Invest - Lead - Thrive: CanWaCH's Submission for Pre-Budget Consultations in Advance of the 2020 Budget

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The Canadian Partnership for Women and Children’s Health (CanWaCH) is pleased to submit this overview as part of the House of Commons Standing Committee on Finance pre-budget consultation process. CanWaCH continues to work with its members and sector partners to fully articulate this vision in a more detailed investment case. We invite the opportunity to share this additional background by contacting us at info@CanWaCH.ca.

INVEST — LEAD — THRIVE

Written Submission for the Pre-Budget Consultations in Advance of the 2020 Budget

By The Canadian Partnership for Women and Children’s Health (CanWaCH)

List of Recommendations:

Recommendation 1: That the Government of Canada fully realize its funding commitment of June 4, 2019 to scale up its investment to $1.4 billion annually by 2023 for 10 years to promote the health and rights of women and girls around the world. Through this funding, it is recommended that the Government take an integrated, ‘non-siloed’ policy approach to global health programming for women and children that reflects a comprehensive multi-sectoral package of interventions across the life course, encompassing Canada’s suite of expertise in newborn, child, adolescent and women’s health, rights and nutrition. 

Recommendation 2: That as part of its investment in women, adolescent, child and newborn health and nutrition around the world, the Government of Canada fully integrate funding into all programming for innovative approaches to measure and evaluate results that emphasize data for impact.

Recommendation 3: That the Government of Canada increase Canada’s spending on global development and humanitarian assistance over 10 years, beginning in 2020, through predictable 15% annual increases to the International Assistance Envelope (IAE). 

Canada is a Global Leader in Women and Children’s Health and We Must Continue to “Lead On”

The right to health, as part of our Canadian identity, has fuelled our proud tradition across governments of taking a leadership role in advancing the health and wellbeing of the world’s most marginalized people. Canada’s leadership in global health draws upon the collective efforts and expertise of governments, civil society organizations, research institutions, medical practitioners and more.

Canada’s bold commitment to gender equality, health and rights comes at a critical moment when rollbacks on sexual and reproductive health rights (SRHR) are being acutely felt around the globe. Moreover, Canadian leadership is crucial as the world contends with the destabilizing effects of climate change on the world’s poorest and most vulnerable. Without urgent action, climate change could thrust an additional 100 million people into poverty by 2030.   

Who is CanWaCH?

Established in 2011, we are a proud membership of 100 Canadian non-governmental organizations (NGOs), academic institutions and health professional associations working together so that more women and children survive and thrive around the world.

The global community has made significant strides in women, adolescents and children’s health but needs Canada now more than ever to lead on. Since 1990, global maternal mortality has dropped by 44% , under 5 mortality has decreased by 58%  and the adolescent fertility rate has declined from 65 to 44 births per 1000 women aged 15-19 . Even as we celebrate significant achievements, we are mindful that the work is not over and women and girls in fragile and conflict settings have failed to benefit from these important gains. Every year, in 50 countries across the world, more than 5 million mothers, children, and adolescents die from mostly preventable conditions, and the economies of these countries lose billions of dollars to poor health and nutrition. Without sustained investment and impact-based action, hard won gains could be lost. Canadian leadership continues to be vital.

Recommendation 1

That the Government of Canada fully realize its funding commitment of June 4, 2019 to scale up its investment to $1.4 billion annually by 2023 for 10 years to promote the health and rights of women and girls around the world. Through this funding, it is recommended that the Government take an integrated, ‘non-siloed’ policy approach to global health programming for women and children that reflects a comprehensive multi-sectoral package of interventions across the life course, encompassing Canada’s suite of expertise in newborn, child, adolescent and women’s health, rights and nutrition.

The Thrive Agenda: An Evidence- and Impact-Driven Approach to Canadian Leadership on Women, Adolescent and Children’s Health and Rights

With Canada’s financial commitments to women and children’s global health set to end in 2020, a diverse coalition of Canada’s leading global health organizations came together in 2018 to develop the Thrive Agenda, a collective vision for the next phase of Canadian leadership. The Thrive Agenda outlines an integrated and gender-transformative approach to health, rights and nutrition that would enable Canada to deepen its impact on the lives of women, adolescents and children around the world, including those in fragile and conflict settings. 

Thrive is a holistic agenda that places the woman, adolescent or child at the centre, layering the interventions they need, and to which they are entitled, around them, and closing artificial silos that negatively impact health and other progress. The case also leverages Canada’s unique voice and global reputation to drive progress where we have a strategic contribution to make, and where there is critical, unmet need. This is primarily in the most neglected and stigmatized areas of SRHR as well as adolescent health, advocacy for health, and data collection and analysis.

To achieve this comprehensive case, the Thrive Agenda called on the Government of Canada to renew current annual commitments of $1 billion with an additional investment of $400 million annually, for 10 years, beginning in 2020. Within this funding, it called for $500 million to be dedicated each year to the neglected areas of SRHR.

Canada’s Increased Commitment to the Health and Rights of Women and Children

Based on the evidence put forward in the Thrive Agenda, on June 4, 2019 the Government of Canada announced that it will scale up its funding to support women and girls’ health around the world to reach $1.4 billion annually by 2023. A ten-year commitment, this historic investment will support SRHR and maternal, newborn, and child health – with $700 million invested annually to SRHR as of 2023. The Government of Canada articulated that this investment will advance the 2030 Agenda for Sustainable Development, promote SRHR around the world and leverage Canada’s global leadership on gender equality. 

