OTTAWA — International concern is growing in medical and development circles that the Trudeau government is about to step back from its much-publicized global leadership on eradicating AIDS, tuberculosis and malaria.
In 2016, Trudeau announced with fanfare that Canada was contributing $804 million to the Global Fund, a 24-per-cent increase to the international organization that aims to curb the three afflictions that are now widely seen as preventable with the proper amount of medical and financial support.
The increase in Canadian spending was in keeping with past bump-ups to the Global Fund’s replenishment drive every three years, both from the previous Conservative government of Stephen Harper and the Liberal governments before it.
But development officials in several organizations say they believe the government is simply planning to announce a repeat of 2016’s funding with no increase, which would be a first for Canada.
Chris Dendys, the executive director of Results Canada, a grassroots anti-poverty advocacy group, said that based on conversations that she and others in her sector have had with federal officials, the government is planning no increase because of a “cash crunch” heading into the fall election.
The Global Fund wants to see a 15-per-cent increase in total pledges this year, to US$14 billion.
A spokeswoman for International Development Minister Maryam Monsef said Canada respects the Global Fund and will announce its contribution in “due course.”
Canada recently announced at the Women Deliver conference in Vancouver that it will contribute $1.4 billion annually to 2030 to fund global health and nutrition, including sexual and reproductive rights and health, said Hanna Button, Monsef’s policy director.
“Our ongoing support to the Global Fund will be an important part of this holistic approach,” Button said in an emailed statement.
The Women Deliver funding is a reallocation of money from the current budget for international development.
“It’s really a matter of political will in an election year, or not an election year,” said Dendys, who noted that Canada’s overall spending on foreign aid has not been significantly increased under the Liberals to meet the United Nations target of 0.7 per cent of gross national income.
She said the spending has not increased “beyond the basement of 0.26 per cent of GNI. There’s been plenty of opportunities to do the right thing.”
Canada’s last Global Fund pledge came at an international conference that Trudeau hosted in Montreal in September 2016, a star-studded event that featured U2 singer Bono, who founded the anti-poverty advocacy group, the One Campaign.
France will host this year’s pledging conference in October, in the middle of Canada’s federal election campaign, so advocates want to see Canada take the lead and deliver its increased pledge before the election writ is dropped, to show leadership to other countries.
Two other G7 countries, Britain and Japan, recently announced increased pledges of almost 17 per cent and five per cent respectively.
“Other countries are starting to move in that direction,” said Dr. Julio Montaner, the director of the British Columbia Centre for Excellence in HIV/AIDS.
“My bottom line is we want Canada to be not just counted but playing a leadership role, making an early pledge and in doing so, providing an example to the rest of the world.”
Montaner’s research led to the medical breakthrough that controlled and reduced the spread of HIV-AIDS in the late 1990s: the “triple cocktail” of antiretroviral drugs that has been credited with reducing mortality across the globe.
The approach has been replicated worldwide, and is now the cornerstone of the work of the Global Fund, he said.
“I am very hopeful that Prime Minister Trudeau will make an executive decision in short order to do the right thing,” Montaner said.
“He promised me, privately, before the (2015) election that he would do so. He did so in writing … I hope that he will be consistent with that kind of approach when it comes to supporting the Global Fund.”
Montaner said that with reduced funding the fight against the spread of HIV-AIDS will be curtailed and that will mean more long-term financial burdens on health care across the world.
About one-third of the Global Fund’s spending targets women and girls through programs aimed at comprehensive sexual and reproductive health, said Stuart Hickox, the executive director of the Canadian branch of One.
“If Canada doesn’t increase its support, it’s essentially a retreat from its leadership. We asserted that space in 2016 as a global leader in this area,” said Hickox.
Dr. Mark Dybul, who was the executive director of the Global Fund from 2013 to 2017, said Trudeau showed great leadership in 2016, mobilizing youth and creating a great sense of optimism at the 2016 Montreal event.
“I understand the pressures on budgets but I think given the leadership Canada had, in particular with this same prime minister and because of the emphasis on girls and women, I think it would be unfortunate if they didn’t follow the trend of the other donors and show a leadership role,” said Dybul, the co-director of the Centre for Global Health Practice and Impact at Georgetown University Medical Centre in Washington.
Dendys said her organization has lobbied 30 MPs to push Trudeau to increase Canada’s support for the fund.
“What we’re hearing is Canada is going to keep its pledge to the Global Fund flat-lined, which really is a really a retreat in global leadership,” she said.
“Everyone we’ve spoken to has basically said, there’s just a cash crunch.”
Women and children are disproportionately affected by malaria and TB, which creates massive burdens on the health budgets of developing countries. Keeping up funding levels to help eradicate preventable diseases is in the economic interest of every country, especially with Africa’s population predicted to double by 2050, said Dybul.
“If they don’t have health, education and economic opportunity — you’re worried about refugees today? What do you think the world is going look like?” he said.
“It is necessary for the long-term growth of the global economy, Canada’s economy, and also so that we don’t have a continent collapsing.”
Mike Blanchfield, The Canadian Press
Province freezes funds for doctors and launches process to work out a new funding formula
New physician funding framework announce
Alberta will maintain physician funding at $5.4 billion, the highest level ever, and implement its final offer to the Alberta Medical Association (AMA) to avoid $2 billion in cost overruns.
