Prabhat Jha is professor of disease control and director of the Centre for Global Health Research, St. Michael’s Hospital and University of Toronto; John W. McArthur is visiting fellow at the Brookings Institution and senior fellow at the UN Foundation.
This year, approximately six million children and 300,000 mothers will die during childbirth, mostly in the low-income countries of Africa and Asia. Next week, Prime Minister Stephen Harper hosts world leaders in Toronto for a major summit on maternal, newborn and child health, building on efforts he first launched at the G8 Muskoka summit in 2010.
Canada is leading the meeting, but it contributes less than 5 per cent of the world’s total annual health aid of about $30-billion. How can the Prime Minister help the country punch above its weight in this pivotal effort? We offer three suggestions.
First, Canada can substantially increase its funding to key multilateral institutions like the Global Alliance for Vaccines and Immunization (GAVI); the Global Fund to Fight AIDS, Tuberculosis and Malaria; UNICEF and the World Health Organization. The GAVI Alliance has probably been the world’s most life-saving new public-private partnership over the past decade. With its innovative structure of results-based financing, the organization has already stimulated several breakthroughs in vaccine technology around the world. Parents in Canada have seen that their kids have far fewer ear infections than they themselves did as children. If these same vaccines are made available everywhere, more than 1 million deaths a year can be avoided. GAVI has just launched its new five-year replenishment and needs $7.5-billion (U.S.) to meet its global targets. Canada could easily fund $100-million per year, or $3 per Canadian.
Some skeptics might believe non-governmental organizations are best suited to deliver health aid. But the GAVI Alliance can do this far more efficiently, deploying its huge purchasing power to push prices down, and then relying on rigorously reviewed country-driven plans. Indeed GAVI and the Global Fund deliver far more health for the buck than Canada’s bilateral grants, and have much lower overhead costs than most NGOs.
Politicians might worry that writing cheques to multilaterals, while efficient, diminishes Canada’ visibility and risks losing citizen support. Thus we suggest a second major effort: allocating some of Canada’s less-effective $600-million in bilateral health aid to ensure even better multilateral results. The adage that “what gets measured is what gets done” applies equally to global health. A recent UN panel co-chaired by Mr. Harper and Tanzanian President Jakaya Kikwete called for strengthening country health information and accountability. Only 3 per cent of the world’s child deaths have adequate information on cause of mortality, limiting evidence-driven spending decisions.
A one-time $100-million Canadian “health data revolution” initiative could improve census operations, routine health surveillance, surveys on cause of death, and hospital use statistics, while providing fully open source data. For example, for the last 10 years, the Indian Million Death Study has obtained cause of death information from a random sample across the country. This helped uncover that India’s HIV/AIDS deaths were only a quarter of the number feared, leading to better targeting of funds. These low-cost systems can enable results-based financing. Donors can write cheques to pay for specific outcomes, and the local governments figure out how best to use the money. A big data effort might be seen as the “Canadarm” for global health, helping to advance maternal and child survival well beyond 2015, in the same way the actual Canadarm was pivotal to building the International Space Station.
Third, the large number of robustly growing developing economies can contribute ever more to their own health programs. In the process, they must make crucial decisions on whether to adopt universal public health insurance. Thanks to universality, Canadians who get sick very rarely become poor, as so often happens in many low- and middle-income countries, and sadly, still among our friends in the United States. In India alone, 37 million people become poor every year as a result of catastrophic health expenses. Canada’s tremendous moral leadership in this area has been underleveraged. We therefore propose that $100-million per year be allocated to help interested developing countries introduce universal health insurance.
These modest Canadian investments could make enormous contributions to global health while adhering to the business case of investing more money in health to get more health for the money. Our proposed spending is comparable to the nearly $300-million that Canada underspent on its approved development budget last year. The proposals would raise Canada’s global health investments by less than $10 per Canadian per year, for a total of below $50 per capita annually. We would be closer to the Swedish spending of about $60 per capita but still well below the Norwegian level of $130 per capita. Canada competes well with these countries in hockey. We can do equally to ensure our foreign aid helps to save lives.