Strategy for Health
Cat. No.: E94-251/1997
ISBN: 0-662-62807-1
"The pursuit of health is inseparable from the struggle for a fairer, more caring society."
- David Werner, health activist and
author of Where There Is No Doctor
"Human-centred development - in the sense of investing in people generally, and particularly in health, education and building equity and equality between the sexes - is seen as a firm basis for sustained economic growth and sustainable development."
- The State of World Population 1995, UNFPA
Summary
Introduction
Background
The Strategy For Health
Implementation
Figure 1 : CIDA's contribution to health in development
 Summary
Vision
Canadians affirm the highest attainable standard of physical, mental and reproductive health as a human right, an essential resource for everyday life and a crucial investment for global prosperity, security and equitable social development.
Goal
The Canadian International Development Agency (CIDA) aims to contribute to improving the health and well-being of people in partner countries by maximising the health benefits of Canadian development assistance.
Guiding principles
- Supporting developing countries as they lead their own health development.
- Addressing the determinants of health through a broad intersectoral approach to health-in-development.
- Reflecting Canadian foreign policy.
- Setting priorities for programming.
Objectives
CIDA will support efforts to:
- promote the development of sustainable national health systems;
- improve women's health and reproductive health;
- improve children's health;
- decrease malnutrition and eliminate micronutrient deficiencies;
- help prevent and control important and emerging pandemics;
- introduce appropriate technologies and special initiatives.
CIDA's new Strategy for Health presents a comprehensive, intersectoral and integrated approach to health in development. Top priority is accorded to strengthening national health systems and to improving women's health and reproductive health.
Introduction
Canadian Foreign Policy: Emphasis on Poverty Reduction and on Basic Human Needs
The world is witnessing a revolution in the approach to development. People, institutions and governments have realised that respect for human rights and attention to basic human needs are essential for development. The recent creation of the human development index, which captures elements of the educational attainment and health of people as well as the economic performance of a country, illustrates the new emphasis on human development and recognises the centrality of health in the development process.
In February 1995, the Government of Canada released its new foreign policy statement Canada in the World. The stated purpose of Canada's Official Development Assistance (ODA) is "to support sustainable development in developing countries, in order to reduce poverty and to contribute to a more secure, equitable and prosperous world". To attain this goal, the foreign policy sets out six priorities for Canada's ODA programme and pledges to commit 25% of its ODA budget to programming for basic human needs, for which primary health care, family planning and nutrition are specifically mentioned. Addressing each of the six priority areas for Canadian ODA will not only reduce poverty, promote prosperity and protect security, key objectives for Canada's international actions, but can also have direct positive impacts on health. Moreover, programming in health can promote good governance and democratisation and have a positive impact on education and on development as a whole.
| Canada in the World: government statement
Mandate:
The purpose of Canada's ODA is to support sustainable development in developing countries, in order to reduce
poverty and to contribute to a more secure, equitable and prosperous world.
Program priorities:
Basic human needs: to support efforts to provide primary health care, basic education, family planning, nutrition,
water and sanitation, and shelter; Canada will continue to respond to emergencies with humanitarian assistance.
Canada will commit 25% of its ODA to basic human needs as a means of enhancing its focus on addressing the
security of the individual.
Women in development: to support the full participation of women as equal partners in the sustainable
development of their societies
Infrastructure services: to help developing countries to deliver environmentally-sound infrastructure services,
with an emphasis on poorer groups and capacity-building
Human rights, democracy and good governance: to increase respect for human rights, including
children's rights; to promote democracy and better governance; to strengthen both civil society and the security of the individual
Private sector development: to promote sustained and equitable economic growth by supporting private
sector development in developing countries
Environment: to help developing countries to protect their environment and to contribute to addressing
global and regional environmental issues |
Health is a Human Right
The foreign policy statement further states that "the Government regards respect for human rights not only as a fundamental value, but also as a crucial element in the development of stable, democratic and prosperous societies at peace with each other". Article 12 of the International Covenant on Economic, Social and Cultural Rights, inspired by Article 25 of the Universal Declaration of Human Rights, recognises "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health." The International Conference on Population and Development (Principle 8, Para. 7.2) and the Fourth World Conference for Women (Art. 94-96) have established that men and women also enjoy a right to reproductive health.
