Beyond 2020: An Agenda for Canadian Leadership in Women and Children's Health
CanWaCH Conference Outcomes Report
The April 2018 CanWaCH ‘Beyond 2020’ conference brought together national and international leaders to: 1) discuss and learn from Canada’s past ten years of health programming under the Muskoka commitment, 2) take stock of where we are at with regards to addressing key gaps, and 3) shape the way Canadian leadership on development and women and children’s health will unfold post-2020. Taking stock of where we have come from and what has been achieved, Canada’s multi-billion dollar investment over the past ten years has contributed to saving and improving the lives of millions of women and children in hundreds of communities around the world. More recently, effort has been focused on closing key gaps relating to sexual and reproductive health and rights. But challenges and gaps still remain and a key focus of the conference, and of this report, is the pivots needed from Canadian international development and gender equality stakeholders in order to best implement the Feminist International Assistance Policy, and accelerate progress towards achieving the Sustainable Development Goals (SDGs), partiuclarly SDGs 3 and 5.
Seven clear themes emerged from the conference proceedings:
- Gender-Transformative as Core. Gender-transformative approachesmust be built in as the core component of our work, from programming to policy, data to research, and advocacy to partnership. A gender-transformative approach drives programs and policies that attempt to redefine women and men’s gender roles and seek to transform unequal gender relations in order to promote shared power, control of resources, decision-making and support women’s empowerment.
- Integrated Approach. Improving health is never solely about healthcare provision and services; using a lifecycle approach, we must collaborate across sectors and consider critical factors impacting health overall, including the social, political and cultural contexts within which women and children live.
- Reaching the Hardest to Reach and Most Vulnerable. Starting from a rights-based approach that sees everyone’s lives as being of equal value, we must go beyond the ‘low-hanging’ fruit to achieve progress for everyone.
- Institutional and Systemic Change. To achieve prolonged and widespread impact, we need to broaden our work on projects and programs, expanding and incorporating them into strategies that institutionalize permanent transformation at all levels - individual, organizational, community, national and international.
- Impact and Data. We need to make the shift from reporting outputs or activities only to donors, to instead seeing our efforts as part of a collective, global project to make progress on the SDGs and other international frameworks.
- Feminist Partnership. A feminist approach to partnership means a conceptual shift from seeing people as clients or beneficiaries, to active partners with agency, and partners in collective success. This means listening to local people and organizations, and meaningfully involving them as leaders.
- Advocacy and Political Will. Advocacy is key to addressing root causes – systemic, legal or institutional barriers – of poor health. - We need to empower affected communities to engage in this advocacy, and in particular to empower youth.
Implementing the Feminist International Assistance Policy and achieving the SDGs are collective challenges, and all actors plays a different role. The themes outlined in this report represent a transformational shift in approach, activities and financing. CanWaCH looks forward to working with its members and partners as we collectively rise to the challenge.. Broadly, CanWaCH, as a platform for knowledge exchange and partnership, presents an effective channel for building our collective capacity through webinars, country-level coordination, working groups, and more. Additionally, the recently launched #LeadOnCanada Public Engagement campaign and Canadian Collaborative for Global Health will generate important new learning and bring our message to the Canadian public. Other specific moments for moving these conversations forward and discussing concrete actions include Canada’s G7 presidency, the 2018 Canadian Conference on Global Health, and Women Deliver 2019 conference.
The April 2018 CanWaCH ‘Beyond 2020’ conference brought together national and international leaders to shape the way Canadian leadership on development and women and children’s health will unfold post-2020. Over two days, delegates discussed how Canadian leadership on gender equality and women and children’s health will accelerate progress toward the Sustainable Development Goals (SDGs). Delegates strongly emphasized that business as usual is insufficient, and change is needed at Canadian and global levels to reach the SDGs. They saw Canada’s presidency of the G7 and hosting of the 2019 Women Deliver conference as key moments for leadership. Delegates stressed the need to connect our domestic efforts, particularly to improve Indigenous health, to our work abroad - “If our communities don’t work, the world doesn’t work and vice versa. That’s the universal agenda”. Participants also stressed the need for Canada’s approach to account for the changes in the global landscape over the coming 20 years, including the impact of climate change, increased conflict and the youth bulge. From these discussions, emerged seven key themes discussed below.
This outcomes report brings together both quantitative and qualitative analysis of the panels, speakers and discussions. It was informed also by a specific session on outcomes that examined in depth the pre-conference discussion paper. This report is designed to prompt further discussion and change within the sector, and to inform Canada’s role in the collective action required to fulfil the SDGs at home and around the world, in line with Canada’s Feminist International Assistance Policy (FIAP).
