through the extension years. For the evaluation, lessons learned were identified through the document review, survey results and the insightful comments of stakeholders and key informants. The most important of these include the following:

Operational Framework

• The Program remained effective by refocusing its priorities, goals and objectives and evolving strategically over time.
• While it was important to implement a centralized Program structure (i.e., to alleviate redundancies), it was also critical to establish a close working relationship and joint decision-making framework with the regions. This encouraged strong, consistent regional support.
• PAG was a key element in the development and design of the Program. It had the right skills and was a ‘sounding board' that brought together representatives of stakeholder groups who worked together to guide the direction of the Program. In the final extension year, PAG was expanded to include a broader base of expertise and knowledge from community groups beyond HCV-specific work (i.e., HIV/AIDS, harm reduction).
• JAC provided the Program with current information with respect to the research component and was to keep the Program up-to-date and knowledgeable.
• Stable, multi-year funding was required for effective planning and timely funding decisions and approvals. In the extension years, this was problematic and had a negative impact on the results and achievements of the Program.

Results and Achievements

• There was extensive capacity building. Without the Program, it would have been impossible to deliver the sheer volume of projects/initiatives across the country to as many community groups over the first five years. This resulted in improved and/or increased knowledge, skills and access to improved care and support in addressing HCV in Canada.
• HCV research increased dramatically. Prior to the implementation of the Program, there was minimal Canadian research capacity in HCV and only a few scientific publications per year. Over the seven-year history of the joint-initiative with CIHR, research was funded that otherwise would not have been funded without the Program, including increased capacity through the National Canadian Research Training Program (NCRTP).
• Successful partnerships / collaboration were achieved on many fronts: funding of over 200 community projects; funded front-line peer support projects for “mainstream” persons infected with HCV as well as vulnerable populations; three highly successful national youth symposia; leveraged resources and partnerships with other sectors and levels of government through cost sharing projects with provincial health, federal corrections and First Nations; development, delivery and evaluation of regional education and awareness campaigns; collaborative networks with F/P/T Heads of Corrections Working Group on Health; and investments under Canada's Drug Strategy. Partnerships that were built on funding alone did not necessarily survive the extension years.
• There were significant efforts toward prevention. Individuals, organizations and communities are better prepared in their efforts to create awareness of and prevent HCV infection now than in the past; a wide array of information, tools and resources are available including access to the Canadian Hepatitis C Information Centre.
• The best results were achieved by integrating prevention and support into a holistic package as opposed to using the “support group” model. While some good results were achieved from funding support groups, in the end, people did not attend or commit to these fora.
• Program partners were able to leverage scarce resources. An integrated approach to HCV and HIV/AIDS co-infection, particularly at the regional level, helped communities leverage scarce financial and human resources.
• The regions were key to the delivery of hepatitis C programming. They were the ‘front-line' and developed very close working relationships with a wide variety of very heterogeneous HCV stakeholders at the community level.
• Knowledge and information was most effective when it was translated into understandable language and practical measures, packaged and disseminated to the right people.

Strategic Alignment

• Over the first five years of the Program, there was tremendous success in charting the Program's strategic direction and priorities. National and regional offices developed a solid relationship (or made significant effort) and were able to do annual strategic planning and develop longer-term strategic plans. However, hepatitis C did not appear to be on the agenda of decision-makers except in terms of compensation. This was evidenced particularly in the extension years when there was considerable uncertainly surrounding the Program's ongoing sustainable future and extent to which HCV was a government priority.
• The federal government has a continuing key role to play in ensuring that the hepatitis C community has a very strong political voice. This is particularly important for the most vulnerable populations across the country unable to articulate their own needs and to reduce the gap between vulnerable and non-vulnerable populations.
• The complexity of the hepatitis C issue requires separate but complimentary approaches in order to work successfully with a segmented population and many heterogeneous groups.
• Social/behavioural research should be an objective for the future. Answers are needed for why there is vulnerability and why some people are at risk and, how to address these needs more effectively.

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