Has Canada’s MNCH initiative failed to deliver on its promises for transparency?

When Canadian Prime Minister Stephen Harper made maternal and child health a development priority for his country, committing 2.85 billion Canadian dollars ($2.5 billion) to the cause between 2010 and 2015, he assured the public that transparency would be ensured, and results delivered. “The important thing will be to show everybody results, and that we are not just a bunch of people here looking for money,” he said during the Saving Every Woman Every Child summit, held last May in Toronto. But as Canada moves on to the second phase of the Muskoka Initiative with a renewed funding of CA$3.5 billion over the next five years, whether the government has delivered on that pledge and successfully demonstrated the effectiveness of the first phase is up for debate. Measuring effectiveness Knowing where Canadian dollars went during the first round of funding has proven difficult. The government has made data sets available online regarding the first three years of Muskoka 1, including details on program recipients and the amount of funding disbursed by Department of Foreign Affairs, Trade and Development. When Aniket Bhushan, a researcher at the now-defunct North-South Institute, analyzed the files, he found the data was “fragmented” and couldn’t be easily browsed by the average visitor — the data sets are in raw .CSV formats. His analysis showed that 47 percent of the funds were channeled through multilateral partners such as U.N. agencies and the World Bank, and 16 percent went to Canadian nongovernmental organizations. About a third, accounting for CA$657 million, could not be analyzed due to a lack of data at the time. Bhushan’s analysis showed the government was on track to fulfill its financial commitments. Information available on the DFATD website regarding Canadian programming is limited to a list of projects funded by Muskoka 1, including the amount of funding disbursed for each project, as well as results achieved. Outcome reports for completed projects have not been made public due to confidentiality reasons, but it appears the vast majority of programs are still ongoing, with their target end dates scheduled between 2015 and 2018. Project evaluation seems strictly based on outcomes; there is no indication the programs have been independently evaluated for impact. “The problem is it's just the way that [the former Canadian International Development Agency] and many of these organizations have worked historically in terms of accountability; they report on results, not effectiveness,” said Janet Hatcher Roberts, a longtime international health expert and former head of the Canadian Society for International Health. The lack of basic national population statistics in impoverished countries, such as census data or birth and death registrations add to the difficulty of measuring the effectiveness of health programs. “We do struggle to use country data to support program evaluation, and more often than we’d like, we end up having to set up evaluation systems with data collection on our own to address the question of how effective our programming is,” added Helen Scott, director of the Canadian Network for Maternal, Newborn and Child Health. To help improve the quality of national statistics, the Canadian government announced last September a CA$200 million participation in the Global Financing Facility, of which CA$100 million will be dedicated to civil registration and vital statistics. The funding comes as part of Muskoka 2. Other efforts by the Canadian government to ensure transparency have yielded mitigated results. In late 2010, Canada became co-chair of the U.N. Commission on Information and Accountability for Women’s and Children’s Health, which in 2011 issued a report including 10 recommendations for donor countries working toward improving maternal, newborn and child health. For the most part, these recommendations — which included establishing vital statistics registries and developing national health information systems — were deemed “impossible to achieve by 2015” by the Commission’s independent expert review group. The COIA also came up with a list of 11 common outcome indicators to be used by donors and implementing partners to make results comparable across programs. Yet in a 2012 report, Scott wrote that only 36 percent of organizations that were part of the network were collecting them, and “only one-third of organizations reported using any outcome measures to evaluate their program`s impact.” In an interview with Devex, Scott said CANMNCH had worked to improve data collection efforts by setting up an online portal where partner organizations could log in their own data at various stages of their projects. According to Scott, the network was in discussion with DFATD to expand the use of the portal for the upcoming round of programming. The DFATD website does not include any information regarding progress toward the 11 indicators established by the Commission. Repeated requests for comment from DFATD, meanwhile, were left unanswered. Bridging the gap between research and implementation Concerns have also arisen surrounding the lack of evidence in Canadian programing. “Many of the programs are not evidence-based, using critical methodological approaches,” Roberts told Devex. “The programs that are chosen are usually chosen because they worked before. We need to work much harder at ensuring a stronger evidence base to programming in these large and important MNCH efforts.” The Muskoka Initiative sought to address the divide between research and implementation — two different worlds that rarely collide — by funding projects in both areas, and to make use of Canadian expertise by bringing the country’s researchers together with African researchers. But according to the latest calls for proposals, the government kept the two funding streams separate: on one side, grants for applied research focusing on implementation, health systems strengthening and policymaking, managed by the International Development Research Center; and on the other side, programming handled by DFATD, with few connections between the two streams, if any. Research projects funded through IDRC are nonetheless geared toward impact, and are selected based on their ability to translate into improvements brought to local health systems. “The lack of coordination is very clear in the Muskoka Initiative,” said Valéry Ridde, an international public health associate professor at Université de Montréal and a specialist of health systems in West Africa. “We’re missing the opportunity, once again, to build bridges between research and intervention.” Ridde noted that Canadian research in the field of international health has been made increasingly difficult due to reduced public funding under the Harper government. As Canadian organizations currently prepare to submit proposals for a new round of overseas programming totalling CA$370 million, it is unclear what lessons have been drawn from the past five years, and what successes have been achieved. Until now, the Muskoka Initiative has generated more questions than it can answer. 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