THEME: GENDER-TRANSFORMATIVE AS CORE
Addressing discriminatory norms is crucial because decision-making power is paramount to adolescent girls’ health. Dominique LaRochelle, Save the Children Canada
Consideration of gender equality is critical for every aspect of global health. Don’t let anyone tell you differently. Michelle Dowling, SickKids Centre for Global Child Health
Participants in every session emphasized that gender-transformative approaches must be built in as the core component of our work, from programming to policy, data to research, and advocacy to partnership. A gender-transformative approach is the best way to achieve the SDGs and implement the FIAP. They also spoke about viewing a gender-transformative approach as itself an innovation. Innovation doesn’t have to be technological - it can be innovation in our policies, approaches and programming. They acknowledged these were difficult conversations, and will mean fundamental shifts in approach and internal changes within organizations. Participants spoke about Canada being well-placed to tackle tough issues, including sexual and reproductive health and rights, through a gender-transformative approach.
Most participants identified social norms, culture and power dynamics as major root causes of poor health and health access. Particularly in sessions about antenatal care, abortion, and sexual and reproductive health and rights (SRHR), women and girls’ decision-making ability was highlighted as key. “We cannot simply give one method of contraception to a woman and assume she’ll be able to use it”. Choice is constrained by lack of information, education, autonomy and empowerment. Shame and stigma around women’s health was also a strong theme, and spoke to the need for organizations to work closely with local community groups and leaders to better understand and help change harmful norms, myths and stereotypes using a gender-transformative approach. A number of speakers stressed the need for a gender-transformative approach to include gender non-binary communities too, and their specific challenges.
Participants in each session also emphasized how, beyond women and girls, a gender-transformative approach needs to involve gatekeepers of decision-making, and those who hold or perpetuate harmful gender norms. For communities to empower women and children to advocate for their own health and well-being, men and boys, mothers-in-law, community and faith leaders, healthcare providers and the media must be integrated as champions and allies.
THEME: INTEGRATED APPROACH
We need integrated, complete approaches, not cherrypicking…..There is no linear conceptual framework that will achieve our objectives. We need to start from the intersection point - the girl or woman, in a family, a community and a country. Caroline LeClerc, Global Affairs Canada.
Every panel underscored the implications of a gender-transformative approach on health programming - that improving health cannot be solely about healthcare provision and services, but must also consider other critical factors impacting health overall, such as water, hygiene and sanitation, nutrition, early and forced child marriage, and education. This highlights the need for an integrated and multi-sectoral approach to improving women’s and children’s health, incorporating a life-cycle approach, and aligned with SDG Three to “ensure healthy lives and promote well-being for all at all ages.” Participants noted that this applies domestically in Canada, particularly for Indigenous communities, as well as in lower and middle income countries.
Panelists spoke about the often complicated intersections in their work, and how the goals identified in the FIAP are best achieved by also addressing health-sensitive factors causing poor health. For example, improving menstrual hygiene means addressing school washroom facilities; interpersonal violence is a key risk factor for pre-term birth; improving adolescent health outcomes means tackling early, forced and child marriage; and mothers who are educated and empowered are more likely to have the decision-making ability to vaccinate their children. Participants also spoke about the importance of seeing MNCH and SRHR not as silos, and instead, integrating them both broadly into women and children’s health and well-being.
THEME: REACHING THE HARDEST TO REACH AND MOST VULNERABLE
There was universal concern that our collective efforts are not reaching the most vulnerable and marginalized, a key aspect of both the SDGs and of the FIAP, and that this is true both at home or abroad. Several sessions identified the issue of ‘low hanging fruit’ and that inequities in progress are often masked by averaged data that construes progress of some as progress for all.
Participants spoke about the need for a rights-based approach, that saw everyone’s lives as being of equal value. This also came out strongly in sessions that discussed challenges in Indigenous communities. There was a great deal of focus on the specific needs of the poorest, the most marginalized and vulnerable, and the hardest to reach. Most sessions acknowledged the differences between these groups, and emphasized a differentiated approach to identifying the needs of each, reaching them and measuring projects. This differentiated approach includes the fact that reaching the poorest and most marginalized is more expensive and requires discussions about development financing.
THEME: INSTITUTIONAL AND SYSTEMIC CHANGE
In many sessions, participants spoke about systemic and institutional change being essential for achieving deeper, broader, and more resilient improvements in health and health systems. Examples of conversations included capacity building for country-level data collection, health systems strengthening, and supply chain management for increased access to vaccination. Participants acknowledged that much of our collective work has focused on the individual or household level, and more work is needed to affect change in health systems, for example, working towards a common goal of universal health coverage - one of the targets of SDG Three. As Khalil Shariff of AKFC put it, “our projects should contribute to a coherent network and system”.