CIDA Believes in Human Development
In carrying out its mandate to support sustainable development in developing countries, the Canadian International Development Agency (CIDA) aims for a programme that reflects the needs of partner countries and is people-centred, with a focus on human development. The new Strategy for Health builds on and complements CIDA policies, statements and strategies on poverty reduction, meeting basic human needs, human rights, democratisation and good governance, women in development and gender equity, environmental sustainability, population and sustainable development, results-based management, HIV/AIDS and the upcoming strategy on water and sanitation.
CIDA seeks to help improve the health of people in developing countries by encouraging them to take charge of their own health development, helping countries improve the performance of their health sectors, targeting specific health challenges to meet international goals, and maximising the health benefits of official development assistance in all sectors. CIDA's new Strategy for Health presents a comprehensive, intersectoral, and integrated approach to health in development and provides the foundation for building a healthy development policy. This strategy document both serves as a guide to programming in the health sector and encourages programme officers and development partners to consider the effects on health of CIDA programming in other sectors.
Poverty, Population Growth and the Unique Role of Reproductive Health
In many of the world's poorest countries, and in particular in Sub-Saharan Africa, population growth outstrips economic growth. Despite recent positive GDP growth, the per capita GDP is falling in many of these countries, due to population growth. Without addressing the high unmet demand for family planning services, it will be very difficult to address poverty reduction, Canada's ODA mandate. Strengthening reproductive health services can thus contribute uniquely to Canada's development efforts.
Canadian Comparative Advantage
CIDA can strive to optimise its contribution to global health improvement by building upon Canada's comparative advantages and strengths. With a health care system based on equity, universal access, primary health care and public administration, Canadian expertise in the health sector is highly credible and well recognised. Along with a long tradition in health promotion, the development of healthy public policy and public involvement in health systems, Canada has expertise in public health, epidemiology, health policy development, health systems management and financing, pharmaceuticals, and environmental evaluation including health impact assessment. Its training and research institutions are recognised internationally and have an important tradition of development cooperation in the area of education of health professionals. Canada's bilingual character fosters development partnerships in both French and English.
Canada will build on the lessons learnt from — and on the strengths of — its past programming in health and population: training of health professionals, strengthening of primary health care and capacity development, immunisation programs, HIV/AIDS programming, its population and family planning programs and health research programs.
Background
What are the major health challenges in developing countries?
Remarkable improvements in life expectancy and child survival have occurred in many parts of the world; but in more than 20 countries, life expectancy at birth is still under 50 years, a full 30 years less than in Canada.
Women's health
Although strides are being made in improving the health of children, indicators of women's health show little progress. Improving the health of women is critical: their health has been neglected far too long. Women also play a pivotal role in the health of their families and communities. Maternal mortality rates remain shockingly high, especially in Africa, where a woman still has a one-in-thirty chance of dying from pregnancy-related causes. One third of women in the world have anemia, compounding the effect of the long and arduous work days that most face. Violence against women occurs everywhere: UNICEF cites surveys which show that a quarter of the world's women are abused in their homes. Too many girls and women suffer the devastating effects of female genital mutilation. Gender inequality with lower access to education, health services, employment and social equity for girls and women remains entrenched in most societies. Poor reproductive health and lack of access to family planning for men, women, and youth are major contributing factors to ill health and sustained rates of population growth.
Child health
Maternal and child health are intimately linked; further progress in child survival and health will require improvements in maternal health. Although the infant mortality rate in developing countries fell by over five percent per year in the 1980's, in many countries it is still twenty times higher than in industrialised nations. In Sub-Saharan Africa, a child has a more than one-in-ten chance of dying before the age of one year and a more than one-in-five chance of dying before her or his fifth birthday. Immunisation coverage rates have increased dramatically, but progress has stalled and children are still dying of vaccine-preventable diseases. The world still sees 100,000 new cases of crippling polio every year, but polio eradication has been achieved in the Americas and is within sight globally. Efforts must be intensified in several of the poorest countries. Progress in our fight against polio leads us to believe that the elimination of measles can now be contemplated. Respiratory infections, diarrhea and malaria remain important causes of childhood suffering and death. The increasing social ills of child labour, orphanhood due to the AIDS epidemic, the rising phenomenon of street kids, and the commercial sexual exploitation of children bring complex challenges for the social and psychological development of children and put them at higher risk of physical ill-health.
