Foreign Affairs Committee on June 1st, 2010

[Aynsley Morris]

We're primarily funded by CIDA. We've enjoyed strong CIDA support for almost 20 years. We also have smaller grants from our partners in the UN system and also from some private foundations. Because the Micronutrient Initiative also works to fortify food with micronutrients, at times we'll receive funding from food companies in countries to help us with our work.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

And Results Canada...?

[Christina Dendys]

We have no government funding. It's all grassroots network fundraising and a few private foundation grants.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

That's my question. I might come back in just a second.

I'll pass it over to Mr. Goldring.

[Peter Goldring, Conservative, Edmonton East, AB]

Thank you, Mr. Chair.

Thank you, ladies, for your appearance here today.

Ms. Morris, you made a comment that I found rather interesting, along with the nutrition requirements of children from “minus nine months to 24 months”. I'm assuming that's from conception straight through to birth and then to 24 months after birth. It's an interesting way of looking at it.

The comments have been made here, and I believe that it's so, but perhaps you could help me by giving me some kind of idea of what the overall benefit of this action would be, for providing nutrition, for providing maternal health care, for providing all the services that we're envisioning could come forward from this. If we were able to impact and reach everybody who would be concerned with this, what would the raw numbers be of the expectations? It has been mentioned before that one child in five dies of diarrhea. What would the impact of this intervention be, in lives saved globally, if all of this were to have an impact upon the direction the government is proceeding in?

[Aynsley Morris]

Micronutrients aren't one single intervention. In the case of diarrheal disease, there is the provision of zinc supplements, about a 10-day course of them. Every child who has diarrheal disease won't be saved, but there's about a 20% mortality reduction when a child receives zinc supplements along with oral rehydration therapy. We could significantly reduce the number of child deaths from diarrhea by using zinc in association with oral rehydration therapy. So your 1.5 million children, that's going to reduce by about 20%. There are many children who are currently being treated with oral rehydration therapy. Some live, some don't. Providing that additional zinc supplement would reduce deaths in children.

In the case of vitamin A, we have fairly good coverage. Vitamin A strengthens a child's immune system and helps a child survive illnesses such as measles. It boosts their immune systems. Most studies have shown that two doses of vitamin A per year for the first five years of life reduces the overall child mortality rate by about 20% to 25%. We have pretty good coverage of vitamin A supplementation around the world, and probably 75% of those children who are deficient in vitamin A are getting the vitamin A supplements. Actually, it's probably a bit higher than that. The children we're currently missing are those who are the hardest to reach with health services, so it's geographic. This is why the Micronutrient Initiative is putting an emphasis on the front-line trained health care workers who can actually go out. If we can reach those children with vitamin A supplementation, we can also reach them with an integrated package of services, including bed nets and things that Canada funds.

[Peter Goldring, Conservative, Edmonton East, AB]

This is a significant initiative. It sounds as though it could affect the lives of millions of children and mothers. It sounds as if it's a significant initiative on behalf of the Government of Canada. How does this compare with past initiatives? What makes this substantially different ?

[Aynsley Morris]

The Micronutrient Initiative has been in operation for about 20 years. UNICEF, when it announced its reduced child mortality rates in September 2009, stated that child mortality rates dropped from 12.5 million in 1990 to about 8.8 million now. The Lancet put out a further review saying that it was perhaps 7.2 million child deaths. UNICEF has credited vitamin A as one of the major reasons that child mortality has been reduced during the past 20 years.

[Peter Goldring, Conservative, Edmonton East, AB]

The millennium development goals are not limited to this initiative. There are initiatives for democracy development, women's rights, respect, and education. If we were able to approach all of the millennium development goals, there would be a considerable impact. Certainly, this initiative by the Government of Canada must be affecting several million people.

[Aynsley Morris]

We believe that Canada's strong support, through the Canadian taxpayers, has made a significant difference in reducing child mortality and improving maternal health. There is also a millennium development goal for universal primary education. If a child has access to proper nutrition micronutrients such as iodine and iron during its formative development, the child's cognitive development is enhanced and IQs can be increased. That's the iodized salt that you eat. Rarely do people understand why the iodine is there. It's actually for brain development in a child.

[Peter Goldring, Conservative, Edmonton East, AB]

Thank you.

[Aynsley Morris]

It goes beyond these two millennium development goals.

[The Chair, Conservative, Dean Allison]

Mr. Donnelly.

[Fin Donnelly, NDP, New Westminster—Coquitlam, BC]

Thank you, Mr. Chair.

