Section 6: Evaluation of the Federal Initiative to Address HIV/AIDS in Canada 2008–09 to 2012–13 – Recommendations

6. Recommendations

Recommendations have been developed to address the conclusions outlined in the previous section. However, while these recommendations are distinct, they are all interrelated. For example, addressing the first recommendation (planning and priority setting) should help focus activities to support how knowledge, such as research and surveillance, informs program decision making. This should inform how Federal Initiative partners can address barriers to prevention, diagnosis, care, treatment and support. These types of activities should be tracked and documented to ensure that learning is continuous.

Recommendation 1:

Improve joint work planning and priority setting

The Responsibility Centre Committee mechanism is currently used primarily for information sharing rather than decision making, strategic planning, and priority setting at the Federal Initiative level. Improved horizontal engagement would ensure ongoing discussions on both the short and long term strategic directions of the Federal Initiative as well as integrated advice to senior management on ways to address current and emerging HIV/AIDS needs in Canada.

In response to the 2009 evaluation of the Federal Initiative, a revised Terms of Reference for the Responsibility Centre Committee was developed to further enhance horizontal management. An annual review of an integrated work plan and identification of priorities, also identified as a deliverable in that evaluation, was not consistently conducted.  The need for this type of exercise remains.

Recommendation 2:

Enhance knowledge exchange and application by supporting knowledge translation activities and opportunities to implement promising practices

There is evidence that knowledge translation and exchange is occurring and some practices, programs and policies have adapted based on the vast amount of knowledge developed through Federal Initiative activities. Key informants, both those working within the Federal Initiative and those external to it, agree that there has been a significant amount of knowledge and understanding that has been developed and disseminated over the years. While there is a recognition that new information will be needed to address emerging needs associated with HIV/AIDS, one of the challenges outlined in the evaluation was the ongoing need for federal management of enhanced knowledge translation activities.

  1. Knowledge exchange: While a lot of knowledge and information has been produced and disseminated, the Federal Initiative should increase its efforts to foster a culture of sharing information and knowledge exchange.
  2. Knowledge application: The Federal Initiative should strengthen efforts to apply knowledge (including research and surveillance) to policy and practice to advance public health action in this area.

The Federal Initiative could play a significant role in bringing partners together across sectors and ensure that intervention work has a vision and strategic plan, which may lead to increased engagement and increased coordination between national and regional offices. These efforts can provide opportunities for Federal Initiative partners, and others, to connect and share information on HIV/AIDS activities to advance the Federal Initiative's efforts to address HIV/AIDS in Canada.

Recommendation 3:

Strengthen activities to address barriers to prevention, diagnosis, care, treatment and support

The 2004 program authorities outlined the need to address barriers to prevention,diagnosis,  care, treatment and support. Even though some work has been carried out in this area, further work should be done to address the social determinants of health as well as stigma and discrimination, which impact access to prevention, diagnosis, care, treatment and support. There is a recognition that there are limitations to the work those in the health portfolio can accomplish as often, activities to address barriers are part of the mandate of other jurisdictions. Therefore, work in this area should focus on engaging with others who are responsible for key social determinants of health.

Evidence has shown that stigma and discrimination still exist and reducing those and other barriers will, in turn, improve access to prevention, diagnosis, care, treatment and support for those living with HIV/AIDS. Increasing action on the social and economic determinants of HIV/AIDS was one of the goals of the Federal Initiative and, as the problem still exists, work in this area should be enhanced.

Recommendation 4:

Enhance internal collection and use of information

The Federal Initiative has advanced their collection of performance measurement over the last five years, partially as a response to the last evaluation. There was a lot of performance measurement data available to assess activities and outcomes for this evaluation. Therefore, the ability to assess success in terms of achieving outcomes was possible. However, improvements to performance measurement can enhance the ability to assess success on a continuous basis, including how knowledge generated is used to inform policy and practice.

  1. Monitor and adjust for continuous improvement. While key informants noted anecdotal evidence of knowledge exchange, bilateral meetings, policy change, and international meetings, often this was not documented in a way that could be used to monitor activities and thus improve them on an ongoing systematic basis. Frequently, this falls outside traditional mechanisms of performance measurement. However, tracking these types of activities will help the Federal Initiative to continuously improve over the short and long-term.
  2. Update the logic model and performance measurement strategy to reflect the evolution of the Federal Initiative. The Federal Initiative has evolved over the past five years based on the changing nature of HIV/AIDS as well as government direction in this area. The logic model and accompanying performance measurement strategy should be reviewed in light of these changes to ensure that activities and outcomes still align with the evolution of the Federal Initiative. This should include developing mechanisms of collecting information that focus on the impact of activities of the Federal Initiative in addition to what is produced.
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