Canada's G8 health plan receives praise and criticismстатья из журнала
Аннотация: G8 nations backed Canada's plan to improve maternal health in developing countries last week despite the country's refusal to fund groups that do safe abortions. Paul C Webster reports.Three months after Canadian Prime Minister Stephen Harper pledged to push the G8 club of rich nations to support maternal health in poor nations, the plan is taking shape.At a late April meeting of G8 international aid ministers in Halifax, Nova Scotia, the Canadian Government outlined a strategy for next June's G8 Summit in Muskoka, ON, that at once pleases and appals many global health researchers and programme leaders.By pushing the G8 for a wide focus on both child and maternal health involving a major new framework for nutrition and several integrated health interventions, Harper's Conservative Government has won praise. But by promising the government's largely rural, evangelical Christian powerbase that Canada will no longer support abortion in its international health efforts, it triggered a storm of anger across a largely urban and secular country where elective abortion has been a routinely available procedure for decades.In recent years, the G8 nations have made substantial commitments at their yearly summits to humanitarian programmes including last year's CAN$20 billion commitment to international food security. As host of the upcoming G8 Summit, Canada has the opportunity to set the G8's humanitarian agenda this year. Harper's Conservative Government will focus on tackling easily preventable maternal and child deaths, which are estimated to kill around 350 000 mothers and 9 million children per year.But as Canadian efforts to help delineate the G8's approach to these long-overlooked global health crises got underway in Halifax, the Canadian Government's strategy of focusing on a list of evidence-backed health interventions—including family planning—while beginning to deny access to abortion through its international health programmes proved explosive. Although the G8 ministers attending the Halifax meetings refused to openly acknowledge a rift with their host, Canadian politicians and global health experts immediately condemned Harper's strategy.Charles Larson, director of the Centre for International Child Health at the British Columbia Children's Hospital, Vancouver, reacted with strong criticism. “If you are looking at evidence-based public health practice you cannot ignore the impact of unwanted pregnancies and abortions. Access to safe abortions is an important part of good maternal health practice. If you are going to pursue a policy of denying safe abortion there is no doubt about it, you will increase maternal mortality.”Larson also noted that the new Canadian policy on abortion represents a major setback in light of the growing understanding of rape in women's reproductive health research in Africa. “As many as 50%of women in many areas [of East Africa] may have experienced rape as we define it in the west”, he said. “It's a huge issue.”Ron Labonte, Canada Research Chair in Globalization and Health Equity at the University of Ottawa, in Ottawa, Ontario, also rejected the Canadian decision. “The nod to family planning is ironic in light of Canada's adoption of the discredited Bush-era gag rule on funding services that counsel abortion”, he said. “Perhaps we should fly women in developing countries requiring this service to Canada, where it is not only permissible but also publicly financed?”But while decrying Canada's abortion policy, Larson said that Canada has selected a “comprehensive list” of health-care interventions to promote within the G8 “that will make a lot of people happy”. That list, according to Canada's International Development Minister, Bev Oda, includes a wide range of interventions across “the continuum of care for both mothers and children, including training and support for frontline health workers; better nutrition and provision of micronutrients; treatment and prevention of diseases such as pneumonia, diarrhoea, malaria, and sepsis; screening and treatment for sexually transmitted diseases, including HIV/AIDS; proper medication; family planning; immunisation; clean water and sanitation”.Venkatesh Mannar, president of the Ottawa-based Micronutrient Initiative, which promotes usage of nutritional supplements including zinc and vitamin A, said the focus on nutrition is welcome news. Mannar is pushing Canada to lobby the G8 to support a nutrition Framework for Action based on research published in The Lancet and developed for the G8 with support from the UN, European Commission, International Conference on Nutrition, USAID, WHO, Bill & Melinda Gates Foundation, the Government of Japan, and the UK Department for International Development.“Nutrition has been a very fragmented area of global health and it has been difficult to get the global community to come together around a nutrition agenda”, says Julian Schweitzer, the World Bank's acting vice president for human development section. “We've now got everyone around the table and the hope is that Canada will champion this framework. There are huge, long-term health consequences of malnutrition. It has a multiplier effect with diseases such as AIDS, TB, malaria and other mother and child health problems.”In a summary statement following the G8 ministers' meeting in Halifax, the Canadian Government stopped short of endorsing the nutrition Framework, although the summary notes that the ministers “recognised that investments in nutrition could have a catalytic impact on making progress towards the Millennium Development Goals”.The G8 ministers have asked the UN High-Level Task Force on the Global Food Security Crisis “to identify a set of common nutrition indicators to monitor progress in the area and operational guidelines to improve nutrition”.The maternal and child health interventions listed within the Canadian G8 strategy are “appropriate foci”, says Jerome Kabakyenga, Dean of Medicine at the Mbarara University of Science and Technology in western Uganda. “The interventions are wide-ranging, and children appear to be well covered”, Kabakyenga said. “But what is rather lacking is a focus on maternal health, apart from family planning.”The lack of detail concerning maternal health also worries others. Both Christopher Murray, director of the Institute for Health Metrics and Evaluation and professor of Global Health at the University of