ARCHIVED - Federal Initiative to Address HIV/AIDS in Canada Implementation Evaluation Report
This report presents the findings, conclusions, and recommendations of an internal implementation evaluation of the Federal Initiative to Address HIV/AIDS in Canada, covering the three-year period from 2004-2007. The purpose of this evaluation is to assess the extent to which policies, programs, and strategic initiatives have been implemented as planned; determine if improvements to delivery and management approaches are required; and test for early evidence of results. As well, the evaluation highlights unanticipated obstacles or barriers that may impact the ultimate success of the Federal Initiative, allowing managers to make adjustments to ensure successful program outcomes.
The Federal Initiative was established in 2004 in response to a submission by four federal departments and agencies to authorize funding for a horizontal initiative intended to achieve the following:
- prevent the acquisition and transmission of new infections;
- slow disease progression and improve quality of life;
- reduce the social and economic impact of HIV/AIDS; and
- contribute to the global effort to reduce the spread of HIV.
The total planned allocation for the first five years (2004-2009) of the Federal Initiative is $321.2 million. In 2004, new funding was added to the ongoing yearly baseline amount of $42.2 million and was to reach $84.4 million a year by 2008. The allocation of new funding by year was $5.0 million in 2004; $13.0 million for 2005; and $21.0 million for 2006. The four participating departments and agencies are the Public Health Agency of Canada (PHAC), Health Canada (HC), the Canadian Institutes of Health Research (CIHR), and Correctional Service of Canada (CSC).
This evaluation is intended to inform governance managers and executives, and program managers. It is one of the commitments identified in the evaluation workplan included in the Federal Initiative’s Results-Based Management and Accountability Framework (RMAF).
Evidence for the evaluation was collected between April 2007 and October 2008. The evaluation was conducted by the Accountability and Evaluation Section of the HIV/AIDS Policy, Coordination and Programs Division (PHAC), with the support of the Federal Initiative Evaluation Steering Committee, the Federal Initiative Accountability Working Group, and the Federal Initiative Responsibility Centre Committee.
This report includes an overview of the Federal Initiative; provides a description of the scope of the evaluation; and discusses methodology, findings, and conclusions related to questions concerning relevance, design and delivery, governance, and performance management.
B. Overview of the Federal Initiative
Exhibit I-1 - Priorities of the Federal Initiative
- Sustain and strengthen ongoing federal activities;
- Shift to population-specific approaches to address the needs of people living with HIV/AIDS, gay men, injection drug users, Aboriginal people, prison inmates, youth and women at risk for HIV infection, and people from countries where HIV is endemic;
- Conduct social marketing campaigns to increase prevention and ecourage those infected but unaware to access HIV/AIDS programs;
- Increase awareness of HIV/AIDS among the general population to reduce stigma and discrimination;
- Enhance accountability and communication of results on progress and achievements
- Integrate HIV/AIDS interventions with other diseases where appropriate;
- Expand engagement of other federal departments related to the determinants of helath (e.g., housing, disability, social justice, employment); and
- Align the federal contribution with the directions arising from "Leading Together: Canada Takes Action on HIV/AIDS 2005-2010".
The federal government has contributed to the fight against HIV/AIDS for over 15 years. In 1998, the Canadian Strategy on HIV/AIDS (CSHA) was launched as a $42.2 million collaborative approach to address HIV/AIDS in Canada. Federal funding was allocated to Health Canada, the Medical Research Council of Canada (replaced by the Canadian Institutes of Health Research in 2000), and Correctional Service of Canada. The CSHA partners worked with multiple stakeholders across various jurisdictions including communities, non-governmental organizations, health professionals, researchers, institutions, the private sector, and people at risk of, or living with, HIV/AIDS. The purpose was to deliver prevention services and access to care, treatment, and support programs; conduct research, epidemiology studies, and surveillance; and support laboratory science, multi-sectoral co-ordination, and international collaboration.
