:
Thank you very much, Mr. Chair.
Thank you for inviting me to speak about the Canadian International Development Agency's work on maternal and child health.
Aid effectiveness is a priority of the Government of Canada, and CIDA's work on maternal and child health delivers on the government's commitment to ensure that Canada's development assistance is focused, effective and accountable.
[English]
Improving the health of mothers and children is a foundational development issue. Healthy children, able to thrive and ready to learn, are fundamental to the long-term growth and prosperity of all countries and societies, and ensuring the health of children begins with their mothers. That is why improving maternal and child health and reducing maternal and child mortality and morbidity are both an essential part of the international framework of the millennium development goals.
[Translation]
It is also the reason why the government has chosen to champion this cause at the G8.
[English]
The medical journal The Lancet recently reported that maternal deaths have dropped by approximately 35% between 1980 and 2008. This is according to a new study by researchers from the University of Washington and the University of Queensland in Australia.
Now, while I must caution that this is only one study, and it is based on estimates, early reports of new data from the World Health Organization seem to indicate a similar trend. And if true, this provides evidence that investing in maternal and child health can work and can save the lives of millions of women.
[Translation]
But even with these encouraging results, progress has been slower than it should be.
Allow me to start with Millennium Development Goal 5, improving maternal health.
[English]
Of all the millennium development goals put forward a decade ago, maternal health is the one that lags the farthest behind. Complications from pregnancy and childbirth are the leading cause of death for young mothers, young girls aged 15 to 19. Every year more than 500,000 mothers die worldwide from pregnancy and childbirth, particularly in sub-Saharan African and Asia, and 20 million mothers suffer lifelong illnesses or other harmful effects from their pregnancies.
[Translation]
For Millennium Development Goal 4, reducing child mortality, the situation is equally concerning.
[English]
Although death in children under five has declined steadily worldwide, we have not yet achieved the results we need to at this point if we are to meet the millennium development goals for 2015.
Every year, as you know, three million babies die within the first week of life, and almost nine million children in the developing world die before their fifth birthday because of causes that are largely preventable, such as pneumonia, diarrhea, malaria, severe acute malnutrition, measles, and HIV.
As we approach the G8 summit in June and the United Nations millennium development goals summit in September, we are reminded that much work remains to be done.
With proper planning and resource mobilization, it is within the reach of many developing countries to prevent the deaths of mothers and children by strengthening their health systems, training health workers, and providing simple proven interventions such as immunizations, insecticide-treated bed nets, and better nutrition.
The G8 can make a tangible difference in terms of maternal and child health. G8 countries have a strong record of accomplishment in health. In recent summits they committed to eradicate polio and they agreed to scale up support to the fight against HIV/AIDS, tuberculosis, and malaria, and these have seen results.
They have also repeatedly stressed the importance of strengthening health systems, particularly in Africa, so that people, particularly women and children, have access to quality local health services.
During the G8 development ministers meeting in Halifax last week, the G8 ministers agreed that the most effective approach to improving maternal and under-five child health and reducing mortality and morbidity is through a focus on strengthening developing-country health systems to provide high-impact, integrated interventions on the ground, including skilled birth attendants and immunizations.
Central to these discussions was the view of G8 ministers, who were joined by Mali's health minister, that if you could provide these integrated and comprehensive services at the local level it could make a significant difference in terms of the lives and mortality of children and mothers. These include access to primary care; equipped and resourced facilities; trained front line health workers, particularly skilled attendants for births; and robust health information systems to monitor performance and progress. Ministers also committed to support countries' efforts to improve access at the local level through properly equipped and resourced health systems, including a skilled health workforce.
The G8 ministers also recognized the fundamental importance of improving nutrition. Nutrition is essential to early childhood development and to building a healthy population in the long run, and today, malnourishment leads to serious illness, blindness, mental disorders, and death among the world's most vulnerable. According to the World Health Organization, malnutrition contributes to over one-third of all childhood deaths, and the nutrition of mothers, as you know, is critical for the health of their newborns and their children's future development. So by underscoring nutrition and putting forward its importance as a crossover issue between maternal and child health, I think the G8 can make a fundamental difference here.
I think we gave the chair a copy of the chair's summary coming from the G8 ministers meeting last week in Halifax, if you'd like to circulate it.
