Section 2: Evaluation of the Canadian Public Health Service Program at the Public Health Agency of Canada – Background and context

2. Background and context

This section provides an overview of the Canadian Public Health Service program. The expected results and activities of the program are explained, and an overview of the governance is also included. In addition, a summary of the financial and human resources used by the Public Health Agency to support the Canadian Public Health Service program is provided.

2.1Defining the public health system

Before describing the Canadian Public Health Service activities and expected results, it is important to first define the public health system towards which the Canadian Public Health Service program targets its efforts. Within the context of this program, public health system refers to federal, provincial/territorial, local and non-governmental organizations that carry out public health activities. The Public Health Agency of Canada Act states that the Government of Canada wishes to take public health measures, including measures relating to health protection and promotion, population health assessment, health surveillance, disease and injury prevention, and public health emergency preparedness and response and in the field of public health and wishes to foster cooperation in that field with provincial and territorial government, foreign governments and international organizations, and other interested persons or organizations.

This differs from publically funded health-care, which provides health-care to individuals and is a responsibility of the provincial and territorial governments.

2.2Program overview

Canada’s public health system’s capacity challenges were brought to the forefront in the landmark report issued by Dr. Naylor in response to the SARS crisis in 2003.^{Endnote 1} The Naylor Report was the culmination of National Advisory Committee work mandated to assess “…current public health efforts and lessons learned for ongoing and future infectious disease control.” The Naylor Report described public health system deficiencies that contributed to the inadequate public health capacity to respond to the SARS outbreak including:

• lack of surge capacity in the public health system
• poor capacity for epidemiological outbreak investigation.^{Endnote 1}

The Public Health Agency subsequently developed the Canadian Public Health Service program in 2006 to help address Canada’s public health capacity needs. The Canadian Public Health Service program temporarily places trained federal public health employees (Public Health Officers) into public health organizations (placement sites) across Canada to respond to short-term routine and emerging public health needs at these sites. Placement sites may include provincial, territorial and local health authorities as well as public health-oriented non-governmental organizations. These placements are expected to contribute towards two intermediate outcomes: Public Health Officer placements increase the public health capacity of the site, and serve as an opportunity for career development of the Public Health Officers. As a result of their contributions at these placement sites, it is expected that Public Health Officers will gain valuable experience in a range of public health issues and settings, helping to equip them for potential mobilizations should the need arise. A sub-component of the program places graduate students into public health organizations in Northern communities to facilitate the completion of their research practicums, and to help contribute to the host organizations’ scoped capacity needs.

2.3Program logic model

Program theory is “the set of assumptions about the manner in which the program relates to the social benefits it is expected to produce and the strategy and tactics the program has adopted to achieve its goals and objectives.”^{Endnote 2} Since the program theory for the Canadian Public Health Service program was not explicit, for the purposes of this evaluation, a decision was made by the evaluation team to focus the analyses on select outcomes from the draft program logic model (Appendix A).^{Endnote 3} The outcomes selected (both intermediate outcomes and two of the immediate outcomes) reflected the broad program outcomes described elsewhere in the program documentation and were also inferred from engagement with key stakeholders. The two ultimate program outcomes were not selected as they were still under development in the draft logic model when this evaluation was being conducted. Program staff noted that the ultimate outcomes in the logic model were still under development because they were waiting to align them with the Branch-level expected results which were not yet completed. However, through its program authorities, we note that the Canadian Public Health Service was broadly mandated to build a skilled and responsive federal public health workforce across Canada and provide the critical public health capacity required to prepare for and respond during a public health emergency.
As listed in the logic model for the Canadian Public Health Service program, the intermediate outcomes and two immediate outcomes selected were:

• a cadre of Public Health Officers is qualified and available to function in a range of public health issues including mobilizations (immediate)
• the Canadian Public Health Service helps to address identified public health gaps of participating placement sites including a focus on the North (immediate)
• partner organizations have enhanced capacity to fulfill their public health needs (intermediate)
• Public Health Officers and [graduate] students acquire transferable core competencies and experiences that respond to a range of public health needs across Canada (intermediate).