Malnutrition
Eight hundred million people in developing countries are malnourished, and more than 8 million deaths of children under five each year are associated with malnutrition. There is also a growing realisation of the impact on health of micronutrient deficiencies. The increased child and maternal mortality, lowered resistance to disease (and in particular the vicious cycle of malnutrition and infection), blindness and mental retardation that occur due to deficiencies of iron, vitamin A and iodine are easily preventable at low cost.
Neglected and emerging problems
Epidemics of tuberculosis, sexually-transmitted diseases, HIV/AIDS, and malaria continue to rage, and illness and death due to tobacco consumption and injury and violence are on the rise. These scourges cause childhood morbidity and mortality, take a significant toll on the well-being and productivity of adults, and pose a threat to the health of Canadians and fellow citizens of the global village. As countries move through the epidemiologic transition, they face the double burden of coping with communicable diseases as well as a rising incidence of non-communicable diseases such as cancer and cardiovascular disease.
In Sub-Saharan Africa, the AIDS pandemic has reached catastrophic proportions, with an estimated 14 million people infected with HIV. They represent more than two-thirds of the men, women and children affected worldwide. The next explosion in the HIV pandemic is now occurring in South and Southeast Asia.
Complacency, neglect and AIDS have allowed tuberculosis to make a frightening comeback in many countries, including industrialised nations, and it now causes almost 3 million deaths annually around the world. Tuberculosis has been declared a global emergency by the World Health Organisation (WHO).
Malaria still causes 2 million deaths annually and is a major killer of children. The 400 million cases of malaria occurring at any one time cause untold suffering and loss of productivity.
With 800 million smokers in developing countries, tobacco is an increasing cause of premature death and low birth weight, and is a major threat to sustainable and equitable development. According to WHO, smoking is the world's largest single preventable cause of illness and death, killing 3 million people each year.
Deaths due to violence and trauma reach 1.8 million annually. The more than 120 million occupational injuries annually kill 220,000 people each year. Violence in the home, particularly against women, violence on the streets, and conflicts within and between nations cause untold suffering and disruption.
What are the determinants of health in developing countries?
Health is largely a matter of the social, physical, economic, political, and cultural environment of the communities in which people live and grow. The major determinants of health in a developing country illustrate the need for a broad societal view of health and illness and demonstrate the fact that almost any development project can have an impact on the health of a population. The Declaration of Alma-Ata called for primary health care that "involves, in addition to the health sector, all related sectors and aspects of national and community development... and demands the coordinated efforts of all those sectors". However, progress towards an integrated approach to health has been slow.
Major determinants of health in developing countries:
- low status of women / gender inequity
- illiteracy and limited education, particularly of girls and women
- poverty and inequity
- rapid population growth and rural-urban migration
- poor nutrition / lack of food security
- squatter settlements and poor housing
- inadequate access to safe water and sanitation
- environmental degradation
- unhealthy human behaviour
- social unrest and armed conflict
- inadequate access to health services
|
Status of women: Empowering girls and women through community development, access to education, and promoting economic and political participation are key to improving their status. As gender equity improves, so does the health of women resulting in ripple effects for their families and communities.
Education: Education of all children through primary and secondary school is critical to their ability to improve their own health, through literacy and acquisition of life skills. The World Bank estimates that for each additional year of education for girls, child mortality is cut by up to 10 percent, female fertility is reduced by 10 percent and wages are boosted by 10 to 20 percent.
Poverty and inequity: The grinding poverty of the world's most vulnerable people reduces their access to adequate food, shelter, education, employment and health care, compromising their health and well-being. The inequitable distribution of available resources in developing countries is compounded by policies resulting in excessive military spending and insufficient investment in the social sectors of health and education.
Population growth: Rapid population growth maintains or worsens the cycle of poverty when it outstrips economic growth, leading to decreased GDP per capita. In the poorest countries, social programmes, such as education and health, cannot keep up with the rising demand, thus further compromising their capacity to meet basic human needs.