Canada's proposed contribution to the G8 maternal and child health thrust could involve various interventions, including responding to the importance of strengthening health systems, in particular human resources for health, at the country and local level through the training, deploying, and retaining of skilled health workers, and family planning, which includes the use of modern contraceptive methods.
It is also important to note that through the government's consultations with the United Nations and other partners, this G8 initiative will complement and make a key contribution to the United Nations Secretary-General's millennium development goals summit in September.
As you know, CIDA is the main means by which the Government of Canada can address maternal and child health, and I'd just like to take a few minutes to give you an outline of some of the things we're already doing.
As you may know, one our main priorities is around children and youth. We're already working in many countries to strengthen health systems, improve access for women to maternal and reproductive health care, reduce sickness and death in newborns, increase immunization, and promote nutrition. Maternal and child health is one of the three components of our priority around securing a better future for children and youth, and it starts with the mothers.
We recognize that effective family planning is one part of improving maternal and child health, and it is an important element of an effective health system. One of the things we know about family planning is that this kind of programming reduces unwanted pregnancies.
Family planning includes the woman's ability to space and limit her pregnancies, which has a direct impact on her health and her well-being, and on the outcome of each pregnancy. So in response to the needs of developing-country partners, family planning is integrated with activities in a number of CIDA's maternal health and safe motherhood projects, in line with our international commitments.
For example, in western Mali, CIDA support has helped to ensure that skilled health workers attend almost half of all deliveries. In Guatemala, CIDA's support to the Society of Obstetricians and Gynaecologists of Canada and its local partner associations has helped to train over 730 health professionals so they may better provide for mothers and newborns during childbirth.
The other component of CIDA's maternal and child health strategy is to promote a healthy start for infants and young children, so they may thrive, attend school, and become active members in their communities.
CIDA has been a leader in promoting proper nutrition and medical services like immunization. We know that undernourishment increases children's susceptibility to infectious diseases, mental impairment, blindness, and permanent physical stunting. That is why CIDA is helping to provide vitamin A, iodine, and other micronutrients, which play a crucial role in the health of young children and mothers. As a founding partner and principal donor of the micronutrient initiative, Canada has become known for its leadership on vitamin A and iodine. Indeed, UNICEF has said that Canada's support for iodized salt programs has saved six million children from mental impairment.
[Translation]
Canada is also helping children through the Catalytic Initiative to Save a Million Lives. In fact, CIDA was the first to support UNICEF in training and equipping front-line health workers to deliver modern malaria treatments, bed nets, antibiotics for infections, and other health services to children and vulnerable groups.
The need to improve maternal and child health is instrumental to fulfilling CIDA's mandate of reducing poverty in the poorest countries around the world.
At the recent UN roundtable meeting in New York, Minister Oda stated that the government is prepared to invest a significant level of new funding in this initiative, and we expect that it will be successful in inspiring other donor countries to follow suit.
[English]
Thank you very much, ladies and gentlemen. I welcome your questions.
Ms. Biggs, thank you very much for attending.
If I may, I will just take 30 seconds on politics, then we'll get more into your area.
I must say that I have been dismayed and disappointed at the fact that Mr. Ignatieff and the Liberals have decided to introduce a topic into this issue that has nothing to do with this issue, and the fact that it, in turn, will create a massive disservice to the women and children of the developing world by us being diverted and the amount of ink that there has been on this issue as a result of him introducing an absolute red herring, a bogus issue, into this debate.
That said, I must say that I'm very impressed with your statement, if I may read it:
With proper planning and resource mobilization, it is within the reach of many developing countries to prevent the deaths of mothers and children by strengthening health systems, training health workers and providing simple solutions like inoculations, insecticide-treated bed nets, and better nutrition.
This is what the original thought was of the Prime Minister, and certainly of our government.
I was particularly impressed, because this morning all of us received the chair's summary of the G8 development ministers meeting, which I think will go an awful long way to answering the concerns of Mr. Rae about foreign nations making comments about the topic that he chooses to bring up.
I'll take look at clause 11 of the chair's report:
In terms of scope, Ministers agreed that improving maternal and under-five child health requires comprehensive, high impact and integrated interventions at the community level, in country, across the continuum of care from pre-pregnancy through delivery to the age of five, including such elements as: antenatal care; post-partum care; family planning, which includes contraception; reproductive health; treatment and prevention of diseases; prevention of mother-to-child transmission of HIV; immunizations; and nutrition.