An Integrated, ‘Non-Siloed’ Policy Approach to Global Health Programming

Women and children do not experience health in compartments or silos. Thus, we urge the Government of Canada to implement this historic investment through a comprehensive continuum of care to ensure that access to healthcare meets a variety of life stages, contexts and settings. This approach means deploying the full range of interventions in Canada’s suite of expertise in newborn, child, adolescent and women’s health and nutrition, and, for women and girls, their reproductive health - which includes sexual and maternal health - throughout their lives. 

CanWaCH also strongly urges the Government of Canada to prioritize leaving no one behind … anywhere. In humanitarian settings, at least 75% of those displaced are women, adolescents and children and more than half of all maternal, newborn and child deaths occur in these settings. Despite potentially higher costs to deliver programming, the rights and wellbeing of those living in the most desperate and fragile humanitarian settings must not be overlooked.

Urgent Needs throughout the Life Course

Infancy
●    2.5 million newborn infants die each year at birth.  
●    One in five infants miss out on basic vaccines needed to stay healthy.  

Childhood
●    Each day 15,000 children die before their fifth birthday, many from preventable causes such as pneumonia, diarrhea, and malnutrition.  
●    More than 3 million girls are at risk every year for Female Genital Mutilation or Cutting.  

Adolescence 
●    For girls aged 15-19, pregnancy and childbirth complications are the second leading cause of death.  
●    130 million girls, most aged 15-17, are not in school.  Inadequate school washroom facilities for menstrual hygiene is a key factor.
●    280 million girls are at risk to become child brides. 

Adulthood
●    Every two minutes a woman dies from pregnancy or childbirth-related complications.  
●    74 million unintended pregnancies occur in developing countries annually due to lack of access to contraceptives or contraceptive failure. 
●    60% of maternal deaths occur in settings affected by conflict, disasters and displacement. 
●    35% of women globally experience physical and/or sexual violence by a partner or sexual violence by a non-partner. Sexual and gender-based violence is higher in emergency and humanitarian settings. 

Life cycle diagram

 

Canada CAN Make a Difference through an Integrated Approach

If full care for all pregnant women and newborns was combined with full provision of modern contraception to women who wish to avoid pregnancy, maternal deaths would drop by 73% and newborn deaths would drop by 80% per year. 

5 to 6 million lives can be saved and economic benefits of between $US80-100 billion could be realized by immunizing 300 million children over 5 years. 

Improving the physical, mental and sexual health of adolescents aged 10-19 years, at $4.60 per person per year, brings 10 times the economic benefits, preventing 12 million adolescent deaths and over 30 million unwanted pregnancies.  

Malnutrition costs the global economy $3.5 trillion every year. Every dollar invested in nutrition yields $16 or more in returns. Meeting global nutrition targets brings results: 3.7 million children’s lives saved, 65 million fewer children stunted, and 265 million fewer women suffer from anemia.  

Recommendation 2: 

That as part of its investment in women, adolescent, child and newborn health and nutrition around the world, the Government of Canada fully integrate funding into all programming for innovative approaches to measure and evaluate results that emphasize data for impact.

The Government of Canada and its partners must urgently increase our work on gathering, sharing and analyzing data. Canada needs to continue investing in its vital work to develop tools that allow us to shift from solely reporting activities to linking our activities with impact through an evidence-based theory of change. This means achieving a better understanding of how outputs lead to outcomes, not just within specific projects, but at sub-national, national and regional levels. This requires us to understand our efforts as part of a collective, global project to make progress on the Sustainable Development Goals (SDGs) and other international frameworks. 

We recommend that Canada increase the pace of its work to:
●    Align standardized indicators to track progress on its own work with SDG and World Health Organization targets and indicators.
●    Improve data on the most vulnerable and hardest to reach, with an emphasis on disaggregated data by gender and other intersecting factors.
●    Work collaboratively to strengthen country systems for collecting data across regions/provinces/countries. 
●    Consider the burden that data requirements place on local partners and providers and identify opportunities where we can work more effectively or seek additional support and financing.
●    Balance quantitative and qualitative data to better understand the gender norms, social inequities and root causes of poor health.

Recommendation 3

That the Government of Canada increase Canada’s spending on global development and humanitarian assistance over 10 years, beginning in 2020, through predictable 15% annual increases to the IAE.

Canada’s increased investment in women and children’s health should form part of sustained, planned, and incremental annual increases to the IAE. The benefits of an increased Canadian IAE are incredibly impactful for global health, poverty, inequality, and for addressing the most serious impacts of climate change. Recognizing the integrated nature of the Thrive Agenda, Canada’s Feminist International Assistance Policy, as well as the 2030 Agenda, the targeted investment in women and children’s health announced on June 4, 2019 should complement, and not replace, other investments in global development cooperation and humanitarian assistance.

Canada’s IAE must reflect the fact that, just as human rights are indivisible, so is progress on development objectives. We must, therefore, commit adequate resources to ensure that development objectives are not pitted against one another but pursued in tandem, and in ways that are effective and efficient. For Canada to fulfill the ambitious goals it committed to in the 2030 Agenda, it must commit adequate resources to achieve these development objectives.