Op-Ed: Canada’s next act of global health leadership

By John W. McArthur, Ottawa Citizen, November 27, 2013

Canada’s global health contributions remain underappreciated in our national debates. Amid flashpoint foreign policy topics of conflict and military deployment, the quieter business of delivering health services usually affects a far greater number of lives around the world. In recent years, Canada’s contributions have been nowhere more evident than in its founding support for the Global Fund to Fight AIDS, TB, and Malaria. Over the coming week, Canada has an opportunity to provide decisive leadership for the institution’s critical next phase of expansion.

The Global Fund’s Fourth Replenishment conference begins in Washington next Tuesday, Dec. 3. It will cover the three year period 2014 through 2016, including the final stretch of the Millennium Development Goals through to end-2015. As a pioneering blend of government, non-profit and private sector partners, the Global Fund has played a pivotal role in transforming minimum global health standards.

Canada has long been in the middle of this global health revolution. The 1996 Vancouver International AIDS Conference was the watershed moment presenting evidence that antiretroviral medicines could convert AIDS from a death sentence to a treatable disease. But by 2000, treatment still remained essentially inaccessible throughout the developing world. At the time roughly 30 million people were HIV infected, mostly in Africa, where the disease was killing more than a million people year. In 2001, then-UN Secretary-General Kofi Annan called for the launch of a new global fund to make treatment possible at scale. Canada joined the Gates Foundation, the United States and a handful of other countries to seed the institution.

Many individual Canadians have been centrally involved in the global effort. For example, Stephen Lewis served with passionate distinction as UN Special Envoy for HIV/AIDS in Africa. James Orbinski was a leader in advancing academic research and access to essential medicine. Stephanie Nolen vividly documented the personal journeys of individuals struck by the AIDS pandemic. Ernest Loevinsohn played a crucial role helping to shape and govern the Global Fund itself. By 2010, Prime Minister Stephen Harper had assumed a personal leadership role on global health accountability, especially on areas linked to maternal, newborn and child survival.

Today the Global Fund has racked up a stunning track record of success. It has made AIDS treatment possible for more than five million people, including an extra million people registered in the first part of 2013 alone. Thanks to the Fund and its partners, nearly 300 million malaria cases have been treated, and nearly half of at-risk African households are using modern anti-malaria bednets, compared to less than three per cent in 2000. Amid perhaps inevitable growing pains, the institution has also continuously innovated in its procurement methods to cut costs and leverage dollars.

Under its highly respected leader, Dr. Mark Dybul, the Global Fund has established a Fourth Replenishment budget of $15 billion, or $5 billion per year. They anticipate this will be enough to save 5.8 million lives and improve hundreds of millions more. Crucially, the Fund also sees the opportunity for a decisive “tipping point” in slashing underlying infection rates of major diseases.

How much should Canada contribute? Earlier this year, the Obama Administration pledged $1.65 billion for 2014, or roughly $5 per American, through a challenge whereby the U.S. matches every $2 of other countries’ funding with $1 of its own. However, the U.S. situation is unique, since it also has major bilateral disease control programs and makes only a small share of its global contributions through the Global Fund.

For Canada’s purposes, more comparable pledges have recently been made by the Nordic collaborative of Denmark, Iceland, Finland, Norway and Sweden. These countries have a combined population of around 26 million and committed $250 million per year, or nearly $10 per person. Meanwhile the United Kingdom pledged $533 million per year, more than $8 per citizen. A similar annual commitment of $8 to $10 per Canadian works out to roughly $280-350 million per year. This represents an important increase on our most recent contributions of roughly $175 million per year, or $5 per Canadian. I believe most Canadians would be proud to invest an extra $5 per year toward the world’s most transformative multilateral health institution.

Canada has not yet announced how much it will pledge at next week’s conference, but the timing matters almost as much as the amount. In addition to the 50 American cents unlocked by each Canadian dollar, campaigners feel that an early Canadian commitment can also help to crowd-in additional funds from other countries that have not yet formally pledged. An announcement before the end of this week can still have a significant multiplier.