Nutrition and food security: A plentiful, nutritious and affordable food supply and appropriate dietary practices are essential for the healthy growth and development of children, for safe motherhood and for a productive work force.
The environment, housing, water and sanitation: Access to clean water and adequate sanitation is an integral part of primary health care and fundamental to healthy living. With rapid urbanisation, overcrowded unsanitary housing, and pollution by newly industrialising societies, environmental degradation continues to pose a major threat to health and highlights the urgent need for environmental protection, safe housing and infrastructure development.
Socio-political instability, conflicts, and migration of refugees and displaced persons have increased dramatically and have resulted in the maiming and deaths of millions. In the last decade, the effect of war on children has left 2 million dead, 4 to 5 million disabled, 12 million left homeless, more than 1 million orphaned and some 10 million psychologically traumatised.
Healthy behaviour and national health systems: The Declaration of Alma-Ata describes primary health care as "essential health care ...that forms an integral part... of the overall social and economic development of the community. It includes at least health education, food supply and proper nutrition, safe water and basic sanitation, maternal and child health care, including family planning, immunisation against the major infectious diseases, prevention and control of locally endemic diseases, appropriate treatment of common diseases and injuries, and provision of essential drugs." Empowering individuals and families to take responsibility for their own health through health promotion and health education and ensuring universal access to quality essential preventive and curative health services are fundamental to improving health for all. However, health systems in many countries do not have the capacity or the commitment necessary to deliver essential services to those most in need. Excessive centralisation of health planning, large central bureaucracies, weak management, the absence of community participation, insufficient qualified human resources, inadequate funding for health by countries and donors with different priorities and strategies, vertical programming, inadequate attention paid to country needs, and lack of recognition of the impacts on health of national policies and development projects in other sectors have all contributed to failures in the health sector. Ultimately, this results in unsustainable programs.
Improving Health: Constraints and Opportunities
In the post Cold War context of political instability and regional conflicts with the resulting social upheaval, strained economies, damaged infrastructure, and displaced populations, development activities often give way to humanitarian relief. Natural disasters, drought and climate change also take their toll in regions that are most susceptible to their devastating effects, sometimes wiping out years of effort.
We are also witnessing a new era of fiscal restraint due to government debt burden in the South and in the North. Structural adjustment programs, while needed, have had negative impacts on the educational attainment and health of people in many developing countries. The simultaneous fall in ODA from the North is leaving some development initiatives in the lurch when they most need support.
Nonetheless, the growing interdependence of the world economy, the wave of democratisation of societies around the world, the new emphasis on global governance and human rights, and the arrival of the information age and global telecommunications provide opportunities to make commitments and implement effective solutions for improving the health of all people.
Health: The International Challenge
Powerful commitments for improving health have been made on the world stage, setting the tone for development policies and strategies for the new millennium. The International Conference on Primary Health Care, held in 1978, resulted in the Declaration of Alma-Ata, calling for urgent action to 'protect and promote the health of all people of the world'. The movement launched at Alma-Ata has gained momentum in recent years, with an unprecedented series of international conferences and summits that place the rights of children and women as well as progress towards social development at the centre of the international agenda, and affirm the primacy of health, education, and the status of women for economic development. The World Health Organisation is reiterating the challenge for equity, solidarity and health through a global consultation to renew the Health-for-All strategy. With the State of the World's Children 1996, UNICEF has declared a new anti-war agenda to protect the health and well-being of children.
The goals agreed upon by international consensus, and particularly those of the World Summit for Children, the International Conference on Population and Development, and the Fourth World Conference on Women are realistic and achievable. Progress towards these goals will require committing funds to programming for basic human needs and basic social services. The international movement towards human rights, sustainable development and health for all can only be sustained with political will and the marshalling of adequate resources.
| Recent International Summits and Conferences for Human Development
1989: The International Convention on the Rights of the Child
1990: World Summit for Children, New York
1990: World Conference on Education for All, Jomtien
1992: United Nations Conference on Environment and Development, Rio de Janeiro
1992: The International Conference on Nutrition, Rome
1993: World Conference on Human Rights, Vienna
1994: International Conference on Population and Development, Cairo
1995: World Summit for Social Development, Copenhagen
1995: United Nations Fourth World Conference on Women, Beijing
1996: Second United Nations Conference on Human Settlements (Habitat II), Istanbul |
World Summit for Children 1990: Goals for the year 2000
1. A one-third reduction in 1990 under-five death rates (or to 70 per 1,000 live births, whichever is less).
2. A halving of 1990 maternal mortality rates.
3. A halving of 1990 rates of malnutrition among the under-fives (to include the elimination of micronutrient deficiencies, support for breast-feeding by all maternity units, and a reduction in the incidence of low birth weight to less than 10%).
