ARCHIVED - Summative Evaluation of the Blood Safety Contribution Program - Final Report

Appendix A: Detailed Key Findings

This section presents the key findings for each of the evaluation questions.

Resources Required to Sustain the Surveillance Systems

Evaluation question 14: What resources are required to sustain, strengthen or enhance blood safety surveillance?

As a contribution program, the BSCP does not provide permanent funding for provincial and territorial activities related to blood safety surveillance. There is an underlying assumption that the costs of starting up a surveillance system will be different from those of maintaining such a system once it is established. However, some form of ongoing funding may be necessary to sustain and/or enhance surveillance over the long term. This section explores potential funding requirements from this point forward.

Costs of Maintaining TTISS

The mid-term review of TTISS (2003) looked at how the TTISS could be sustained in the long run by focusing on the degree of commitment to the TTISS by provincial governments and necessary conditions for sustainability of the program. At that time, provincial representatives indicated that most provincial governments are committed to the TTISS, but formal commitments are absent. When asked about this in the survey, representatives from only two provinces were certain that TTISS had been included in the strategic plan of their ministry or department responsible for health.

The provinces and territories do make financial and in-kind contributions to the surveillance system. The mid-term review found that TTISS activities received more financial support from some provinces and territories than from others. The mid-term review also concluded that most provinces and territories will expect federal funding for the program on an ongoing basis, and recommended that the program attempt to reach agreement with the provinces on sustainable funding arrangements (p. 28).

Resources, activities and outputs required to maintain a program are normally fewer than those required when first establishing the program. This does not appear to be the case with TTISS: most survey respondents indicated that the annual overall cost (including both federal and provincial/territorial contributions) of maintaining TTISS had increased over time. There was substantial variation in whether provincial and territorial contributions had increased, remained the same, or decreased over time.

Opinions of PHAC staff about the costs of maintaining TTISS compared with the earlier costs of developing the system varied, with most responses being theoretical rather than evidence-based. Responses included:

• Initial surveillance system costs are always higher at the start, however, left with the impression that provinces/territories have decreased funds over time;
• Costs will not change, as funds that go to provinces/territories mostly go to staffing; and
• Costs will increase, because of inflation and ongoing improvement and updating of the system.

In terms of specific funding needs anticipated, provinces/territories indicated that they will require between $10,000 and $290,000 in BSCP funding each year (above and beyond what their province or territory contributes) to maintain TTISS in their jurisdictions. The total BSCP funding required to maintain TTISS across all jurisdictions is estimated at $1.2 million. Survey respondents indicated that this money would be spent on (listed in order of frequency):

• Education/Training;
• Staff;
• Meeting/conference attendance (including travel);
• Database/system maintenance;
• Data quality (extractions, validation, follow up on incomplete reporting, etc);
• Develop/update safe-transfusion practice clinical tools; and
• Enhance/simplify duplicated reporting efforts between blood manufacturers and the provincial/territorial blood coordination office.

Summary

To determine the resource requirements for sustaining a surveillance system appears to be challenging, as no formal long-term commitments are present from any of the parties involved. In addition, it is unclear exactly what the resource requirements may be for maintenance of TTISS and what activities and outputs are required in the long-run for TESS and CTOSS.

The provinces and territories participating in TTISS anticipated that the annual overall costs of maintaining the TTISS system may actually be higher than the annual costs during the initial implementation of the system, possibly because of inflation and the costs of updating the system. The provinces and territories represented in the survey estimated that they would need a total of about $1.2 million per year in BSCP funding to maintain TTISS.