Women in Global Health Security High-Level Digital Summit Synthesis Report

On Sept. 17, 2020, Foreign Policy, in collaboration with Women in Global Health and the Wagner Foundation, hosted the Women in Global Health Security Summit to address these intertwined challenges by elevating the voices of international female healthcare experts and giving their insights the attention they deserve. Throughout a series of insightful conversations, experts and leaders laid out how to activate women’s full contributions in the battle against COVID-19, offered concrete ways to achieve global health security through gender equity, and shared ideas for how stakeholders across different sectors can work together to build gender-responsive health systems.

Watch a recording of the Women in Global Health Security Summit here, and read on for insights from the event:

Key Takeaways

• Countries should elevate the voices of women in global healthcare leadership at all levels, from local to executive, as their expert insights would enhance global health security and improve global health administration.
• Countries worldwide are, by and large, far behind where they should be in terms of achieving the goals of the Beijing declaration and related gender-specific multilateral commitments; they need to redouble their efforts to get back on track.
• Economic relief efforts to combat the effects of the COVID-19 pandemic should be specifically designed and administered through a gendered lens to alleviate the stresses on the disproportionately impacted female workforce.
• To help combat the spike in domestic violence caused by the COVID-19 pandemic, services for victims should be deemed essential, and funds should be budgeted for relevant policies and training.
• Female representation in government continues to lag; quotas for female representation have proven an effective tool, although social norms are also critical for enabling women to take advantage of legally enshrined rights.
• High-quality, gender-disaggregated healthcare data is sorely lacking in the global debate and is critical for ensuring targeted, intelligent solutions.
• Women who were already in the informal sector, or who have been pushed back into it by the COVID-19 pandemic, are at a particularly high risk of backsliding into poverty; if not carefully addressed, this could have multi-generational negative consequences for economies worldwide.
• An intersectional approach to global healthcare responses is critical for ensuring equal access and responsiveness to people of all nationalities, ethnic groups, sexual orientations, and religions.

Opening Remarks

The Summit kicked off with a conversation between Women in Global Heath’s Roopa Dhatt MD, the Wagner Foundation’s Charlotte Wagner, and FP’s Ravi Agrawal. This framing discussion provided background about the state of gender equity in global healthcare and decision-making, gave an overview of the summit’s aims, and summarized the related commitments made by over five countries and over 40 organizations to pursue gender equity in global health. Dr. Dhatt provided an overview of the broader situation, noting that a disproportionate number of women are on the frontlines of the COVID-19 pandemic and are providing unpaid care work as part of the informal economy—all of which has helped to expose deep structural inequalities that only contribute to international female healthcare workers’ widespread underpayment, under-recognition, and unequal exposure to contagion. Dr. Dhatt also laid out Women in Global Health’s five principal “asks” surrounding the Summit:

1. That women be included in global health security decision-making structures and public discourse;
2. That health workers be provided with safe and decent working conditions;
3. That the value of women’s unpaid care work be recognized through its inclusion in the formal labor market and the equal redistribution unpaid family care;
4. That a gender-sensitive approach to health security data collection/analysis and response management be adopted worldwide;
5. That women’s movements receive funding to better address critical gender issues.

Charlotte Wagner argued that gender is frequently a significant, defining factor for global health equity. She also laid out the importance of both top-down and bottom-up decision-making when engaging in global gender health equity advocacy and development through NGOs, arguing that the input of on-the-ground experts is as critical as high-level engagement in securing concrete, effective, wide-reaching transformation.

A Fireside Chat with Ethiopian President Sahle-Work Zewde

FP’s Ravi Agrawal conducted a virtual “fireside chat” with  Sahle-Work Zewde, the first female president of Ethiopia. President Zewde provided her insights on an array of issues related to female equity across the public and private sectors—noting Ethiopia’s recent successes in enhancing female leadership within the Ethiopian government, female participation in higher education, and women’s access to healthcare—and underscored the importance of cultural change in order to enable women to actually take advantage of their existing legal rights and protections. As an example of the gender disparities in healthcare, President Zewde described the vital role of the 98 percent female, 42,000-strong Ethiopian health extension worker network—which has unparalleled reach within local communities across Ethiopia—in delivering vital care and information during the COVID-19 pandemic.

