A Call for Coordinated Global Action to Build Back Gender-Responsive Health Systems
Dr. Roopa Dhatt, Executive Director of Women in Global Health offers the following address at the UN Women and OECD's Women Leaders Virtual Roundtable on COVID-19 and the Future:
Excellencies and esteemed fellow guests, it is a privilege to be here today.
Let me start with the good news: there is a vibrant global movement of women in health actively organizing around COVID-19, sharing evidence and resources across borders in a spirit of sisterly solidarity. Women are the majority in health and social care. The expertise and the woman power is out there. This is our time to lead.
I have five key points:
1. Now is the time.
If this is a war – and we contest that – then women are the frontline soldiers in this pandemic. They are 90% nurses worldwide and were 90% of frontline health workers in Wuhan. In many countries, female nurses and community health workers will be the first and only health worker seen by COVID-19 patients.
But when we raise gender equity issues and push back against COVID-19 decision-making bodies with no women we are told 'now is not the time.' The systematic sidelining of women's expertise and lived experience in health is a major reason why this pandemic has hit so hard.
Women are 70% of the health workforce, but hold only 25% of senior roles. Women from the Global South are particularly underrepresented in global health decision-making. Women are the experts in health; they know the solutions we need. They are also doing a better job when they get into decision-making positions – but the world isn't listening.
2. Applause is great, but safe and decent work is better.
Women health workers are being applauded as heroines in this pandemic and we too applaud their extraordinary resilience and commitment to their profession. But health systems established by men for men have been slow to recognize that the default health worker is a woman and that she has different needs. We congratulate UNFPA for having sent sanitary towels and adult diapers for health workers in Wuhan, recognizing their needs as women.
The needs of female health workers in COVID-19 now include ensuring their safety as they move about communities, personal protective equipment that fits women and policies that don't assume women can work long shifts in hospitals while at the same time home school children, care for elderly relatives and carry the full burden of domestic work. For too long women have been the social shock absorbers in times of crisis.
This pandemic shines a spotlight on the lack of value we put on women's work, the superhuman expectations we have for women and especially women from lower socioeconomic groups who face extreme financial hardship if they do not work. Although men face higher mortality from COVID-19, women have a higher infection rate because of their work in health and care.
We must turn today's applause into decent and safe work for women in health and social care, equally paid. There is a danger that after this pandemic, women will be expected to return to their gender roles, undervalued, un-compensated, and un-protected. And that will leave us all vulnerable.
3. The poorest women in the world subsidize global health with their unpaid work.
Half of the work done by women in the health and social sector is unpaid: $1.3 trillion per year. During a pandemic, women engaged unpaid in vital roles such as vaccinators and community health promoters, will be the first to leave the health system. And then the house of cards that global health security depends on will come tumbling down.
We must recognize the value of women's unpaid health and social care work and bring it into the formal labor market.
4. We're working blind.
Only 25 countries out of 193 are reporting sex disaggregated data on COVID-19 to the WHO. Without sex disaggregated and gender-responsive data, we are working blind in this pandemic and will not document the lessons that will help combat future health challenges. Twice as many men than women are dying from COVID-19 and we need to know why – but we also need to document the deaths of women from gender-based violence and in childbirth because they were unable to access maternal and reproductive health services. We saw this in recent Ebola outbreaks. We don't need to keep making the same mistakes.
We need gender responsive data collection and analysis feeding into COVID-19 response policies that avoid multiplying indirect harm for women and girls.
5. Let's break through the echo chamber.
COVID-19 has disrupted business as usual on a global scale, giving us an opportunity to re-imagine the future. Although there is an unprecedented level of organization by women in health around COVID-19, I fear there are just larger numbers of us in the same echo chamber talking to each other. COVID-19 strategies and plans continue to be published that are gender blind, so our messages are not being heard by those who need to hear them.
We do not need to seek permission. Everything I have asked for has been agreed by the world's governments in the Sustainable Development Goals and at last year's UN High Level Meeting on Universal Health Coverage - and it has a delivery date of 2030.
We need one coordinated global vehicle for the pandemic response now that can also lead the global effort to build back better gender responsive global health, led by at least 50% women, based on global collaboration, compassion, social cohesion, equity and human solidarity.
We are calling for equal representation of women from all geographies as a standard in all health decision-making bodies, including COVID-19, from global to community - not just for women - but to enable women to deliver better health services for everyone including men.