This is an awfully big basket we're talking about, to be able to come up with some funding that will work in that direction.
I would like to ask you about current programs CIDA has in the areas of inoculations and/or better nutrition, and how they may be fed into this initiative that we're talking about.
I should say that I had a briefing last night by a doctor from a totally impoverished country. The statistics from that country show that 93% of the population suffer from gonorrhea, and just a hair under 100% suffer from syphilis. The frustration of the indigenous doctor from that country was the fact that particularly the syphilis could be answered by a matter of inoculations and that kind of thing. Indeed, this is the kind of work that Canada is into and that I think all Canadians should be proud of.
I would like to give you an opportunity to give us a very quick idea on inoculations and also in the area of micronutrients, as to where we are going with that at this point.
:
Thank you very much for the question.
I'm going to ask my colleague Diane Jacovella to talk about some specifics around what Canada and CIDA have been doing with immunization and micronutrients. It is an area where Canada has been a leader, and we are also a leader in terms of malarial bed nets. We were one of the first out the door.
In terms of your general point, and referring back to the chair's statement from the G8 development ministers meeting last week, one of the things I'd like to point out is the shift that I think has to happen. In the past number of years we've had a focus on a number of diseases in particular—whether it's malaria, HIV, AIDS, or polio—on which we all know we can produce results through immunization. We know we can produce results through antibiotics and treatment of infectious diseases. We all know we can produce tremendous health results through adequate nutrition and micronutrient supplementation. But what often doesn't happen is their integration into one package. We know that if they are integrated into a package that a local, trained health care worker can deliver, we can have substantial improvements in terms of the outcomes for mothers and for children.
I think the key now is to look at it as an integrated approach. We did this with the catalytic initiative with children in terms of front line health workers having a basket of things that we know have high impact in terms of treating infectious diseases, in terms of treating diarrhea, in terms of immunizations, in terms of nutritional supplements, and we know that it can work. It's very cost-effective, high-impact, and not that complicated. But you do have to have the health system behind you to ensure that on the ground it is delivered in that way. That's what I think the development ministers focused on: how everybody supports that integrated, comprehensive approach.
Going back to the specific things that Canada has done, as I mentioned, CIDA has been a leader in terms of the micronutrient initiative. Canada has also been one of the leaders in terms of the global fund for AIDS, tuberculosis, and malaria, which has saved millions of lives.
I'm just going to ask Diane perhaps to give a few more facts on some of the key things that you asked about.
Maternal and child health are the focus of a number of our bilateral or geographic programs. You've drawn attention to one of them in Mali. The Mali health minister was with us in Halifax. We can't do the whole country necessarily or the western part, but we have supported the training in one region, the Kayes region, in terms of skilled birth attendants, which has made a significant difference in the number of assisted births and therefore the reduction in child mortality in Mali.
Another component we're working on with the Government of Mali as part of their overall health systems plan is on broader health care human resource planning and skills and training so they can extend this across their country.
We also have extensive maternal and child health programs in countries like Tanzania, where we work with the Government of Tanzania and their Marie Stopes International particularly around maternal and reproductive health. Again, we've had significant success there.
We also work in Mozambique to support the overall implementation of the Government of Mozambique's health system. One key component is around maternal health, again around the training and provision of skilled health workers, local health workers for both maternal health and attended births, and for child health.
We also work in Bangladesh, particularly focused around the rural poor and their health services. As you know, we've done a fair amount of work around maternal and child health in Afghanistan as well. That's partly been about the polio eradication initiative, but we have also helped to build the obstetrical facilities for the Mirwais Hospital in Kandahar, which provides gynecological and obstetrical assistance not just in the city but across the region. So it's very important.
It is an area where CIDA has a lot of strength to build on, a lot of expertise to build on, both in terms of what's happening on the ground in terms of maternal and child health and in terms of nutrition. I think the area of nutrition is going to have its day now that everyone recognizes that it's an underlying contributor to not just mortality but also diminished development and life chances for children.
