Saving women and children: How has Canada delivered?

Paulina Safari sits on a plastic jug under a papaya tree and listens as Issa, her local community health worker, talks to her about keeping healthy. Paulina is 22 and expecting her fourth child in five years.

Her two-year-old, Jennifer, squirms in her lap and fusses until her mother lets her go to run around the yard behind the small, squat home built of red bricks. A chicken wanders nearby.

• 2015 Travers Fellowship: Is Canada's aid working?
• Photos: Who is Canada helping?

Though she may not know exactly how Issa came to be in her yard, Safari is one of the beneficiaries of $2.85 billion in Canadian funding under the Muskoka Initiative, announced by Prime Minister Stephen Harper in 2010. The centrepiece of the Harper government's foreign aid policy was meant to press ahead on the two UN Millennium Development Goals on which the world had fared the worst: reducing maternal deaths and improving child health.

The topics Issa might cover range from breastfeeding and nutrition to the importance of family planning and why Safari should see a doctor during her pregnancy.

In the field with a Tanzanian health worker

9 years ago

Duration 0:32

A community health worker in Tanzania uses his phone to guide him through a questionnaire as he collects health information on Paulina Safari and her daughter Jennifer.

Safari's mother-in-law looks on from the door at the group of strangers observing the visit between health worker and his client. It's a one-hour journey down a bumpy red dirt road to the closest town with a hospital, Singida, and a five-hour drive from Arusha, the nearest major city in Tanzania.

The CBC's Laura Payton is this year's R.JamesTravers Fellow. The Travers Fellowship provided $25,000 in funding for her pitch to look at whether Canada's maternal, newborn and child health program was working. Read more about the project here.

• Tomorrow: Budgets, time crunches limit help
• Thursday: Canada's family planning problem
• Friday: The trouble with Haiti
• Saturday: What'snext?

As with other community health worker programs, Safari gets regular visits from Issa and runs into him at the local clinic. Through theWorld Vision Canada project, he's counselled her on contraceptives, which she plans to start after she gives birth. He also got her a mosquito net, something that's vital for preventing malaria, which causes 10 per cent of deaths in children under five years old in Tanzania.

The UN goals were created in 2000 and aimed to improve life in developing countries by the end of 2015. At its most basic, the idea was to make sure children like Jennifer and women like Safari don't die for no reason that their lives don't end because of causes which are entirely preventable.

What's happening in Safari's village inTanzania is a sample of the work being done in 10 countries around the world that the Canadian government selected to receive the bulk of its aid.It's also a unique case because of the accountability work the country's president, Jakaya Kikwete, has committed to withHarper.

Tanzania is just one part of the story, however. CBC News will take a closer lookat the challenges of Canada's international developmentthroughout this week.

More women getting care

In the poorest and most remote parts of the world, like Safari's village of Mughanga, women tend to deliver babies with a traditional birth attendant or a family member, far from basic medical care or even electricity and running water.

Some of those women are now served, thanks to the Muskoka Initiative,through a range of options, from essentially untrained volunteer workers, wholiaisewith the community, to nurses and doctors in facilities.

The results of those efforts are clear, according to numbers provided by the Canadian High Commission in Tanzania:

• 10,000 community health-care workers have been trained and visited people in their districts.
• The number of women getting four visits with health professionals during pregnancy(a World Health Organization standard) is up 50 per cent, though the high commissionrefused to provide numbers.
• Births at health facilities are up.

In regions visited by CBC News with the support of the Travers Fellowship, more women are relying exclusively on breastfeeding for six months another WHO standard more children are being vaccinated and more women are getting access to contraceptives so they can space out their pregnancies and have fewer children.

But it hasn't just been about getting community health workers to encourage families to seek health care or teach them how to live healthier lives.

NGOs have also set up village savings and loan groups that encourage people to set aside small amounts of money to start or expand businesses, pay for school fees or build homes, and nutrition groups that teach parents how to make sure their kids aren't malnourished. The participants love them and say they actively recruit others to attend.

'Shifted the focus'

In Tanzania, these programs are due in part to $153 million provided by Canada over the course of the five-year program.

"The Canadian leadership has been really important, particularly for women and children,"said Dr. Mickey Chopra, chief of health for UNICEF.

Chopra says women and children hadn't been a central focus of global aid until the Muskoka Initiative rather, the focus was on specific diseases or illnesses.

"That [positioning by Canada] really shifted the focus of debate and discussion, and has resulted globally in a four-fold increase in international aid for women and children,"he said.

"So it's not just been rhetoric and talk. It has translated into substantial new resources for women and children, particularly in the poorest countries."

Some have criticized theCanadianfocus on mothers, rather than women more broadly, or say the money should have been spent on different projects, but it's hard to find anyone who feels Canada didn't make good on its promise.

Still, the number of women who die due to pregnancy and labour hasn't dropped as quickly as child mortality.

The challenge is not insignificant. A number of barriers keep women from seeking care, including the distance from clinics and mistreatment at understaffed and under-equipped facilities.

Ensuring 'money well spent'

While those efforts are unfinished, there are other reasons to be optimistic.

The world is better able to measure what it's done because recipient countries more closely tracked their results. The data collection reflects an effort by Harper andKikweteto improve accountability for the international development assistance distributed over the past few years.

Under the auspices of the World Health Organization, the Commission on Information and Accountability set out ways to track donations, follow the resources and measure results.

Guillermo Rishchynski, Canada's ambassador to the UN, recalled Kikwete speaking last year in Toronto about how his country used that data to shift resources from areas that were doing well to areas that weren't.

"That is the efficacy of an accountability framework. It ensures that the money is well spent, it's spent in the areas of greatest need, and obviously impacts people in the most positive way," Rishchynski said.

The accountability framework doesn't likely matter much to Safari's toddler Jennifer, who at two and a half years old is still in the delicate under-five stage, at risk of dying from malnutrition or disease.

But the hope is she'll live an easier life than her mother, now that the world is paying closer attention.

• Tomorrow: How tight budgets and time crunches stand in the way of progress

The CBC's Laura Payton is this year's R.JamesTravers Fellow. The Travers Fellowship provided $25,000 in funding for her pitch to look at whether Canada's maternal, newborn and child health program was working. Read more about the project here.