This opinion article was written by Sarah Degnan Kambou, President of the International Center for Research on Women and Ravi Verma, Director of ICRW Asia and member of the advisory council of Global Health 50/50. For more like this, see our health and wellbeing newsfeed.

Women need to be at the table to ensure adequate investment in global health.

While overall public commitment to gender equality continues to rise steadily, the reality in the health sector is that equality still lags considerably behind.

With a world population over 7.7 billion and half the population being female, women and girls cannot be left out of the discussion. More importantly, they must not be left out of the decisions — from the household to the clinic and boardroom to the legislature.

Integrating women in decision-making for global health initiatives is particularly important, given that they “bear the brunt of inequitable health systems.” According to the World Health Organisation’s director-general Dr. Tedros Adhanom Ghebreyesus and his chief advisor Dr. Senait Fisseha, “Unless explicit attention is paid to gender inequalities, health systems can fail to improve gender equality and may even worsen it since some groups have greater health needs and lower financial resources.

That applies within the health system itself. Gender pay gaps, lack of formal employment, violence and lack of representation in leadership and decision-making in the health workforce undermine its ability to deliver the care people deserve.”

Not dissimilar to other industries, the global health sector is heavily male-dominated

Taking a step back, data and awareness play an integral role in informing the work that lies ahead.

They provide a more accurate picture of the global health landscape and guide us in what changes need to be made to address inequity and improve the quality of healthcare.

Gender is under-reported and overlooked

In 2019, Global Health 50/50 took a closer look at this landscape with a gender lens.

The collaborative – made up of experts from the University College London Centre for Gender and Global Health, the UN, People’s Health Movement Advisory Council, WHO, UNDP, The Lancet, Stanford University, BRAC, CREA, the International Center for Research on Women (ICRW) and others — produced a groundbreaking report that breaks down gender equality across a range of factors in the global health space.

Out of 198 organisations - including World Bank Group, UNICEF, Journal of Global Health, Mercy Corps, Unilever and the Department of International Development, UK (DFID), the Global Health 50/50 team found vast discrepancies in leadership, policies, programs and overall gender equality in the workplace.

If you’re seeing something that works, take those learnings to scale and integrate them into your organisational fabric

Not dissimilar to other industries, the global health sector is heavily male-dominated. The team of researchers and implementers found that organisations headed by women, that have a female board chair, that have reached gender parity in senior management and that are governed by bodies that have reached parity all fall below 30%. With nearly 70% of all healthcare and social workers worldwide being women, this discrepancy is troubling.

A gap like this in leadership positions creates a ripple effect, which impacts a range of other factors in global health. According to the findings, under half of the organisations reported sex-disaggregated data, and there were comparable results for health organisations setting targets and measures to support women’s career pathways.

Further, only 33% defined gender in a manner consistent with standard global classifications, and very few global health organisations recognise that gender drives health outcomes. All of this raises serious implications for men, women and the LGBTI community.

Here’s the to do list

There are solutions to addressing the disparities, but the challenge can be difficult to overcome. How can global health organisations be more inclusive — not just paying lip service to gender initiatives but integrating them into the fabric of their policies, structures and programming?

Here are some thoughts:

  • Create checklists, like this one, to raise the bar on gender parity – This may sound basic, but ensuring inclusion in the decision-making process requires that we bring our unconscious biases to the surface, to examine them and to shift our approach.
  • Institute policies that are informed by evidence – If you’re seeing something that works, take those learnings to scale and integrate them into your organisational fabric.
  • Integrate a gender equity lens in your programs – Having more women serve in leadership positions will increase the likelihood that this will happen, but programs must be infused with gender-responsive approaches in a very conscious and strategic manner to produce the best outcomes.
  • Institutionalise mechanisms for monitoring, accountability and learning – Taking the integration of gender in policies and practices a step further, it is important to create a culture of learning and growth. We must continue to assess and adapt to meet the needs of an evolving population.
  • Dismantle cultures of sexual harassment and other forms of gender-based violence – ICRW has been doing some research on how to change a culture that condones, or even inspires, harassment in the workplace. It is one very serious barrier to women feeling empowered to be part of the decision-making process in any organisation, and we must break those cycles wherever they exist.
  • Go beyond tokenism – From hiring practices to selecting leaders to program implementation, women can no longer be tokenistic emblems of gender equity. There must be a meaningful culture shift and concerted effort to ensure that the voices of women filling seats are heard and integrated in initiatives.
  • Ensure equal pay for equal work – In addition to shifting the ratio of women to men in leadership positions in global health, it is also essential that women are paid equitably.

The Equality Works report from Global Health 50/50 covers all of this in more detail with practical recommendations that can be implemented with the right level of commitment.

Yes, changes like these in the global health sector can be slow in the uptake, particularly as their aim is to counter the deeply ingrained inequities in our institutions and that they counter a dated view of what a leader should look like.

Sometimes, we need to see it to believe it. That’s where the research and the data comes in — evidence that informs and guides meaningful institutional, program, and policy change.

But there’s much more work to be done, including more research on the intersections of gender – well past heteronormative systems — and the organisation of global health activities. And we need to break down sector silos.

Illiteracy, fluctuating employment rates, the backlash on gender equality campaigns, mental health – all have an impact on global health. We need to find ways to work together to tackle cross-cutting issues that do not exist in a vacuum. And we need to start acting on all of this now. Our very well-being depends on it. — Sarah Degnan Kambou and Ravi Verma

This is part of an article series exploring the intersection between health and gender leading up to the high-level meeting on universal health care taking place in New York, 23 September 2019. In the previous article in this series, Jocalyn Clark, Executive Editor at The Lancet, argued that the lack of women in health science isn't only a moral problem - it also leads to worse health outcomes for everyone. Read that article here and take part in the discussion on Twitter.

(Picture credit: Life of Pix//Jenna Wang)