President Zewde also provided her insights on why women in the informal sector continue to experience particularly unequal outcomes. While women are understood to comprise a large proportion of workers in the informal sector, there are a number of obstacles to providing that sector with adequate support and compensation—most notably its lack of formal organization, which effectively prevents governments across Africa from providing targeted relief and engagement. Despite these many challenges, Ethiopia had succeeded in providing some protection schemes for these workers, and it hopes to do more still.

President Zewde concluded by suggesting that, instead of COVID-19 being “the great equalizer” many had hoped it would be, it had instead helped to shed light on the inequalities and disparities still inherent in the global system—including the unfortunate reality that women still have a long way to go in terms of realizing the Beijing commitments made a quarter of a century ago.

Remarks from WHO DG Tedros Adhanom Ghebreyesus

WHO Director-General Tedros Adhanom Ghebreyesus delivered a message to the Summit about the vital nature of gender equity for promoting global health security:

“We need more and better disaggregated data and research into how COVID-19 affects women and men differently: biologically, socially, and economically. We must ensure gender balance in global health-security mechanisms, such as COVID-19 task forces and other advisory groups. We also need to make sure this involves women from different backgrounds and scientific experience. We also have to develop the capacities in all advisory and decision-making bodies to integrate and change the gender approach in their assessment, analysis, and decisions. Ultimately, we cannot achieve a healthier and safer world unless it’s also a more equal world.”

Panel 1: Achieving Global Health Security through Gender Equality

In the first panel discussion, participants H.E. Maria Fernanda Espinosa, Ambassador Päivi Sillanaukee, and Dr. Maria Van Kerkhove tackled women’s representation in multilateral institutions, how gender equity in those institutions underpins global health security, and the importance of women having a seat at the table in decision-making surrounding their own health and governance. H.E. Maria Fernanda Espinosa argued for the importance of elevating female voices at the UN and across global multilateral institutions, and underscored three converging multilateral milestones on women’s rights—twenty-five years since the adoption of the Beijing declaration, twenty years since the establishment of the Women, Peace and Security agenda, and seventy-five years since the establishment of the UN itself—and how the ongoing under-representation and underpayment of the 70 percent female global healthcare workforce illustrated how far there was to go in achieving these resolutions’ promises. Dr. Maria Van Kerkhove underlined how seriously the WHO treated gender equity, and how it had taken strides to ensure that female voices were at the table in all levels of decision-making; this had resulted in over 60 percent female senior leadership. Ambassador Sillanaukee explained how equitable female representation in all levels of Finnish government, as well as gender-responsive welfare efforts to provide childcare and elder-care support and encourage female education, had laid the foundation for the country’s prosperity and responsive governance.

The discussion continued to underscore the cross-cutting benefits of gender equity in health care and governance decision-making. If the majority-female healthcare force is not led by the very women who compose it, their critical insights for global health security and healthcare administration will be lost—producing major negative economic, social, and broader productivity consequences; on the other hand, if gender equity is achieved in both governance and global health, the domino effect of positive outcomes would be equally wide-reaching. Participants underscored the importance of community organizing for elevating the voices of indigenous people and those without digital access. The conversation concluded with insights about the vital nature of enshrining access to shelters, health care, and reproductive and perinatal care for combating the spike in domestic violence seen during the pandemic and ensuring that women can be healthy participants in the global economy, their governments, and their societies.

A Fireside Chat with UN Women’s Anita Bhatia

However, there were many ways that governments and multilateral institutions could effectively encourage their countries to get back on track in fulfilling these critical commitments. COVID-19 economic relief efforts needed a gendered lens to effectively support the female workforce, who—as the dominant majority in many of the most severely impacted sectors, including hospitality, services, and tourism—were suffering to an unequal degree.FP’s Ravi Agrawal and UN Women’s Anita Bhatia held a wide-ranging conversation about the challenges to achieving the promises laid out in the Beijing declaration, the Women, Peace and Security Agenda, and the Sustainable Development Goals, and how multilateral institutions and governments could best confront ongoing female marginalization across society and governments, and particularly within the healthcare sector. Bhatia revealed that, even before the COVID-19 pandemic hit, UN Women had been focused on tackling the reality that countries around the world had largely failed to meet most of the commitments enshrined in these multilateral resolutions, and that the COVID-19 pandemic had only worsened the state of women in an array of key areas. While notable global successes had been made in reducing maternal mortality and enhancing women’s access to education, female representation in government, equal compensation, and reductions in gender violence had proven to be far more stubborn issues.