As we would know in Canada, in terms of the development of children and their cognitive development, we can really make a difference in terms of the futures of these countries if we really focus on nutrition. Very simple nutrition packages for mothers and children on the ground, delivered in a timely way, can make a world of difference.
:
Thank you very much, Mr. Chairman. It's always a great pleasure to be back in Canada.
Someone asked me the other day--having been a special representative of the Secretary-General on internally displaced persons, and now on the prevention of genocide--why they always give me such difficult mandates. This mandate is obviously recognized as being very difficult, some would even say impossible. I say it is a mandate that is impossible but must be made possible.
I think we can all say that humanity must be united to prevent and punish genocide, but in reality we know that genocide is generally recognized only after the fact. While it is occurring or unfolding, there is a tendency to deny it, not only by the perpetrators, but by those who would be called upon to step in and do something about it. Because it is such a sensitive issue and difficult to manage once it has blown up, I believe prevention is absolutely critical early on, before positions harden into denial.
For me, prevention also means defining the problem in a manner that we can easily understand and manage. That's why I have focused on seeing genocide as an extreme form of identity-related conflicts, whether these identities are defined, according to the 1948 Convention on the Prevention and Punishment of the Crime of Genocide, as national, ethnic, racial, or religious groups, and perhaps even other factors of identification.
It is not just that we are different that causes conflicts; it's the implications of those differences in terms of access to sharing power, wealth, resources, services, employment, and the enjoyment of rights of citizenship. As a special representative to the Secretary-General on internally displaced persons, I went to many parts of the world. I was always struck by how acutely divided these societies were, with some, considered in-groups, enjoying the rights and dignity of citizenship, and others, marginalized, discriminated, excluded, and denied the rights. Sooner or later there is bound to be a conflict in that kind of a situation. When it occurs, you have the disadvantaged being the victims of the more powerful.
If this is our understanding, then I think the challenge is really how to manage diversities constructively, with means to promote a sense of equality, a sense of belonging to the nation, a sense of enjoyment, a sense of dignity as a citizen, as a human being. I believe that no country worth self-respect, respect by others, and legitimacy can say that we want to deny citizens their rights.
I must say, having served in this wonderful country for years, I was always very struck by your system of managing differences and diversities--your multiculturalism philosophy. I travelled around the country in many places and saw how this was playing out.
I see this as a challenge for government. It also means that the first layer of protecting--or, as you say, prevention--is a responsibility of the state. I believe very strongly that unless we work with governments, unless we challenge the governments to constructively manage their differences, we cannot succeed. We cannot come from outside and dictate solutions that people from within do not see as the national vision.
That's why, when I was at Brookings developing the Africa project, the post-Cold War assessment of conflicts in Africa, I emphasized the shift from seeing these conflicts as proxy wars of the superpowers during the Cold War period, to reassigning responsibility by seeing problems in their proper context, as regional or national, and reassigning responsibility to that of the state in the first place, supported by the international community if it lacks the capacity. And only in extreme cases, where the governments fail and people are suffering and dying in large numbers, will the international community be called upon.
But that is a tough one, because if there is any capacity at all to resist, however limited, intervention can be very costly. Therefore, as Boutros-Ghali used to tell me, the problem that the Third World fears intervention, that is a misplaced concern, because in most cases, when the going goes rough and there are threats associated with intervention, the opposite is often the case, rather than the threat of intervention.
The most constructive way is to work with governments on the three pillars of their responsibility for their people, supporting them to build the capacity to be able to protect their own people, and various ways, short of military intervention, of actually getting the international community to be more involved to fill the vacuum of responsibility where that exists. I think it is a challenge for countries that have the capacity to be supportive of countries that are lacking, whether it is projecting the kinds of strategies and models that we can take as models to emulate, or whether it is projecting practices that can divide and lead to genocidal conflicts of identities that we should avoid.
That is the way I'm approaching this mandate. I see my role as that of a catalyst for others with the capacity to do what needs to be done.
I should say that I have a very small staff. I'm glad to say that one of those very dedicated staff members is a Canadian citizen, sitting next to me, Kelly Whitty.
I'm looking forward to our exchange of views on this. Thanks.
In a sense you could say that the responsibility to protect is the result of the evolution of the notion of sovereignty as responsibility. Some studies have documented the link between what we try to do at Brookings and the responsibility to protect.