In order to implement the FIAP, we need to build on our projects and programs, with the aim to impact the institutional and systemic level. For example, eradicating polio is a point in time accomplishment, but reducing child mortality is a permanent, ongoing challenge and needs permanent, ongoing solutions and structures. Time-limited, results-focused projects can be siloed and temporary unless they are part of a coherent strategy of permanent transformation, guided by the SDGs and other frameworks. While acknowledging the enormity of the challenge, participants agreed this transformational shift to sustainable, systemic development was also needed in fragile and conflict settings.
THEME: IMPACT AND DATA
Using data to drive greater positive impact was identified as a key challenge facing the sector in adopting a gender-transformative approach and implementing the FIAP. Participants discussed the need to shift from reporting activities, to linking our activities with impact through an evidence-based theory of change. Participants identified that implementing the FIAP means better understanding how outputs lead to outcomes, and not just within specific projects, but at sub-national, national and regional levels. This requires a mindset shift from a goal of reporting outputs or activities only to donors, to instead seeing our efforts as part of a collective, global project to make progress on the SDGs and other international frameworks. As officials from Global Affairs Canada said, it’s not just about showing how successful we are, but about contributing to the overall effort.
To that end, panelists emphasized we need to set goals not just for each program, but across our work. We won’t achieve success unless we first define it, then have the data and check-in points to course-correct, if needed. Therefore, we must be nimble and willing to change course with the right tools, not just at project level, but sub-national and national levels too.
A panel on “Using Data to Inform Decisions” delved further into challenges associated with making better use of data to drive impact. They included the need to:
- Align the standardized indicators to track progress on the FIAP with SDG and WHO targets and indicators.
- Improve data on the most vulnerable and hardest to reach. Much of the exclusion we are concerned with is hidden by averaged data. To that end, we need gender and other intersecting factors disaggregated in data.
- Work together to strengthen country systems for collecting data across regions/provinces/counties. Data at sub- and national levels can be patchy, so we don’t have a full picture of what we’re achieving (or not achieving).
- Consider the burden that data needs place on local partners and providers, and identify opportunities where we can work smarter and more effectively, or seek additional support and financing.
- Balance quantitative and qualitative data. Qualitative data gets at the ‘why’ behind the numbers, and helps us understand the gender norms, social inequities and roots causes of poor health.
THEME: FEMINIST PARTNERSHIP
Most participants, including Global Affairs Canada, emphasized the impact of a feminist approach to partnership. Unequal relationships are not feminist, and speakers noted the need to account for the privilege that many Canadians experience, as well as Canada’s legacy of colonialism when we work at home and in the Global South.
Panelists explained that a feminist approach to partnership - as outlined in the FIAP - means a conceptual shift from seeing people as clients or beneficiaries, to active partners with agency, and partners in collective success. This means listening to local people and organizations, and meaningfully involving them as leaders. It means including marginalized voices in all aspects of work, from policy and programming, to advocacy and research. And it means seeing youth as leaders of today and investing in their work. By partnering with local and country-level participants to lead our collective work, they are more likely to have ownership of programs and outcomes, ultimately leading to greater success.
A number of panelists stated that Canada must contribute to local, national and international evidence-based approaches, exchange knowledge, and share learnings across projects, donors, regions and countries.
Participants emphasised that the shift to sustainable development requires seeing solutions as community and country-developed and owned. Donors and implementers need to see themselves as part of a country-led and country-owned effort, to which they contribute. As stated by Khalil Shariff of the Aga Khan Foundation of Canada, this means moving from external change to locally-cultivated networks of change that learn from each other in a specific context and culture. We cannot do this unless we partner equally with, and fund, local organizations. A number of presenters noted this means adapting our tolerance for failure and risk.
THEME: ADVOCACY AND POLITICAL WILL
Barriers to inclusivity are always rooted in discrimination.
Sarah Kennell, Action Canada for Sexual Health and Rights
Most participants spoke about the need to invest more in advocacy as an essential way of strengthening gender-transformative approaches. They identified advocacy as particularly key to addressing systemic, legal, and institutional barriers that are root causes of poor health. In some cases, the changes Canada has stated it wishes to achieve are only accomplished by advocacy that drives demand and generates political will. Speakers emphasized the need to empower affected communities to engage in this advocacy, noting the particular power of youth voices.