At a September global health event in New York, Harper eloquently stated that, “Degrees of failure are not measured in dollars. They are measured in thousands of lives.” Moreover, “Before 2015, and in pursuit of what are urgent and noble Millennium Goals, therefore let us give one final vigorous and decisive effort.” Over the coming week, Canada can decide to offer such measurably life-saving global leadership. If we do so, it will mark the next rung in a ladder of global health contributions, one in which all Canadians can rightfully be proud.

John W McArthur is a Visiting Fellow at the Brookings Institution and Senior Fellow at the UN Foundation. He previously managed the UN Millennium Project. Follow him at Twitter.com/mcarthur.

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Ottawa Citizen Op-Ed: Redefining Accountability Abroad

This week I ran an Op-Ed in the Ottawa Citizen.  Full text pasted below.

Redefining accountability abroad


One of the foremost challenges Christian Paradis faces in his new role as Canada’s minister of international development is the need for better accountability structures across the complex patchwork of global development actors.

This is a hot topic in the international debates on what post-2015 framework should follow the Millennium Development Goals that have guided global anti-poverty efforts since 2000. Local governments, donor governments, private companies, civil society organizations, international agencies and philanthropists all have a role to play. But even when all sides share common goals, there needs to be a clear way to track responsibilities over time.

Nowhere is this more relevant than Mozambique, one of 20 focus countries in Canada’s current international assistance strategy. The country’s history is complex. Having suffered a brutal civil war from 1977 to 1992, it has since seen major progress on many fronts. Over the past decade alone, average per capita incomes grew more than 50 per cent while child mortality declined nearly 40 per cent, backed significantly by external aid. The country’s natural resource industry is booming, and mining companies, including Canadian firms, are investing hugely in local production. However, the progress builds from an incredibly low starting point. Mozambique still ranks 185th out of 187 countries on the UN’s Human Development Index. One in 10 children still don’t live to see their fifth birthday, and more than half of the population still lives on less than $1.25 per day, according to the latest available data.

In May I visited Maputo, the national capital. On a Friday night I was riding in the passenger seat as my friend Erik Charas drove me back to my hotel following dinner and a concert. Erik is a highly respected local entrepreneur, best known as the founding publisher of Verdade, Mozambique’s most widely read newspaper. It is distributed for free, guided by a simple mission of empowering local citizens with the tool of public information. Erik is a former mentee of Graça Machel and is also an accomplished social entrepreneur. His latest business venture introducing affordable, working-class apartments is popular enough to garner strangers’ unsolicited purchase offers when he strolls through public cafés.

A couple of weeks before my visit, Erik was detained overnight by police for not paying a bribe at an informal roadside check point. Given his profile and sophisticated knowledge of the law, the issue was picked up by local media and generated significant public attention. Erik was confident that the detention was illegal, and so asked for a proper written record of it at the police station. By the time I arrived, the legal proceedings had not yet started to churn in any direction.

Against that backdrop, I was not entirely surprised when two police officers wearing military-style greens and machine guns pulled Erik and me over as we were driving. However, I was surprised when the lead officer recognized Erik’s face and dejectedly waved us on, clearly wanting to avoid a public debacle. Even more remarkable was that we were pulled over again a second time by different police only a few minutes later, just outside my hotel. But this time the police didn’t recognize Erik and so an apparent shakedown sequence began. I don’t speak Portuguese, but I understood enough to know that Erik was declining the officer’s instructions. Agitation grew quickly until I heard the officer cock his machine gun. Erik simply drove away mid-sentence, in defiance of the threat.

Sadly, police intimidation is not uncommon in much of the world, but this was a shockingly crass breakdown of public institutions in the middle of what is otherwise a peaceful tourist zone. Locals later told me the problem in Maputo is recent and growing, a new fact of life for nighttime driving.

