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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5 Key Dimensions of Massively Open University Education

By: John McArthur

Nov 27th 2013

Education worldwide is undergoing a profound shift in emphasis from teaching to learning. Much of this is linked to the rise of massive open online courses (MOOCs), which are generating both excitement and concern around the role of digital technology. After several years of false starts, universities like MIT, Harvard and Stanford have cracked early elements of a broader code to success. Enterprises like Coursera, EdX and Udacity are partnering with these and many other universities to launch classes connecting faculty and students around the world.

The success stories are inspiring. Last year more than 150,000 people signed up for MIT’s first MOOC on “circuits and electronics,” in which a teenage boy from Mongolia achieved a perfect score. Coursera now has nearly 5 million students taking 400 courses in seven languages. Meanwhile Michael Sandel’s online Harvard ethics class is so popular that he has achieved celebrity status in countries like China and Korea, thousands of miles away from his Massachusetts lecture hall.

The backdrop is a university delivery formula that had changed little over several centuries. I call it the “One to N” experience, meaning one teacher in a room, standing in front of some N number of students. Historically, a small N has been preferred for its richer presumed student-teacher interaction, although this is subject to luck regarding the quality of the relevant professor. Today the formula has been flipped. MOOC efforts focus on both growing the N and limiting the role of luck. The core idea is that any number of people, even millions at a time, should be able to take a course with the best professors in the world.

The natural worry is that large-N courses become too mechanized, sacrificing quality for quantity. World class lectures might help students in the first instance, but if a million people take the same class then only a tiny fraction get the chance to interact with the professor. What are the broader social learning consequences if a million students “go to school” together via an equal number of disparate video screens scattered around the world? And how can the institutions without superstar professors survive?

These are legitimate concerns, but they misframe both the problem and the opportunity. When I was on the faculty of Columbia University’s School of International and Public Affairs, I coordinated an experimental “global classroom” that leveraged low-cost online technology to connect faculty and students in a unified course spanning a dozen universities across Asia, Africa, Europe and the Americas. The experience prompted me to identify and discard my own “One to N” presumptions. It also led me to recognize and unbundle at least five distinct learning products that modern university learning systems need to provide, each with its own formula of providers and participants.

Photo: A teenage boy from Mongolia achieved a perfect score in MIT's first massive open online course on circuits and electronics, writes John McArthur, highlighting the huge potential of online learning. What are the consequences of taking lectures out of the classroom and onto the world wide web?  http://forumblog.org/2013/11/five-key-rules-for-open-access-online-education/  Photo: Reuters/Claro Cortes

Photo: Reuters/Claro Cortes


Product 1 is Motivation. This is the winner-take-all realm of the superstar professors and lends itself to “One to Large-N” experiences. Students feel tremendous inspiration by being able to access live lectures given by world leaders in any particular field. For example, someone studying globalization and inequality wants to hear what Nobel economists like Amartya Sen and Joseph Stiglitz have to say. In a class on genetics, students will likely want to listen to legendary MIT professor Eric Lander, pioneer behind the Human Genome Project. Even if only a few of the massive-N audience are able to ask live questions, being part of an interactive classroom with a world leader can prompt a sense of accessibility and motivation for further study of which previous generations could only dream.Watch movie online The Transporter Refueled (2015)

Product 2 is Explanation. The most famous researchers and professors are not necessarily the best explainers of material. People like Salman Khan of Khan Academy and Hans Rosling of Gapminder have developed enormous global followings by pioneering innovative ways of explaining topics through online videos. Equally importantly, there is no single best method of explanation for any topic, since students have so many different learning styles. Hence this is also a One to Large-N product, but the One might differ for each student in each subject. As the global library of online explanations grows, students will have even more opportunities to find the best One for them.

Product 3 is Tutorship. This is where the N gets small again. Even with access to the world’s most inspiring and lucid instructors, students still need the opportunity to ask questions, feel directly engaged and explore certain topics in more detail with a professor who has mastered the material. MOOCs do not kill the local classroom; they only focus its role. The local lecturers’ monopoly on content provision is over, but their role in enhancing learning is more targeted and open to be enhanced.

Product 4 is Interaction. Students need a chance to discuss concepts among themselves. This seems to grow in importance as they mature and acquire greater autonomy and skepticism towards authority figures, including through professional experience. A relevant generational shift might also be underway for youth who have grown up with the world’s information at their digital fingertips. This learning is “N to N” among students themselves. The scale of the group depends on the means of interaction. In-person groups are scaled to local class size. Online interactions can be as vast as any platform allows.

Product 5 is Feedback. Most people appreciate objective comments when framed in the right tone. And learning outcomes need to be assessed, so that students can understand their own progress and how to improve. Traditionally this has come down to grading, where N was constrained by an individual instructor’s available time. Technology is fast improving in this realm, with new machine-reading technologies even marking essays. It is unclear how far automated grading can go, but the odds are that it will soon cover a larger N with higher quality than most of us currently imagine. One potential implication is that local professors will shift time allocations from ex-post evaluation towards ex-ante coaching. Instead of “how did you do yesterday?” the question becomes “how can you do better tomorrow?”

These five products might well be universal. Nonetheless, one must be cautious in predicting trends in a realm subject to such profound innovation. The changes may reshape many universities’ core business models. But the key point is that this suggests the death of neither the university nor of the classroom. Instead it should be seen as a source for targeted renewal. As the ancient overarching One to N model is unbundled, professors and institutions can refine their products to compete on the areas where their relative offerings are best. Some schools might face a hard time keeping pace with the need for change. But in the end, where things go well, the outcome should be dramatically improved opportunities for those who matter most: the students of generations to come.

Author: John McArthur is a Visiting Fellow at the Brookings Institution and Senior Fellow at the UN Foundation. He chairs the Global Agenda Council on Poverty and Sustainable Development and is a Young Global Leader. Follow him on twitter @mcarthur

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.

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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)

An International Credit Facility for African Smallholder Staple Farmers

Early last year I wrote a 3-page concept note proposing “An International Credit Facility to Support Commercialization of African Smallholder Staple Crop Farmers”  This would be a mechanism to tackle the “missing rural middle” of African farmer finance.

It would target staple crop farmers, rather than cash crop farmers, who typically have much greater access to capital, for many reasons.  (It is also the same mechanism cited in a recent blog post for Rio+20.)

The basic idea is as follows:

A systematic financing mechanism is needed to address the “missing middle” of rural Africa, whereby smallholder farmers can coordinate to access “patient capital” loans of perhaps $25,000-$100,000 at a time. This mechanism should be focused on making capital available in the context of a broader ecosystem of business support and agricultural extension services that help farmers identify market opportunities based on agronomic comparative advantage, then develop business plans, introduce new farming techniques, and implement successful marketing programs. Importantly, the complementary services are not a substitute for the patient capital itself. The financing facility would focus on neither pure public subsidy nor pure private capital. Instead it would focus on covering the risk-adjustment component of private loans.

The cost would be roughly $5 billion per year of public finance to leverage roughly $25 billion per year of private capital.

I wrote this as an input to a working group that was chaired by Mthuli Ncube, chief economist of the African Development Bank, and which included people like Nancy Birdsall of CGD.  Everyone in the group seemed to support the idea, but in the busy-ness of life we didn’t have a chance to spend more time on it.  As a minimum step I thought it worth posting the note online here.