In Canada, a new federal budget was just announced. Canadians are talking about our economic future. Yet arguably the biggest surprise in the budget was a decision that has the potential to impact the future of people well beyond Canadian borders. In the final pages of the budget there was a quiet announcement that the Canadian International Development Agency (CIDA) as we have known it will cease to exist. The agency is going to be amalgamated with the Department of Foreign Affairs and International Trade (DFAIT). Reaction to the decision has been mixed.
The government claims “This decision will have no impact on Canada’s international assistance budget.” That may well be true. But aid to Bolivia, Cambodia, Ethiopia, Malawi, Mozambique, Nepal, Niger, Pakistan, Rwanda, South Africa, Tanzania, Zambia, and Zimbabwe has already been eliminated or reduced. I believe Canadians want to make a genuine collective contribution to international development. What concerns me most about the news is the potential that as aid and trade become officially mixed along with the foreign affairs portfolio, “Canada’s international effort to help people living in poverty” risks becoming lost in the effort to promote commercial interests.
I wouldn’t call myself an expert on international development. But I’ve been involved in issues related to international health for almost my whole adult life. I’ve developed a few opinions about where we should invest our energy and resources to assist some of the world’s most vulnerable people.
Thirty years ago this summer, I had my first big opportunity to learn about health in a less resourced setting. It was the summer of ’83. I was about to start my final year of medical school. I managed to put my summer holiday together with some elective blocks and I set off to spend four months in western Kenya – in a village called Kapsowar, outside of Eldoret. Kapsowar Hospital is set in the Cherangani Hills overlooking the great Rift Valley – an idyllic setting to be sure.
In the 30 years since then, I’ve had the privilege of working or traveling in ten countries in sub-Saharan Africa. I’ve worked with faith-based non-governmental organizations, universities and a humanitarian relief agency. I’ve been involved in clinical care, research and teaching. To say that my work on the continent has been enlightening, demanding and satisfying would be a profound understatement. But if I were to start all over again now, I’d probably invest my time and energy a little differently. Here are some of my opinions about how Canadians can contribute wisely.
Focus on people ahead of products
I’ve said this before but I’ll say it again. One of the best ways Canadians can aid development in less resourced setting is through contributions to education at all levels. From the health perspective, this includes supporting medical education and institutional infrastructure in countries where economic growth will be accompanied by an escalating demand for a robust health workforce.
Last week I attended a conference of the Consortium of Universities for Global Health (CUGH). One of my favourite speakers was Dr. Agnes Soucat who is Vice-President of the African Development Bank. She demonstrated several of the benefits of expanded health workforce. For example, she noted the fantastic work in Ethiopia where over 30,000 health extension workers were trained in a five-year period. Dr. Soucat showed an amazing chart revealing how the growth in the number of health extension workers was mirrored by a steep rise in the use of insecticide-treated bed-nets. For me, this was a great example of the need to invest in people who will then employ the appropriate products to promote health. It turns out that in many low-income countries, growing health care needs is the biggest trigger for job creation. Through a focus on people ahead of products, the economy still benefits.
Dr. Soucat talked about the severe shortages of health workers in low-income countries. I was interested to hear her opinion that a discussion of wages is actually a red herring in debates about human resources for health. In her view, the biggest problem is the lack of capacity of education institutions to produce health workers. She proposes that the quantity and quality of medical and nursing schools in Africa will need to substantially increase during the next two decades. I believe Canadians as individuals and as a collective can make an important contribution by enabling this growth.
Focus on public ahead of private
In Dr. Soucat’s inspiring talk, she emphasized the important role of institutions in the development of nations that will be increasingly educated and ever more democratic. In my opinion, with respect to international development, the best institutions in which we can invest our time, out talent and our money are public ones. The reason for this is simply that public institutions are usually the only ones accessible to marginalized and vulnerable members of society. Contributions to the capacity of public institutions will remain long after the foreign benefactor is gone.
At the CUGH conference last week, my other favourite speaker was Dr. Agnes Binagwaho, Minister of Health in Rwanda. The incomparably brilliant Dr. Binagwaho made a plea to wealthy nations to make sure that foreign aid includes a focus on public institutions, saying “Poor people cannot afford private doctors. Please strengthen the public sector.” I couldn’t agree more with her entreaty.
The merger of CIDA with DFAIT may not be a problem in and of itself. But the purposes of aid and trade are quite different. I suspect many development experts would agree that we have reached a point where we need a serious re-examination of our goals and strategies regarding international cooperation. The new structure with a merging of the departments for aid and trade may not be the worst setback to achieving our national objectives for development assistance. The worst problem will be when we no longer have any official objectives that are actually directed toward genuine aid.