Global health is top priority, with a strong focus on MNCH
Canada was the fourth-largest donor to global health among members of the OECD development assistance committee (DAC) in 2015, spending US$791 million. This corresponds to 16% of Canada’s ODA, which is the second-highest share spent by any donor country on global health (after the United States), and above the average spent by DAC countries (9%). However, this is a reduction both in terms of absolute amounts (US$939 million) and share of overall ODA (22%) from 2014, mostly driven by decreases in bilateral aid, including earmarked funding to multilaterals. Gavi, the Vaccine Alliance (Gavi) for example, received US$46 million in 2014 and only US$9million in 2015. Health sub-sectors most affected by reductions in bilateral aid include: basic nutrition (21% decrease), infectious disease control (35% decrease), population policy and administration (70% decrease), and HSS (25% decrease).
Within health, Canada traditionally places a strong focus on maternal, newborn and child health (MNCH), and has shown international leadership in the past years. It spearheaded the G8 Muskoka Initiative in 2010 and pledged an additional CAD1.1 billion (US$1 billion) for MNCH for 2010 to 2015, on top of its base funding of CAD1.75 billion (US$158 billion). Ultimately, Canada well exceeded this target, spending more than CAD340 million (US$308 million) over the pledged CAD2.85 billion (US$2.6 billion) commitments. Canada has further extended its Muskoka commitment by pledging CAD3.5 billion (US$3.2 billion) for MNCH between 2015 and 2020 — this is a 25% increase over its previous pledge. In total, this includes CAD520 million (US$459 million) pledged to Gavi for 2016 to 2020 and CAD200 million (US$226 million) to the Global Financing Facility in support of Every Woman Every Child. CAD100 million of this is dedicated to civil registration and vital statistics. In September 2016, Canada hosted the fifth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in Montreal, and pledged CAD804 million (US$721 million) for 2017 to 2019, an increase of 23% in nominal CAD terms compared to the 2014-2016 pledge (CAD650 million).
Prime Minister (PM) Trudeau pledged to ensure that Canada’s focus on health and especially on MNCH “is driven by evidence and outcomes, not ideology, including by closing existing gaps in reproductive rights and health care for women”. This commitment has resulted in a stronger focus on sexual and reproductive health and rights (SRHR), including family planning. In March 2017, at the ‘She Decides’ conference in Brussels, the government announced a one-time CAD20 million contribution to five organizations that support SRHR globally: United Nations Population Fund, Ipas, International Planned Parenthood Federation Global, Marie Stopes International, and Population Services International. ‘She Decides’ is a fund established by the Netherlands to fill the gaps in financing for women’s global health programs consequent to US President Trump’s decision to reinstate and ramp up the Mexico City Policy. This policy requires that organizations certify they will not perform or promote abortion as a method of family planning even with non-US funds as a condition for receiving US global health assistance. Further, in March 2017, PM Trudeau announced an investment of CAD650 million over three years for SRHR, and that Canada will join the Family Planning 2020 commitment and Ouagadougou Partnership.
Overall, Canada provides 38% (US$298 million in 2015) of its health ODA through core contributions to multilateral organizations. Apart from the Global Fund, key recipients include the World Bank's International Development Association (IDA) and Gavi. Of the CAD520 million (US$459 million) Gavi pledge for 2016 to 2020, CAD500 million is direct funding and CAD20 million is earmarked funding for francophone African countries. Canada is a key supporter of the Global Polio Eradication Initiative (GPEI), and one of its top-five donors since 1998. In absolute terms, Canada is the third-largest donor to GPEI overall, and will have contributed US$564 million in total from 1985 to 2019.
In addition to core contributions, Canada channels almost half of its bilateral health ODA (44% in 2015) as earmarked funding through multilaterals, bringing total health ODA flows channeled through multilaterals to US$517 million, or about 65% of all health ODA.
Bilateral ODA for health stood at 62% (US$493 million) of total health ODA in 2015. This makes health the second largest sector of Canada’s total bilateral ODA, at 14%. 2015 bilateral investments to health targeted basic nutrition with US$126 million (25%), making it the second-largest DAC donor to basic nutrition after the US (for more details, see the nutrition deep dive). Other focus areas include basic health care (15%), infectious disease control (12%), health systems strengthening (HSS; 12%), and medical research (8%). These highlight Canada’s three thematic priorities within the MNCH sector – nutrition, HSS, accountability, and treatment and prevention of diseases, including infectious diseases. Within MNCH, Canada has identified 10 focus countries (see inset).
Canada’s 10 focus countries for MNCH
- Americas: Haiti
- Asia Pacific: Afghanistan, Bangladesh
- Sub-Saharan Africa: Ethiopia, Malawi, Mali, Mozambique, Nigeria, South Sudan, Tanzania
GAC’s Minister of International Development and La Francophonie leads on policy development with support from the Deputy Minister of International Development
Under the leadership of the Prime Minister (PM), Global Affairs Canada (GAC) steers development policy, including for global health. GAC is headed by the Minister of Foreign Affairs, Chrystia Freeland. With her oversight, the Minister of International Development and La Francophonie, Marie-Claude Bibeau, sets development policy within GAC.
The Deputy Minister of International Development, Peter Boehm, manages GAC’s development policy units and budget allocation. An important stakeholder, Minister Boehm is also the PM’s Sherpa to the G7 and Nuclear Security Summits. Other relevant branches to health development policy within GAC are: the Global Issues and Development Branch under Assistant Deputy Minister Sarah Fountain Smith, which manages multilateral policies and contributions; the Strategic Policy Branch, headed by Vincent Rigby (also the PM’s Sherpa to the G20 Summit); and the four geographic branches (Americas; Asia Pacific; Europe, Middle-East and Maghreb; sub-Saharan Africa) managing country programs. Within the Global Issues and Development branch, relevant units include Food Security and Environment; Health and Nutrition; International Humanitarian Assistance; and International Organizations.