In 2004, the federal government reaffirmed its commitment to a comprehensive, long-term approach to address HIV/AIDS by announcing an expanded and strengthened federal role, and doubling the HIV/AIDS funding allocation from $42.2 million to $84.4 million annually. The funding allocations, goals, objectives, and policy directions of the Federal Initiative were based on the House of Commons Report of the Standing Committee on Health entitled, Strengthening the Canadian Strategy on HIV/AIDS (2003), and a five-year review entitled, Getting Ahead of the Epidemic: the Federal Government Role in the CStrategy on HIV/AIDS 1998-2008 (2003) Epidemiological evidence, public health research, and consultations with community stakeholders were also drawn upon. The result was a revised approacto all program components, and substantially strengthened support to build the evidence base to guide policy and program decision making, and to ensure sound program management. Exhibit I-1 - Priorities of the Federal Initiative depicts eight priorities, derived from the evidence and lessons learned from the CSHA, that guided the design of the Federal Initiative and the allocation of funds to participating federal government departments and agencies. Funding for the Federal Initiative was allocated for the years under study as laid out in Exhibit I-2.
Exhibit I- 2
Scope, Objectives, and Target Populations
The Federal Initiative represents the federal contribution to a larger, multi-sectoral national action plan in response to HIV/AIDS (Leading Together: Canada Takes Action on HIV/AIDS (2005-2010)) and fulfills the commitment to the Standing Committee on Health to develop a new coordinated and comprehensive framework for federal involvement in HIV/AIDS in Canada. Global engagement activities have also been established to complement Foreign Affairs and International Trade Canada’s (DFAIT) foreign policy role and the Canadian International Development Agency’s (CIDA) role as Canada’s lead agency for development assistance.
The following objectives were designed to address Federal Initiative priorities and correspond to the areas of action through which funding was allocated:
- increase knowledge of HIV/AIDS through research of the factors that contribute to the epidemic, and on improved methods to respond effectively;
- increase the availability of evidence-based HIV interventions, centred on the needs of at-risk populations and people living with HIV;
- increase the awareness of the Canadian public of the need for HIV testing; access to prevention, treatment, and care; and supportive social environments for people living with, or at risk of, acquiring HIV;
- increase the effective collaboration of new and current partners towards the achievement of a coordinated and integrated response to HIV; and
- establish a strong coherent health sector response to fulfill international commitments and to contribute to global efforts to address HIV.
Epidemiological evidence identified the following eight key populations:
- People living with HIV/AIDS
- Prison inmates
- Gay men
- Youth at risk for HIV infection
- People who inject drugs
- Aboriginal peoples
- People from countries where HIV is endemic
These populations are intended to be reached directly through national and regional Grants and Contributions (Gs&Cs) programs and projects; health services; and national awareness and social marketing campaigns; and indirectly through research, surveillance, policy development, and targeted studies.
Federal Initiative Partners and Roles
- PHAC is responsible for the overall coordination of the Federal Initiative (including joint planning, reporting, monitoring, and evaluation), communications, social marketing, national and regional programs, policy development, surveillance, laboratory science, and global engagement focusing on technical assistance and policy advice.
- CIHR, as the federal government’s health research funding agency, sets priorities for, and administers the Federal Initiative extramural research program in partnership with PHAC.
- HC is responsible for community-based HIV/AIDS education, prevention, and related health services for First Nations on-reserve and some Inuit communities. HC, in partnership with PHAC, is also responsible for coordinating global engagement activities under the Federal Initiative, as well as (for the period 2004-2007) program evaluation activities.
- The CSC provides health services, including services related to the prevention, care, and treatment of HIV/AIDS, to offenders sentenced to imprisonment for two years or more.
The Federal Initiative’s Global Engagement Component is led by HC’s International Affairs Directorate (IAD), which works in partnership with PHAC to deliver results. The objective of this component is to establish a strong, coherent health sector response to fulfill international commitments and to contribute to global efforts to address HIV. HC contributes health sector policy expertise, and fosters linkages and learning between international and domestic stakeholders, while PHAC contributes public health policy and technical expertise to global efforts.
The governance structure has two components – an oversight body, and a performance management strategy. The Responsibility Centre Committee (RCC) is the governance body for the Federal Initiative. The RCC is composed of mid-level management representation from each of the programs. The terms of reference stipulate that the RCC group ensures that accountability commitments are met; information is shared; support for collaboration on crosscutting activities and policies is available; and appropriate linkages with other federal government HIV/AIDS committees are facilitated.
