809 Assignment 1 Program Evaluation

Needle Exchange Review

The program evaluation I chose was “Needle Exchange Program

Review” prepared for the Government of Saskatchewan (Population Health Branch, Saskatchewan Ministry of Health.) The report was compiled by Laurence Thompson Strategic Consulting in December 2008. Needle exchange programs exist throughout the province, where a clean needle is exchanged for a used one. The impetus for the review was to evaluate public perception/concerns about needle exchange programs, as well as rising HIV infection rates. This report looked generally at its effectiveness in terms of rates of HIV infection and overall health costs. Six main questions guided the program review.

Research evidence: What works to reduce the spread of blood diseases from injection drug use? Cross-Canada comparison: How do Saskatchewan programs compare to other programs in Canada? Public safety: What can we do to reduce the risks of discarded needles? Needle distribution and return: Do we distribute an appropriate number of needles, and do we get as many returned as possible? Oversight: Is there appropriate oversight to ensure program policies are followed? Acceptability: What are community concerns and how can we better address them?  (http://www.health.gov.sk.ca/needle-exchange-review)

The full report was over 100 pages, but organized into large summary areas making it quite easy to peruse. A shorter ten page summary was more concise, and explained the results effectively.

 

The program evaluation method used seems to be outcome based. To check this, I used the steps provided in the course module from managementhelp.org.

Step 1: identify the major outcome you are trying to examine. In this case, the Minstry of Health wanting to know how effective the needle exchange program is.

Step 2: Choose the outcomes you want to examine, possibly the top 2 – 4.  Since money was no option for the government, they looked at six major areas as previously stated above.

Step 3: For each outcome, show the related indicators. Under each of the main six guiding questions, more specific questions were listed. These questions were provided to the program evaluators from the Ministry of Health.

Step 4: Have a “target goal of clients.” The research indicated that “in Saskatchewan, most of this increase can be attributed to injection drug use. The proportion of newly reported HIV cases reporting injection drug use in Saskatchewan is three times as high than for Canada as a whole. Most new HIV cases in Saskatchewan report injection drug use.” (LTSC 8) This report was very specifically looking at intraveneous drug users as their target clients.

Step 5: Show what information is needed to prove the indicators. The program evaluators had access to a myriad of health information, including specific data from the seven different needle exchange sites. They also did interviews from front-line health workers, police, fire, school board directors, mental health workers, and more. Many tables and graphs were included to show trends for these indicators at a glance, as well as being included in the Appendix.

Step 6: Gather and compile the information.

Step 7: Analyze and report the findings. The program evaluators provided a ten page summary of their results, as well as the 100 page report.

 

Both short term and long term recommendations were given. The short term outcomes were to continue the “harm reduction” strategy of the needle exchange, as research previously showed very low success rates of stopping the addiction completely. The financial benefit of needle exchange in terms of health care costs for treating HIV was also listed. Specific recommendations for each of the six main areas were included. Two long term outcomes were outlined. The review recommended a “more aggressive and integrated approach to harm reduction” for the users themselves. It also suggested a province-wide approach to disposing of needles and other “biohazard waste collection.”  Money and political will were cited as factors in getting these outcomes to fruition.

Using this outcome-based model, the program evaluation was summative in nature. It examined the needle exchange program here in Saskatchewan, while considering best practices from other parts of Canada, with the end goal of making recommendations and improvements to the program. I think that this was a logical approach to take.

Overall, the report did a very good job in outlining all aspects of the needle exchange program, both positive and negative. At several points, it referred to the complexities involved, and the balancing of needs of different groups. The program evaluators also acknowledge that there were not any Canadian public opinion surveys on needle exchange, but referenced statistics from the United States and Australia. They also acknowledged differences in how the program worked depending on urban/rural areas. Obviously, the program evaluators had a wealth of government health data to work with, as well as likely not being limited by a small/nil budget and could interview many different stakeholders. I did like the fact that the ten page summary was accessible and understandable by a layman audience, as well as having the larger report with their scientific data in detailed graphs and tables. I wasn’t able to determine a drawback to the model chosen, except that there might be specific regional differences where province-wide recommendations might not be workable. The recommendations were clear and it would be interesting to look at more recent data to see how effectively their long term strategies were implemented!