Canada is a leader in global health on the world stage. Yet this leadership role for what is a “middle-power” nation has not been attained from investment alone. Yes, the Government of Canada has invested billions in global health and nutrition programming, including contributing over $7 billion in sexual and reproductive health and rights and maternal, newborn and child health programming since 2010. However, Canada stands out as a leader in global health and nutrition through its focus on exploring innovative ways to amplify its investments, making its contributions even more impactful.
Canada’s current work in Haiti exemplifies this strategy of working to maximize the positive impacts of its investments. In Haiti, the Canadian government is working closely with health organizations working in the country, the Haitian Ministry of Health as well as local partners. Together, they are taking a comprehensive, system-wide approach to health development, looking at not only meeting the donor country’s needs, but also meeting local needs and priorities. They prioritize working with local officials and strategize together on how to best strengthen the Haitian health system.
The Canadian Government is also focused on being able to see the whole picture of its investment impact in Haiti. Working with the Canadian Partnership for Women and Children’s Health (CanWaCH), it has launched a Call to Action for Canadian partners working in Haiti with the precise goal of enhancing coordination and collaboration. Canada sees its work as a whole, not as siloed, separate projects.
The Haitian example is an important one as the global health community works to achieve the Sustainable Development Goals (SDGs). While many significant achievements were made in global health during the Millennium Development Goals era (1990-2015), including reducing maternal mortality by 45% and child mortality by more than half, a disproportionate number of women and children, particularly the most marginalized, still die and suffer unnecessarily. Now with the SDGs, it is time for the global community to ensure that no one is left behind.
In other words, it’s time for some more Canadian-style innovation in advancing global health.
What is required is a fundamental shift in the overall approach to global health and development. An approach that shifts from focusing on specific diseases to a comprehensive one that prioritizes equity and health systems strengthening, as shown by the Haitian example.
Why comprehensive healthcare?
Comprehensive healthcare is certainly not a new idea – it has been around since the 1978 Alma Ata Declaration. It focuses on people as whole individuals and recognizes that their healthcare needs will change throughout their life. For example, rather than addressing pregnancy and childbirth, infancy and childhood as medical conditions, a comprehensive approach views women and children as whole human beings with changing needs. It also emphasizes prevention by addressing social and structural conditions that lead to poor health such as poor access to clean drinking water.
Comprehensive approaches are also driven by the needs of those in low- and middle-income countries rather than the agendas and reporting requirements of donor countries. They shift focus from immediate project-level results to long-term, population health outcomes and address all aspects of a health system, including financing, human resources and primary, secondary and tertiary health care.
The challenge for donors:
Over the past 15-20 years, donor countries have been driven by the desire to demonstrate short-term successes for their investments and many low- and middle-income countries and their healthcare providers have chosen (or have been forced) to focus on selective services – in many cases, disease-specific services. This approach has led to fragmentation and even competition within health systems, resulting in a weakening rather than strengthening effect. Many of these countries have struggled to build sustainability and cohesion while responding to donor nation needs.
To be true to our commitment to the Sustainable Development Goals, our investment in global health should focus on:
- Comprehensiveness though a lifecycle approach.
- Health systems strengthening, rather than a project-level and disease focus.
- Long-term investments rather than short-term funding cycles.
The upcoming Women Deliver 2019 Conference, to be held in Canada, provides a perfect opportunity for the global health community to further explore how to best leverage their global health investments to achieve the SDGs. We have seen how far a siloed, vertical approach can take us, and we know how much further we need to go. Now is the time to raise the bar.
This article was published as part of Women Deliver's 'Deliver for Good' July 2018 theme on Comprehensive Health Services.