Women in Global Health Top Five Items to Watch at WHA72

The Women in Global Health Team – bags packed, banners rolled and voices tuned – are on our way to join the global health community at the 72nd World Health Assembly (WHA72) in Geneva 20-28 March 2019. This year the Geneva event looks set to be bigger than ever before, with more side events and some substantial items on the agenda.

These are the top five issues Women in Global Health will be following at WHA72:

1. Universal Health Coverage (UHC) just has to be top of the list given the UN High Level Meeting on UHC (HLMUHC) in September. But following the rule that ‘what happens in Vegas, stays in Vegas’, will discussions on UHC stay in New York where, officially, negotiations are supposed to take place? Or will it dominate WHA72 in Geneva? The decision to release the Zero Draft of the HLMUHC Political Declaration in New York on 21st May, two days into WHA72, means UHC will be a huge talking point at WHA72. Three papers on UHC are on the WHA72 agenda:

1.1 Preparation for the HLMUHC A72/14 - Women in Global Health fully support UHC as the beginning of a life transformation for billions of people – at least half the world’s population – who currently lack access to essential health services. And although not specifically mentioned in the paper, if UHC is implemented effectively it will have a major impact on SDG 5 Achieve Gender Equality and Empower All Women and Girls. And women as 70% of the global health and social care workforce, will be drivers and change agents of UHC, not only beneficiaries.

Readers may know that at the March Commission on the Status of Women, Women in Global Health, the International Women’s Coalition and Women Deliver got together to co-convene a new civil society Alliance for Gender Equality in UHC. The Alliance now has 34 civil society organisations, from 22 countries and membership is growing. It should not still be necessary to make the case for gender equality and women’s rights as drivers of health since the case has been proven and global commitments made. But we feel compelled to do so, particularly given the growing push back on women’s rights in UN processes and at national level in some countries. Join us at our WHA72 side event ‘Achieving Women’s and Girls’ Health and Human Rights: Putting Gender Equality at the Center of UHC’.

Women in Global Health fully endorse the 6 Key Asks[1] for UHC presented by UHC2030 to Member States for consideration in the HLMUHC discussions and Political Declaration. And we added a 7th Ask on Gender Equality and Women’s Rights at the April Multi-stakeholder Meeting for the HLMUHC. The ‘7th Ask’[2] has now been finalised and adopted by the Members of the Alliance for Gender Equality and UHC and we expect a 7th Ask will be adopted by UHC2030. Collectively, as the Alliance we ask Member States to ‘Commit to Gender Equality and Women’s Rights’ at the HLMUHC and beyond and ‘Integrate gender equality and women’s human rights, including sexual and reproductive health and rights (SRHR) into UHC. We ask for this not as special pleading by an interest group but because the evidence is clear that UHC will not be achieved unless gender equality (meaning all genders) and the human rights of women and girls are integrated into health systems and society. It is essential for the health of women and girls, essential for health systems and therefore essential for UHC.

Paper A72/14 on Preparation for the HLMUHC also covers the HLM Modalities Resolution [3]. WGH’s Call to Action for the HLMUHC ‘Gender equality and women’s rights in UHC drive better health for all. This is everybody’s business’[4] reminds Member States and the President of the General Assembly of commitments made in the Modalities Resolution to choose speakers and panellists for the HLM ‘taking into account gender equity, level of development and geographical representation.’ And the commitment to select HLMUHC participants ‘taking into account the principles of transparency and equitable geographical representation, with due regard to the meaningful participation of women’. We expect to see this in practice in September and can propose diverse, female experts from our global network should this be in doubt.

In addition - regrettably not included in the Modalities Resolution - Women in Global Health call on Member States to send gender balanced delegations to the September HLMUHC. Although women hold the majority of posts in global health, they continue to be in the minority in global health decision making at the World Health Assembly. In 2018, only 31% of health ministries were headed by women and only 25% of Member State Chief Delegates to the World Health Assembly 2015-2018 were female.[5] Women in Global Health will be compiling statistics again at WHA72, trusting that the representation of women has improved and that our message on representation of women will be heard for the HLMUHC.

1.2 Primary health care towards UHC A/72/12 - A strong case is made for investment in primary health care as the foundation for UHC, especially given changing demographics and the epidemiological transition to Non Communicable Diseases (NCDs). Primary health care (PHC)is not about providing low quality services for poor people while people who can afford better pay for private health care. It has to be the solid foundation where health prevention and early diagnosis head off whatever burden of disease we can prevent or delay. Women in Global Health are advocating Primary Health Care that is high quality, affordable and accessible to the hardest to reach women and girls and that addresses their health needs and priorities throughout the lifecourse, including their sexual and reproductive health and rights. It has to be a system that everyone regardless of income chooses to use and where even the most marginalised social groups are treated with dignity and respect. Srinath Reddy at a recent meeting described PHC as ‘the canary in the coalmine’. Who chooses to use PHC will be an indicator of success of the whole health system. Paper A72/12 has a heading ‘Transforming Vision into Action’ and that will be the test.