4. The achievement of 90% immunisation among under-ones, the eradication of polio, the elimination of neonatal tetanus, a 90% reduction in measles cases, and a 95% reduction in measles deaths (compared with pre-immunisation levels).
5. A halving of child deaths caused by diarrheal disease.
6. A one-third reduction in child deaths from acute respiratory infections.
7. Basic education for all children and completion of primary education by at least 80% - girls as well as boys.
8. Safe water and sanitation for all communities.
9. Acceptance by all countries of the Convention on the Rights of the Child, including improved protection for children in especially difficult circumstances.
10. Universal access to high-quality family planning information and services in order to prevent pregnancies that are too early, too closely spaced, too late, or too many. |
| International Conference on Population and Development 1994: Programme of Action
The Programme of Action, based on the principles of human development and gender equity, champions reproductive rights and reproductive health for all. It reaffirms the goals of the World Summit for Children and calls for universal access to primary education, reduction of infant, child and maternal mortality and universal access to a full range of high quality reproductive health services, including family planning and sexual health, through the primary health care system by the year 2015.
Fourth World Conference on Women 1995: Platform for Action
The Platform for Action reaffirms the right of women to the enjoyment of the highest attainable standard of physical, mental and reproductive health and urges governments to support and implement the commitments made at the International Conference on Population and Development and the World Summit for Social Development. The section 'Women and health' of the Platform for Action calls for increasing women's access to health care, and increasing resources, strengthening preventive programmes, and promoting research for women's health, including gender-sensitive initiatives that address sexually transmitted diseases, HIV/AIDS, and sexual and reproductive health. The section 'Women and violence' calls for integrated measures to prevent and eliminate violence against women, study of the causes and consequences of violence against women and the effectiveness of preventive measures, elimination of trafficking in women and assistance to victims of violence due to prostitution and trafficking. |
The recent major international agreements and Canada's new foreign policy statement provide CIDA with a mandate to give high priority to health in its development policy.
In May 1996, at a High Level Meeting of the OECD Development Assistance Committee, ministers and heads of development agencies approved a report entitled Shaping the 21st Century: the Contribution of Development Cooperation. Canada thus renewed its commitments to contribute to the attainment of several development goals and in particular to two directly related to health, family planning and reproductive health:
- "The death rate for infants and children under the age of five should be reduced in each developing country by two-thirds the 1990 level by 2015. The rate of maternal mortality should be reduced by three-fourths during the same period."
- "Access should be made available through the primary health-care system to reproductive health services for all individuals of appropriate ages, including safe and reliable family planning methods, as soon as possible and no later than the year 2015."
CIDA's new Strategy for Health presents a comprehensive and integrated approach to health in development. Top priority is accorded to strengthening national health systems and to improving women's health and reproductive health. Although Canada's contribution represents a small part of global resources for health, implementation of CIDA's Strategy for Health will be additional tangible evidence of Canada's commitment to human development.
The Strategy For Health
Vision
Canadians affirm the highest attainable standard of physical, mental and reproductive health as a human right, an essential resource for everyday life and a crucial investment for global prosperity, security and equitable social development.
Goal
CIDA aims to contribute to improving the health and well-being of people in partner countries by maximising the health benefits of Canadian development assistance.
Guiding Principles
1. Supporting developing countries as they lead their own health development
Nationally-designed and coordinated strategic health plans
Developing countries should be in the driver's seat in taking charge of their own health development. The effectiveness and sustainability of health development depend on a coordinated national health plan with country control over priority setting and programme implementation. Collaboration for capacity development in the health sector, including South-South collaboration, and the training of health professionals, are key elements to enable national governments to assume this leadership and for others in the sector to participate effectively.