Advocacy was highlighted as particularly important to speakers to ensuring health care and services for the poorest, most marginalized or discriminated-against groups, including LGBTQ+ communities. Marginalization is never accidental or individual. It is a result of deliberate policies, laws or practices, and so advocacy is an integral strategy for reaching the most vulnerable and marginalized.
When participants spoke about the need to increase financing, they linked the issue directly to advocacy and political will, both in Canada and in the countries in which CanWaCH members work. Without driving demand in country through advocacy, we are unlikely to generate the political will to increase either domestic resources or Official Development Assistance to fill the priority gaps participants identified. Several speakers highlighted the importance of public engagement campaigns, to increase Canadians’ own understanding of the SDGs and development, and to build broad public support for the work of CanWaCH members and the broader Canadian global health community. A key aspect of building this support is being able to easily communicate results of members’ work to be able to clearly explain to Canadians the value and impact of the FIAP on the lives of women and children around the world.
CONCLUSION - KEY TAKEAWAYS AND NEXT STEPS
Implementing the FIAP is a collective challenge, and everyone plays a different role - from researchers and academics, to programming teams, health experts, and advocacy organizations, governments and private sector. The themes outlined in this report represent a transformational shift in approach to advance women’s and children’s health, activities and financing. Some key takeaways emerging from the conference, as reflected in the themes outlined above, include the following:
- Canada has the opportunity and motivation to play a leadership role in demonstrating the impact of gender-transformative approaches in advancing the helath-related SDGs, and engage with difficult and sensitive programming issues.
- Key to gender-transformative approaches is re-envisioning the nature of partnerships, to make them more equitable and rooted in feminist principles. Both donors and implementers need to see themselves as part of country-led and country-owned efforts, to which they contribute.
- When it comes to realizing the potential of data, we must do more to leverage this tool, not just for reporting but for ensuring ongoing positive impact, focused on the communities and individuals most in need. As well, we must work with partners to strengthen country level data systems to support ongoing decision making.
- In all that we do, we must break down silos between our areas of work, utilizing a lifecycle approach to make sure that the full picture and context of a person’s health and wellbeing is central.
- The SDGs present a universal agenda, and we must do our part to ensure that progress is made in all communities, both in Canada and around the world.
- To achieve and entrench lasting change, we must pay more attention to building up systems and institutions and commit ourselves to the advocacy work that is required to support that objective.
There are many opportunities ahead of us for advancing the outcomes of the conference and CanWaCH looks forward to working with its members, associates, and partners as we collectively rise to the challenge of implementing the FIAP.
Upcoming and ongoing opportunities for continued collaboration include:
- Continued support for the Future Planning Initiative, which seeks to empower 18 million adolescents and young women in the world’s most vulnerable communities.
- Supporting Canada’s presidency of the G7, including the theme of “advancing gender equality and women’s empowerment” and the work of the Gender Equality Advisory Council. The 2019 French Presidency of the G7 may also present opportunities for advancing the themes outlined in this report.
- The Canadian Conference on Global Health, (November 19-21, 2018) organized by the Canadian Society for International Health and with CanWaCH as the lead partner, is an upcoming moment for Canadian and international CSOs, practitioners, and researchers to convene and continue to move forward our collective agenda.
- The Women Deliver 2019 conference presents a major opportunity for Canadian leadership on the intersection of gender equality and global health. CanWaCH is actively engaged in leading Canadian CSO engagement in the conference. Of note, the themes emerging from the CanWaCH Beyond 2020 conference are well-aligned with the recently released results of the Women Deliver Listening Tour.
- As noted above, part of our work is to engage with the broader Canadian public, and the recently launched #LeadOnCanada public engagement campaign has this objective at its core. Organizations and individuals can join in this campaign led by CanWaCH and its member organizations.
- With the potential for huge impact and generating solutions to urgent data challenges in global health and gender equality, the CanWaCH-led Canadian Collaborative for Global Health was recently launched and is accepting proposals for funding until the end of June.
- Through its knowledge exchange work, CanWaCH regularly convenes webinars and meetings in collaboration with members and partners, on a variety of topics. One recent success is our ongoing work with GAC to convene Canadian organizations working in Haiti.
While an important milestone, the Beyond 2020 conference is just one step in the path towards achieving a world where every woman and child survives and thrives. Ongoing collaboration, innovation, and commitment are key, and CanWaCH looks forward to being an active leader and partner on this journey.
In partnership with Global Affairs Canada
 UN Women https://trainingcentre.unwomen.org/mod/glossary/view.php?id=36
 John McArthur, Brookings Institution
 Colleen Keilty, Plan International Canada
 Khalil Z. Shariff, Aga Khan Foundation Canada