1.3 Community Health Workers (CHW) A72/13 - We agree with the paper that Community Health Workers are essential members of the health workforce and critical in reaching underserved populations. We also agree that CHWs should not be seen as a cost saving alternative for other health care professionals and endorse the call for safe and decent working conditions and freedom from discrimination, coercion and violence. In many health systems, women will be the majority of CHWs and ensuring their safety when working remotely and in conflict zones is paramount. Women in Global Health’s Call to Action for the HLMUHC notes that women’s work in health contributes an estimated US$3 trillion to global GDP but around half is unpaid. Women provide unpaid care in the absence of UHC and skilled care workers. UHC delivery means bringing women’s unpaid work into the formal labour market as decent work and ending the subsidy the poorest women make to health systems through their unpaid work. We call on Member States implementing UHC to integrate the unpaid health and social care work done by women into the formal labour market and end the practice of engaging women as unpaid and underpaid community health workers.

In addition to UHC, there are four other topics we will be tracking at WHA72:

2. Human Resources for Health A72/24: The report covers activities undertaken by WHO as part of the Global Health Workforce Network, which includes the Gender Equity Hub co-chaired by WHO and Women in Global Health. Earlier this year the Hub launched a new report ‘Delivered by Women, Led by Men. A Gender and Equity Analysis of the Global Health and Social Care Workforce’ [6] Given the findings we would have expected this report to highlight the urgent need to address gender inequities in the health workforce given major gender gaps in pay, leadership and widespread bias, discrimination and sexual harassment experienced by female health workers. These gender inequities weaken the health workforce and limit the scaling up of 18 million jobs needed to achieve UHC. We were pleased to see the recommendation in Paper AR72/54 that 2020 be designated as the International Year of Nursing and Midwifery. Recognition of the contribution of nurses and midwives to global health and the need to increase the numbers of both in global health leadership is long overdue. Women in Global Health will hold a Heroines of Health dinner at WHA72 to mark the contribution women leaders makes in health at all levels and will make awards to seven Heroines of Health for their outstanding achievement.

3. WHO Transformation A72/48 - We read with interest the rationale behind the WHO organisational transformation and restructuring this year which has not always been clear to external observers. We will be interested to hear more about the impact, amongst other things, upon delivery and coherence of gender mainstreaming in the General Programme of Work.

4. Human Resources AR72/43 -In this report from 2018 we are delighted to see WHO taking steps to address unconscious bias in recruitment and to see improvements in gender balance. We will be interested in whether the gender balance in senior leadership (60% women in 2018) in WHO Geneva has changed after the recent restructuring. Although the overall prevalence rate of sexual harassment at WHO was lower than the global UN average (35.5% and 38.7%, respectively) action clearly needs to be taken to create a safe and dignified work environment, particularly for women.

5. WHO Programme Budget A72/4, A72/5, A72/INF/2, A72/INF/3 - Have Member States stepped up to fund WHO to the levels needed for it to deliver its critical mandate and ambitious ‘triple billion goals’ [7] And if not, which parts of the programme remain underfunded, knowing that this will distort delivery of WHO’s work.

Finally, Women in Global Health are launching a competition to guess the end date of the negotiations on the HLMUHC Political Declaration. We hear negotiations are scheduled for four weeks June – July. We hope there will be fast and unanimous agreement (facilitated by the inclusion of the Alliance’s 7th Ask) but four weeks seems ambitious. To join the competition, please tell us when you predict the negotiations will close. There will be a prize for the winner!

[1] UHC2030 Key Asks from the UHC Movement for the UN High Level Meeting on Universal Health Coverage https://www.uhc2030.org/news-events/uhc2030-news/uhc2030-launches-key-asks-from-the-uhc-movement-for-the-un-high-level-meeting-on-universal-health-coverage-544846/

[2] Alliance for Gender Equality and UHC 2019 The 7th Ask: Integrate gender equality and women’s human rights, including sexual and reproductive health and rights (SRHR), into UHC

[3] Resolution A/RES/73/131 Scope, modalities, format and organization of the high-level meeting on universal health coverage, UN General Assembly on 13 December 2018

[4] Women in Global Health Call to Action on Universal Health Coverage https://www.womeningh.org/uhc-gender

[5] Women in Global Health

[6] Gender Equity Hub Report: Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health and Social Workforce 2019 https://www.who.int/hrh/resources/health-observer24/en/

[7] WHO’s 13th General Programme of Work 2019-2023 https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019-2023

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