What role for Canada’s universities in global health – ten ideas
by Dr. Allan Ronald, University of Manitoba
Canadians are important contributors to health in the resource limited world, possibly ‘punching above our weight’ considering our population. Yet the November 2011 report of the Canadian Academy of Health Sciences (CAHS) Expert Panel on Canada’s Strategic Role in Global Health found that we lack a coherent national strategy to develop global health strengths within our universities with limited influence on Government of Canada (GoC) decisions. What more will enable us to achieve the potential that we expect of ourselves? The CAHS made a substantive investment in its Assessment of Canada’s Strategic Role In Global Health. Important outcomes may evolve from this report, but to date it has not created significant forward momentum. What else can be done to mobilize Canadian university global health leadership?
My bias is that universities are an important determinant, perhaps the most significant, for development and health. But in many societies the university mission is no longer to facilitate ‘change’. Long term relationships (10-30 years) with Canadian universities that build trust and promote mutual learning and shared decisions, along with Canadian funding could encourage the needed transformation and ignite ‘change’. There are Canadian universities that have individuals with expertise and credibility to be involved as partners with low and middle-income country (LMIC) universities and their leaders in this ‘change scenario’.
How can Canadian universities facilitate a healthier world in LMICs? What is the role of science? Of new technologies? Of advocacy for Canadian principles in health and health care such as equity, human rights, accessibility, universal health care, the importance of evidence based decisions, health systems and logistics, continuous life long learning, interdisciplinary teams, good management? Can partnerships to create sustainable change together with Canadian fiscal resources to LMIC governments and universities enable leadership to emerge that ensures health becomes a national priority throughout all government structures and that national universities have the capacity to lead or facilitate these outcomes through training, research, service, and professional development?
Here are some ideas based on my own experiences of working with LMIC universities.
1. GoC development experts with Canadian academicians and LMIC colleagues would together develop ‘peer approved’ research and training programs for Canadian Institutions -possibly through CIHR. This might require a new Institute for Global Health at CIHR.
2.Lessons learned through three decades of acquiring culturally sensitive HIV science and translation/implementation experience in LMIC societies has been acquired by Canadian universities and has helped change the course of the epidemic. This can be a foundation to address other health challenges.
3. A Canadian structure is needed that builds synergies with other global health academic initiatives in Canada. This could include among others the Royal College International Initiative, the Gairdner Award in Global Health, Grand Challenges Canada, the Canadian Coalition for Global Health Research, the Canadian Society for International Health and the Canadian Public Health Association. These entities function with little shared activity. I argue that they can contribute to the whole while maintaining their individual strengths and organizational structures.
4. South to South interaction and cooperation with partners, consultants, and networks facilitating shared ideas and programs in global health – supported with Canadian resources.
5. An organization is needed that would advocate at the level of university presidents and deans to ensure that academic positions and departments/sections of Global Health are created so that individuals completing global health training would have opportunity for academic careers as scientists and develop as leaders in global health and development.
6. We need an annual meeting that convenes the best of Canada’s science in global health and also is a venue for shared planning with interactions between research funders, government, academicians, and development experts as well as participation from the countries with whom we are significantly involved, creating excitement and ‘buzz’ about global health.
7. Public or population health is inadequately funded in much of the world. Canada could have significant role partnering with LMIC universities and ministries of health and develop capacity for research, training leaders and partnering to build sustainable programs with a significant commitment from the volunteer /private sector. In particular occupational diseases need to be known and prevented with appropriate precautions/regulation/legislation.
8. Canada has a long 40-year history of providing health research funding through IDRC to LMICs. I have limited knowledge of critical long-term evaluation of outcomes from these expenditures but the successes and failures of IDRC’s efforts as well as experience of other countries and foundations should provide direction for a new Canadian funding initiative. This could be a health research agency owned by the recipient country that allocates funds and strengthens their national university system to train scientists, rewards excellence with renewal scholarships, and funds locally determined research priorities. This could be an investment in a few countries that request this support that could have long-term benefit to these societies and to Canada.
9. Formal Canadian training programs in global health exist in several Universities. The proposal by Dr. Kish Wassan and colleagues to create a network of training centers through a GoC supported Network of Excellence is an excellent initiative to build additional training capacity for Canadians and create synergies across Canada. Health professional students also are searching for learning opportunities and field experiences in LMICs and further effort to support this may be required.
10. Private philanthropy has changed the Global Health world over the last decade. Wealthy Canadians are beginning to become involved in leading global health through their organizational expertise and generosity. We need to facilitate this involvement in multiple ways to strengthen LMIC and Canadian university initiatives. Also Canada has invested over 16 billion dollars in extractive mining activities in Africa and has a national interest as well as an obligation to promote health and well being in these societies.
I recognize that this is a “tall order”. Although university structures primarily need internal cohesion, we also need to be part of a national structure if possible shared with government, within which we organize these activities. But this will require that the GoC recognizes the importance of universities in societal development. Non-government organizations are essential but universities are unique. We can be the most important agent for global health in resource-limited countries if together with their universities, we fulfill the mission to educate and prepare leaders and health professionals and solve problems through science.
Allan Ronald is Professor Emeritus at the University of Manitoba. He and his colleagues have been partners with the University of Nairobi (Kenya) and Makerere University (Uganda), each for well over a decade. He also spent a year at the University of Hong Kong assisting with the development of the discipline of infectious disease. Dr. Ronald was a member of the CAHS Expert Panel on Canada’s Strategic Role in Global Health.