April 23rd, 2020
The World Health Organization was designed to address threats exactly like COVID-19—where global cooperation is our only chance of success.
The global community is racing to slow down the spread of COVID-19, a pandemic that has claimed the lives of over 160,000 people globally and sickened over 2 million more. As researchers and epidemiologists work around the clock to find a solution to halt both the deaths and the spread of the disease, our health workers are leaving loved ones at home to fight on the front lines of this crisis. I am moved daily by the stories of those doctors, midwives, nurses and other essential workers, who are working tirelessly to keep us safe, facing the dangers head-on, often with inadequate equipment and information.
Much of the world is locked down, isolated in households and communities, renewing and deploying the age-old and time-tested techniques of personal, social, surface and environmental hygiene, which all depend on the availability of clean water—an essential resource often scant where it is needed most. In Africa, the virus has spread to dozens of countries within weeks. Governments and health authorities across the continent are striving to limit widespread infections.
As always in times of crisis, the most vulnerable among us will be the ones hit hardest. Women and girls will suffer the most from this disease, and we have already seen a rise in gender-based violence and rights violations of pregnant women. Sufferers of domestic violence are now locked down with their abusers, isolated from their support systems, and other at-risk groups are unable to access routine services. The ripple effect of COVID-19 runs far beyond the disease itself. Humanity will bear the scars of this pandemic for many years to come.
Around the world, we are seeing countries and communities acting both together and apart. Fear is impeding mechanisms for an effective response to the coronavirus pandemic, giving rise to anger, racism, a rhetoric of blame and a dangerous spread of misinformation. Beyond health services, countries with large ratios of informal economic sector citizens are struggling to feed themselves, increasing the present hunger and suffering, as well as the undeniably unwelcome prospects of unrest.
Now more than ever, the world needs a well-functioning global organization designed to facilitate international coordination. The global community must unite behind a strong World Health Organization, an institution designed to address exactly this kind of global issue, our standard-bearer in these unprecedented times for this unprecedented virus. Countries need factual information based strictly in science with the benefit of a global perspective to ensure the most vulnerable communities have the support and information they need to survive.
The WHO works closely with governments to provide evidence-based guidelines for response and facilitate adaptation to the country context. Remote support is being provided to affected countries on the use of electronic data tools, so national health authorities can better understand the outbreak in their countries. Preparedness and response to previous epidemics is providing a firm foundation for many African countries to tackle the spread of COVID-19. Following their lead, which has urged nations to track and trace in order to tackle and treat the coronavirus, my organization, the Wellbeing Foundation Africa, has partnered with Pocket Patient MD to launch an app-based digital platform that enables individuals across Nigeria to run a health check and identify early symptoms of COVID-19.
Where basic preventative measures by individuals and communities remain the most powerful tool to prevent the spread of COVID-19, the WHO is helping local authorities craft radio messaging and TV spots to inform the public about the risks of COVID-19 and what measures should be taken. The organization is also helping to counter disinformation and is guiding countries on setting up call centers to ensure the public is informed. Every country is a beneficiary and a partner of the WHO’s work.
In the same vein, it is inconceivable to imagine a healthy future for our world without acknowledging the pivotal role of the United States in ensuring we realize it. The WHO has operated with the majority of its funding coming via the U.S. government throughout its 70-year history. We must recognize and respect the interconnected nature of our world, the relationships between countries and institutions, and the significant roles of member states in enabling such important institutions to function and deliver during these crucial times. We must prioritize unity and diplomacy at all levels.
COVID-19 is cruel in many ways. Many of us have been shaken by the loss of a loved one, made all the harder by separation enforced by lockdowns. But we cannot allow it to divide us, to pit us against one another—against countries, organizations and neighbors. If we allow that perspective to prevail, we will not only lose ourselves and experience greater isolation, we will also make ourselves more vulnerable. We must come together to manage this shared challenge, show solidarity as country and institutional leaders, advocates and allies, health workers and communities. We know, through hard-earned experience, that global cooperation is our only chance of success.