It's good to be here, and thank you very much to all our witnesses for your passionate and very informed presentations. I very much appreciated hearing what you had to say.

I wanted to change tack a bit here and focus a little more on HIV/AIDS. By the end of 2008, women comprised half the adults living with HIV/AIDS. In sub-Saharan Africa, women and girls account for six out of every ten people living with HIV. I'm wondering if any of you or each of you could tell us what impact HIV has on maternal mortality or its implications generally for the G-8 initiative and beyond, and what role Canada has and can play in addressing this crisis.

In the last budget, the government announced it would not be increasing our overall aid budget past the 2011 fiscal year, which goes against previous commitments. I'm wondering if anyone would like to comment on that.

[Christina Dendys]

Thank you for that question, because I think it speaks to the notion of the need for new money in terms of addressing this. We can't forget that HIV is the leading killer on the planet, and we can't start shifting priorities to the point where millions are left stranded.

I think some of the studies I've seen about HIV and its impact--and I'm sure my colleagues are much more informed. The maternal mortality ratio appears to be more than six times higher in HIV-positive women than in HIV-negative women. Also, in terms of HIV having an impact on this initiative, I think there is a real area and focus of prevention of mother to child transmission of HIV which half.... I think 500,000 children die every year because of it. It's very easy to treat. It's ARV, isn't it? And it's treatment right after birth.

Not losing sight of the fact that HIV is crucial to this initiative, and way beyond it in terms of global health, but also in terms of getting at it, I think this year is important because of the G-8 initiative that's happening in June in Canada. There's also a Global Fund replenishment happening in the fall. The Global Fund is one of the biggest legacies of the G-8, born out of the G-8.

Half the people who have HIV in Africa are on ARVs. That would never have been thought possible before. Half of those are because of funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria. I think we need to recognize that along with a significant G-8 initiative, we need to ensure a robust replenishment of the Global Fund.

[Jolanta Scott-Parker]

I think the question around HIV/AIDS speaks very strongly to the need for comprehensive sexual reproductive health services as part of the initiative, and comprehensive would obviously include prevention both in the form of contraception, in terms of birth spacing, but also in terms of STI prevention, including HIV/AIDS, and then along the continuum of care, including, as my colleagues mentioned, ARVs for all those who are HIV positive. In particular, women who are pregnant, who are treated, have a much greater chance of success in terms of their childbirth, as well as access to the prevention of maternal to child transmission. It's all part of an important comprehensive and integrated approach.

[Katherine McDonald]

One of the five issues International Planned Parenthood Federation addresses is HIV/AIDS. The others are safe abortion, advocacy, access to sexual and reproductive health services, and adolescents, all of which would address in an integrated and comprehensive manner the issues you are talking about.

[Bridget Lynch]

I wanted to address some of the statistics on that. The leading cause of death, globally, among women of reproductive age is HIV. At this point, only 45% of women who are pregnant receive antiretroviral drugs to prevent mother to child transmission.

The other thing to throw into this, and it's not exactly apropos of HIV, but the leading cause of death for 15- to 19-year-olds globally is pregnancy and childbirth.

[Fin Donnelly, NDP, New Westminster—Coquitlam, BC]

Did anyone want to comment on the aid budget question in my remaining two minutes?

[Bridget Lynch]

You know, Canada has taken the lead in putting maternal and newborn health, including issues of nutrition, including issues of workforce, on the table. This is our point in time to continue to be leaders.

It's one thing to pick up a ball and hold it and start a game and play the game. It's another thing to pick up a ball and start a game and then walk away from the game. This is really important. This is Canada's opportunity to shine.

The amount of feedback from the Canadian public in terms of taking up this global initiative has been profoundly, resonatingly powerful. It has rallied this nation together. It has said that we can lead the countries of the world. We're not the biggest superpower; we never will be. We need to take a lead ideologically. We need to take a lead that was handed to us in the 1960s by Pearson. Where is our 0.07%? Scandinavian countries are doing this. This is simply a matter of choice. It's not that we can't do it; it's that we're choosing not to lead. What is that all about? The stop/start leaves us.... We're not gaining a global profile here; we're gaining a global “Oh, there's Canada putting up its hand and then taking it down again and running off, and putting its hand only halfway up.”

[Katherine McDonald]

The economic numbers came out this morning: first quarter, 6.1% productivity in Canada. We can do it. The eurozone is in big trouble. We have the money. We should change that flatlining. We should change that in the next budget and we should increase aid, not decrease aid, and we should have a significant amount of money for this maternal and child health initiative.

