Thank you. It's a great opportunity for the Canadian Society for International Health to be here.
We are a non-government organization committed to the strengthening of health systems. I personally have worked and interacted with ministers of health, education, family and youth, NGOs, and researchers, in over 35 low- and middle-income countries. I've had the privilege of seeing health systems in action and the importance of interaction with other ministries.
I first want to give two points on the political context, and then move into the health systems evidence and add on a bit from Dr. Shaw's comments.
In July 2009 in Italy, as you know, the G-8 heads of government agreed that maternal and child health was one of the world's most pressing global health problems. They committed to accelerating progress on maternal health, including sexual reproduction health care and services and voluntary family planning. They also announced support, as Dr. Shaw mentioned, for building a global consensus on maternal, newborn, and child health as a way to accelerate progress on the MDGs--millennium development goals--for both maternal and child health.
In June 2009 Canada co-sponsored a landmark resolution at the UN Human Rights Council recognizing maternal mortality and morbidity as a pressing human rights concern.
I'll talk a bit more on the health systems evidence. Most maternal deaths are easily preventable, as we said. We've seen this wonderful progress in Canada, although we do have some inequities. The gap between rich and poor countries is shockingly wide. In Canada, for example, the lifetime risk of maternal death is one in 11,000. In Ethiopia, the risk is one in 27. In Angola and Liberia, the risk is one in 12; and in Niger, it's one in seven.
Of the 10 million women who have died in pregnancy and childbirth since 1990, three-quarters of the deaths were preventable, primarily where they occur in Africa and South Asia. Millions of other women have been left with crippling injuries or illnesses as a result of poor care during childbirth.
A new study released in March 2010 by the United Nations Population Fund, UNFPA, and the Guttmacher Institute estimates that 70% of the world's maternal deaths could be prevented for $13 billion. That's about $4.50 per person, per year. That's not a lot of money.
Dr. Shaw mentioned some of the care gaps. Of the 123 million women in the developing world who gave birth in a health care facility and needed care, 62 million received it. Of the 5.5 million women who needed care for hemorrhage or bleeding, 1.4 million received it. You can see these huge gaps. Of the 7.6 women who needed care for obstructed labour--that means when the baby is not coming out very well--1.8 received it. There are huge care gaps.
There are 215 million who would like to delay or avoid child bearing and do not have access to modern contraception. A dramatic improvement in access to family planning, including contraception, would sharply reduce the number of unintended and unplanned pregnancies. That in itself means fewer pregnancy-related deaths and complications. Evidence shows that access to family planning alone could prevent as many as one in every three maternal deaths by allowing women to delay motherhood.
It's not just what we need to deliver but how we need to deliver it. And how we need to deliver it is through a sustainable and well-funded health system. That's not just the care part, the services and programs you've heard about, which are very, very important, but a whole health system.
There is a picture here of what a health system is--you will all receive copies of this. The services and treatment and programs are the health care system, but a health system has many elements. One is a vision for equity and a fair distribution of resources coupled with leadership and sustainability. It also has to do with a fair access, not equal access. We'll never have equal access, but we can have a more fair distribution and availability of services for health care.
We also need health information systems. That is often forgotten about, but unless we have funding for health information systems when we also fund intervention programs for maternal health, we will never know how well we are doing. So we need to make sure that is integrated within the health system, because that gives evidence for policy, but it also gives evidence for how well we are doing in terms of quality of care.
A great gap in many low-income countries is the ability to plan, the ability to say where these resources should go. Most countries have a decentralized social system in education and health. They were decentralized almost overnight as a result of World Bank demands and their structural adjustment, and they have very little capacity for planning. Therefore, the decisions about where the money goes are left in the hands of people who don't have data, who don't have capacity, and thus the resource allocation is not evidence-based. Of course, we need well-trained professionals--nurses, doctors, midwives, community health workers--to be in the right place at the right time doing the right thing, but we also need to promote a continuum of care throughout: a primary health care system that delivers a large part of maternal and child health, well baby care, well pregnant care, and we need emergency obstetrical care. That is essential. Without a primary health care system--if that gets gutted--we don't have a continuum of care. That's the access point for mothers and for their children. It allows for anything that needs to be dealt with at a specialist level to be picked up.
Sub-Saharan Africa faces the greatest challenge. While it has 11% of the world's population and 24% of the global burden of disease, it has only 3% of health workers. In addition to the care part of the system and the health information, it's also important that there be public participation in health care decision planning, as we have here in Canada. People get involved and make their views known. Non-governmental organizations need to be funded to build that capacity for communities so they can start to understand what they need and where and how they need it.
Finally, there needs to be a transparent and accountable public system. Most countries have a publicly funded system, and they often have a privately funded system. Doctors sometimes work in the mornings in the public system, and in the afternoon they go to the private system. So if you go to a clinic in the afternoon in many of these countries, there is nobody there. That is because the doctors are off in the private system, because they have probably not been well paid in the publicly funded system. This shows the need for a well-funded public system.
There are two pillars that really support a health system. One is the determinants of health, and you have probably heard about those: poverty, education, peace, gender. These are things that make us healthy. If we have a peaceful situation, if we don't have an environmentally challenged system, if we are not poor, if we are well educated, if we have jobs, we tend to be healthier. You will get copies of these maps that show the absolute significant and critical inequities of the distribution of these determinants of health. If you look at education, if you look at poverty and wealth, the maldistribution is huge.
Finally, we have to look at the policies that have an impact on health. It's not just the ministry of health. It is the ministry of transportation. It's the ministry of environment. It's trade. It's labour. It's human rights. If we work with the transportation sector to look at where the roads would go, we could hook up with the primary care systems and the delivery of good care. If we know that the environment and environmental policy are health promoting, we have a better chance at improving our health, so we have to look at all of those policies in terms of health, but more particularly in terms of maternal and child health.
Finally, Canada has played a leadership role in promoting good governance and accountability across many sectors, including health, and we feel it could take a leadership position in supporting this as it relates to maternal and child health.
I'm sorry that you didn't get the slides, but I'm sure you will get them later, and you will be able to see them in colour as well. I'm sure that's the case for yours too, Dr. Shaw.
Thank you.