CIDA programming responsive to the needs and priorities of developing country partners with strong emphasis on local participation
Activities of concern to recipient governments and in line with the policies and strategies of the national health plan are more likely to be sustainable. Local ownership of ideas and strategies in all stages of programming and at the community, district and national level are essential to the success of health development programmes.
National responsibility for aid coordination in health
Coordination of health aid under national leadership can lead to maximum complementarity and effectiveness of projects and better use of resources. National responsibility for aid coordination can be facilitated by strengthening the government's ability to lead, supporting collaborative and consultative processes such as sectoral roundtables or sector investment programs, co-financing projects, and seeking opportunities for joint policy and implementation work.
2. Addressing the determinants of health through a broad intersectoral approach to health-in-development
A health-in-development approach recognises that health resides within a context of human and social development and is a function of the social, physical, economic and cultural environment of the communities in which people live and grow. Good health is both a resource for development and an aim of development in a mutually reinforcing cycle. Consequently, it is possible to adopt a "healthy development policy" , whereby programming in all sectors is undertaken in such a way as to maximise the opportunity to improve health, whether directly or indirectly. Promoting the creation of an enabling environment for health is one of the most important strategies for the prevention of disease and disability.
" Primum non nocere "
The first dictum of medical ethics is "First, do no harm". Development in the private and industrial sectors benefits health through stimulation of the economy and poverty reduction. However, development projects can also have negative impacts on the health of the most vulnerable, for example, through changes in the environment or the displacement of populations. A healthy development policy incorporates awareness, evaluation, prevention and mitigation of the potential negative health effects of development in all sectors. By considering its international relationships in the context of a "healthy foreign policy", Canada can integrate attention to health in all its foreign activities, including foreign trade and official development assistance. The recently announced Canadian comprehensive unilateral moratorium on the production, export and operational use of anti-personnel landmines provides an example of healthy foreign policy.
Programming in other sectors that contributes to improving health
CIDA has long been making contributions to improving health by addressing directly the determinants of health through programming in other sectors such as education, water, sanitation, and agriculture. The reduction of poverty and inequity are important goals of Canada's ODA programme. Championing the role of women in development and promoting gender equity are central to CIDA's mission. Canada has a strong record in environmental issues and CIDA projects subject to the Canadian Environmental Assessment Act are required by law to evaluate potential effects on health (Art 2(1)). CIDA has been programming for poverty reduction, human rights and democratic development, has announced new initiatives in conflict prevention and resolution and will continue to play a role in implementing Canadian foreign policy for peacebuilding. Humanitarian assistance in emergencies provides medical care, food, shelter, clean water, sanitation, and prevention and control of epidemics for refugees and displaced persons.
Opportunities to approach health in an integrated fashion through programming in other sectors also arise frequently. Examples include agricultural programmes that encourage the phasing out of tobacco farming or that support crop diversification with a more nutritious cereal to be consumed locally as well as exported. Water programmes might add hygiene education to enhance the health gains of a clean water supply. Infrastructure projects might include backfill of ruts to reduce malaria spread when roads are under construction. Telecommunications development can take into consideration the needs of health professionals and health education. Education can be designed to further enhance the maintenance of good health by inclusion of health issues in the school curriculum. CIDA's Food Aid Centre is increasingly judicious in its use of food aid so as not to affect local food production and is linking its food aid initiatives to programming for health, nutrition and income generation.
Intersectoral action for health
An intersectoral approach to health refers to a partnership that mobilises actors within the public sector to act synergistically with each other and with the private sector for the attainment of specific health goals within a health promotion and 'healthy public policy' framework. 'Healthy public policy' refers to the adoption of policies in all sectors, including social and fiscal policies, that are designed to promote and safeguard health while pursuing sector-specific objectives. The healthy cities movement exemplifies healthy public policy at the municipal level, a concept reinforced at Habitat II.
