Ministerial Roundtable on the Muskoka Initiative - Summary Report

November 1-2, 2010; Ottawa, Ontario


Introduction

Minister Oda opened the roundtable by thanking participants for their support and advice, calling Canada's G8 priority of maternal, newborn and child health (MNCH) a collective effort. The Minister noted that Canada has been recognized by the United Nations Secretary-General for its leadership on the Muskoka Initiative, and that she was pleased that Canada was a major contributor to the Secretary-General's Global Strategy for Women's and Children's Health.

The Minister provided details of how CIDA will profile its $1.1 billion contribution to the Muskoka Initiative, highlighting the three paths of strengthening health systems, improving nutrition, and reducing the burden of diseases and illnesses affecting mothers and children. Supporting country partners in providing comprehensive and integrated maternal, newborn and child health services to mothers and children at the local level will be a focus of CIDA's efforts.

Minister Oda noted that Canada benefits greatly from the active partnership and engagement of Canadian organizations and experts and that she would be looking to continue this collaboration. This roundtable meeting, she explained, was an opportunity to discuss some of the challenging issues related to MNCH service delivery, but also to consider how this group might continue to advise CIDA in the coming years.

The roundtable meeting featured three thematic sessions that were aligned with CIDA's Muskoka Initiative paths (strengthening health systems, improving nutrition, and reducing the burden of diseases and illnesses), a discussion about mutual accountability, and a conversation about next steps.


1. Comprehensive and Integrated Approaches to Strengthening Health Systems

Question 1: How can we work together to best support our country partners in achieving the ultimate goal of comprehensive and integrated maternal and child health services at the community level?

Question 2: What concrete steps should Canada take to increase coordination and harmonization at the partner country level?

Question 3: How do we operationalize this approach in-country at the local level?

Participants stressed the need to work through national plans and strategies, as well as involving communities in developing culturally relevant solutions, as ways of ensuring that Canada's investments are sustainable. The integration of health services - as well as the consideration of health-related determinants and health promotion activities - was also noted as a critical contributor to successful programming efforts, as was the fundamental role that health workers play in providing these integrated services. It was acknowledged that the majority of maternal and child deaths continue to occur at a community-level, but the specific role of community health workers in providing MNCH services is an issue that will differ from country to country.

The need for improved data related to MNCH was highlighted as a critical element in the strengthening of health systems; along with calls to consider how best to use emerging technologies in collecting information about vital events such as pregnancies, births and deaths. This presents an opportunity to engage the private sector, both in Canada and in partner countries. Participants emphasized the unique strengths that Canadians have in supporting the integration of health services, but that better advantage must be taken of the expertise that exists.


2. Accountability - Measuring Results and Impact

Question 1: How will we demonstrate, five years from now, what the Muskoka Initiative accomplished?

Question 2: How do we ensure that MNCH investments are producing sustainable results on the ground?

Question 3: What measures, informed by best science, should we use as our common baseline?

Question 4: How do we ensure that health practitioners are part of these discussions at partner country level?

Participants agreed that the availability of timely, accurate health information for every woman, newborn and child was a critical first step, supported by the establishment of clear definitions, indicators and targets. It was emphasized that a range of output and outcome indicators should be tracked to measure both the effectiveness and impact of CIDA's programming; particularly since significant reductions in maternal, newborn and child mortality represent a longer-term challenge.

In addition to tracking financial commitments, participants stressed the need for all partners to demonstrate their own accountability through tools such as codes of conduct, voluntary reporting, and standards setting.


3. Improving Nutrition

Question: How can Canada build on its strong history of innovation and support for nutrition to support the integration of nutrition programming into national health systems?

Participants fully supported efforts to integrate nutrition programming into health delivery platforms and systems, calling on CIDA to "push nutrition" in all of its thematic priorities. As a specific example, participants highlighted "child health days" as an opportunity to integrate nutrition and health interventions and education into the delivery of routine health services. Participants also stressed the need to consider related determinants of maternal and child nutrition, including those related to gender equality, water and sanitation, HIV/AIDS and economic growth.

The need to ensure that nutrition is part of a common basket of interventions for MNCH was emphasized by participants. It was also suggested that Canada prioritize indicators that are easy to measure and collect, such as birth weight and weight for age

Finally, it was recommended that Canada could take a leadership role in supporting developing country partners in developing multi-sectoral nutrition strategies and in better integrating nutrition into national plans, priorities and systems.


4. Reducing the Burden of Disease

Question: What steps can Canada take to incent vertical approaches to reducing the burden of leading killers, such as pneumonia, diarrhoea and malaria, to align better with comprehensive and integrated health services at the community level?

Participants recognized the benefits of aligning Canadian support across channels (bilateral, multilateral and NGOs) to support national health strategies, emphasizing that a health systems approach to health care, disease, and illness reduction requires multi-sectoral solutions at both the national and community levels. Participants emphasized that while bottlenecks in service delivery are often system bottlenecks, they are sometimes social, cultural or policy bottlenecks. Additionally, the participants stressed that both morbidity and mortality be included when examining the burden of disease.