While many nations have attempted to build health security borders to combat the pandemic, COVID-19 is a stark reminder that humans are connected, and that what happens in one country can impact the everyday lives, social fabrics and economies of countries far away. Working individually does not shield us from the global framework in which we are operating – we are part of an interconnected world, and when we respond accordingly, we can more accurately and effectively combat our shared challenges.
Human connectivity holds power. The positive impact of our collective will to physically distance from one another alone shows what power we hold. In working together to promote unity, overcome global inequality and support measures to protect public health, we are striving to ensure that no one is left behind in our response to the pandemic.
Toyin Saraki is the founder and president of the Wellbeing Foundation Africa, the inaugural global goodwill ambassador for the International Confederation of Midwives and special adviser to the independent advisory group of the World Health Organization’s regional office for Africa.
The views expressed in this article are the writer’s own.
Project Syndicate March 3rd, 2020
From labor shortages to racial bias, the barriers to achieving Sustainable Development Goal 3 – “ensure healthy lives and promote well-being for all at all ages” – are as diverse as they are high. But the chances of success are significantly better if we listen to those who understand the situation on the ground.
ABUJA – We have a decade left to achieve the United Nations Sustainable Development Goals (SDGs), and we are nowhere near where we need to be to succeed. One crucial reason is that women remain largely excluded from decision-making processes, which leads to policies that do not provide women the support they need to prosper – or even to survive. Nowhere is this dynamic more apparent than in the health sector.
Women comprise roughly 70% of the global health workforce, and perform the majority of the sector’s most challenging, dangerous, and labor-intensive jobs. Yet they hold only 25% of the health sector’s senior roles, and are rarely represented adequately in policymaking. Instead, they are often expected to remain passive actors, quietly finding ways to do their jobs in difficult – even impossible – circumstances.
The reality for women health workers was reflected in a recent letter to the medical journal The Lancet from two Chinese nurses describing the conditions they and their colleagues face on the frontlines of the battle against the new coronavirus, COVID-19, at its source in Wuhan, China. It may be an extreme case (and the letter has now been retracted over claims that it was not a firsthand account), but the challenges described, from shortages of protective equipment to chronic overwork and exhaustion, are all too familiar to health workers everywhere.
Such conditions make essential health-sector jobs unattractive, contributing to severe labor shortages worldwide. The World Health Organization estimates that, for all countries to achieve SDG 3 (“ensure healthy lives and promote well-being for all at all ages”), an additional nine million nurses and midwives will be needed globally by the year 2030.
Closing this gap is matter of life and death. For example, midwives are often the difference between safe childbirth and newborn or maternal mortality. Lack of access to them – especially for vulnerable populations, such as poor rural dwellers – is a major reason why two-thirds of all maternal deaths occur in Sub-Saharan Africa. The WHO estimates that adequate midwifery care (including family planning) could prevent 83% of all maternal deaths, stillbirths, and newborn deaths.
Infant and maternal mortality are hardly limited to developing countries. In the United States, the maternal mortality rate has actually increased in recent decades, from 7.2 deaths per 100,000 live births in 1987 to 16.7 deaths per 100,000 live births in 2016. More than half of these deaths could have been prevented if the mothers had better understood the importance of – and had easier access to – quality prenatal and postpartum care.
There is a clear racial dimension to this disturbing trend. In the US, a black woman is 3-4 times more likely than a white woman to die from complications in pregnancy. In the United Kingdom, that multiple rises to five. While this discrepancy may be partly explained by health complications black women experience, racial bias also plays a role. Black women often report feeling that they are not taken seriously by medical professionals.
The health consequences of not listening to women extend further. Children born to healthy mothers are more likely to remain healthier throughout their lives. Because a woman is most likely to engage with the health sector during pregnancy, the support of a midwife or nurse can pull a woman’s entire family into the health-care system.
