The intense repercussions of the COVID-19 pandemic have led to massive ripple effects felt around the world, particularly in marginalized communities and for the women and girls within them. Within this crisis, however, there are also opportunities for improving the status of women and healthcare workers, and advancing toward universal healthcare as a basic human right.
However, the prevailing narrative around the pandemic tends to paint women and girls as “victims” of the pandemic, or victims of issues and events that impact access to healthcare. This may not be the best way to frame the issue, asserts Sarah Hillware of Women’s Global Health. Relegating women and girls to the role of “victim” can be a major barrier in the path to universal healthcare.
“Globally, women’s rights and gender equality are still seen as technical, siloed issues,” says Hillware. “This was magnified during COVID-19, when we’ve been hearing from governments that ‘now is not the time to focus on gender equality.'”
Hillware asserts that this is a huge strategic mistake. “Unless gender equality is viewed as a foundational pillar of any health system, we will continue to miss the mark. At a time when women have been (and continue to be) disproportionately impacted by COVID-19, we must change the narrative and view women as leaders and part of the solution, not as victims or beneficiaries.”
Hillware is the Deputy Director of Women in Global Health (WGH), an organization with the largest network of women and allies working to challenge power and privilege for gender equity in health. As a US 501(c)(3) started in 2015, WGH has grown to include over 50,000 supporters in 90 countries and has 24 official chapters, with 19 in the pipeline, and a strong presence in low-and middle-income countries.
The global team and its network of chapters drive change by mobilizing a diverse group of emerging women health leaders, by advocating to existing global health leaders to commit to transform their own institutions, and by holding these leaders accountable.
WGH is among the many women-serving organizations that have pivoted immediately to meet the needs of women and girls during the pandemic. However, WGH pursues a different narrative, focusing on elevating women and girls while also addressing their basic needs for access to healthcare.
Focusing on the Pay Gap for Female Frontline Workers in COVID
Among WGH’s many foci is the pay gap for female frontline workers. Especially during the pandemic, when female healthcare workers are quite literally risking life and limb to take care of others, the underpayment — or sometimes, lack of payment at all — for women on the front lines of the pandemic represents an egregious oversight on the part of the healthcare organizations staffing these women.
“In 2021, Women in Global Health will work with the World Health Organization and the Government of France on a ‘Gender Equal Health Workforce’ initiative to catalyze change,” says Hillware. “One element will be a #PayWomen campaign to end the practice in some countries of engaging women as frontline community health workers either unpaid or underpaid on stipends. Another element will be a campaign to encourage governments to ratify the landmark new ILO Convention 190 on Violence and Harassment at work. Women in the health and social care workforce commonly face violence and sexual harassment at work that harms them, but also harms health systems.”
“Of course,” Hillware adds, “we will continue to campaign for women to have an equal role in leadership and decision-making within the health systems they know best, because diverse leadership groups make better decisions and we know that is good for everyone’s health.”
This concept of funding the women who “know best” is a central strategy for WGH. WGH and Hillware are strong proponents of trust-based giving for grassroots organizations that serve women and girls. After all, the women leading these organizations are closest to the problem — and understand the best possible paths to finding a solution.
“To have sustainable impact, trust-based investment is monumentally important,” says Hillware. “Grassroots women’s organizations are on the frontlines of driving change, and therefore, are the most powerful catalysts for gender equality. They know the needs of their communities, and are truly the ‘experts’ in a multitude of ways. Yet, due to racism, classism and other -isms, donors rarely trust them or fund their work.”
Universal Health Care and Gender Equality Go Hand in Hand
To Hillware, the path to universal healthcare is paved by women and for women. Where “traditional” philanthropic organizations (and, let’s face it, male-dominated leadership boards) view women’s rights as a problem to solve “tomorrow,” female philanthropic leaders can shift the narrative. Feminist donors, in particular, have an opportunity and a responsibility to lead the way toward universal healthcare and women’s empowerment as hand-in-hand goals.
“Feminist donors can take personal accountability in their work to listen to the needs of their grantees serving women and girls, and remove modalities of working that place additional unnecessary burdens on them,” says Hillware. “Donors should likewise ensure that any program or organization they fund prioritizes diversity in leadership, and has a leadership that directly reflects those the program serves.”
One example Hillware provides could be a program addressing maternal mortality might consider hiring a local midwife or traditional birth attendant in its design and implementation.
“Donors can embed modalities into their funding applications that prioritize organizations taking such gender-responsive approaches,” she explains.
“It is clear that universal healthcare will be delivered by women,” Hillware adds. “Women health workers currently deliver services to around 5 billion people and comprise 70% of the health and social care workforce, yet occupy only 25% of leadership roles in health. To build back better post-COVID, we must challenge power and privilege in health to ensure women are at the decision-making table, in both the design and delivery of health systems. We won’t achieve health for all unless we can reach the most marginalized girls and women, and connect local reality to policy, hardwiring rights and agency across the board, and safeguarding access to services, especially sexual and reproductive health.”
In the next 5-10 years, Hillware encourages feminist funders and healthcare leaders to:
- Mainstream a gender perspective in healthcare design, delivery and monitoring.
- Integrate sexual and reproductive health and rights into essential healthcare services by 2030.
- Protect health workers from all forms of violence and ensure safe and decent working conditions. If women are to fill the 18 million health worker jobs needed to reach universal health coverage, urgent action will be needed to address gender gaps in leadership and pay as well as the discrimination, bias and lack of family-friendly policies that constrain their careers.
- Commit to recording, recognizing and rewarding women’s unpaid work in health and social care, estimated at half the US$3 trillion women contribute.
- Fund women’s organizations at community, national and global levels. The story of the universal health coverage process over the past two years highlights the political and technical role played by women’s movements and organizations, in keeping gender equality and the rights of women and girls on the agenda.
- Include women’s voices and leadership in all healthcare conversations. This includes gender parity, diversity and inclusion in all conversations. We must ensure that women and other underrepresented groups are at the decision-making table to ensure “leave no one behind” is being implemented from design to delivery.
“There is a growing awareness of the critical role that women’s organizations and feminist movements play in achieving long-term transformation,” says Hillware. “They have already ‘proven’ themselves in labor rights, sexual and reproductive health and rights, ending FGM, ensuring accessibility of menstrual products, mobilizing movements against climate change, ending maternal deaths and more.”
So what’s the next step?
“Now, it is time to walk the talk and put our money where our mouth is,” says Hillware. “It’s time to increase investments, availability of flexible funding, and put systems in place where funding is responsive to and driven by local priorities.”
To learn more about Women in Global Health, visit their website at www.womeningh.org.
About Sarah Hillware: Sarah Hillware is the Deputy Director of Women in Global Health (WGH), a 35,000+ strong women-led organization working to challenge power and privilege for gender equity in health. Sarah leads fundraising efforts, partnerships, and grassroots movement-building through its global network of 24 chapters. WGH’s intersectional approach puts the traditionally “last” women first and intentionally elevates underrepresented women to visible roles in global health. WGH drives policy change at all levels by mobilizing a diverse group of emerging women health leaders, advocating to existing global health leaders to commit to transform their own institutions, and by holding these leaders accountable.
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