The obvious question is, who should be held accountable? The answer, alas, is less simple. I am not an expert on Mozambique, but this type of problem probably results from multiple factors. Part of it is likely driven by extremely low wages for front-line police officers, who feel compelled to supplement their incomes amidst a rising cost of living. Part of it is likely driven by the strain of highly visible inequalities, with the natural resource boom boosting elites’ incomes while rising prices eat away at others’ stagnant paycheques.

Part of the problem is by definition a breakdown in the discipline of public institutions. But many level-headed locals believe this to be a byproduct of a structurally flawed relationship between the national government and foreign companies. There is a broad concern that the natural resource contracts are providing huge returns for foreign investors and the politicians, but not much for local Mozambicans. And once the contracts are set, even when highly flawed, they are typically in place for decades, with no recourse for Mozambicans to cry foul and renegotiate. The rule of law protects bad contracts, even if it does not prevent them.

Such difficult situations need multi-pronged solutions. Canada should not meddle in other countries’ politics, but it should support local development and democratic processes while enforcing highest standards for its own companies. On one side, aid budgets can continue to support targeted service-delivery initiatives, like the health programs that have been hugely successful all around Africa. They can also help to ensure local civil servants’ wages are properly indexed, especially when foreign industries are pushing up the cost of living. And they can support, with no strings attached, local think-tanks that promote transparency in public debates and critical evaluations of public finances.

At the same time, new ground rules are needed for extractive industries themselves. Firms that make or facilitate bribes of course need to be punished, but that sets too low a bar. Although companies should not be expected to play the role of governments, some form of global “fair share” principle is probably required as a minimum percentage of profits that always stays within a host country. Cash transfers could be sent directly to citizens through modern banking technology, as World Bank researchers have recently suggested. Companies could support specific job training and co-op programs as a standard portion of their revenues. They could also commit a common portion to local think-tanks that promote public debate.

As a major player in natural resources, Canada has a responsibility to tackle these global issues. In 2010, the Harper government helped introduce the important G8 accountability report that tracks progress on government commitments. Amidst the shifting weight of responsibilities in the global economy, post-2015 accountability needs to incorporate the private sector too. The Canadian government should work closely with Australian counterparts to propose a draft in time for the November 2014 Brisbane G20 summit. Minister Paradis’ previous portfolio at Natural Resources positions him well to play a key role. If he can bring industry and policy leaders together to create higher explicit performance standards on all sides, Canada can be at the forefront in defining new notions of accountability. In Mozambique and all the other emerging resource exporters, countless citizens will be grateful.

John W. McArthur is senior fellow at the UN Foundation and non-resident senior fellow at the Brookings Institution. He is former manager of the UN Millennium Project.

© Copyright (c) Ottawa Citizen

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The Need for a New Canadian Conversation on Foreign Aid

I have a new post at OpenCanada.org, the first of a 3-part series that aims to help kick start a new Canadian conversation around how the country approaches foreign aid over the coming generation.  Please feel encouraged to share comments directly!


Canada’s foreign aid conversation is lost.  The recently announced merger of CIDA into the Department of Foreign Affairs and International Trade prompted a spate of agitated commentary across the country.  But the public debates underscored the extent to which an institutional tail is wagging the policy dog.  The issues to be resolved are much more fundamental than problems of bureaucratic org charts.  They require systematic and robust thinking, rather than the loose commentary commonly trotted out during moments of sporadic media debate.

Most significantly, there is one central question that needs to be flipped on its head.  Instead of becoming stuck in the supply-driven query, “How should Canada’s foreign aid structures be improved?” the country needs to start with a demand-driven approach, mapping out the nature and scale of the global development challenge, and then asking how Canada can best organize itself to help to tackle the problems at hand.

To that end, this post marks the start of a three-part series.  To help set the stage, below we start by unpacking some of the most common misconceptions around foreign aid.  The second installment provides some historical context for the current debates, and some recent assessments of global need.  The third proposes a way forward, not just for the Canadian government, but for the range of key constituencies that will be essential for moving Canada’s national development strategy forward.