In a bid to recognize their vital contribution in the health sector, the WHO has designated 2020 as the Year of the Nurse and Midwife. But beyond celebrating nurses and midwives for their hard work, we must seek to rectify structural inequities that exclude women from leadership positions in these professions. That is a key goal of the upcoming Women in Dev conference – a women-led, women-focused initiative that deserves the support of us all.
From labor shortages to racial bias, the barriers to achieving SDG 3 are as diverse as they are high. But the chances of success are significantly better if we listen to those who understand the situation on the ground, and work to enhance inclusion at all levels, taking into account varying socioeconomic conditions. This will require a fundamental shift in mindset, with publics and policymakers alike recognizing that women – as nurses, midwives, and mothers – are often the gatekeepers of health.
A decade of rapid progress toward SDG 3 is possible. But women must be at the helm.
H.E. Toyin Saraki is the President and Founder of The Wellbeing Foundation Africa.
All Africa December 12th, 2019
Abuja — Today, as we mark International Universal Health Coverage (UHC) Day, I am encouraged by the growing momentum behind the belief that every single person should have access to the care they need when they need it, and that no one should be forced to suffer financial hardship or forgo treatment they cannot afford.
The Wellbeing Foundation has committed to employing a whole system approach for health for all with ten essential features, centering on the provision of quality primary health care for all, with a focus on women, infants, and children. It has been three months since the High-Level Meeting (UN HLM) on Universal Health Coverage at the 74th UN General Assembly, in which leaders around the world recommitted to their promise of health for all. At the heart of this progress is the understanding that quality maternal care should be at the centre of our drive to achieve universal health coverage.
I believe that it is critical that next year has been identified as the World Health Organization (WHO) Year of The Nurse and The Midwife. The year, which fittingly marks the 200th anniversary of the birth of Florence Nightingale, presents us with a unique opportunity to consider the role of gender parity and equality in health coverage and health provision.
In March 2019, the WHO, the Global Health Workforce Network, and Women in Global Health produced a report on Global Health and Social Workforce entitled “Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health and Social Workforce.” Strikingly, the report found that ‘women deliver global health and men lead it’. The report highlighted that women comprise 70% of the global health workforce, but only 25% hold senior roles, while women face gender discrimination, barriers, and inequalities not faced by their male colleagues at work. Gender inequality within the sector is not only unacceptable, but it ultimately weakens the quality of healthcare that we are able to provide.
Nurses and midwives represent half of the professional health workforce and are overwhelming, although not exclusively, women. They play a critical role not only in delivering healthcare to millions of people in every country, but they are key to transforming health policies, disease prevention, emergency care, and supporting the families of patients. They are necessary partners supporting the health and wellbeing of the communities they serve in a multitude of ways that include health care delivery, education, and counselling. If we are to build universal health coverage that is of quality and value, it is essential that we ensure that frontline workers in maternal care have not just a have a seat at the table but sit at the head.
As nations develop UHC frameworks, I am encouraged to see a groundswell in the number of individuals and organisations advocating for sexual and reproductive health and rights (SRHR) and prioritising the needs and rights of women and girls. SRHR means liberating women and girls with access to family planning and empowering them with the information and confidence to make informed decisions about their lives. Strong SRHR frameworks include education, awareness, and choice: the choice to have children in clean and safe conditions. The choice to space children, so that resources can be distributed to maximise the opportunities of each child. The choice to be properly informed and empowered in the decision-making process that surrounds these issues is important for the young. Effective SRHR may prioritise women and girls, but it also cannot afford to exclude men and boys; these are issues that affect everyone.
In 2013, at the World Health Assembly, then-President of the World Bank Group, Dr Jim Yong Kim, asserted that “we must be the generation that delivers universal health coverage.” I couldn’t agree more: now is the time to get this right.