Existing terms will remain in place until March 31, 2020. A new funding framework will then be introduced, in a multi-year process that will require consultation with the AMA at all stages. The new framework will make changes proposed during negotiations to prevent cost overruns, align benefit programs and administrative fees with those of comparable provinces, and improve services for patients.
The eleven consultation proposals will also be implemented on March 31. This includes phasing in changes to complex modifiers, reducing the rate physicians can charge for this billing code to $9 from $18, for a period of one year before the code is removed in 2021-22. In summer 2020, at the direction of the Minister of Health, the Government of Alberta will also introduce a new alternative relationship plan (ARP) with built-in transition benefits to encourage physicians to move from fee-for-service to a three-year contract.
“Our province is facing cost overruns of $2 billion in the next three years due solely to physician compensation. If left unaddressed, these costs would impede efforts to reduce surgical wait times, improve mental health and addiction services, and expand the number of continuing care beds. Despite repeated efforts, the AMA failed to put forward alternatives that would hold the line on physician compensation. The new framework announced today will prevent cost overruns, allow our province to improve services for patients, and still ensure that Alberta’s doctors are amongst the highest paid physicians in all of Canada.”
- The new funding framework will maintain government’s current level of spending on physicians at $5.4 billion.
- The new funding framework avoids anticipated cost overruns of $2 billion over the next three years.
- Alberta has been spending more on physician salaries than other provinces, yet most of its health outcomes are below national averages.
- A doctor in Alberta earns approximately $90,000 more than a doctor in Ontario and physicians’ fees have almost tripled since 2002.
Elements of the new funding framework
- Changes to Alberta’s complex modifier billing system. The rate physicians are able to charge for complex modifiers will be reduced to $9 from $18 for a period of one year before this billing code is removed in 2021-22. Once the new framework is fully phased in, physicians will be able to bill an additional fee after spending 25 minutes with a complex patient case. Alberta remains the only province in Canada that allows for a top-up payment for complex visits.
- Removal of the comprehensive annual care plan from the list of insured services. Currently, physicians can also bill for a similar consultation called a comprehensive annual visit. No other province in Canada compensates physicians twice for annual care consultation.
- Implementation of a new daily cap, modelled after a cap in place in British Columbia, of 65 patients per day. Large patient loads can contribute to physician burnout and may compromise patient safety and quality of care.
- Removing physician overhead subsidies from all hospital-based services. Physicians who work in AHS facilities should not be billing for overhead costs that their community physician colleagues face, such as leases, hiring staff and purchasing equipment.
- Ending of clinical payments, or stipends, by AHS to physicians. This change ends duplication of payments to contracted physicians.
- In September 2019, government provided notice to the AMA that it intended to begin negotiations on the AMA Agreement. The notification provided time for the AMA to prepare its proposals.
- In November 2019, negotiations began with the AMA to reach a new agreement; government began consultations on 11 proposed changes to the schedule of medical benefits (SOMB, or “insured services”).
- In January 2020, negotiations and consultations proceeded with no agreement reached. Mediation, on both the negotiation and consultation proposals, began January 31 and continued into February.
- The parties were not able to reach an agreement during mediation.
- Government will implement its final offer from the negotiating table, including the 11 consultation proposals, on March 31.
Letter from MLA Jason Stephan in response to United Nurses of Alberta protest
Submitted by Red Deer South MLA Jason Stephan
Today the United Nurses of Alberta (“Union”) held a protest at my MLA constituency office.
Protests should be honest; without disingenuous distortions of facts, or attacks on persons instead of policies where genuine differences of opinion may exist.
In the recent salary arbitration, the Union asked for a 3% increase. The independent arbitrator stated “no change in wage rates is justified … particularly given the prevailing general economic conditions in the Province.”
The arbitrator was right. Out of Government, Alberta businesses and families must limit spending to their incomes; in Government, public sector salaries should respect taxpayers and not impose structural billion-dollar debts and deficits upon our children. That is in the public interest.
In the recent ‘MacKinnon Report’ and supporting documents (collectively, “Report”), there is a comparison of registered nurse compensation to other provinces. Alberta nurse compensation is significantly higher than the Report’s comparator provinces: BC, Ontario and Quebec. The Report is available to all Albertans for viewing at:www.alberta.ca/mackinnon-report-on-finances.aspx
The Report also identifies that Alberta nurses receive taxpayer funded benefits more generous than comparator provinces, and certainly not available in the private sector.
As an example, I received a letter from a nurse describing how some Union members may be choosing to work part time hours in order to leverage automatic double time pay once their part time, not full time, hours were exceeded, or with work falling on “designated days of rest” or “X days”. The concerned taxpayer stated ours is “a system ripe for abuse”.
The Union appears to disagree with our Government taking steps to confront outlier benefits or restrain salaries which exceed provincial counterparts.
Our Government was elected to restore fiscal accountability and sustainability in the face of structural billion-dollar Government deficits. On the strength of the Report, our focus is on reducing the cost of services, as opposed the services themselves.
We would invite all nurses, including our nurses in Central Alberta, to ensure their Union avoids taking unreasonable positions which disrespect taxpayers or undermine a sustainable health care system. That is in the public interest.
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