Improving Maternal Health
An Open Discussion with Experts from the field
Canadian Society for International Health
Of all the forms of inequality, injustice in health is the most
shocking and the most inhumane
(Attributed to Dr. Martin Luther King) in: Paul Farmer. Pathologies of Power
An Issue of Inequity
Setting the Context
Distribution of the World’s Wealth
Russian Federation
UK
Germany
China
USA
Switzerland
France
Spain
Italy
Bangladesh
India
Philippines
Fr
Guyana
Indonesia
Australia
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Distribution of Poverty in the World
Russian Federation
Canada
USA
China
Bangladesh
India
Ethiopia
Thailand Philippines
Kenya
Indonesia
South
Africa
Australia
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Girls not at Secondary School
"... my father thinks it’s a waste
letting me go to school. It’s better for
my family to let me work than go to
school. My father also says it’s easier
for men to tell girls what to do if they
Worldmapper.org
World Health Expenditure
Data (% of GDP)
SOURCE: WHO (2002) Patterns of Global Health Expenditures: Results for
191 Countries EIP/HFS/FAR Discussion Paper No. 51
Nurses Working
"[they] are also being poached
by industrialised countries.
There are more nurses from
Malawi in Manchester than in
Malawi …" Glenys Kinnock,
2005
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A Global Response which is supported by
Canada: Global Health Workforce Alliance
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A new global partnership that will strive to address the worldwide
shortage of nurses, doctors, midwives and other health workers was
launched today. The Global Health Workforce Alliance will draw
together and mobilize key stakeholders engaged in global health to
help countries improve the way they plan for, educate and employ
health workers. Its secretariat will be hosted by the World Health
Organization (WHO).
Responding to the call by African Heads of State, the G-8 and the
World Health Assembly for urgent solutions to the health workforce
crisis, the Alliance will seek practical approaches to urgent problems
such as improving working conditions for health professionals and
reaching more effective agreements to manage their migration. It
will also serve as an international information hub and monitoring
body. (WHO)
Five Strategies: To address the Health and Human resource Deficit
which will have and impact on maternal health
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Mobilizing direct financial support for health training institutions, through a
model similar to that of the Education for All Fast Track Initiative - a global
partnership between donor and developing countries to ensure accelerated
progress towards the Millennium Development Goal of universal primary
education;
Training partnerships between schools in industrialized and developing countries
involving exchanges of faculty and students, with the aim of improving the
education of doctors, nurses, midwives and paraprofessional health workers,
and training more of them now;
Nurturing a new generation of academic leaders in developing countries with the
support of experts in the clinical, public health and managerial sciences from
around the world;
Developing innovative approaches to teaching in developing countries with
state-of-the art teaching materials and continuing education through information
and communications technology;
Assistance with the creation of planning teams in each country facing health
worker shortages, drawing on the top leadership of the major schools, whose
task will be to develop a comprehensive national health workforce strategy.
(Source WHO)h
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Where the greatest inequities exist:
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Sub-Saharan Africa faces the greatest challenges. While
it has 11 percent of the world's population and 24
percent of the global burden of disease, it has only 3
percent of the world's health workers.
A 7000 times greater risk of dying in SSA than in Canada
in childbirth (WHO)
IMPACT
 There is a direct relationship between the ratio of health
workers to population and survival of women during
childbirth and children in early infancy. As the number of
health workers declines, survival declines
proportionately. (WHO)
Midwives Working
"The lives and health of many
millions more would be saved with
greater investments in midwives."
Thoraya Ahmed Obaid, 2006
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Illiterate Young Women
"My dream now is to become
a teacher and work here at
the Kuchinerla School and
help people in our villages
understand the dangers of
working in the cotton fields
and the importance of girls’
education." Vijaya Lakshmi,
2006
Worldmapper.org
Maternal Mortality
Worldmapper.org
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New frameworks for sustainable health and human
development within a context of human rights are required
which consider the contribution of health and social
programmes to economic development and promotes
complimentary actions in all development efforts (Kreisel,
1997)
New and emerging challenges to health and development
include:
 globalization, human rights violations, environmental
degradation, population transitions/growth and migration
and health system reform which requires a new type of
health system
 decentralization of the social sector to the local level means
that local action is becoming more important
As these health systems reform and reshape it will require
interconnecting webs constituting new relationships and
partners resulting in strengthened or new institutional and
community interaction: ngo’s are key to this interaction
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Specifically with the health care sector there must be a
balancing of the goals of providing fair access to health care
(equity), efficiently allocating resources and services, and
responding to the needs of the population and health care
providers
Improvements to the health care system cannot be achieved
just by allocating more resources to this sector; resources be
shifted to respond to community needs and to address the
need for sustainable and integrated approaches to health
promotion
Ensuring public participation in decisions about health planning
and the allocation of resources is particularly key. It
encourages action by communities to demand health as their
right
Non-government organizations often support or provide the
mechanisms by which such public participation is ensured and
institutionalized in planning and decision making processes
What is needed?
A Health Systems Response
A Health Systems Response
Vision: Equity and Accountability
“
Stewardship and Leadership
Social
Determines
of Health
Framework
Health Human Resources
Health Financing and Resource
Allocation
Research for Development (Evidence-Based
planning and policy-making)
Health
in all
policies
”
Health Information Systems
Data for Decision-making
Evidence-Based Decision-Making (Clinical and
Community-based)
Service delivery treatments and programs
Community interventions and
health promotion
Strong and vibrant Civil Society
Transparent and Accountable Public/Private Sector
Copyright CSIH 2005
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If health is a human right, it has to be distributed in a fairer or
more equitable manner utilizing processes of reform and capacity
building within the health system
We therefore need to get better at transferring and adapting
models that will promote a fair distribution of access and
availability of services for health care and strengthen the systems
infrastructure to improve accountability (eg., health information
systems)
We need to promote coverage for basic services which are
universally accessible and available (Next year’s WHO Report:
Universal Health Coverage)
Finally we have to promoting the understanding that the
determinants of health and the inequitable “loading” of those
determinants: poverty, education, environmental risks, gender,
employment, peace…have a greater impact than health care in the
improvement of health status
INTERSECTORAL
COLLABORATION FOR MATERNAL HEALTH EQUITY IS
Need for KEY
coherence
Development
Security
Trade
Health
Maternal Health
Policy
Labour
Environment
Human Rights
Foreign Affairs
Interact with related policy domains Source IOM
2007
Strengthening Health Systems with
Human Resources
Reflective Questions
Strengthening Health Systems
for Human Resources
How does our work strengthen
the human resources responsible for delivering preventive
health services and treatment in targeted communities?
What is being done to strengthen the human resources
in the environment in which we work?
How do we ensure that the human
resources for health are stronger as a result of
our work?