Close to three years ago, when I first came to New York, my colleague, the adviser on issues related to the responsibility to protect, Edward Luck, and I were talking to permanent representatives and mission members in New York. The overwhelming response from these particularly third world country representatives was almost a denial of the fact that the responsibility to protect had been accepted as a concept. People would say that what we had agreed upon was a framework for further discussions and that it had not been accepted.
The reason was that when we speak of these three pillars, the last pillar, which calls for military involvement--and even then, after other measures have been attempted--was taken to be the essence of the responsibility to protect. So our task was to really disabuse people of that kind of misinterpretation of the concept by emphasizing the responsibility of the state, support for the state to build its capacity, and only when the state is manifestly failing, with disastrous consequences for the civilian population, would the international community consider several phases of getting involved, including, as a last resort, the military response.
The Secretary-General had a report this year, which was debated by the General Assembly. I think we have seen a tremendous shift from this initial reluctance to go ahead with R2P--the responsibility to protect--to accepting it with concerns. The question is how to address the concerns of countries that feel this could be abused as a tool by more powerful states of the global north to intervene in the global south. Those kinds of concerns have been significantly ameliorated by our emphasizing the first two pillars. But they still need to be addressed.
I think this is connected with your second question, the will to intervene. It is true that if you have a Rwanda or you have genocidal situations that history tells us all after the fact, if we relive those situations, I doubt that there will be many who would say we should not develop the will to intervene. That last resort, when all fails, I think is to be borne in mind. But my emphasis is on early prevention and on cooperating with the governments concerned as a national responsibility in the first place.
:
Absolutely, and I'm glad you raised that question. In my own work, I have emphasized the role of subregional organizations and regional organizations, and I'm glad to say that the approach I have adopted for my mandate is being well received in Africa.
I have addressed the Peace and Security Council of the AU. I have addressed the Panel of the Wise of the AU. We have developed a framework of analysis that gives us some lenses or tools for assessing the risks of genocidal conflicts in a situation. The AU is adopting them to be integrated into their early warning system.
But specifically on the Congo, when I went there, first I was warned not to talk ethnicity and not to talk genocide. When I went there, everybody was talking ethnicity. Everybody was alleging that genocide was being committed against them.
The UN forces there, no matter how reinforced they might be, have a tough job--to not only support the government and protect the civilians--with proliferating armed groups that, to be disarmed, would require, as one commander told me, expeditionary force.
But I saw that if we addressed some of the underlying causes that generate these sorts of problems, and in a regional framework, where all the interests of the countries involved, not just Rwanda and Uganda but all the regions of the country... Nyerere used to say that the problem with Rwanda and Burundi is that they're tiny, overpopulated countries surrounded by large countries with a lot of land.
So in my report from DRC, I emphasized working with the regional actors to address those underlying causes. I would say that if we range from early prevention to certain involvement that is short of military action, there's a lot that the world can do.
Some of the more powerful countries... I've just been to Washington and had very good meetings in the State Department, in the White House, and the think tanks, and all that. There's so much that can be done by the more powerful states.
For me, I think the question related to the earlier question, too, is that I cannot see the powerful countries of the world--by “powerful” I mean both economically and militarily--see certain regions of the world go into chaos and destruction and massive killing and just sit. I think there is national interest in global security, particularly in those countries that have a much deeper reach and whose interests are tied to global peace and security.
:
I think we already have all the three pillars at work in the Congo. We have a government that lacks the capacity, but of course is charged with its national duty. We have an international community that is helping the government. And we have a force that by UN standards has a very strong mandate to protect civilians. And we know that women and children are among the most victimized civilians.
So far, all these three pillars working together are not improving the situation. That's because I do believe we have to shift from dealing with the armed groups, trying to disarm them... While protection of civilians is critically important, we need to shift towards a peace process, a peace process that will bring in all the countries of the region that have a stake.
Now, instead of this, two...in terms of more countries that are overpopulated, open up regional arrangements that will bring all the countries of the region into the picture to create regional peace, security, and stability. The regional approach is effective because countries feel they are in the same boat. They are faced with the same problems; they have to work together to help one another. For instance, ECOWAS has been relatively successful in doing that for the countries of west Africa.