In alignment with World Health Organization recommendations, the Wellbeing Foundation Africa’s whole system approach to UHC is comprised of ten essential components:
1)Pregnant women should receive the right care, at the right time;
2) Newborns should receive essential care immediately after birth;
3) Small and sick babies should be well cared for in a facility;
4) All women and newborns must receive care that prevents hospital-acquired infections;
5) Health facilities must have an appropriate physical environment;
6) Communication with women and their families must be effective and respond to their needs;
7) Women and newborns who need referrals can obtain them without delay;
8) No woman should be subjected to harmful practices during labour, childbirth, and the early postnatal period;
9) Health facilities need well-trained and motivated staff consistently available to provide care;
10) Every woman and newborn should have a complete, accurate, and standardized medical record.
Each of our flagship programmes and initiatives; our Emergency Obstetric and Newborn Care programme, our Water, Sanitation, and Hygiene programme, our Personal Healthcare Record Book initiative, our Alive and Thrive programme, and our MamaCare/MamaCare+N programme are tailored to meet these priorities.
This year, leaders made progress by affirming UHC as a key strategic interest. But millions of lives hang in the balance of this essential promise, a promise on which we must deliver. The WHO cites that today approximately half of the world’s population live without full coverage of fundamental health services while an estimated 100 million people are being forced into extreme poverty due to health care expenses.
The equivalent of one in ten people is spending over 10% of their household budget on critical health care costs. We know that there is a myriad of ways that health will impact the achievement of sustainable development, including, but not limited to the health-specific objectives.
How can we solve poverty if people are forced into bankruptcy themselves to pay for treatment? We will only meet all of the SDGs by 2030 if everybody is able to access affordable, safe, respectful, and quality healthcare.
Today I call on all health partners and stakeholders to urge our leaders to deliver on their promise of UHC. I wholeheartedly believe that we must collectively champion UHC frameworks that are grounded in equality and inclusion and take into consideration not only the unique experiences of women in the health workforce, but that centre on SRHR policies that prioritise women and girls.
Toyin Ojora Saraki is founder-president of Wellbeing Foundation Africa
May 4th, 2020
Today, on 5th May, we celebrate the most momentous day in a century for the midwifery profession, the International Day of The Midwife, in the first ever Year of the Midwife, as the world is currently at a standstill fighting the coronavirus pandemic, an invisible enemy that has claimed hundreds of thousands of lives. It cannot be a coincidence that today we also celebrate World Hygiene Day, a day set aside to focus on hand hygiene: that simple act of handwashing with soap. Hand washing was originally propagated by the 1840 Physician Ignaz Semmelweis to midwives at his maternity wards, as the best means to prevent and control childbed fever infection—as puerpural sepsis was then known. Thus, midwives and their clean hands have established and led life-saving and life-enhancing infection prevention and control protocols for centuries. They are at the very frontlines of health, safely guiding new life, as the first eyes to see and first hands to touch a newborn child, as they stand by women all over the world in their hours of labour, delivery and need.
And they are not alone.
Health care workers, midwives, nurses, doctors, and the entire medical profession are at the forefront to save lives because they took an oath, an oath to serve regardless of the situation. They risk their lives to save the world in these unprecedented times. It is sad that during this crisis we have pushed to the background the work that we have put in over the years in various development aspects. I fear that this progress of prominence on the work we have put in reducing maternal mortality through they essential role of the midwifery profession in standing with women to ensure safer births will be threatened by a recession of recognition, and subsequent key investments as the focus shifts.
My thoughts and prayers are with the families of all the nurses and midwives who have lost their lives to Covid-19. Their deaths are a tragedy and I join their colleagues standing with midwives around the world in mourning their beautiful souls. Each and every one of them will be remembered in our hearts as a heroine.
As always in times of crisis, the most vulnerable among us will be the ones hit hardest. Women and girls will suffer the most from this disease which has already seen a rise in gender-based violence, and rights violations of pregnant women forced into giving birth alone. Some will face child-birth complications risking the lives of both the mother and child, some will have stillbirths and some others will successfully give birth to the future leaders that will hold us accountable for the lives of their mothers lost during child birth.