A national health plan should include policies and mechanisms for consultation, collaboration and involvement with relevant government ministries and the private sector. For example, appropriate national policies and the cooperation of industry are critical for the implementation of occupational health and safety programs or pollution emissions controls. Economic structural adjustment programs can be designed with safety nets built in for the health and education of the most vulnerable. The Universal Salt Iodization programme for the prevention of iodine-deficiency disorders and the Micronutrient Initiative pioneered by International Development Research Centre (IDRC) with the support of CIDA provide examples of programmes that require concerted intersectoral action to achieve specific health objectives.
3. Reflecting Canadian foreign policy
CIDA's health programming will be guided by the development principles outlined in the foreign policy statement, Canada in the World, and will strive to:
- focus on countries and peoples in greatest need;
- adopt a broad basic human needs approach;
- foster equity, which implies focusing on community-based primary health care and aiming for universal access to essential services;
- recognise the central role of women in development, making women's health a priority;
- promote good governance, highlighting the importance of sustainable, equitable, national health systems;
- foster health reform and capacity development to enhance sustainability;
- match Canada's comparative advantages, resources and capabilities to the partner country's needs;
- build on past accomplishments and lessons learned.
4. Setting priorities for programming
CIDA will encourage needs-and results-based programming for the greatest impact on health per dollar invested:
- importance of the problem: burden of disease measures including morbidity, mortality, and measures that combine morbidity and mortality such as disability-adjusted life-years (DALYs) lost or other appropriate methods, including qualitative methods;
- cost-effectiveness of interventions (e.g., dollar per year of life saved);
- feasibility and socio-cultural acceptability of interventions.
Objectives
The first guiding principle of the Strategy states that "CIDA will support developing countries as they lead their own health development". In the past, vertical programs, while at times achieving quick results in difficult environments, have often experienced difficulty sustaining these results and have tended to be an expensive and fragmented means of service delivery. Furthermore, they have not fostered community participation and local ownership and have therefore not contributed optimally to system sustainability. Without sustainable national health systems, it will be extremely difficult to ensure universal access to priority substantive programs over the long term. For these reasons, CIDA has made supporting sustainable national health systems one of its two top health priorities, together with improving women's health and reproductive health.
CIDA will support efforts:
Objective 1: To promote the development of sustainable national health systems
A well-functioning health system should ensure universal access to quality essential public health and clinical services through an integrated primary health care approach, engage in health education and health promotion, promote the development of healthy public policy in other sectors, and provide well-targeted, effective and committed programming to meet the objectives set by the national health plan. National health systems do not imply that governments should provide all health services. Rather, governments should ensure equity and thus universal access to essential services, provide funding, and orchestrate the role of the many players within the sector to ensure an optimal health response at a cost which is sustainable by the country.
Health reform and capacity development is one of the most important strategies to assist countries to improve health and attain specific health goals. The following are important elements of a health reform strategy:
- political commitment, enabling legislation, policy development and intersectoral action;
- sectoral roundtables and sector investment programmes;
- situation analysis, health information systems and health planning at local, district and national levels (bottom-up participatory planning);
- human resources planning and training of health professionals;
- improved management and appropriate financing mechanisms;
- effective decentralisation to districts and communities, with close collaboration with non-governmental organisation (NGOs) and other development partners;
- local governance and community participation;
- empowerment of households and of women in particular;
- developement of the capacity of health systems and services to implement health promotion and prevention activities and to foster the development of healthy public policies;
- evaluative research on programs and services, research training, and essential national health research.
Objective 2: To improve women's health and reproductive health
- women's health programming throughout the life cycle in the context of family health (including attention to issues such as violence and female genital mutilation);
- safe motherhood;
- women's nutrition;
- quality family planning services;
- information, education and communication on reproductive health for men, women and youth;
- prevention and control of sexually transmitted diseases and HIV/AIDS;
- youth health: school and community-based programs for adolescents and street kids.
Objective 3: To improve children's health
- strengthening primary health care;
- full immunisation of every child, and in particular for the eradication of polio and the elimination of measles;
- integrated management of childhood illness;
- school-based programmes including health promotion and education;
- targeted programmes for the girl child.
Objective 4: To decrease malnutrition and eliminate micronutrient deficiencies
- breast-feeding promotion, support and protection;
- dietary improvement;
- micronutrient supplementation for individuals;
- micronutrient fortification of the food supply;
- surveillance of household food security and nutritional status.