Participants also encouraged CIDA to support partner governments in better integrating the work of disease-specific approaches within national health systems, while using its influence to incent the integration of global health initiatives at country level. As one participant noted, "Funding can be the tail that wags the integration dog".

Participants strongly supported a universal basket of interventions to equip front-line workers with key tools, equipment, and medicines. They favoured a practical approach that meets the essential needs of mothers and children without over-burdening local communities and health workers.


5. Next Steps - Canada's Contribution to MNCH

Question 1: As Canadian stakeholders, what commitment are you ready to make to align to national health plans and to avoid parallel systems?

Question 2: What practices exist to strengthen Canadian and global partnerships in support of MNCH?

Participants encouraged the development of country teams to structure MNCH work and future collaboration, including a mapping exercise to identify current engagement and programming, as well as the information management capacity of national governments. Participants saw merit in contributing to a collaborative plan, led by the country itself and complemented by the establishment of a measurement group to ensure monitoring and evaluation.

Participants welcomed the proposal to establish a Canadian version of the global Partnership for Maternal, Newborn, and Child Health (PMNCH) to structure future collaboration and information sharing between roundtable participants and CIDA. Dr. Dorothy Shaw (Canadian Spokesperson; PMNCH) and Rosemary McCarney (Plan Canada) agreed to coordinate the establishment of this network. Participants encouraged each other to use their respective networks to build on the maternal, newborn and child health constituency, and to engage more Canadians and parliamentarians. Additionally, it was urged that memberships at various international organizations be utilized to maintain momentum on maternal, newborn and child health.


Summary of Key Comments and Recommendations

• There was confirmation that, while there are many implementation challenges, Canada is focussing on the right areas.
• Emphasis must be given, through national and local leadership and grassroots engagement, to ensuring that programming reflects country and community needs.
• Integration of health services - particularly at the community level - is critical to sustainably reducing maternal, newborn and child morbidity and mortality.
• Health workers, across the spectrum, will play a critical role, requiring training, strategies for their retention, and improved integration into the health system.
• Our shared success will be determined by results on the ground, for which we must be collectively accountable.
• Data collection should focus on a common set of indicators, and expand based on the country's and community's ability to collect and monitor data.
• Technology provides us opportunities to better measure our progress, in terms of both impact and effectiveness, and is an opportunity to engage the private sector in our work.
• Knowledge translation and learning need to be embedded in the design and delivery of our programming. An important legacy of this initiative will be in building the evidence base for continued successful programming.
• Solution to reduce the burden of disease and improve nutrition must be multi-sectoral and be better integrated into national systems and plans.
• Canada needs to leverage its funding relationships to incent integration. Through their networks, Canadians are also well-positioned to assist partner governments in providing integrated health services. Domestically, creation of a Canadian PMNCH could help strengthen the constituency on maternal, newborn and child health.

Annex A: List of participants

Ms. Gisela Becker, President, Canadian Association of Midwives
Dr. Jennifer Brenner, Alberta Children's Hospital
Dr. Flavia Bustreo, World Health Organization
Dr. Jean Chamberlain, Save the Mothers International
Dr. Jan Christilaw, BC Women's Hospital & Health Centre
Ms. Marie Adèle Davis, Canadian Paediatric Society
Ms. Chris Dendys, RESULTS Canada
Dr. Mark Fryars, Micronutrient Initiative
Ms. Debbie Grisdale, Canadian Nurses Association
Dr. Lori Hanson, University of Saskatchewan
Dr. JoAnn Harrold, Children's Hospital of Eastern Ontario
Dr. Jody Heymann, Institute for Health and Social Policy (McGill University)
Dr. André Lalonde, Society of Obstetricians and Gynaecologists of Canada
Dr. John LeBlanc, Dalhousie University / IWK Health Centre
Dr. Kellie Leitch, Hospital for Sick Children (SickKids)
Ms. Bridget Lynch, International Confederation of Midwives
Dr. Heather MacDonnell, Children's Hospital of Eastern Ontario
Ms. Rosemary McCarney, Plan International Canada
Mr. Kevin McCort, CARE Canada
Ms. Kimberly Moran, UNICEF Canada
Dr. Vic Neufeld, Canadian Coalition for Global Health Research
Dr. Reg Sauve, University of Calgary
Ms. Claudia Schauer, Save the Children Canada
Dr. Dorothy Shaw, PMNCH / University of British Columbia
Dr. Anne Snowdon, University of Windsor
Ms. Elly Vandenberg, World Vision Canada
Dr. Peter von Dadelszen, BC Women's Hospital & Health Centre
Dr. Mark Walker, Ottawa Hospital Research Institute
Dr. Robin Walker, IWK Health Centre (Halifax)
Dr. Alvin Zipursky, Hospital for Sick Children (SickKids)

Canadian International Development Agency

The Honourable Beverley J. Oda, Minister of International Cooperation
Ms. Jessica Oliver, Policy Advisor, Minister's Office
Ms. Margaret Biggs, President