The repercussions will be a constant reminder that for years we have failed and continue to fail women and children where public health is concerned.
While the world grapples in its response to COVID-19, we must be mindful that everything else still functions as before. We still require access to SRHR, women will continue to require prenatal care and safe spaces to deliver in order to reduce maternal mortality.
For years midwives have joined the battle and reduced maternal mortality ensuring that even in the poorest communities, women still had access to safe births. This is most likely one of those challenging situations for midwives in various communities.
Midwives continue to be an essential service in this crisis and we should do more than just applaud their hard work and dedication. How are we ensuring their access to protective clothing and reaching women in need. This is why on this International Day of the Midwife we are launching the We Must Applaud Midwives with WASH campaign that seeks to remind people on the importance of washing hands. As well as protecting frontline healthcare workers, WASH plays a vital role in stopping disease transmission yet two out of five healthcare facilities still lack hand hygiene facilities at points of care.
Ten Immediate WASH Actions in Healthcare facilities to Respond to COVID-19
BONUS – Preventative maintenance: Check on WASH infrastructure and undertake any necessary preventative maintenance, such as repairing possible disruptions to the water supply, storage, distribution or treatment.
There is much work to be done to ensure that the focus on WASH lasts beyond this crisis and translates into a radical change in how we understand and prioritise water, sanitation and hygiene. A key part of achieving that will be demonstrating that without good WASH standards, global health security is impossible.
Clean water is health and security, and clean hands save lives.
The ripple effect of COVID-19 runs far beyond the disease itself. We must stand in support of midwives, and the entire medical profession, to build a strong bridge between the global health community and WASH, in order to mitigate and heal the scars of this modern-day pandemic on medical workers, women, our newborns and humanity for the many years to come.
My prayers are thus reinforced as 2020 marks not only the Year of the Midwife but also heralds the Decade of Action and Delivery, designed for us to take deliberate steps towards the 2030 Sustainable Development Goals. Because midwives have supported women for centuries by delivering routine maternity care and counsel on a daily basis, we must use this opportunity to advocate louder and stronger together. We must mobilise women and policymakers to stand with midwives as midwives stand with women, newborns and their families. We must stand for the midwifery profession around the world to be recognised, respected and remunerated, and routinely provided with whole-system support.
April 7th, 2020
Her Excellency Toyin Saraki, founder of The Wellbeing Foundation Africa is set to launch a powerful new e-health check tool in partnership with PocketPatientMD which will make free ‘COVID-19 Health Check’ available to all 200 million Nigerians.
The digital e-health tool – soon to be complemented by a mobile application and an offline version – will educate the public on how to stay healthy; provide users with information about whether or not they need to be tested for the Coronavirus; give public officials critical insights into vulnerable populations while providing early identification of potential COVID-19 hotspots around the country.
“This is a first-of-its-kind tool in the global fight against this pandemic. This health platform has the potential to be an effective early warning system, accelerating the response time of public health officials with limited resources, and giving every Nigerian accurate and immediate health advice”, commented Saraki who is also the Special Adviser to the World Health Organisation Africa Office Independent Advisory Group.
“Our efforts will complement the heroic efforts of the Nigeria Centre for Disease Control (NCDC) and all those working to solve this unprecedented challenge.” Dr. Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control (NCDC), commending the efforts of The Wellbeing Foundation Africa, noted that “it is important that Nigerians have the tools that enable them to take proactive steps to protect their health” as we work hard to prevent and control the spread of COVID-19.
In the same vein, Dr. Sani Aliyu, the National Coordinator of the Federal Government of Nigeria’s Response to COVID-19 has lauded the tool as “a welcome digital innovation to help Nigerians better understand their potential risks and symptoms and direct them to government resources for any required follow-up.”
