ARCHIVED - Integrated Strategy on Healthy Living and Chronic Diseases - Community Based Programming Functional Component

Conclusions

The objective of this evaluation was to examine issues related to relevance and design and delivery; to determine the success/progress of the CBP Functional Component; and to propose improvements to the Diabetes CBP, as well as the ISHLCD as a whole.

4.1 Relevance

The findings of this evaluation confirm there is general support for PHAC’s role in prevention of chronic disease, including diabetes.  In light of a rapidly increasing prevalence of diabetes in Canada, there is general recognition of the importance of supporting community-based programs in promoting healthy living and preventing diabetes and its complications.  There is also general support among stakeholders for the population health approach, which recognizes the role of broad determinants of health and the importance of addressing the needs of all members of the population in a variety of ways.

This evaluation found evidence of potential overlap or duplication between CBP and other Functional Components of the ISHLCD, as well as within CBP.  Program representatives noted overlap/duplication between CBP and the KDED Functional Component, largely as a result of a lack of clarity with regards to how the two Components fit under the Strategy. Within CBP, there appears to be certain overlap between Diabetes CBP and the Healthy Living Fund in supporting communities in promoting healthy living to prevent chronic disease, including diabetes.

Generally, stakeholders consulted through the Diabetes Policy Review saw diabetes prevention as an area where PHAC should focus its efforts.  The issue of jurisdiction persists in the area of diabetes management, as some provinces do not consider it to fall under PHAC’s mandate.  Defining PHAC’s role vis-à-vis that of the provinces in addressing diabetes management appears to be a challenge for regions in delivering CBP (Diabetes Policy Review Committee chaired by the Honourable Brian Peckford, 2008a; Diabetes Policy Review Committee chaired by the Honourable Brian Peckford, 2008b).

4.2  Design and Delivery

This evaluation found there is a lack of consistency in the delivery of Diabetes CBP in the regions, due to the lack of human and financial resources in most Regional Offices and the program’s inability to obtain timely funding approval for the solicitation process for Gs&Cs.  There was evidence there may not be sufficient clarity on, or understanding of, the roles and responsibilities of Regional Offices in delivering programs under the ISHLCD, including Diabetes CBP.  At the same time, regional representatives emphasized the challenges in delivering CBP regionally in the current uncertain environment and with limited resources, particularly in managing stakeholder expectations.

A number of gaps and challenges were identified with CBP, most notably in the delay of funding approval for the solicitation process for Gs&Cs.  Other key challenges identified included:

• Limited program reach to people living with diabetes, primarily resulting from a relative focus on the promotion of healthy living and diabetes prevention among funded projects;
• Limited progress in integration among community-based programming activities/initiatives in chronic disease prevention and management;
• Inability to use multi-year funding;
• A lack of focus on knowledge transfer; and
• Limited integration and collaboration with KDED.

This evaluation also found evidence the existing monitoring system under Diabetes CBP was not effective in measuring many of the outcomes of funded projects.  While the intention was to include questions on the outcomes achieved from project activities in PERT, this was not done for the 2006-07 pilot reporting.  In addition, the collection of program data undertaken as part of this evaluation revealed a lack of systematic tracking of program information.  These findings raise concern over the program’s ability to monitor and assess both project- and program-level administrative and evaluative data.

4.3   Success/Progress

This evaluation found that overall, the implementation of CBP has been significantly challenged by a number of factors existing within PHAC as well as in the broader environment in which it operates.  In particular, the delay in obtaining funding approval for the solicitation process for Gs&Cs has resulted in a limited scope of solicitation in many regions and at the national level.  Also, lack of program capacity has led to limited progress in implementing many of the expected program activities.

At the individual project level, a review of data reported by 2006-07 funded projects suggested limited, but promising, progress in achieving some of the expected results.  The majority of funded projects reported using evidence in planning and implementing their activities, and to a lesser extent, in evaluating project activities, outputs and outcomes.  Funded projects generally succeeded in reaching their target populations, while numbers of individuals reached varied greatly from one project to another, depending on strategies used.  However, as the majority of funded projects were aimed to address prevention among high-risk groups, the program’s reach to persons living with diabetes was limited.

A review of 2006-07 data on funded projects also suggested that overall, partnerships were a key feature of the funded projects, with most projects having formed new partnerships as a result of the projects.  Over half (n=107) of the new partners were from the health sector, followed by education (11%, or n=22) and social services (10%, or n=21).

In relation to the outcomes achieved by funded projects, available data provide evidence of limited but promising success in increasing the awareness and knowledge among high-risk populations and in contributing to organizational or system-wide policy changes.  However, the reports of success in achieving early outcomes in these areas were often not supported by strong evidence.

At the program level, this evaluation found only limited progress was made in two of the three action areas under CBP, namely “Partnership Development and Collaboration” and “Community Delivered Projects”.  Also, stakeholder involvement in the delivery of Diabetes CBP at the overall program level has been very limited largely due to the context in which the program is being delivered.