Hello from Canada! We are Peter Czerny, Ashley Zelmer and Robert Tkaczyk, three federal government evaluators with the Public Health Agency of Canada (PHAC) and Health Canada. Our evaluation team is in the middle of a journey to incorporate “Sex and Gender-Based Analysis Plus” (SGBA+) into our practice. Since 2015, the Government of Canada has been making more concerted effort to take a Gender-Based Analysis Plus perspective on policies, programs and budget decisions. Our health-sector departments add ‘Sex’ to this term (in recognition of the relevance of biological differences for some health issues), but the aim is consistent: to consider how diverse groups of people may be affected by government policies, programs and initiatives (impacting their effectiveness).
The theme of health equity has been a guiding light in our evaluation work, driven by the missions of the two federal organizations that we serve. Lately, health equity has been thrown into sharp focus in countries everywhere by the COVID-19 pandemic, revealing how some groups are more impacted than others when it comes to risk of illness and death, access to health services, and the ability to cope with public health guidelines intended to reduce the rate of infections.
As public-sector evaluators, we are excited by the latest conceptual tools shared through professional channels (like AEA365) at the same time as we adhere to directives governing our Canadian federal evaluation practice. Faced with new needs, we’ve tried making our
· Inspired by a PHAC plan on health equity we created our first set of scoping questions in 2015 to push ourselves beyond rote inquiries on relevance and performance (i.e., explore health equity issues at play in any given evaluation project).
· In 2017, a Health Canada-wide Action Plan to further adopt SGBA+ prompted us to revisit these questions, simplifying the questions and aligning them with new policy and guidance from the federal Treasury Board (who sets the federal evaluation policy and standards) as shown in the image below. This iteration was also inspired by our knowledge of Realist Evaluation – we wanted to reflect the concept of “what works, for whom, and in what circumstances”.
We have now had some experience with this tool, helped by the fact that PHAC and Health Canada programs tend to consider health equity in their activities. Furthermore, PHAC has created a Rad data Resource, the Health Inequalities Data Tool, which has helped to provide evidence for the first set of questions in our lens. That said, there is feedback from programs that looking at population differences from an intersectionality perspective (i.e. the ‘Plus’ in SGBA+) has proven to be difficult to put into practice. There are new tools being developed in the academic world to help practitioners cope with the complexity of intersectionality which will help us as evaluators to further operationalize this evaluation lens.