The e-health check tool works by asking users a few questions in order ascertain whether or not they need to get tested for the Coronavirus. In keeping with the Federal Government of Nigeria’s directive on staying home to curb the spread of the pandemic, the tool refers users directly to both the NCDC and state government hotlines for medical advice on how to get tested. Mark Wien, co-founder and CEO of PocketPatientMD explained that the focus of the partnership is reach “as many Nigerians as possible, and we are honoured to partner with Her Excellency Toyin Saraki who has a global reputation as an advocate for the vulnerable and a champion of better healthcare for all.”
“We can only beat Coronavirus if we work together”, added Saraki. “Misinformation has become
widespread as we respond to this pandemic and this ground-breaking approach will only be as effective as the number of people who sign up and join us.” She implored Nigerians to “take the test every 7 days, or when their symptoms change, and to ensure that they are paying close attention to, and reporting any changes in their health status not only to stay safe but also to help keep our frontline health workers safe and our public officials aware.”
The e-health check tool is available for free at https://covid19.wbfafrica.org/ and users can access real-time updates on how to stay connected, safe, and healthy during the pandemic on Instagram and Twitter @Wellbeing_PPMD, and @WellbeingPPMD on Facebook.
The Wellbeing Foundation Africa (WBFA) was founded in 2004 by Her Excellency Mrs Toyin Ojora Saraki, with the aim of improving health outcomes for women, infants and children. The Foundation combines programmes with advocacy work in Nigeria and around the world.
Through a multi-layered strategy of research, advocacy, policy development, community engagement, philanthropy and education, the Wellbeing Foundation Africa devises and implements programs which boldly deliver upon the stated objectives of United Nations Sustainable Development Goals Three, Five, and Six: Good Health and Wellbeing, Gender Equality, and Clean Water and Sanitation, respectively. All Wellbeing programs address multiple intersections between these three goals, including, but not limited to further education for midwives and frontline community health workers, improved education around water, sanitation and health (WASH) for life-saving healthy habits, advancement of early childhood mental and physical health development, and, the fundamental necessity of gender equality and the empowerment of all women and girls for a fair and just society. The WBFA supports the 8 pillars of WHO’s COVID-19 Strategic Preparedness and Response Plan.
PocketPatientMD is a free, interoperable, fully integrated medical platform currently in common African languages, available online and offline. PocketPatientMD allows physicians and patients access to medical information anywhere, anytime, safely, securely and at no cost. Stakeholders throughout the health system can easily connect to one another, leading to, cost-effective, higher quality care. PocketPatientMD works on any device (computer, phone, tablet) and with any operating system and can link to any lab, pharmacy, diagnostic centre, or application and be customised as needed.
April 3rd, 2020
Following the recent call of the UNWomen supported African Womens Leadership Network Nigeria’s call for Nigerian Women to lead national responses in the age of the coronavirus, and as governments and international bodies battle to combat the coronavirus pandemic, Women In Global Health, an international non-profit organisation comprised of women leaders in global health have launched the COVID-5050 campaign for a more inclusive pandemic response.
In an opinion-editorial, ‘Fighting COVID-19 With One Hand Tied Behind Our Backs, published by the prestigious United States Council of Foreign Relations, authors, Roopa Dhatt, Ann Keeling and Toyin Saraki have advanced the opinion that for better health security, it’s time to end gender biases that keep women out of global health positions.
The authors stated:
‘Fighting COVID-19 With One Hand Tied Behind Our Backs? For better health security, it’s time to end gender biases that keep women out of global health leadership positions’
‘Whenever a high-profile health emergency breaks out or an influential commission needs experts, it seems global health reverts to the default of delivered by women, led by men. The message seems to be Health emergency! Step aside, ladies – men coming through. Although women make up 70 percent of the global health workforce, and although they work at all levels in health security—from the front lines of healthcare, to research labs, to health policy circles – they have not been represented equally in decision-making bodies that are informing our COVID-19 responses.’
