ARCHIVED - Evaluation of the C-EnterNet Program Final Report

Introduction

1.1 Introduction and Purpose of Evaluation

This report presents the results of the evaluation of the C-EnterNet Program.  The evaluation was undertaken by Government Consulting Services (GCS) for the Public Health Agency of Canada (PHAC) between May and October 2009.  The primary purpose of the evaluation was to inform resource allocation decisions of PHAC senior management.  A secondary purpose was to inform future design and delivery decisions of the C-EnterNet Program team.

The evaluation followed the scope and methodology set out in an evaluation plan developed during a planning phase completed prior to the commencement of the evaluation.  The evaluation planning phase was undertaken by GCS between January and April 2009.  The evaluation plan was aligned with the Treasury Board Policy on Evaluation¹.

The report is organized as follows:

• Section 1 presents a profile of the C-EnterNet Program;
• Section 2 presents the methodology for the evaluation and discusses methodological considerations;
• Section 3 presents the findings by evaluation issue; and
• Section 4 presents the overall conclusions and related recommendations.

1.2 Profile of the C-EnterNet Program

The National Integrated Enteric Pathogen Surveillance (C-EnterNet) Program is designed to support activities to reduce the burden of enteric disease in Canada.  Enteric disease refers to gastrointestinal illnesses that result from pathogenic micro-organisms, often coming from food or animal sources.  The program involves systematic and integrated data collection, analysis, interpretation and communication of results. 

C-EnterNet is based on a model of active sentinel site surveillance, as used by the Centers for Disease Control and Prevention (CDC) in the United States for its FoodNet program.  This model involves a limited number of communities acting as reporting (sentinel) sites, from which the information may be extrapolated to the general population. This model is intended to allow for more comprehensive and rigorous surveillance than the passive enteric disease surveillance approaches traditionally employed in Canada.  Active surveillance includes:

• sustained coordination among all levels of the health care system;
• specialised laboratory involvement/partnership;
• standardized microbiological and epidemiological methods; and
• regular reporting and communication.

The core objectives of the program are to²:

• detect changes in trends in human enteric disease and in levels of pathogen exposure from food, animal and water sources in a defined population;
• generate human illness attribution values (i.e., the proportion of human cases due to exposure via water, food and animals); and
• improve the analysis, interpretation and reporting of laboratory and epidemiological data for public health, water and agri-food purposes.

The business case for the C-EnterNet Program was made in December 2004 and a pilot sentinel site was initiated in June 2005.  While the program design called for five sentinel sites across Canada to meet its pan-Canadian objectives, C-EnterNet has been implemented in one pilot sentinel site to determine the feasibility and usefulness of the program’s design.

The selection of the pilot sentinel site in the Region of Waterloo was based on specific criteria, including population size and local public health capacity.  In the pilot site, C-EnterNet works in collaboration with the Region of Waterloo Public Health (ROWPH) to undertake enhanced human disease surveillance, including standardized case follow-up.  C-EnterNet supports a site coordinator working within the health department to coordinate and lead activities within ROWPH.

In addition to the work undertaken with ROWPH, the C-EnterNet team also manages and coordinates active surveillance (i.e. sample collection) of pathogens in surface water, retail food and on farms, and undertakes analysis of these samples in partnership with laboratories.  A brief overview of the four components of integrated surveillance is provided in Table 1.

Along with the surveillance component, the program includes a source attribution component.  Source attribution determines what proportion of a particular disease is acquired from a specific source (e.g., chicken) and pathway (e.g., food, water, person-to-person transmission)³.

Lastly, the program also undertakes targeted research studies of relevance to the program.  These have included one-time studies related to food consumption, water consumption, and other topics of relevance.

The program is currently staffed at 7.0 Full Time Equivalents (FTEs).  The C-EnterNet Program team is located within PHAC offices in Guelph, Ontario, with the exception of one member based in St-Hyacinthe, Quebec.  Team members are assigned to one or more elements of the program (i.e., human, water, farm or retail components), depending on their roles and areas of expertise.  Team members’ backgrounds include veterinary medicine, epidemiology, public health, environmental microbiology and parasitology.  The core team is supported by a network of partners, including a Site Coordinator based in the ROWPH, ROWPH public health inspectors, sample collectors, laboratory technicians and other support staff.

The C-EnterNet program is jointly managed by the Centre for Food-borne, Environmental and Zoonotic Infectious Diseases (CFEZID) and the Laboratory for Foodborne Zoonoses (LFZ), both located within PHAC.   An Advisory Committee of governmental and non-governmental stakeholders has been developed to provide advice and guidance to the program.  The Advisory Committee is intended to meet in-person on an annual basis, with additional communication done on an as-needed basis.

Table 2 shows the amount and sources of financial resources committed to the program from 2003-04 to 2009-10.  From 2003-04 to 2007-08, C-EnterNet was primarily funded by Agriculture and Agri-food Canada (AAFC) through its Agricultural Policy Framework (APF).  Funding from the APF totalled $3.3 million.  Other contributing funders included the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) and PHAC.  Since 2008-09, C-EnterNet has been primarily funded through the Food Safety Action Plan (FSAP), with PHAC also providing salary and operating funding through both LFZ and CFEZID.

Source: C-EnterNet Program
* Foodborne, Waterborne, Zoonotic Infections Division (within the Centre for Infectious Disease Prevention and Control), now the Centre for Food-borne, Environmental and Zoonotic Infectious Disease, IDEP

A timeline of key C-EnterNet Program events is presented in Table 3.

1.3 Program Logic Model

A logic model for the C-EnterNet Program was developed during the evaluation planning phase.  The logic model provides a visual representation connecting the program’s activities and outputs with expected results (outcomes).  The logic model formed a framework for assessing the success of the program in the evaluation.

¹ This evaluation was undertaken using the direction from Treasury Board’s evaluation policy from 2001.  A new evaluation policy came into effect on April 2009, however, at the time of planning this evaluation, no direction on applying the new policy had yet been provided.

² Public Health Agency of Canada. C-EnterNet 2006 Annual Report.

³ Public Health Agency of Canada.  C-EnterNet Overview.

⁴ Partly based on information from Evaluation of C-EnterNet by Kate Zinszer, June 30, 2007.