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

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3.2 Program Logic Model and Mapping to the Centre for Infectious Disease and Prevention Control (CIDPC) – Community Acquired Infections Division (CAID) Program Activity Architecture (PAA)

 

In 2004, the PHAC developed models to re-align previous departmental business lines, developing a results-oriented approach to programming referred to as the Program Activity Architecture (PAA). Chart 3 illustrates how the Hepatitis C Program maps to the CIDPC-CAID PAA and groups the various elements to activities/outputs, immediate outcomes, intermediate outcomes and final outcomes. This is important because it provides a general overview of the accomplishments of the Hepatitis C Program as well as its contribution to the broader mission, mandate and goals of the PHAC.

 

Chart 3: Current Program Theory Logic Model Mapped to the CIDPC-CAID PAA Logic Model
Logic Model Components	CIDPC-CAID PAA	HepC Program Logic Model
ACTIVITIES/OUTPUTS	Prevention, Promotion, Education & Training Core & Enhance Surveillance Research National & International Policy, Planning & Program Development/Evaluation Emergency Preparedness & Outbreak Response	Development & Dissemination of Information on HCV (needs assessments, tools & training) Funding Prevention, Support & Research Projects Ongoing Consultation & Liaising with HCV Stakeholders Developing Strategic Directions & Priorities (national goals, priorities)
IMMEDIATE OUTCOMES	National Information & Evidence	Increased Use of HCV Information Increased Research Knowledge Increased capacity to address HCV Effective Partnerships & Collaboration
INTERMEDIATE OUTCOMES	Education & Awareness Public Health Practices International Collaboration & Support	Increased Public Understanding & Awareness of HCV Increased Access to Prevention Initiatives Increased Access to Care, Treatment & Support Initiatives
LONG-TERM OUTCOMES	Slow the Spread of HCV, Sexually Transmitted Infections (STIs), HBV, Tuberculosis (TB)	Care & Treatment Support Preventing New HCV Cases
CIDPC Ultimate Outcome: Healthier Population by Promoting Health & Preventing Disease and Injury

3.3 Situating the Program within PHAC

As indicated previously, the Program is situated within the larger context of the mission for the PHAC (or the Agency) “to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health” by addressing infectious disease as mandated by the CIDPC, and is based on a population health approach and supportive of the Social Union Framework Agreement.

The Program is based on a number of principles including:

• using the best evidence for programming investment decisions;
• adopting the population health approach as a framework for design, implementation and evaluation of the Program;
• focusing on the needs and priorities of infected and affected populations, and those at greatest risk;
• emphasizing practical, immediate measures that can enhance quality of life for those infected/affected and at risk;
• building a base to meet ongoing needs on a sustainable basis;
• ensuring equitable, responsive and compassionate consideration and support to all individuals infected with, affected by, and at risk of HCV infection, regardless of mode, source or time frame of infection;
• minimizing program overhead to maximize Program impacts and benefits for the intended populations;
• engaging the commitment and support of key sectors and institutions of society to assume responsibility for, and take initiative on, appropriate research, prevention and community support measures;
• emphasizing complimentarity and coordination of all efforts; and
• maintaining public accountability.

To ensure a coordinated and transparent process, the Program committed to:

• coordinating the National/Regional Hepatitis C Network, and the Program Advisory Group (PAG) of external expert organizations and individuals to ensure information sharing, coordination of regional/national activities, and stakeholder advice;
• coordinating strategic planning and priority-setting exercises to identify gaps and to ensure consensus on strategic priorities, long-term national goals, measurable objectives, and national action plans;
• working with the First Nations and Inuit Health Branch (FNIHB) of Health Canada (HC) to jointly address HCV prevention and care issues for both on and off-reserve Aboriginal people;
• working with Correctional Service Canada (CSC) to address prevention and care for federal inmates (past and present), and to focus on pre-and post-release planning and inmate reintegration to the community;
• undertaking a comprehensive review and analysis of all funded HCV projects to identify and address ongoing gaps and opportunities;
• collaborating with key partners (both internal and external to the Agency) to develop a harm reduction approach from a public health perspective; and
• continuing to develop and implement evaluation tools and processes to ensure timely and comprehensive reporting on program outcomes.

The Program pursued an open, consultative approach with other levels of government, non-governmental organizations, the Agency regional staff and other stakeholders.

Various stakeholders and departmental representatives were involved in the delivery of the Program, including the PAG, PHAC staff from both national and regional offices, and other key community-based organizations.

The primary role of the PAG was to provide advice and guidance to the Hepatitis C Program administrators regarding the strategic direction, implementation and delivery of the Program. The PAG brought together numerous perspectives reflecting the diverse realities, views, and needs of key stakeholders by linking them with existing networks and program administrators. The PAG included representatives from six national non-government organizations (NGOs), including the Canadian Liver Foundation, Hepatitis C Society of Canada, Canadian Hemophilia Society, Canadian Centre on Substance Abuse, Canadian Public Health Association and Canadian Association for the Study of the Liver plus an individual who is living with hepatitis C. The PAG met formally twice a year and teleconference calls were also held, as required. The PAG expanded in later years to include a further representation of stakeholders with a broader perspective than just HCV including HIV/AIDS, anaemia, harm reduction, etc. (ie., CAS, CCSA, HRN, JAC, CATIE, CAAN, etc.).

The role of staff in the national office, or NCR, was to provide a coordinated federal response to the needs of those infected with, and affected by, HCV. Specifically, the national staff had responsibility for providing leadership and strategic direction in the development, planning, and implementation of the Hepatitis C Program. Furthermore, national staff were accountable for the allocation of resources and the overall performance of the Program. As such, the Program was monitored on an on-going basis, and results were reported annually through Health Canada's Reports on Plans and Priorities and the Departmental Performance Report.

Overall coordination of the delivery of the Program was the responsibility of the Hepatitis C Division from 1999 to 2003, subsequently the CAID. There were two component coordinators reporting to the Manager responsible for the Program – one for Research and one for Prevention and Community-Based Support. Two program consultants worked for each of the two coordinators responsible for Research, and Prevention and Community-Based Support. The Prevention and Community-based Support component and the Research component were managed solely by staff in the National Office. The Prevention and Community-Based Support component, on the other hand, was delivered primarily through regional offices and supported by six regional program consultants.

Regional offices were responsible for the provision of guidance, advice and support to local initiatives. Support included skills development, networking, marketing, and partnership building. The regional offices also served as the link between the national office and stakeholders, such as NGOs. A national/regional ‘network' consisting of program staff from the NCR and each regional office was established to coordinate activities and report on progress within the larger program construct. Regions now collaborate on various national projects and address all issues on a continuum of prevention, care and support.

The Program also worked with other federal partners including CSC (regarding incarcerated populations) including participation on the F/P/T Heads of Corrections sub-committee on health for strategic planning and collaboration on projects of national significance as well as working groups on prevention, care/treatment agendas; and, First Nations and Inuit Health Branch (Aboriginal populations and issues).

In 1999, the Hepatitis C Prevention, Support and Research Program and the Medical Research Council of Canada (now the Canadian Institutes of Health Research (CIHR)) also launched an initiative to fund hepatitis C research for a five-year period beginning in fiscal year 1999/2000 and ending in 2003/2004. The original partnership was renewed for two consecutive one-year periods terminating in fiscal year 2005/2006 and is now known as the PHAC/CIHR Joint Research Initiative on Hepatitis C.

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