‘A presidential tweet showed the first iteration of the U.S. Coronavirus Task Force was composed entirely of men. In January, just five women were invited to join the twenty-one member WHO Emergency Committee on the novel coronavirus.’
‘Unrelated to this decision, UN Secretary General Antonio Guterres made a strong public statement a few weeks later. “Women’s inequality should shame us all. Because it is not only unacceptable; it is stupid,” Guterres said in February. “Only through the equal participation of women can we benefit from the intelligence, expertise and insights of all of humanity.”’
‘There is a huge contingency of global health experts who are also women, but they are not being called upon to lead responses to this global health emergency—and this puts us all at risk. Ignoring women’s expertise and perspectives undermines health security for everyone.’
Dhatt, Keeling and Saraki further buttressed their advocacy giving ‘Six reasons why gender matters in global health security’ stating:
‘NUMBER ONE: Strong COVID-19 responses draw leaders from the entire talent pool. Women are 70 percent of the global health workforce but hold only 25 percent of senior decision-making roles. Excluding women from decision making robs health systems of the knowledge and expertise of the health workers who know these systems best. In America, which has a mostly-male Coronavirus Task Force, women have become the majority of young doctors and epidemiologists. Including women (and women from diverse groups and geographies) is about effectiveness and saving lives, not just representation. Diverse leadership groups make better, more informed decisions.’
‘70% v. 25%; Women are 70 percent of the global health workforce but hold only 25 percent of senior decision-making roles’
‘NUMBER TWO: Women are needed to fill the global shortage of health workers, which limits our ability to respond to health emergencies. As the majority of the global health and social workforce, women currently deliver health care to around five billion people. Female health workers are central to the response to any epidemic. The women health workers on the front lines of health systems do not want to be sentimentalized or celebrated as martyrs. They want to lead, they want to be listened to and they want the means to do their jobs professionally, safely and with dignity. Around half of all health workers are nurses and midwives. As the International Year of the Nurse and the Midwife, what better time than 2020 to harness the expertise and leadership potential of nurses and midwives?’
‘A 2019 WHO report concluded, however, that although women are the majority in the health and social workforce, they are clustered into lower status, lower-paid (and unpaid) roles and frequently subject to discrimination, bias and sexual harassment, which can cause them harm, limit their career growth, and cause attrition. With a projected global shortage of around forty million health and social workers by 2030—eighteen million needed in vulnerable low-income countries alone—the world must invest urgently in decent work for female health workers and enable them to fulfil their potential in all areas, including leadership. That is our best chance of retaining female health workers and scaling up the global health workforce to meet demand and the challenges of epidemics and pandemics.’
‘NUMBER THREE: Women’s political voices strengthen health systems for better health security—now and in the future. Women do not have an equal say at political level in most countries on critical issues like health budgets and universal health coverage. Globally, women are only 24 percent of the parliamentarians who make decisions on health systems funding and coverage.’
‘Countries with strong national health systems and universal health coverage are better able to cope with outbreaks and other health emergencies’
‘If women did have an equal say in political decisions on health, research suggests health systems would be stronger as female parliamentarians are more likely to give greater priority to health. This matters now more than ever; countries with strong national health systems and universal health coverage are better able to cope with outbreaks and other health emergencies. Without strong health systems that make care affordable and accessible, the most vulnerable—older people, pregnant women, the homeless, the poor, and those with pre-existing conditions and poor health status (the majority of whom are women)—will be missed by critical outbreak response activities such as widespread testing and treatment. Ultimately, this hinders containment of infectious diseases like COVID-19.’
