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

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5. Overview of Findings

This section of the report addresses the four program goals using the findings of the document review, stakeholder survey and key informant interviews as primary data.

The first section deals with the extent to which the design and delivery of initiatives were appropriate in meeting the goals and objectives of the Program. The assessment focuses on the systems, practices and processes that were implemented to manage the Program and provides comment on the effectiveness and efficiencies of the Program's ongoing development and implementation.

The second section of the review identifies the results achieved and what impact those results had on the immediate outcomes and, to the extent possible, attributes the impact of the results on longer-term (intermediate to long-term) outcomes. In addition, recommendations from the mid-term evaluation and five-year review will be considered to determine if the Program made progress in addressing these concerns as well as the overall goals of the Program.

The final section provides an assessment of the extent to which stakeholders and key informants believe HCV programming was relevant to the Agency's overall mission, mandate, goals and objectives. This includes an examination of the following: relevance of the Program to federal government priorities; relevance to the Agency's priorities; and, the extent to which the Program implemented a health promotion and population health approach.

Throughout the overview/analysis of findings, key informant and stakeholder responses are compared. Given their different roles and perspectives¹⁵, a comparison of the two distinct sets of respondents enabled a more balanced view of the Program's overall results and achievements.

5.1 Program Design and Delivery

The original Program design (beginning in 1999) was based on consultation with a wide range of stakeholders from across Canada including focus groups with people infected/affected by hepatitis C, a national Consensus Conference, a researcher priority-setting workshop, and meetings with F/P/T health officials, representatives from Aboriginal peoples' organizations and other NGOs. Adjustments to Program plans were made over time on the basis of further consultations with all key stakeholders, including P/T governments.

5.1.1 Program Structure

While overall coordination of the delivery of the Program was the responsibility of the Hepatitis C Division (subsequently CAID), PHAC and HC regional offices were responsible for the provision of guidance, advice and support to local initiatives. The Program also worked with other federal partners including CSC and FNIHB. As indicated previously, a multi-stakeholder PAG, PHAC staff from both national and regional offices, and other key community-based organizations were involved in the delivery of the Program.

There was a very high level of confidence (92.9% “strongly agreed/agreed somewhat”) among key informants that the structure of the Program contributed to the achievement of the Program's goals. They described the main areas of focus as “making sense” and the organization of the Program lending itself well to meeting the goals. Further, they suggested “it was good to have a centralized structure otherwise many people would have been reinventing the wheel”.

Key informants proposed one of the key elements in the design of the Program as the implementation of the PAG. “It was very useful. It had the right people with the right skills. It was a ‘sounding board' that brought together representatives of key stakeholder groups who worked together to guide the direction of the Program.”

Even though the level of agreement was slightly lower among stakeholders (just under 80%), they also commented that the Program was “well designed” and “had great success in many areas”.

In line with the Five-Year Program Review, indicating the need for a coherent, collaborative approach at every level, respondents suggested greater clarity or a more definitive structure is required in terms of the relationship with the regions. “It was not clear how regional work flows into the national work plan.” In addition, there was some concern that without a dedicated F/P/T committee for hepatitis C, the issues surrounding hepatitis C were not always fully considered in the context of the government's broader public health strategies.

References

14.	The confidence interval is the plus-or-minus figure usually reported in newspaper or television opinion poll results. For example, if you use a confidence interval of 4 and 47% percent of your sample picks an answer you can be "sure" that if you had asked the question of the entire relevant population between 43% (47-4) and 51% (47+4) would have picked that answer. The confidence level tells you how sure you can be. It is expressed as a percentage and represents how often the true percentage of the population would pick an answer that lies within the confidence interval. The 95% confidence level means you can be 95% certain; the 99% confidence level means you can be 99% certain. Most researchers use the 95% confidence level. (Creative Research Systems http://www.surveysystem.com)
15.	Key informants were individuals who contributed directly to the leadership and/or management of the Program. Stakeholders, both within and outside of government, played a significant role in the development and implementation of the Program

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