Washington, in Seattle, WA, USA, and Jean Chamberlain, executive director of Save the Mothers, a maternal and child health education programme in Mukono, Uganda, say that emergency obstetric care should be added to the array of proposed interventions Canada will encourage the G8 to support. “Although they've mentioned all the key areas”, says Murray, “this is one that is noticeably missing”.Canadian officials say that the G8 ministers have agreed to lay “the groundwork for a new G8 Summit initiative on maternal, newborn and under-five child health and building on past G8 commitments” that will include “comprehensive, high impact and integrated interventions at the community level, in country, across the continuum of care (from pre-pregnancy, through delivery to the age of five)” including elements such as “post-partum care, family planning, which includes contraception, reproductive health; treatment and prevention of diseases; prevention of mother-to-child transmission of HIV; immunisations; and nutrition.”The G8 ministers also stressed that “action is required on other factors that can contribute to improving the health of women and children, such as access to safe drinking water and sanitation and gender equality” and “that health systems needed to be strengthened to provide integrated and comprehensive services at the local level. This would include access to primary care; equipped and resourced facilities; trained frontline health workers; and robust health information”.The G8 ministers have yet to establish how any of these ambitious goals can be reached or paid for. At the outcome of the meeting in Halifax the G8 ministers asked WHO, UNICEF, UN Population Fund, World Food Programme, and the World Bank “to develop a common set of concrete goals and associated indicators, and to develop a common methodology to determine the most effective and affordable basket of integrated interventions based on and adaptable to country-specific needs and to build in-country capacity for these assessments”.In Uganda, both Jerome Kabakyenga and Peter Waiswa of the Makerere University School of Public Health hope that the G8 will settle upon health systems strengthening above all to deliver on its aims. “The delivery system needs to be health systems approaches and strengthening and not vertical or single programmes”, says Waiswa. “Health systems in Africa remain the bottleneck.” In Canada, Ron Labonte and Charles Larson also agree that Canadian leadership at the G8 should make health systems strengthening the paramount goal.In the face of substantial criticism over unmet promises from G8 Summits in previous years, according to Canadian officials the G8 development ministers “emphasised that it is more important than ever to pay what they pledge on time”. They also “acknowledged that predictable, more transparent and more cost-effective development assistance is within their reach”. G8 nations backed Canada's plan to improve maternal health in developing countries last week despite the country's refusal to fund groups that do safe abortions. Paul C Webster reports. Three months after Canadian Prime Minister Stephen Harper pledged to push the G8 club of rich nations to support maternal health in poor nations, the plan is taking shape. At a late April meeting of G8 international aid ministers in Halifax, Nova Scotia, the Canadian Government outlined a strategy for next June's G8 Summit in Muskoka, ON, that at once pleases and appals many global health researchers and programme leaders. By pushing the G8 for a wide focus on both child and maternal health involving a major new framework for nutrition and several integrated health interventions, Harper's Conservative Government has won praise. But by promising the government's largely rural, evangelical Christian powerbase that Canada will no longer support abortion in its international health efforts, it triggered a storm of anger across a largely urban and secular country where elective abortion has been a routinely available procedure for decades. In recent years, the G8 nations have made substantial commitments at their yearly summits to humanitarian programmes including last year's CAN$20 billion commitment to international food security. As host of the upcoming G8 Summit, Canada has the opportunity to set the G8's humanitarian agenda this year. Harper's Conservative Government will focus on tackling easily preventable maternal and child deaths, which are estimated to kill around 350 000 mothers and 9 million children per year. But as Canadian efforts to help delineate the G8's approach to these long-overlooked global health crises got underway in Halifax, the Canadian Government's strategy of focusing on a list of evidence-backed health interventions—including family planning—while beginning to deny access to abortion through its international health programmes proved explosive. Although the G8 ministers attending the Halifax meetings refused to openly acknowledge a rift with their host, Canadian politicians and global health experts immediately condemned Harper's strategy. Charles Larson, director of the Centre for International Child Health at the British Columbia Children's Hospital, Vancouver, reacted with strong criticism. “If you are looking at evidence-based public health practice you cannot ignore the impact of unwanted pregnancies and abortions. Access to safe abortions is an important part of good maternal health practice. If you are going to pursue a policy of denying safe abortion there is no doubt about it, you will increase maternal mortality.” Larson also noted that the new Canadian policy on abortion represents a major setback in light of the growing understanding of rape in women's reproductive health research in Africa. “As many as 50%of women in many areas [of East Africa] may have experienced rape as we define it in the west”, he said. “It's a huge issue.” Ron Labonte, Canada Research Chair in Globalization and Health Equity at the University of Ottawa, in Ottawa, Ontario, also rejected the Canadian decision. “The nod to family planning is ironic in light of Canada's adoption of the discredited Bush-era gag rule on funding services that counsel abortion”, he said. “Perhaps we should fly women in developing countries requiring this service to Canada, where it is not only permissible but also publicly financed?” But while decrying Canada's abortion policy, Larson said that Canada has selected a “comprehensive list” of health-care