‘NUMBER FOUR: Women and men have different, socially defined roles—and this perpetuates inequalities and weakens health security. Women carry out the majority of care for sick family and community members, and that puts women at greater risk of contracting infections like COVID-19. At the same time, women’s role as household caregivers can be leveraged for better health promotion and disease prevention/management at the family and community levels—but only if they are empowered with accurate information and the means to support the sick. COVID-19 was initially associated with a particular food market in Wuhan, China, where it is likely that the majority of traders were women. After the SARS outbreak in China in 2002, women in the same professions could have been vital allies in the cultural and behavioral change needed to avert a new viral outbreak—but clearly, this opportunity was missed. In many country contexts women are less educated than men, have less access to digital technology, and are generally overlooked as potential change agents.’
‘NUMBER FIVE: Biology and gender determinants of health affect the way disease is transmitted and progresses. Data are still being collected and analysed, but early figures from the COVID-19 outbreak in China show higher mortality among men than women, especially in older age groups.’
‘Early figures from the COVID-19 outbreak in China show higher mortality among men than women, especially in older age groups’
‘One hypothesis is that higher smoking rates by men leaves them more susceptible to respiratory viruses like SARS-CoV-2, which causes COVID-19. There are other gender-related aspects of the disease that are virtually unknown—for example, we still need to understand how COVID-19 affects pregnant and breastfeeding women in order to protect both women and the unborn child. A different virus, Zika, if contracted by a pregnant woman, does serious harm to the unborn child. Nothing similar has been reported with COVID-19, but this example show that it is critical that policy responses to epidemics examine the impact of both biological sex and the gender determinants of health.’
‘NUMBER SIX: Global health rests on the foundation of women’s unpaid work. Here’s an uncomfortable fact: women in health contribute an estimated 5 percent to global GDP ($3 trillion), of which almost 50 percent is unrecognised and unpaid. Some of the world’s poorest women and girls are effectively subsidising health systems and missing out on opportunities to enter education and the formal labor market. This is not only inequitable—it weakens global health security everywhere. Infectious diseases like COVID-19 do not respect national borders, and we are all only as safe as people in the weakest national health system. Women’s unpaid work needs to be recorded, redistributed (within the family and community) and rewarded, with women enabled to transition into paid formal sector employment. ‘We cannot fight a global health challenge like this by drawing from just half the talent pool’’
The authors, Roopa Dhatt, Ann Keeling and Toyin Saraki concluded by announcing the launch of the COVID50/50 Campaign, stating:
‘This week, Women in Global Health was proud to launch COVID 50/50, our campaign for a more inclusive pandemic responses, which includes fives asks for more gender-responsive health security. These asks build on Operation 50/50—a crowdsourced list of women health security experts, designed to be a resource for organizations looking for health security experts and media commentary on COVID-19. The current pandemic makes it clear: it’s time to acknowledge that the gender stereotypes and bias keeping women out of leadership and decision making put us all at risk. We cannot fight a global health challenge like this by drawing from just half the talent pool. We cannot win this fight with one hand tied behind our backs.’
EDITOR’S NOTE: The authors are associated with the nonprofit organization Women in Global Health.
Roopa Dhatt is the Executive Director and Co-Founder of Women in Global Health
Ann Keeling is Senior Fellow, Board of Directors, Women in Global Health
Her Excellency Toyin Saraki is Founder and President of the Wellbeing Foundation Africa, and a Steering Committee Member, African Women’s Leadership Network.
The Council on Foreign Relations (CFR), founded in 1921, is a United States non-profit think tank specializing in U.S. foreign policy and international affairs. It is headquartered in New York City, with an additional office in Washington, D.C. Its membership, which numbers 4,900, has included senior politicians, more than a dozen secretaries of state, CIA directors, bankers, lawyers, professors and senior media figures.
The CFR meetings convene government officials, global business leaders and prominent members of the intelligence and foreign-policy community to discuss international issues. CFR publishes the bi-monthly journal Foreign Affairs, and runs the David Rockefeller Studies Program, which influences foreign policy by making recommendations to the presidential administration and diplomatic community, testifying before Congress, interacting with the media, and publishing on foreign policy issues.