Macroeconomics and Health (CMH)

Canada's vision of the health pact of poor and rich countries to achieve mutually agreeable health investments

Dr. Montasser Kamal,
Chief, UN Health-related Institutions Unit,
Canadian International Development Agency

Geneva, 29 October 2003

WHO Consultation on Increasing Investments in Health Outcomes for the Poor
Second Consultation on Macroeconomics and Heath
Day 2 Thematic Focus: How to increase predictability of external funding and improve coordination with partners.

Mr. Chair,

Honorable Ministers, colleagues and Friends,

Canada is pleased to take part of this important Consultation. This meeting serves as an important reminder that the health agenda is inseparable from the economic agenda and that all partners must work collaboratively in order to address the development concerns in both areas.

Canada's vision regarding the health pact of poor and rich countries to achieve mutually agreeable investment includes at least three elements: a) expanding the base for current partnerships, b) strengthening health systems, including human resources, and c) focussing on results.

A. Expanded Partnerships:

Canada is an active participant in the recent initiative on "Accelerating Progress to Meet the Health and Nutrition Millennium Development Goals" along with the World Bank, WHO, DFID, and other developed and developing country partners. The purpose of this Initiative is to help developing countries achieve the health MDGs that are so critical for poverty reduction and economic and social well-being. A high-level multilateral meeting involving donors, U.N. agencies and developing country representatives was held in Ottawa on May 7-8, 2003 to move the Initiative forward. A high-level forum (HLF) was formed at that meeting.

The High Level Forum (HLF) has now produced a concept paper around which the next meeting will be held here in Geneva in January 2004. The meeting will concentrate on three specific issues: (a) Harmonization and the health sector; (b) addressing health systems constraints; and (c) monitoring and benchmarking. CIDA is an active partner in this Initiative and is committed to remain engaged in global efforts to accelerate progress towards achieving the health, population, and nutrition related Millennium Development Goals.

Canada's long history of working in partnership with other stakeholders reflects Canada's view that multilateral initiatives are increasingly becoming the cornerstone of health and development. Examples include Canada's involvement in the Global Fund to Fight AIDS, TB and Malaria (GFATM) and The Global Alliance for Vaccines and Immunization (GAVI); the WHO Special Programme for Research ad Training in Tropical Diseases (TDR); and the UNDP/UNFPA/WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). TDR and HRP have shown that special partneships, when nurtured and under good leadership, can become hugely successful and influential, as the latest evaluation of HRP, for example, has demonstrated.

In the fall of 2000, CIDA released CIDA’s Social Development Priorities (SDP): A Framework for Action, which outlined the Agency's plans to increase programming in the social development sectors (Basic Education, Health and Nutrition, HIV/AIDS, and Child Protection) to a total of $2.8 billion over the 5 year period from 2000-01 to 2004-05. Within this framework, the Health and Nutrition annual spending should double from $152M to $305M. Canada sees expanded partnerships in all their forms as an essential strategy to implement these priorities.

B. Strengthening Health Systems:

In several fora strengthening health systems has been recognized to be as critical for ensuring access of the poor and the disadvantaged of developing countries to health care, treatment and other support.

Canada strongly believes that the effectiveness of current partnerships should be measured, in part, by their impact on strengthening health systems. Strong systems assure the rich countries that their investment is sustainable and the developing countries can guarantee that their hard-won gains will continue to be enjoyed by future generations. Canada will continue to work with its partners to strengthen health systems in developing countries and, following Canada's five principles of Strengthening Aid Effectiveness, engage in Program-based and system-wide approaches (SWAps) in the health sector. The five Principles are: local ownership, results- based approach, improved donor coordination, strong partnership, and greater coherence.

Canada was extremely pleased by the August 30 announcement by the WTO on the TRIPS Agreement and public health. This historic decision will enable poor, developing countries to access the medicines they need to respond to public health problems, like HIV/AIDS, without weakening the intellectual property protection that is essential for the ongoing development of new and improved drugs. While Canada is now working on its own response to this welcome decision, its vision is that long lasting solutions to the HIV/AIDS epidemic must also be accompanied by attention to health systems in developing countries, including, in particular, human resources.

C. Focus on Results:

Canada has long viewed the achievement of results as the best measure of successful partnerships. It is therefore essential that all partnerships make the necessary investment in surveillance, data collection and management, research and human resource development in order to let the rich countries know that their investment is working and for the poor countries to be able to plan effectively.

Polio eradication efforts are a case in point on how partnership can lead to measurable, impressive results. In 1988, the World Health Assembly (WHA) launched the global initiative to eradicate polio (known as the Global Polio Eradication Initiative: GPEI). Spearheaded by WHO, UNICEF, Rotary International and the Center for Disease Control (CDC), the initiative has become one of the largest public health initiative in history and has a goal of certifying the world as polio-free by 2005. The number of polio cases has fallen by 99.8% from an estimated 350,000 cases in 1988 to 480 at end of April, 2002. By December 2002, polio was limited to only 7 countries – four in Africa (Egypt, Nigeria, Niger, and Somalia) and three in the Indian sub-continent (India, Pakistan, and Afghanistan).

Canada has long been a champion of polio eradication. In fact, Canadian researchers played a significant role in the development of the first polio vaccine. Since 1999, CIDA has committed a total of $92.4M towards the Global Polio Eradication Initiative. $50M of this total amount was announced by the Prime Minister at the G8 Summit as part of the Canada Fund for Africa. While an increase in cases has been reported in some pockets, Canada is confident that current efforts by governments and the Polio Eradication Initiative to correct the situation will be successful.

Polio Eradication may have strained the system in some resource-limited situations, but the whole experience continues to offer valuable lessons on how to maximize on gains such as the establishment of a good network of surveillance and good infrastructure that can serve as the basis for future expansion of other immunization efforts and other preventive public health measures.

Results are the engine that drives reinvestment in public health and development and we must strive to show the value of our work together on the wellbeing of populations.


To sum up, Canada's vision regarding improvement in the predictability of external funding and donor coordination is predicated on a systems approach to viewing problems and solutions, on shared responsibility towards achieving results that are tangible, and in accordance with mutually agreed objectives.