Thus, the program strives to build both system-level capacity and the capacity of individual public health professionals (both Public Health Officers and graduate students) to ultimately create “a dynamic and well-trained public health workforce that efficiently and effectively identifies and responds to routine and emergent public health issues across Canada”.^{Endnote 4}

2.4Program delivery

This section provides an overview of how the Canadian Public Health Service program is delivered. It summarizes the roles and responsibilities of those involved, and explains the processes that facilitate program delivery.

2.4.1Public Health Officers

Public Health Officers are qualified public health professionals, employed by the Public Health Agency, who work full time in support of the Canadian Public Health Service program. In general, Public Health Officers are epidemiologists, policy analysts, and public health nurses staffed at intermediate levels on an indeterminate basis.

According to the Canadian Public Health Service Reference Manual, Public Health Officers are expected to possess one or more of a variety of public health skill sets that are required by a placement site, such as epidemiology, data management or other skills related to health programming or health promotion.^{Endnote 5} In their role, Public Health Officers are expected to contribute to placement site activities across the spectrum of public health – from data management to evaluation, surveillance to reporting, and policy development to training. Public Health Officers may work in the topic areas of infectious, communicable, vaccine preventable and chronic disease as well as injury prevention, health promotion, health economics and environmental health. Currently, there are 14 active Public Health Officers placed in sites across Canada.

2.4.2Placement of Public Health Officers

As federal employees, Public Health Officers are deployed to placement sites across Canada and integrated into the daily work there. Placement site locations are established through a program-led site solicitation and application process (described below). Currently, placements are two years in duration, after which time the Public Health Officer is rotated to a new placement site outside their current province of work. However, at the outset of the program, prior to the development of the current rotation policy, a number of sites (n = 4) were deemed permanent Canadian Public Health Service locations. As such, a Public Health Officer was placed in these sites on a permanent basis and was not required to rotate. In two of these cases, the placed Public Health Officer has requested to leave the site (or the program), and upon the Public Health Officer’s departure, the new policy on rotation took effect for these placement sites thus retracting their permanent status. Only two sites (Manitoba and Nova Scotia) continue to be permanent.

2.4.3Solicitation/application process for sites

The site solicitation and application processes are used to facilitate the selection of placement sites for inclusion into the Canadian Public Health Service program. Regional Coordinators, employed by the Public Health Agency’s Regional Operations Division, support the delivery of the Canadian Public Health Service program through the site solicitation process. In this role, Regional Coordinators are expected to actively liaise with key stakeholders in their respective regions to identify capacity needs and gaps, while raising awareness of the Canadian Public Health Service program across the country, and encouraging potential placement sites to apply.

Sites interested in applying for a Public Health Officer are notified of upcoming selection processes by the Regional Coordinators, and at this time submit written applications to the program. Existing placement sites (those already hosting a Public Health Officer) whose Public Health Officer is about to be rotated may also reapply for a new Public Health Officer, although there is no guarantee they will be successful. Components of the application include a description of the host site including its organizational structure and public health need, level of supervision available, level of technical support available, professional development opportunities, and a detailed two-year work plan.^{Endnote 6} Written submissions are reviewed by Canadian Public Health Service Program Managers as well as Regional Coordinators, and are rated based on the criteria listed in Table 3.^{Endnote 7}, ^{Endnote 8} Of note, definitions of these criteria are not available.

2.4.4Placement Site and Public Health Officer matching process

Once successful sites have been screened into the program, a process is undertaken to match rotating Public Health Officers to placement sites.^{Endnote 9} The qualified sites are provided the opportunity to review the available cadre of Public Health Officers, interview those of interest, and then rank their preferences. Similarly, the Public Health Officers are provided with a list of the eligible host sites/ associated projects and then rank them based on their interests and professional suitability. Program Managers and Regional Coordinators then attempt to match host sites and Public Health Officers in a ‘best-fit’ scenario. During this matching process, considerations are given to a number of factors including: Public Health Officer career goals and desired skills and experiences, as well as geographic distribution and preferences of Public Health Officers. Senior management is responsible for final review and approval of the proposed list of matches.