Objective 5: To help prevent and control important and emerging pandemics which cause more than 1 million deaths per year and for which cost-effective interventions exist
- HIV/AIDS;
- tuberculosis;
- malaria;
- tobacco;
- trauma and violence, particularly violence against women.
Objective 6: To support efforts to introduce appropriate technologies and special initiatives
In the past, technologies have frequently been introduced without rigorous assessment of effectiveness, costs or impacts on the health system, often diverting precious resources away from essential programs. Research and innovation are essential to develop more cost-effective and appropriate technologies. These efforts include:
- needs-based technology assessment;
- pilot testing of emerging technologies;
- introduction of appropriate new technologies;
- seed funding for new initiatives;
- operations research.
Implementation
Using the Strategy for Health as a programming guide
The Strategy for Health will provide guidance for CIDA's programme branches in programming for health. The vision, goal, guiding principles and objectives of the strategy will be useful in designing and assessing programmes and projects in the health sector, as well as in other sectors, within the context of overall strategies to support sustainable human development.
The Canadian contribution in health will be further focused by three distinctive lenses:
- With respect to bilateral programming, the Strategy for Health will provide direction for programming within the context of CIDA country and regional programming frameworks.
- The Canadian contribution will be designed to fit within the partner country's nationally coordinated health development plan.
- The role of other donors and development partners will be taken into account.
The objectives and priorities outlined in the strategy can also help guide programming by CIDA's Multilateral and Canadian Partnership branches and assist in deciding the extent to which specific initiatives, programmes, projects, agencies and NGOs should be supported. The Strategy will also inform policy dialogue with development partners and support governance functions of relevant international agencies.
Canada will continue to provide most of its development assistance to low-income countries in Africa, Latin America, Asia and the Caribbean, focusing on countries and peoples in greatest need. The Strategy for Health will also guide health programming assistance to Central and Eastern Europe. CIDA will continue to respond to emergencies with humanitarian assistance. CIDA will strive to optimise its contribution to global health improvement by building upon Canada's comparative advantages and strengths. Canada's contribution can include:
- Canadian technical expertise and technology;
- essential drugs, supplies and contraceptives;
- direct grants and commodities, including food aid.
Partners for implementing CIDA's health programming include:
- developing country partners, including governments, civil society institutions and NGOs;
- Canadian experts, NGOs, universities, colleges and professional associations;
- Canadian private firms, including the pharmaceutical industry;
- Canadian institutions such as the IDRC;
- Health Canada and Canadian provincial ministries of health, regional health boards and health institutions;
- technical and implementing agencies of the United Nations, and in particular WHO, UNICEF and UNFPA (United Nations Population Fund);
- ]international NGOs;
- the World Bank and regional development banks.
What are the next steps?
A number of steps can be taken at CIDA to ensure rapid implementation of the Strategy for Health and give to health, nutrition and family planning the importance accorded to them in Canada in the World as elements of basic human needs programming:
- strengthen access to expertise in health and population, both through a strong in-house team and by drawing on Canadian capacity in the sector;
- foster an environment where CIDA staff and development partners will take into account the impact on health of development programmes and projects in other sectors;
- ensure that projects covered by the Canadian Environmental Assessment Act include appropriate evaluation of effects on health, as prescribed by the Act;
- engage in policy dialogue for health in development;
- contribute to strengthening the UN response in health by fostering better coordination and performance of UN agencies.
Monitoring and Evaluation
CIDA will monitor the development of health programming and will evaluate it with special attention to realisation of program objectives, results achieved and evidence of the effectiveness of Canadian Official Development Assistance.
In this context, CIDA will:
- review and evaluate health programming systematically to ensure quality;
- apply CIDA's results-based management approach to programming in health;
- monitor the amounts and relevance of approvals of new health programmes / projects and disbursements through CIDA monitoring mechanisms for basic human needs;
- identify and share success stories and lessons learned;
- monitor the health development literature and in particular as it relates to aid effectiveness;
- evaluate periodically the results of the implementation of the Strategy for Health in the context of the Basic Human Needs Review and other development assistance review mechanisms (Auditor General, Development Assistance Committee of OECD, etc.);
- periodically update CIDA's Strategy for Health, based on the findings from the above.
Figure 1
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