The RCC established an Accountability Working Group (AWG) with membership drawn from the Responsibility Centres (RC). The purpose of the working group is to share data and report results and verify accuracy of reports to fulfill ongoing accountability requirements for the Federal Initiative.
Federal Initiative governance is supported by a number of coordinating and advisory committees, which increase collaboration with other federal departments and agencies, other levels of government, and relevant stakeholders. These include the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada; the Assistant Deputy Minister Committee on HIV/AIDS; the Consultative Group on Global HIV/AIDS Issues; the Federal/Provincial/Territorial Advisory Committee on AIDS; the National Aboriginal Council on HIV/AIDS; the Federal/Provincial/Territorial Heads of Corrections Working Group on Infectious Diseases; and the Leading Together Championing Group.
The performance management strategy is discussed in detail later in this paper.
The policy directions underlying the design and delivery of the Federal Initiative are summarized in Exhibit I-3. These policy directions are common strategies to reach Federal Initiative objectives and underlie the design and delivery model.
Exhibit I-3 - Policy Directions for the Federal Initiative
Partnership and Engagement
The Federal Initiative is based on the goal of establishing a coherent and coordinated plan, involving local, national, and international partners, to address the HIV/AIDS epidemic. To this end, federal, provincial, territorial, and municipal partnerships will be enhanced. An aligned inter- and intradepartmental approach will be put in place, which will focus on the determinants of health and have clearly defined roles and responsibilities. As well, increased engagement will be sought with the voluntary, professional, and private sectors; international partners; and people living with, and vulnerable to, HIV/AIDS. Continued strong relationships with non-governmental organizations and community partners are essential.
Many people living with, and vulnerable to, HIV/AIDS have complex health needs and may be vulnerable to other infectious diseases, such as those transmitted sexually or by injection drug use. Federal HIV/AIDS programs will be linked with other appropriate health and social programs to ensure an integrated approach to program implementation. Programs will address barriers to services for people living with, or vulnerable to, multiple infections and conditions that have a negative health impact. Those affected play a key role in overcoming these barriers.
The federal government will foster mutual accountability among its delivery partners and will make public their achievements, as well as their challenges annually through the World AIDS Day report (published each year on December 1).
The logic model for the Federal Initiative (Exhibit I-4 below) summarizes the means by which the anticipated long-term outcomes would be achieved.
Exhibit I-4 – Federal Initiative Logic Model
The Federal Initiative delivers a range of activities through the following five broad areas of action:
- Knowledge Development: research, surveillance, laboratory science, knowledge synthesis and transfer;
- Coordination, Planning and Reporting: governance and an enhanced accountability framework, co-ordinating and advisory bodies;
- Policy and Program Interventions: policy development, national and regional Gs&Cs programs and projects;
- Global Engagement : health sector response to fulfill international commitments by sharing policies, best practices, and technical expertise with the goal of strengthening domestic and global responses to HIV/AIDS; and
- Communications and Social Marketing: awareness and social marketing campaigns.
Exhibit I-5 is a visual representation of the horizontality of the Federal Initiative (names and relationshipas of 2006). Funding flows from the 4 partners to the 11 RCs. RCs are part of a vertical organizational structure, with goals, objectives, and financial operations aligned within their department or agency, inaddition to their horizontal relationship through the Federal Initiative. The 11 RCs fulfill 16 roles, 13 of which correspond with program activities and 3 with governance activities, including developing the accountability framework, and the management and administration system (Annexes I-1 and I-2).
Exhibit I-5 - Federal Initiative Responsibility Centres by Federal Partners (2006)
C. Evaluation Objectives and Related Issues
The six key questions depicted in Exhibit I-6 were investigated to address the following evaluation objectives:
- assess the relevance of federal involvement in HIV/AIDS issues in Canada;
- assess the implementation of planned activities (delivery and design of the Federal Initiative’s first three years);
- assess the extent to which the performance measurement and management system of the Federal Initiative has been implemented; and
- assess the Federal Initiative’s progress towards the achievement of immediate outcomes.
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