Prime Minister Stephen Harper chaired a meeting at the United Nations about the creation of a global financial facility to which Canada will contribute with the aim of improving maternal, newborn and child health. I commend the government for recognizing the important contributions Canada can share in this regard with other nations. I offer my perspective on how international partners can best intervene to improve health for women and children in the some of the poorest parts of the world. I have focused my entire working life on improving people’s health both here in Canada and internationally. These are some of the principles we should keep in mind:
1. Focus on people, not gadgets
It is ultimately people, structures and systems, not tools and technology, which drive improvements in health. Any effort to advance maternal-child health must focus on the people to be served not the gadgets to be sold. Canada’s recent efforts to improve maternal-child health emphasize new devices for healthcare but offer less in the way of actual delivery of care or health system improvement. Canada’s current contributions to better maternal-child health appear to focus on opening new markets for our own business interests with less evident concern for the people we purport to help.
2. Improve educational opportunities for women and girls
I spent most of the 1990s living and working in Niger, West Africa. At that time, less than 10% of adult women could read and write. The impact on health was substantial. Literacy rates for women in Niger have only improved slightly since then. Investment in the education of women and girls is the most powerful antidote to poverty, violence and ill health. If we are serious about improving maternal-child health internationally, we need to place an emphasis on strategies to get more girls into primary and secondary schools and more women into training programs for health and literacy.
3. Invest in higher education
To improve the health of women and children in the poorest parts of the world, Canada has neglected one of the most obvious areas to make a contribution. It is time to confront a great hidden crisis of development, particularly in Africa; that is, the disastrous state of higher education. Post-secondary training facilities along with faculty development and the quality of teaching in these institutions has plummeted over the last 30 years. There has been a recent burst of enthusiasm for the expansion of higher education in sub-Saharan Africa, but faculty members are still minimally trained and poorly paid. They are expected to train more students with no compensatory increase in resources. Significant amounts of our foreign aid dollars should be invested to expand higher education opportunities in low-income countries. Another outstanding way that we can contribute to health and development in poorer nations is for Canadian academics to contribute their time and talents to support teaching and research efforts in international settings.
4. Work within the public infrastructure
I learned this the hard way. I worked in health care for at least three non-governmental organizations in sub-Saharan Africa from 1983 to 2005. I treated thousands of patients and hopefully provided much relief from suffering during that time. But my work in Ethiopia since 2008 has taught me that it is so much more effective, sustainable and satisfying to work within the public infrastructure. Every contribution I have made in Ethiopia has been invested in local health facilities and public universities. These are the institutions that will remain long after international partners have left. I hope that the international fund to promote maternal-child health will invest primarily in local structures and systems.
5. Target the investments in primary care
There is a massive body of evidence to prove that investment in primary care is the best way to provide positive health outcomes at the lowest cost with increased access to care and reduced inequity in the system. Primary care does this by focusing on prevention, health promotion, population health and whole-person care rather than focusing on single disease processes or organ systems. Women and children will thrive within nations and regions that have strong systems of primary care. That should be our focus.
6. Make sure every initiative is evaluated
The path to improved health for women and children around the globe is strewn with clever programs and countless pilot projects that some well-intentioned person or organization was willing to finance. If Canada is investing $3.5 billion over the next five years to improve maternal-child health, then we must be committed to rigorous appraisal of every initiative that this new global financing facility supports. The international fund should require evaluation of every program and share those findings about what works and what doesn’t.
Through my work in West Africa and in the horn of Africa, I have learned first-hand about the challenges that women and children face in these and similar settings. Many years ago, we buried our own first-born child who died of meningococcemia in Niger. Our grief was only a small taste of the health challenges families face each day in the world’s poorest regions. I will never give up the fight to improve equity in the area of global health. I’m delighted to know that Canada will play an increasing role in that struggle. Let’s do so wisely.