Policy Options by Elly Vandenberg 7 February 2017
Ten lessons learned from the NGOs that helped convince the Harper government to support maternal and child health abroad.
As nongovernmental organizations (NGOs) today consider how to support the achievement of the Sustainable Development Goals(SDGs), the current UN development framework, it is helpful to reflect on how a coalition of NGOs in Canada contributed to a 2010 “policy win”: the Muskoka Initiative. The coalition persuaded the Canadian government to champion ideas and goals not previously on its agenda and, in the years following, ensured they were implemented.
The initiative was a signature G8 policy to focus global investment on the lagging United Nations Millennium Development Goals (MDGs) on maternal, newborn and child health (MNCH). Canada’s contribution of $7.3 billion was leveraged by the G8 summit and then multiplied by the UN for a substantial total investment of $40 billion. A targeted accountability mechanism ensured funds would be delivered and results achieved. Canadian civil society groups worked alongside international bodies and government stakeholders to develop the policy.
The MDGs, set in 2000, were intended to be reached by 2015. As the target date drew nearer, the UN’s countdown reports revealed a lack of progress on the MNCH goals. In 2009, Canada’s re-elected minority Conservative government had no global development objectives among its priorities, an ambivalence toward the goals, significant doubts regarding the effectiveness of international development assistance and worries over the global economic crisis. Restrictions and cutbacks pummelled Canadian civil society groups. Calls for Canada to spend 0.7 percent of gross national income on official development assistance (foreign aid) were soundly rejected as focused only on dollars, and not on the impact of assistance spending.
Despite this troubled context, a signature initiative — a major long-term commitment by the host government at a summit — was proposed, developed and successfully launched. Results included significant new funding, an accountability commission, a movement to boost nutrition, further investment over many years and continuing robust global MNCH initiatives. Key elements of the advocacy campaign of 2008-10 were reworked to encourage the government to stick to its commitment in the next election and throughout the majority government years that followed.
2. Keep the policy “ask” simple
Former senior civil servants interviewed by the NGOs urged the coalition to make its request modest, measurable, realistic and time-limited. NGOs set aside the questions they usually asked the government about how previous commitments were carried out (report cards) to focus instead on shaping this new commitment. The NGOs’ goal was a significant and accountable investment in child and maternal health that would encourage other countries and international bodies to join in to close the gap on the relevant MDGs by 2015. Rather than focusing on one “silver bullet” tool, such as zinc supplements or polio immunization, this was an investment in front-line workers, giving them support and training to provide an integrated basket of interventions targeted at the poorest people where they live, and a commitment to monitor the results for the desired impact.
3. Leave egos and logos behind when leading in a coalition
The NGO coalition leaders together created a common policy objective. They united around the bigger vision while continuing their own individual work. Effective leadership is about setting a vision, raising resources, finding the right people and then getting out of the way so that staff can move quickly and not get tied up in red tape. NGO leaders invested in advocacy staff with policy, research, communications and government engagement skills, and they dedicated staff time so their personnel could respond speedily as opportunities to shape the policy arose.
4. Build evidence-based consensus
The NGOs’ programming surveys all pointed to similar gaps and needs around MNCH. This evidence was combined with insights derived from previous Canadian government-funded projects, research by Canadian academics and international studies from the Lancet, the Partnership for Maternal Newborn & Child Health, the Copenhagen Consensus and the World Health Organization.
5. Listen carefully to political needs and find ways to respond to them
How could a prime minister deeply committed to accountability and with a limited interest in global development be persuaded to become personally committed to this substantial development policy initiative? The initiative had some advantages: it was practical and counterintuitive, could start immediately, had wide appeal and could soften the government’s image. Early signals from the Prime Minister’s staff were positive. To effectively sell the policy, the development minister’s office wanted a simple narrative to communicate to the public and globally: lives saved and a strong accountability mechanism. Cross-party meetings with MPs, senators and parliamentary committees helped build support so that it would be a Canadian, not just a Conservative, initiative and one that would survive a change in government.
6. Understand that policy development requires flexibility, responsiveness and trade-offs
The NGO coalition took an evolutionary approach: working out the policy details took a year and a half of concerted effort. The asks were refined through many meetings with multiple stakeholders, starting with a general conversation about the concept of a signature initiative with the Prime Minister’s Office, and a one-page working paper was developed. The asks were then widely explored with the civil service across multiple departments.
Eventually, the NGOs formally created the Canadian Coalition for Maternal, Newborn and Child Health. Its seven members provided a range of supporting documents, including one-pagers, op-eds, economic fact sheets, technical briefs, documents making the investment case and communiqués. The coalition’s shared focus and the evidence base it assembled contributed to its being viewed as professional and consistent.
In an environment where political access was highly controlled and limited, the coalition chose to make a trade-off: it sought to achieve a specific policy with the government rather than pursuing the more comprehensive development agenda of the broader NGO community. There was also a substantive compromise around the issue of abortion. Recognizing that the inclusion of “abortion services” could threaten support for the entire MNCH initiative, the coalition decided to focus on the inclusion of family planning — which includes contraception and the “prevention” of unsafe abortions.
7. Gauge the decision-making context through stakeholder “mapping”
This involves the continual assessment of whether particular groups were key players, friends, blockers or onlookers. A tracking tool helped distinguish those who needed to be engaged with closely and influenced actively from others who needed to be kept satisfied, kept informed or simply monitored. Through meetings, events and public communiqués, coalition members navigated constantly between the opposition and the government, between civil society and the government and within parliamentary committees. The most surprising role that some coalition members found themselves in was that of bridge builder and interpreter among stakeholders.
8. Acknowledge that how one engages is as critical as with whom one engages
Principles included being nonpartisan, evidence based, policy driven, respectful, constructive (including constructively critical), solution oriented, knowledgeable of one’s audience and appreciative of stakeholders’ progress. The coalition particularly valued giving voice to the people on the ground for whom the coalition was advocating.
The NGOs in the coalition had a history of collaborating on other issues, providing an important base of trust for people within the various organizations. All had global partners and a wide range of skill sets. The collaboration began at the end of 2008 with a small group of agencies. (One advocacy organization left due to discomfort with some of the trade-offs.) Later, when the policy was being implemented and with encouragement from the Canadian International Development Agency, the coalition membership expanded to include Canadian academic and health professionals’ institutions. On the other hand, the coalition had little engagement with the private sector due to a lack of experience within the NGO community with these potential partners. This probably made the coalition easier to manage.
10. Monitoring and Implementation
A policy win is not just about the initial accomplishment. Investment in advocacy staff and campaigns continued so that the coalition could argue for governments of all parties to keep their commitments to deliver on the policy. To date, women’s and children’s health remains a government development priority.
As compared with the MDGs, the SDGs provide a complex and uncertain context. Rather than focusing on developing countries, the SDGs are universal, implicating all countries. They are integrated, putting sustainability and development together. They are interdependent, with the specific goals meant to work together. How can effective policy be shaped in this new context, and what sort of advocacy will the effort require? What degrees of collaboration and coherence are essential, and where will the players come from? What kind of leadership, stakeholder analysis, policy development, investment, evidence, focus and trade-offs are needed? Although the Muskoka Initiative was shaped in a unique context, it provides a wealth of insights for navigating the new policy world of the SDGs.
Elly Vandenberg is a professor of global practice at the Munk School of Global Affairs and a former senior director of policy and advocacy at World Vision Canada. She has 25 years of global development experience in a variety of contexts.