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Strengthening African health systems — a Canadian agenda for action

On Nov 7,2005, Canadian Minister of International Cooperation, Aileen Carroll, spoke at the 12th Canadian Conference on International Health, hosted by CSIH in Ottawa. Her remarks follow.

Minister Carroll announces that Canada will contribute $12 million to strengthen health systems in Africa.

Thank you for your kind introduction, Janet. Good morning, everyone. I am delighted to be meeting with you today. For those of you here from outside of Canada, let me welcome you to Ottawa.

I would like to begin by applauding the work of the Canadian Society for International Health. CSIH is one of CIDA's trusted partners, and has active projects around the world. Just the other day, we confirmed that CSIH will be implementing CIDA's small grants program which brings together Canadian and developing country civil society groups that are working to fight the AIDS pandemic.

What brings all of us here today is an interest in global health. In some ways, this is an incongruous setting for this discussion. Canada is home to a relatively healthy population with access to one of the world's best health care systems.

The health challenges facing much of humanity might seem a little abstract sitting in a hotel meeting room in Ottawa. Here in Canada, children are routinely immunized. Nutritious food is readily available. When you fall ill there are excellent hospitals close by.

In much of the world, these are luxuries. For too many people, the nearest clinic is a day's walk away, and once there, treatment could cost a month's wages or more.

Every day, Sub-Saharan Africa loses thirteenthousand children underfive, largely to preventable diseases. This accounts for nearly half of the 10.4 million annual child deaths in the developing world ( over 28 000 per day ). This is a moral affront to us all. It is simply unconscionable that so many children are dying so needlessly.

We must increase our efforts to stop such senseless death, particularly in Africa. The continent faces one quarter of the global disease burden with only 1.3 percent of the world's health human resources.

I am pleased to tell you that Canada is acting.

Two months ago, I announced CIDA's agenda for action on health in developing countries.

Our goal is simple: to help save the lives of hundreds of thousands of people, mostly women and children, mostly in Africa.

Our agenda is two pronged.

First, we are stepping up efforts to prevent and control core poverty-related diseases. This means being able to provide basic health promotion and illness prevention services to more communities. It means providing more bednets to fight malaria and antiretrovirals to people suffering from AIDS. It means ensuring safe pregnancy and childbirth and access to emergency obstetric services whenever required. And it also means supporting efforts to vaccinate children against preventable illness.

Second, we are working with our developing country partners to build sustainable health systems. That means a sharp focus on strengthening human resources, and support for health-sector governance, better health information for decision-making, and strategies for sustainable financing of national and local health delivery systems.

The two components of this strategy are mutually reinforcing. Preventing and controlling disease takes the burden off health systems, and building up health systems helps to stop the spread of poverty-related diseases.

Canada wants to help developing countries achieve lasting health outcomes.

That means responding to the priorities identified by African countries in their poverty reduction and national health strategies consistent with our International Policy Statement. That means joining forces with other donors and multilateral institutions to harmonize our efforts.

Simply put : developing country governments must take concerted steps to build up their health-care systems. Many are doing just that. And many donors — including Canada — are supporting their efforts.

Today, I am pleased to announce further details of the Agenda for Action on Global Health, in the form of two exemplary initiatives totalling 12 million dollars.

The first initiative expands on a Canadian project that has been instrumental in supporting Tanzania's efforts to improve its health system and reduce mortality.

You may have read the Fixing Health Systemsstudy that was released last year at this conference or attended Don de Savigny's presentation yesterday afternoon about the IDRC-led Tanzania Essential Health Interventions Project.

Piloted in two districts, this project saw a forty-percent decrease in deaths of children under five and an eighteen-percent reduction in adult mortality.

How did this happen ? By effectively addressing the pressing problems of health service delivery with only a small budget increase. After determining which diseases were most prevalent in the two rural districts, the health budget was directed where the heaviest burden fell. Local health workers used a simple algorithm that showed how to treat common symptoms. Drugs were ordered according to need.

The Government of Tanzania is now launching a Zonal Rollout of this approach. This rollout, which we have been calling ZoRo around the office, is happening because the Tanzanian government recognized that the pilot project made it possible to stop a lot of people from dying with just a tiny injection of cash.

Last June, Tanzania allocated resources in its national budget to take this pilot project's successful approach and use it across the country. Canadian-funded research played an instrumental role in designing and testing these innovative health interventions. And we want to deepen what Tanzania's Minister of Health has described as " an exciting collaboration " between his country and Canada. Which is why we are joining other donors to help the nationwide rollout happen more quickly.

Today, I am announcing a $ 7 million contribution that will help Tanzania use its countrywide network of Zonal Training Centres to apply the lessons learned from the highly successful essential health interventions project to incorporate burden-based budgeting and mapping skill sets and other innovative interventions into pre-service and in-service training for health workers in all 113 districts in Tanzania.

This is a country-driven effort that donors are working together to support. These are exactly the kind of results that we ought to build on.

Effectively strengthening Africa's health systems requires coordinated efforts at all levels — national, regional, and global. This brings me to my second announcement.

The World Health Organization, together with developing countries, the World Bank, UN agencies, and donor organizations — including CIDA, has developed a five-year Action Plan on human resources for health with a focus on Africa.

CIDA is contributing $ 5 million to carry out this global platform, which will support country-level action to develop and implement comprehensive health human resources plans, build regional networks for sharing information and measuring results, and promote global cooperation on critical health sector issues such as making it easier for skilled health professionals to apply their expertise in their own countries where their services are desperately needed.

As we move forward, we will continue to strengthen our health partnerships with developing countries and institutions that are showing the way. With global partners who have proven to be the most effective in achieving positive health outcomes. With Canadian organizations from all sectors that have relevant experience and know-how.

We are quickly approaching 2006, the inaugural year of the WHO-designated decade of health workers. Let us take this opportunity to get tools and knowledge into the hands of Africa's healers, and to move closer to the Millennium Development Goals.

Strengthening health systems is absolutely essential. But it is not possible without the people to run them. There are an estimated 750 000 health workers in Africa providing health services for about 680 million people. The continent needs one million more health workers now.

Africa's leaders have made strengthening health systems and human resources a clear priority. NEPAD, the New Partnership for Africa's Development, reinforces this. And Ministers of Health met recently at an African Union conference to discuss the continent's challenges.

Donors need to help. We need to commit for the long term. And we need to commit to ambitious targets.

Which is why I have put this question to the Agency: working together, what can we and our partners do to support African-led efforts to mobilize and retain 100 thousand additional trained and equipped frontline health care workers?

Meeting this challenge will not be easy. I will want to call on you and other experts in Canada to help us proactively and pragmatically deepen our engagement in this area.

Together, we can strengthen health systems, multiply human resources for health, and help lift the burden of disease from the African continent.

Thank you.