[Read more…]

Globe and Mail: Importance of African Agriculture for Ending Extreme Poverty

Yesterday The Globe and Mail published a short piece I recently wrote on the importance of boosting African smallholder agriculture as a key element of any global effort to end extreme poverty.  The Globe ran the piece under the title, “To end poverty worldwide, fix African agriculture first.”  This reproduced a post I wrote originally for the ForumBlog a couple of weeks ago, under the title “Ending extreme poverty in Africa by 2030.”  Full text pasted below.


To end poverty worldwide, fix African agriculture first

The public chorus to eliminate extreme poverty by 2030 now includes US President Barack Obama, World Bank President Jim Yong Kim and Bono. The backdrop is extremely promising since the developing world has already cut the share of people living below US$1.25 a day by half since 1990. At a consistent rate of progress, the other half could well cross the line in another 20 years too.

But, as my colleague Laurence Chandy and Brookings co-authors have recently pointed out, the distance to crossing the US$ 1.25 line varies tremendously by region. Most of China has already crossed the US$ 1.25 threshold and India has a huge share of its population poised to make the leap next. Sub-Saharan Africa has the farthest to go, despite recent progress, since a large proportion of its population still lives so far below US$ 1.25 per day, often at half that level of income.

Most of Africa’s poorest people live on small farms in rural areas, so those places will likely form the final frontier of the global quest to end extreme poverty. Although fast-growing cities have gained attention for their role in fighting poverty, including in the World Bank’s latest Global Monitoring Report, it is increases in rural productivity, especially agriculture, that are typically a fundamental driver of the urbanization process.Watch Full Movie Streaming Online and Download

There are grounds for optimism. Growing academic evidence highlights agriculture’s unique role in helping to reduce extreme poverty. For example, an important 2011 paper by economists Luc Christiaensen, Lionel Demery and Jesper Kuhl shows that agriculture is roughly three times more effective at reducing extreme poverty than non-agricultural sectors.

There has also been a global renaissance of attention on the need for an African Green Revolution, driven by both public and private investments in a manner that respects local community structures. The World Economic Forum’s Grow Africa initiative, which convened last week in Cape Town, offers a potential high-impact platform, bringing together investors and governments to launch practical joint strategies at scale.

Complementary investments in transport infrastructure, irrigation, farmer credit and input support systems (e.g. for fertilizer and seeds) were essential to Asia’s 20th century green revolutions that laid the foundation for that region’s subsequent economic breakthroughs. The same basic approach, updated for today’s social and environmental realities, can help to ensure Africa’s long-term economic success is equally, if not more, robust. The sooner the process starts, the faster the world gets to the finish line on extreme poverty.

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Who’s the most innovative thinker on Canada’s role in the world?

The Canadian International Council has a novel weekly “Rapid Response” initiative in which they e-mail a topical question  to a bunch of people around the world, aiming to elicit rapid fire answers. A couple of weeks ago they asked, “Who is the most innovative thinker on Canada’s place in the world today?”  I have relatively strong views on this topic, so re-post my original answer here:Watch Full Movie Online Streaming Online and Download

“I’ll answer in three parts. First, there are so many dimensions to Canada’s place in the world that I can’t pick a single most innovative thinker. Second, it is easy to think of many people providing leadership thinking on key elements of the equation – people like Mark Carney on the management of the global financial system; Elissa Goldberg on the practice of global diplomacy; Jim Balsillie on the business and economics of global sustainability; Chrystia Freeland on the rising tensions between global and local communities; Naheed Nenshi on the role of Canadian cities in global society; Bruce Jones on the role of multilateral institutions in fragile states viagra pfizer 25 mg. But the third part of my answer is a more sober critique. We need much more active public thought leadership on Canada’s role in the world – starting from the vantage point of the world’s interests rather than Canada’s interests. Too much of Canada’s foreign policy thinking has been anchored in an implicit premise of adjusting from what the country has been doing until now, instead of focusing on what the world needs Canada to do moving forward. Public opinion surveys consistently show that Canadians want to contribute to global problem-solving. Canadian thought leaders need to spend more time hashing out what that should look like.” (April 22, 2012)

Is Canada Doing “Its Part and More”?