interventions to promote within the G8 “that will make a lot of people happy”. That list, according to Canada's International Development Minister, Bev Oda, includes a wide range of interventions across “the continuum of care for both mothers and children, including training and support for frontline health workers; better nutrition and provision of micronutrients; treatment and prevention of diseases such as pneumonia, diarrhoea, malaria, and sepsis; screening and treatment for sexually transmitted diseases, including HIV/AIDS; proper medication; family planning; immunisation; clean water and sanitation”. Venkatesh Mannar, president of the Ottawa-based Micronutrient Initiative, which promotes usage of nutritional supplements including zinc and vitamin A, said the focus on nutrition is welcome news. Mannar is pushing Canada to lobby the G8 to support a nutrition Framework for Action based on research published in The Lancet and developed for the G8 with support from the UN, European Commission, International Conference on Nutrition, USAID, WHO, Bill & Melinda Gates Foundation, the Government of Japan, and the UK Department for International Development. “Nutrition has been a very fragmented area of global health and it has been difficult to get the global community to come together around a nutrition agenda”, says Julian Schweitzer, the World Bank's acting vice president for human development section. “We've now got everyone around the table and the hope is that Canada will champion this framework. There are huge, long-term health consequences of malnutrition. It has a multiplier effect with diseases such as AIDS, TB, malaria and other mother and child health problems.” In a summary statement following the G8 ministers' meeting in Halifax, the Canadian Government stopped short of endorsing the nutrition Framework, although the summary notes that the ministers “recognised that investments in nutrition could have a catalytic impact on making progress towards the Millennium Development Goals”. The G8 ministers have asked the UN High-Level Task Force on the Global Food Security Crisis “to identify a set of common nutrition indicators to monitor progress in the area and operational guidelines to improve nutrition”. The maternal and child health interventions listed within the Canadian G8 strategy are “appropriate foci”, says Jerome Kabakyenga, Dean of Medicine at the Mbarara University of Science and Technology in western Uganda. “The interventions are wide-ranging, and children appear to be well covered”, Kabakyenga said. “But what is rather lacking is a focus on maternal health, apart from family planning.” The lack of detail concerning maternal health also worries others. Both Christopher Murray, director of the Institute for Health Metrics and Evaluation and professor of Global Health at the University of Washington, in Seattle, WA, USA, and Jean Chamberlain, executive director of Save the Mothers, a maternal and child health education programme in Mukono, Uganda, say that emergency obstetric care should be added to the array of proposed interventions Canada will encourage the G8 to support. “Although they've mentioned all the key areas”, says Murray, “this is one that is noticeably missing”. Canadian officials say that the G8 ministers have agreed to lay “the groundwork for a new G8 Summit initiative on maternal, newborn and under-five child health and building on past G8 commitments” that will include “comprehensive, high impact and integrated interventions at the community level, in country, across the continuum of care (from pre-pregnancy, through delivery to the age of five)” including elements such as “post-partum care, family planning, which includes contraception, reproductive health; treatment and prevention of diseases; prevention of mother-to-child transmission of HIV; immunisations; and nutrition.” The G8 ministers also stressed that “action is required on other factors that can contribute to improving the health of women and children, such as access to safe drinking water and sanitation and gender equality” and “that health systems needed to be strengthened to provide integrated and comprehensive services at the local level. This would include access to primary care; equipped and resourced facilities; trained frontline health workers; and robust health information”. The G8 ministers have yet to establish how any of these ambitious goals can be reached or paid for. At the outcome of the meeting in Halifax the G8 ministers asked WHO, UNICEF, UN Population Fund, World Food Programme, and the World Bank “to develop a common set of concrete goals and associated indicators, and to develop a common methodology to determine the most effective and affordable basket of integrated interventions based on and adaptable to country-specific needs and to build in-country capacity for these assessments”. In Uganda, both Jerome Kabakyenga and Peter Waiswa of the Makerere University School of Public Health hope that the G8 will settle upon health systems strengthening above all to deliver on its aims. “The delivery system needs to be health systems approaches and strengthening and not vertical or single programmes”, says Waiswa. “Health systems in Africa remain the bottleneck.” In Canada, Ron Labonte and Charles Larson also agree that Canadian leadership at the G8 should make health systems strengthening the paramount goal. In the face of substantial criticism over unmet promises from G8 Summits in previous years, according to Canadian officials the G8 development ministers “emphasised that it is more important than ever to pay what they pledge on time”. They also “acknowledged that predictable, more transparent and more cost-effective development assistance is within their reach”. Canada's G8 health leadershipAs a World Report in The Lancet today shows, Canada's pledge, as host of this year's G8 Summit, to make maternal and child health one of its key issues is moving forward. At a meeting in Halifax, Nova Scotia (April 27–28), the G8 development ministers agreed to back Canada's provisional set of principles to improve the health of women and children in developing nations. Full-Text PDF
Год издания: 2010
Авторы: Paul Webster
Источник: The Lancet
Ключевые слова: Child and Adolescent Health, Primary Care and Health Outcomes, Global Public Health Policies and Epidemiology
Другие ссылки: The Lancet (HTML)
PubMed (HTML)
PubMed (HTML)
Открытый доступ: closed
Том: 375
Выпуск: 9726
Страницы: 1595–1596