2.4.5Development of Public Health Officers

Professional development is an important consideration for all public health professionals. The Canadian Public Health Service program views itself as a training initiative and places additional emphasis on the development of Public Health Officers in a range of public health functions and competencies. The program aims to accomplish this through a combination of formal training, mentoring, and experiential learning. Formal training may be offered to Public Health Officers at both the group and the individual level. Group training typically takes place on a yearly basis and on a topic relevant to all Public Health Officers (e.g. Emergency Preparedness). Conversely, individual training is typically based more on individual Public Health Officer needs or preferences. In general, the program aims to focus Public Health Officer training on transferable skill development that may be applied at future sites to help address public health capacity needs and gaps. The program is designed so that mentoring is available to Public Health Officers from multiple sources including Canadian Public Health Service Program Managers, Regional Coordinators, and placement site supervisors. Experiential learning takes place during each Public Health Officer placement; however, the rotational component of the program was designed to further contribute to this outcome. Through multiple placements, Public Health Officers will be exposed to a variety of work experiences in a variety of settings. Through these various forms of development, it is expected that Public Health Officers will become qualified to function in a range of public health issues, including mobilizations.

2.4.6Mobilization of Public Health Officers

Periodically, the Public Health Agency receives requests for employees to assist in a short-term response to an outbreak, public health emergency, or other areas of interest to the Agency. The response to these requests may involve the mobilization of federal employees with the appropriate qualifications and experience to the required location. These mobilizations may also provide learning opportunities for employees, and the Canadian Public Health Service program supports a positive response to these requests through the mobilization of Public Health Officers. Mobilizations are generally two weeks to a month in duration and are discussed in advance with placement site supervisors to accommodate any concerns they may have as a result of the mobilization. To compensate for the Public Health Officer time spent away from the placement site during the mobilization, the amount of time equal to the length of the mobilization may be added on to the placement duration.

2.4.7Graduate students

A sub-component of the Canadian Public Health Service program places public health graduate students (Masters and PhD) into sites located exclusively in northern Canada for four to 12 month practicums. Graduate students undertake scoped project work relevant to the host site and to their degree requirements. It is intended that these practicums will contribute to the host site’s capacity and to the development of public health professionals with experience and potential interest in working in northern Canada; a region with recognized public health capacity gaps.

2.5Governance

The Canadian Public Health Service activities fall under the sub-program Public Health Capacity Building (1.1.1) and the program Public Health Infrastructure (1.1) of the Program Alignment Architecture (2013). The program is located in the Office of Public Health Practice and within the Field Services Training Unit. The program is coordinated under a matrix management structure overseen by two Program Managers who work in the National Capital Region and Regional Coordinators who work in a variety of locations through the Regional Operations Directorate and who report functionally to Regional Knowledge Managers. The Knowledge Managers do not have a direct relationship to the National Capital program management structure.

Between April 2006 to October 2012, the program was led by six different directors and one (consistent) manager located in the National Capital Region. The program manager was responsible for oversight of the program’s development and management of the financial and human resources. Regional Coordinators were responsible for liaising with the placement sites and Public Health Officers. In addition, the Regional Coordinators undertook some managerial responsibilities including Public Health Officer performance reviews and development of their annual professional learning plans.

Since October 2012, the management structure of the program has been adjusted. Currently, two program managers are located in the National Capital Region with responsibilities divided regionally. Program managers are responsible for liaising with the Public Health Officers and the placement site. Regional Coordinators are responsible for maintaining relationships between placement sites and the Public Health Agency.

2.6Program resources

This section provides an overview of the human and financial resources associated with the Canadian Public Health Service between 2006 and 2012.

2.6.1Profile of human resources

Currently, the Canadian Public Health Service program has 14 Public Health Officers placed full-time in a variety of public health organizations across Canada, four Regional Coordinators who dedicate approximately three-quarters of their time to the program, three full-time staff and one shared director (who is also responsible for other programs within the Field Services, Training and Response Division) located in the National Capital Region. The staff contingent located in the National Capital Region includes two program managers, one analyst, and a portion of human resources and administrative support personnel. The Canadian Public Health Service program director is also responsible for the Canadian Field Epidemiology Program, the Field Service Training Unit, and the Field Services Business Operations Unit.

2.6.2Profile of financial resources

Since program inception in 2006, the Public Health Agency has spent $13.2 million on the Canadian Public Health Service program, including the regional office support. In 2012-13, the expenditures were $3.0 million. Details of expenditures will be discussed in section 3.4 of the report.