[This post originally appeared on May 24, 2009 at globalbrief.ca]

This week Canadian Development Minister Beverley Oda made a policy speech outlining Canada’s renewed emphasis on improving the quality of its foreign aid dollars. A focus on efficacy is commendable and important, since taxpayer dollars should of course be subject to strict scrutiny in advancing key development objectives in the poorest countries, particularly the Millennium Development Goals. But an emphasis on quality cannot be presented as a false choice against quantity, since that would distract from many urgent development challenges that need time-sensitive global leadership.

Perhaps most prominently, the rich countries as a group are roughly $35 billion behind on the support they promised for Africa by 2010. Canada is certainly not the worst performer in this regard, since it is generally adhering to its commitment to double aid to Africa, notwithstanding a downward recalculation of the baseline reference numbers. Importantly, the government outlook has been non-partisan on this issue: both Conservatives and Liberals have relied on the talking point that Canada should be praised for maintaining its commitments. As Minister Oda said this week, “Canada has certainly done its part and more” in terms of aid flows.

But what does it mean to do one’s part and more? Amidst the most profound global economic crisis in three generations, is it adequate to rely on commitments from the beginning of the decade as the reference point for the global urgencies of 2009 and 2010? The World Bank recently estimated that this year an additional 55 to 90 million people will be trapped in $1 a day extreme poverty due to the recession, and that the number of chronically hungry will surpass a billion people. At a time like this, when the Global Fund to Fight AIDS, TB, and Malaria is struggling to replenish its budgets and a large number of African countries cannot get funding to help their small farmers access fertilizer, what responsibilities do the most privileged countries like Canada have?film I Am Heath Ledger 2017 online

The real story is that Canada’s commitments are very modest compared to the size of the global problems in disease control, food production, infrastructure, and education that need to be solved. In 2008 Canada allocated 0.32 percent of its national income to foreign assistance, compared to the mean rich country effort of 0.47 percent. This is also well below the amount of support required to achieve the Millennium Development Goals (MDGs) in the poorest countries, which my colleagues and I in the UN Millennium Project estimated at 0.54 percent of national income after a rigorous multi-year study. Simply put, Canada is not yet doing its part even for the MDGs.

Today Canada ranks 16th out of 22 rich countries in its support levels, well behind comparable economies such as the United Kingdom (0.42 percent and rising), the Netherlands (0.80 percent) and Sweden (0.98 percent). The only countries to allocate a smaller share of their prosperity than in Canada last year were Greece (0.20 percent), Italy (0.20), Japan (0.18), New Zealand (0.30), Portugal (0.27) and the United States (0.18).

Even more striking, the OECD projects that Canada will fall even further down the rankings by 2010, the year when it will be the center of global attention as host to both an Olympic Games and a G8 Summit. According to the official statisticians, Canada is projected to rank 20th out of 22 rich countries in terms of its share of income allocated to foreign assistance in 2010. The detailed table is available at http://www.oecd.org/dataoecd/47/56/42458719.pdf. In the absence of new commitments through to 2015, it is difficult to see how Canada could convene the global agenda from a position of extraordinary strength next year.

In my own read, this trajectory is out of step with the underlying preferences of the Canadian public, who overwhelmingly want to play a leadership rather than followership role for the world on global systems and support for the most disadvantaged. I suspect that most of my fellow Canadians, when considering the statistics above, would think that Canada still has much more to do.

** As a footnote, the Minister’s speech (available at http://www.acdi-cida.gc.ca/CIDAWEB/acdicida.nsf/En/NAT-5208469-GYW) included a significant error in citing an alleged failure to get anti-malaria bednets to poor people. In the past this critique was directed at malaria Panik programs at a time when nets were typically sold rather than distributed, and before free mass distribution programs took hold as official global policy. The reality is that over the past three years foreign aid-financed global programs have helped to distributed more than 150 million nets in Africa alone, halfway to the target of universal coverage across the continent by the end of 2010.