I've just come from Guinea and had discussions in Ghana and Guinea. I was supposed to go to Nigeria. There is a willingness there to work with the international community and to work with my mandate for early prevention. There is already a process going on in the Great Lakes region that also needs support. The thing about these regional initiatives, as we have seen in Darfur with the AU forces, is that there may be the will but the capacity is lacking. And support for the capacity of these countries to be able to do what is in their own regional interest is critically important.
Support can come in a wide variety of forms. We need to get the situation right. If I go into a country using my framework of analysis and I come back and say that the core of the problem is poverty, is resource-sharing, is human rights violations, has to do with political exclusion...
We see what happened in Kenya, where, in the end, despite the elections determining a winner and a loser, they had to come to a government of national unity. The same is being done in Zimbabwe. We have to transcend the feeling that democracy simply means elections with a winner and a loser. In the western context, there is respectful opposition for a minority. Being in or being out does not mean you gain or lose everything. But we tend to see elections these days as being democracy, when that is only a small part of what democracy should be about.
:
To answer your question, let me just give a brief historical background.
I co-chaired a task force in Washington that was to develop a U.S. Sudan policy for the incoming administration, which turned out to be the Bush administration. When we started, most people were saying that Sudan was not of national interest to the United States, that the only interest was its involvement with terrorism and destabilization of the countries in the region, and the humanitarian agenda. I was the only Sudanese or non-American on the task force, chairing.
My position was that Sudan is a country that brings together southern Africa and northern Africa, two sets of civilizations and cultures and races. It could be a conciliatory meeting point or a point of confrontation, which would have ripple effects into the Middle East and into the southern part. Sudan is involved in terrorism because they believe that the west is supporting the south in the war. They're linking with like-minded people--the enemy of my enemy is my friend. Sudan is destabilizing the neighbourhood, again because they think black African countries are supporting the south.
The humanitarian agenda, the humanitarian crisis, is a result of the war. Let us make peace the top priority. The United States, as a global power that has interests all over the world, cannot afford to be disinterested on the grounds that it doesn't have a narrow national interest. It has to have an interest implicit in its leadership and the responsibilities of leadership.
Now, it's not just the United States. There are many countries of the world that play a leadership role. Your country is one. You have the U.K., Norway. They've all played a major role in bringing peace to Sudan, and indeed ending the war in the south ended all these other evils that are associated with it.
I believe Darfur is a case of good intentions leading to not-so-good results. Had we taken Darfur as the latest in a series of conflicts that started in the south and moved to the north, we would have probably engaged constructively in bringing an end to the conflict. China, as a major power that is becoming more and more global, has to recognize that the leadership role has obligations that go along with its interests and become more involved with other countries that have already been engaging in bringing peace to that region. I think the responsibilities of leadership are being made apparent to China.
Again, my sense is that in all of these, whether we're talking about the first two pillars or talking about prevention in the broad sense that I'm talking about it, there are many things that can be done in supporting either countries or the regions to build the capacity for the sort of peace processes that I'm talking about. Already the Great Lakes region is organizing itself. There are very specific needs that I think need to be met in order to enhance its capacity to be effective.
I do believe that if we diagnose problems in a country, whether they are political, economic, social, or what have you, there are resources that countries like yours can bring to bear to the situation. They aren't always material. It could be advice. It could be political. I talked before about sharing experiences, sharing models of what works, and doing so comprehensively. I think the Great Lakes region is torn apart by problems that are solvable, and the resources themselves have been a major source of division, which could be a source of coming together.
You mentioned Iraq. I tell my African colleagues in the UN system that we exaggerate here the intervention from the outside. Unless your national interests are so strong, as I'm sure the United States decided was the case in Iraq...or, perhaps as a result of what happened in Somalia, the United States was reticent to get involved in Rwanda. What happened in Rwanda made the United States become more involved in Kosovo, and perhaps also because of other interests there. Unless that is the case, intervention is not a popular concept.
I think we misplace it when we put it on top as a matter of concern, when indeed, for many of these countries, if it's anything at all, it is the lack of interest rather than the threat of intervention that is important. But this is not to say then that you disengage, because I don't think isolationism in the world of today is an option. I think what is needed is a more considered, constructive, productive engagement with the regions and with the countries of the region to bring about the desired objectives.
Mr. Paul Dewar: Thank you.