The Guttmacher Institute says that doubling the investment is what we need, doubling the investment is what we should be doing.

[Bridget Lynch]

If I could add just one further point, I beg just a moment.

The other piece is the innovative financing piece of this. It isn't up to Canada, necessarily, to be funding it, but we can continue in terms of pressing innovative financing. There's a fantastic proposal on the table of 0.05% on money transactions that can be picked up by the stock exchanges. The British government and the other governments are far ahead of us on this. Where is Canada in supporting this plan?

[The Chair, Conservative, Dean Allison]

Thank you very much.

We're going to start our second round for five minutes each.

I'm going to start with Mr. Lake, and then we're going to finish with Mr. Pearson.

[Mike Lake, Conservative, Edmonton—Mill Woods—Beaumont, AB]

Thank you, Mr. Chair, and thank you to the guests for coming today.

I'll start with a comment. Madame Lalonde brought up the fact that there are very few women at the committee table. I just want to stress that you don't have to be a woman to understand the issues we're talking about.

In my personal experience, I have two kids...well, my wife had two kids and I was along for the ride, and it was a bumpy ride. Both of my kids were born by emergency C-section in very difficult circumstances, more or less at the last second. Three weeks after my daughter was born, my wife wound up going into the hospital with very serious complications. She had twice her body's blood volume transfused in a 24-hour period. You can get a little bit of a grasp of how serious that was. Eventually she had to have an emergency hysterectomy, with all of the issues that followed. Thankfully, she made it through okay, but I'm always reminded that if we lived in a different country in the developing world, I wouldn't have a wife and I wouldn't have the two kids.

So when I'm looking at these numbers...I try to get beyond the numbers. I think of every one of these kids as though I'm thinking about my own and about every one of these mothers as though I'm thinking about my wife. It helps to put some perspective on it.

I ask why we, as a global community, haven't made the progress that we ought to have made on these millennium development goals. I think Mr. Pearson touched on a part of it when he talked about scattershot initiatives to try to keep everyone happy. That seems to have been an approach. There's a lot of talk, but nothing actually seems to be coming of it.

Even in this discussion that we've been having in Canada over the past few months, it seems as though many groups are focused on ideas and rights and equality. It's an important discussion for sure, but I think what the government tried to do when we came forward with this initiative was to focus on actually saving lives, bringing down those horrendous numbers, and having the most efficient and effective impact possible while, importantly, having the most support among Canadian taxpayers. I think that's an important part of the process here.

Ms. Dendys talked about funding as we move forward. If we're going to ensure long-term public support for funding moving forward, I think it's important to focus on measures that obviously have tremendous impact and are efficient, but that also have the broad support of the Canadian public. With regard to the measures we put forward as a government, the measures we've discussed, if you did a poll, probably 98% of Canadians would say, “Yes, we want to do that; that's a good idea. We need to move forward. We can't live with these numbers anymore.” As we get into the broader debate, I think we get closer to a 60-40 or 50-50 split, and I don't think that's productive. I don't think that's going to help us bring those numbers down.

Because it's important, I want to come to Ms. Dendys and talk about one of the things that impressed me about your presentation today. You actually put forward core recommendations. It looks like a game plan that seems fairly well thought out in terms of actually making an impact. Maybe you could speak to the research done by the organizations that make up your organization, in terms of the type of impact that approach will make in terms of bringing those numbers down.

[Christina Dendys]

As I said, Results Canada developed this brief with five leading development organizations in Canada. To repeat, they are Save the Children, UNICEF, CARE, World Vision, and Plan Canada. They are in the field and doing this incredible work day in and day out.

In terms of developing this proposal and this brief with our core recommendations, it's about an acknowledgement that, first of all, broadly and globally there's a belief in supporting the continuum of care, meaning the connection between home and community to health centre and hospital. We wanted to put an emphasis on that and support our colleagues globally in terms of what they've been calling for.

The emphasis on front-line community health care was really about the capacity to reach the poorest people where they live. It recognizes that the bulk of the world's poorest children and poorest mothers are far away from hospitals; they live in rural and remote communities, so we need to bring health services and dependable health care close to home.

The approach of using an integrated bundle and package of interventions, which would include micronutrients, contraception, and other interventions, was taken because there's absolutely no debate. It didn't take a lot of research. We know what works when it comes to saving children's lives and mothers' lives.

It didn't take very much, actually, on the part of our six organizations to come together on this, because for the most part these approaches are widely endorsed in terms of being a core part of the solution. That's what we came to in our analysis.