Report to Manitobans:  Hepatitis C Services Expansion

For the Period 2000 – 2005

Related to the
Undertaking Agreement Between The Province of
Manitoba and the Government of Canada

Background:

Between January 1986 and July 1990, a number of Manitobans, along with other Canadians, were infected with hepatitis C through Canada’s blood supply system during hospital procedures. Many of these individuals have received compensation through the 1986-1990 hepatitis C Settlement Agreement funded by the federal, provincial and territorial governments.  For individuals infected with hepatitis C before January 1986 and after July 1990, the Government of Canada adopted a “care not cash” policy and, by means of an Undertaking Agreement, provides provinces and territories with up to $300 million over 15 years.  Manitoba is to receive a total of $7.8 million dollars by 2015 when the transfer payment will end.  Manitoba signed the agreement in September, 1999; the first payment was in  March 2001. 

The Shared Objective of the Undertaking Agreement states:

“The parties agree that their shared policy objective is to ensure that persons infected with hepatitis C through the blood supply system prior to January 1, 1986 and after July 1, 1990, have reasonable access to therapeutic health care services indicated for the treatment/cure of hepatitis C.”

The provinces and territories agreed to report to the public every five years on the use of the funding to its citizens in a manner and form of their choosing.   

Services Provided in Manitoba:

Over 50% of Manitoba’s 1.1 million population live in the City of Winnipeg and surrounding area.  Consequently, the majority of medical specialty services are located in Winnipeg including resources for diagnosis, support and follow-up of individuals with hepatitis C. 

During 2000-2001 Manitoba Health led an extensive consultation process with key stakeholders including the Winnipeg Regional Health Authority (WRHA), health professionals and the Hepatitis C Society.  This resulted in a comprehensive service delivery model being adopted and implemented by the WRHA.   Within this context of program development activity and health care services, Manitoba, with financial assistance form the Government of Canada, negotiated a multi -year agreement with the WRHA to enhance the care, treatment and support services available to Manitobans with hepatitis C.  This comprehensive service model became the Blood Borne Pathogens Programs and Service Model: Hepatitis C Virus component.

Goals of the Program are to:

  • Prevent and limit the spread of hepatitis C
  • Ensure appropriate, accessible and comprehensive clinical care, treatment and support for clients with hepatitis C in Manitoba.
  • Ensure appropriate information on prevention, care, treatment and support is available to those who require it in Manitoba
  • Create partnerships and delineate roles for an integrated service delivery model for hepatitis C.

In March 2001, Manitoba advanced $260,000 to the WRHA to fund start up expenditures related to the planned expansion of services.   In July 2001, Manitoba finalized the details of the service enhancement agreement with the WRHA and confirmed annual funding allocation of $520,000 for a multi-year period.  The WRHA agreed to track costs and units of service funded under the agreement and report to Manitoba Health on an annual basis.

Specifically, the WRHA uses the $520,000 annually:

  • Enhance community based services by approximately $326,000 with additional nursing/allied health professionals for patient follow-up, counseling, support, outreach, education and training for patients and families.
  • Expansion of facility based services (Viral Hepatitis Investigation Unit [VHIU] at the Health Sciences Centre) with increased clinic days, additional nursing and support staff and an additional physician with training in Hepatology.
  • Introduction an/or upgrading of information technology to enhance communication, track and monitor patient care and treatment and expedite access to service.

The Province of Manitoba funds the following services not covered in the Undertaking Agreement:

  • Services of Cadham Provincial Laboratory.  
  • Blood transfusion recipients prior to April 1992 when blood donor was not screened for hepatitis C or the screening test was not available were notified of the possible risk of having been exposed to the virus.  More than 16,000 Manitobans were tested for the virus and 1% was found to be positive.      
  • Provincial drug program for hepatitis C drugs – between 1999 and 2004 funding for drugs was approximately $2.7 m.
  • Manitoba provides free vaccines (Hepatitis A and Hepatitis B) for individuals with liver diseases including hepatitis C patients, to prevent further damage or risk of damage. 
  • Hepatitis C treatment with antiviral drugs is offered in community clinic settings in collaboration with and using guidelines and protocols developed at the VHIU at the Health Sciences Centre.
  • Manitoba’s contribution to the Canadian Blood Services includes funding for the most up to date screening technology to assure that blood for donation is free from hepatitis C.
  • Physicians fees for the provision of services, including surgical services to patients.  
  • In-patient hospital care.
  • Support for research processes and databases that utilize the province’s surveillance database.
  • Support for educational forums with other partners.
  • Manitoba provides compassionate assistance to individuals infected with hepatitis C prior to January 1, 1986 and between July 1, 1990 and September 28, 1998 in the form of a one time grant of $10,000.  $3.5 m is allocated for this program.  To date 307 individuals and estates have received this grant.

Moving Forward

The agreement with the WRHA is periodically reviewed.  Refinements and modifications to the program will continue to occur.  The Province of Manitoba works with Regional Health Authorities to ensure that specialized services are available and accessible to Manitobans with hepatitis C, to foster disease prevention strategies and to educate health care professionals on this disease and model of care.  

October 11, 2007