Thank you. It's a pleasure for me to be able to speak before this committee this morning.
As president of the International Confederation of Midwives, I represent 250,000 midwives in 87 countries. I also represent the confederation on the board of the Partnership for Maternal, Newborn, and Child Health, an international partnership made up of UN agencies, the Gates Foundation, USAID, formerly Canadian CIDA, and other major NGOs organized to address the fundamental issues and the interventions required to achieve the targets in MDGs, millennium development goals, 4 and 5.
Much time has been spent during the last few weeks discussing the statistics and failures of governments to reduce maternal and infant morbidity and mortality and the lack of progress in achieving MDGs 4 and 5 here in Canada. Canada has made a tremendous commitment in its determination to address this issue at the upcoming G-8. This commitment has allowed the Canadian public to become educated and involved in the discussions of Canada's role in addressing maternal and newborn health in the world's poorest nations.
This week we learned that the government has committed $1 billion to this initiative. Although this falls short of the $2 billion that had been hoped for, we should nonetheless be proud of this commitment. But we must not be naive. Canada has made its commitment. It is time now to focus on implementation.
This morning I will be highlighting a significant area of Canada's plan, that of supporting the development of the health care workforce to achieve MDGs 4 and 5. As we discuss the imperative of improving health systems, we must bear in mind that the health care workforce is the critical axis through which health care is delivered. We need to make sure we have the right person in the right place at the right time. The education and training, deployment, and retention of health care workers is our next challenge. As we look at this need and distribution, it is important, first of all, to identify the challenges in order to achieve the health MDGs in sub-Saharan Africa, where most of the lowest-income countries are located. The investment case for health in Africa, compiled by African ministers of health, the WHO, and the World Bank, has found that the lowest levels of public spending on health per capita are, not surprisingly, in the poorest countries.
What is needed to save 3.9 million lives, of which 90% will be women and children, is an additional average annual investment per capita, over the next five years, of $21 to $32 U.S. This will provide 58,000 to 77,000 additional health facilities. This plan also calls for 2 million to 2.8 million additional health workers and administrators. This investment is estimated to provide at least $6 billion in economic and productivity gains in these countries. It's important to recognize that in saving lives, we're also providing countries with tremendous economic gains. These numbers can seem overwhelming, especially the numbers of the health care workforce at 2 million to 2.8 million. When we look at it in this fashion, the health care workforce can become a nameless, faceless, and overwhelming entity. In order to address the needs of developing this workforce, and particularly addressing MDGs 4 and 5, we must break it down into the specialties required and identify the services each area of the workforce will provide.
The World Health Organization, the World Bank, UNICEF, and UNFPA have identified midwives as the critical workforce to achieve millennium development goals 4 and 5. It is estimated that a midwifery workforce working within a functioning health care system would reduce maternal and infant deaths and disability by 99%. The WHO estimates that to achieve these targets there is a need for 350,000 more midwives globally. If we are going to develop a health care workforce—and most critically a sustainable midwifery workforce—we must address the following challenges.
Education for midwives in most of these countries is remarkably poor. Few are attracted to the profession, because midwifery is an invisible workforce in many of these sub-Saharan and South Asian countries.
A recent story was told to me by the CEO of the International Federation of Gynecology and Obstetrics. He was visiting a minister of health in one of the low-resource countries in sub-Saharan Africa, and the minister proudly took him to not one, not two, but three new medical universities where they're planning to educate more physicians. He turned to the minister of health and asked to be taken to see the new midwifery schools. The minister of health said there weren't any new midwifery schools.
They went to visit the existing midwifery schools, which were underserviced, falling apart, and had had no facility improvement in easily 20 years. The CEO of FIGO, the obstetrics association globally, looked at the minister of health and said, “Why are you wasting your resources on physicians? What we need now are midwives.”
The second area is regulation. In many of these low-resource countries, Canada has to insist that as we're growing the workforce, we have to have regulated health care providers. On my recent visit to Haiti, where there is no regulation for physicians, for midwives, or for nurses, I found that the government is recognizing that in order to have sustainable high standards of care, there need to be standards of regulation.
Retention is a huge issue, and one that we're facing square on as we're devoting our billion dollars to improving a workforce. The midwifery and health care workforce is largely a female workforce. This goes back to MDG 3, which is looking for equity for women globally. It applies directly to the female health care workforce, in which too many women are underpaid, working in terrible working conditions, and brutally overworked. About 250,000 health care providers go abroad globally from these low-resource countries, or else go into privatized health care and NGOs in their own countries, leaving the publicly funded health care system very underserviced. Women are dying in the underfunded public health care system, and, as we know, fewer and fewer government dollars are spent, while privatized health care continues to proliferate globally. At this point in time, 50% of health care in the world is privatized.
The health care worker exodus to western countries, where governments purposely undereducate their own health care workers, is also something we need to identify as Canadians. Countries such as Canada, where governments purposely undereducate health care workers and count on making up these shortages, are taking advantage of the situation in Africa by offering better working conditions to the African health care workers. This was identified at a meeting I attended last year in Addis Ababa in Ethiopia, where ministers of health from 23 sub-Saharan countries were gathered to look at this issue of health care workers. They were discussing charging the high-resource countries the costs that they have incurred in educating the health care workers who leave the country.
Most people do not want to leave their countries of origin, and decent pay and improved working conditions within properly functioning health systems will make the freedom-of-movement argument a non-issue for the majority of professionals. Canada currently recruits approximately 23% of its health care workers; as part of our global commitment to reduce this brain drain, we can commit to training 100% of our workers. This happens currently in both Japan and the Scandinavian countries.
Canada has committed to the development of the health care workforce to reduce maternal and infant mortality globally. Let us use our world-renowned midwifery schools and our own country to give guidance. Let us share our high standards of midwifery regulation. Let us share our successes in working with obstetricians and pediatricians and multi-disciplinary teams and commit this country to working with those low-resource nations to develop a high-quality and sustainable health care workforce.
We know what needs to be done. Let's work together to make sure our committed moneys are well spent.
Thank you.