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Politics vs Delivery: the G8’s maternal health agenda

G20 countries are asking why rich nations should continue to direct the form and substance of development programmes when many health innovations now originate in the developing world.
Sara Mojtehedzadeh
1 July 2010

The Canadian government’s decision to focus the G8’s development agenda on maternal and child mortality was meant to be a political point scorer for the host nation. Instead it kicked up a storm of public controversy. At its crux was Prime Minister Stephen Harper’s refusal to fund safe abortions in the developing world - a subject upon which Harper bluntly told his House of Commons that debate was not wanted “here or elsewhere”.

As G8 negotiations unfolded, it wasn’t clear that Harper entirely meant what he said. With big promises to make and little cash to keep them, G8 countries probably weren’t complaining about the abortion smokescreen. As Patrick Watt, Development Policy Director for Save the Children UK told me, “France, Germany, Italy, Japan, and Canada have all frozen their development budgets...the reality is that the G8 summit is a political, not a delivery, moment”.

Of course, expectations for G8 summits are famous for the speed at which the curdle. At the Heiligendamm Summit, leaders made three pledges:  they committed to universal coverage of ‘prevention of mother to child transmission programmes’, agreed to universal access to paediatric HIV/AIDS treatment, and promised to ‘scale up efforts to reduce gaps in maternal and child health care’. Though progress has been made, all three goals remain unaccomplished. For example by 2008 45 percent of HIV infected women in the developing world had received some form of PMTC treatment, up from 23 percent in 2006. But that leaves over half of women unprotected; UNICEF and UNAIDS say that an additional 5.9 billion dollars is required to fully implement the programme. 

This puts the sum of money raised by the 2010 ‘Muskoka Initiative’ for maternal health into some harsh relief. G8 leaders mustered 5 billion dollars  – less than needed to accomplish just one of the promises made three years ago. New promises now on the table include preventing 1.3 million deaths of children under five and 64,000 maternal deaths, as well as providing better access to family planning (no word on whether this includes abortion). Save the Children UK estimates the money earmarked to accomplish these worthy goals is half of what is needed. To fulfil the Millennium Development Goals on child and maternal health, a further 30 billion is needed. The summit’s final communique says the Bill and Melinda Gates and UN foundations, together with some non-G8 donors such as Spain and Norway, will provide additional funding of 2.3 billion to the Muskoka initiative, but this commitment is ‘subject to their respective budgetary processes’. Given the austerity drive (particularly in the EU) these sorts of qualifications make aid workers nervous.

“I’ll believe in their commitments when I see the statistics” says Dorothy Ngoma, Executive Director of the National Organization of Nurses and Midwives of Malawi. Dorothy’s home country has the fourth highest rate of maternal mortality in the world; despite lofty promises made at the UN and G8 summits like Gleanagles and Heiligendamm, Dorothy says she has seen little progress over the past ten years. “Malawi has not even suffered war like Rwanda or Congo, but still 16 women a day die here” she tells me.

Dorothy’s frustration raises some vital questions about the suitability of the G8 as a forum for setting – and delivering- an aid agenda. As I sat in the confines of the Toronto-based media centre, the studiously orchestrated photo ops seemed the focal point of the whirlwind world leader tour. Do these summits truly inspire meaningful debate and action – or does their transient and conspicuous nature encourage picture perfect pledges that fade with the dimming limelight?

And though it remains the primary space where matters of peace, security, and development are decided, there are many who believe the G8 is a clique that may just crumple under the weight of its own irrelevance. In the weeks before the summit, I attended the Three Voices conference that brought together experts from both ‘emerged’ and emerging powers to discuss the future of the G8 and G20. Why, asked some members of the latter, should rich nations continued to direct the form and substance of development programmes when many health innovations now originate in the developing world? One of the most notable examples is ‘Kangaroo Care’, an incubation system developed in Columbia encouraging women to carry pre-term babies in slings that was so effective that it has since been adopted in the USA.

Developing states are thinking laterally about how to reach the most vulnerable segments of their population. This reality is being recognized by public health professionals like Nigel Crisp, who recently published a book on health innovation in poorer nations entitled "Turning the world upside down - the search for global health in the 21s Century". Big businesses are also investing in it - General Electric, for example, last year launched a 3 billion dollar programme to invest in low-cost health products developed in emerging economies like China and India.

The architecture of international relations has been slower to respond. So far the G20 summit’s agenda is restricted to economic issues, and countries not represented in either forum must watch from a largely ignored sideline. Until the G8 can embrace the potential of both emerging and ‘peripheral’ countries, its gallant manifestos will be buried under a more grating message: debate not wanted.

 

 

 

 

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