The result had been a rapid expansion in the number of women in the informal sector across Africa and the Middle East, and targeted aid to limit the long-term economic consequences of this backslide needed careful implementation and robust funding. To combat the spike in domestic violence, police forces need to be sensitized, and shelters and other support services for victims need to be considered essential. The imposition of quotas and gender-equal cabinets had been effective in supporting female representation in government, which has made particularly slow progress, but widespread buy-in to change social norms is vital to ensuring that women can take advantage of their legal rights once secured. Underscoring all of these efforts is support for women’s rights groups, whose funding and activity have been particularly severely reduced by the pandemic.

Bhatia underscored the importance of gendered budgeting and establishing firm trade-offs and priorities in achieving many of these goals. Funds should be specifically allocated for women-owned businesses, and the definition of “security” should be expanded to include health security—as the pandemic has made clear—with health security receiving funding comparable to all other elements. Bhatia concluded that gender-based data and analysis, which are all too rare, will be critical for intelligently combating the ongoing challenges faced by not only women, but also those at high risk from COVID-19.

Panel 2: Build Back Better: Gender-Responsive Health Systems

In the final panel discussion, moderated by Ilona Kickbusch, participants Anuradha Gupta, Laura Petrella, and Dr. Monique Vledder took a deep dive into how countries around the world can best address ongoing gender disparities in healthcare leadership and administration, as well as ensure that lessons learned from the crisis are applied to transform existing healthcare structures to be more gender-sensitive.

Anuradha Gupta stressed the importance of gender-disaggregated data for making intelligent, targeted efforts to enhance gender equity in healthcare; for instance, while girls and boys on a global level have roughly equal access to vaccination, on a country level the COVID-19 pandemic has produced troubling gender-based discrepancies. Much of this issue is related to social norms as well as economic constraints, to which healthcare providers from the local to global levels should be attuned and responsive. Dr. Monique Vledder argued that the COVID-19 pandemic has shone light on how healthcare systems worldwide have remained far from gender-sensitive, and that gender equity needs to be a strategic concern in related financing by multilateral finance institutions. That would not only enhance female global health leadership, which is strongly linked to more gender-sensitive health system outcomes, but also help to alleviate the “secondary crisis” caused by COVID-19 surrounding the decline in essential healthcare services for women worldwide. Laura Petrella underscored the importance of city structures themselves for ensuring global health equity of access, driving home the importance of elevating women’s voices from the bottom up, to ensure maximally effective, tailored, and responsive local, national, and international healthcare approaches.

The importance of high-quality, gender-disaggregated data, the urgency of elevating the voices of women’s groups and organizations, the need to integrate male voices and secure male buy-in to ensure resilient long-term social and structural transformation, and the critical nature of increasing female leadership at all levels of global healthcare administration were running themes throughout the discussion.

Looking Ahead

Although important strides have been made in recent decades to secure women’s equal rights, compensation, and representation, the COVID-19 pandemic has highlighted that—particularly in the global healthcare sector—there remains a long way to go before healthcare stops being, in Dr. Maria Van Kerkhove’s words, an industry “delivered by women but led by men.”

As speakers from across the WHO, UN, and international governments reminded us, the multilateral commitments made in previous decades surrounding women remain largely unfulfilled, and the COVID-19 pandemic risks setting women everywhere back by decades more. While women compose the large majority of the global healthcare workforce, they remain largely underpaid, under-represented in leadership positions, and subject to unsafe working conditions.

Targeted, intelligent interventions should be made by multilateral institutions and governments worldwide in order to support gender equity in healthcare leadership and bolster global health security—two critically intertwined and mutually supporting issues. However, the commitments made by over forty organizations and over five countries, as a result of the Summit, to redouble their efforts to support women’s equity in healthcare access, compensation, and decision-making will play an important role in improving the living and working conditions of the millions of women who work on the front lines of the COVID-19 pandemic to enhance global health security every day.

The Women in Global Health Security summit and this synthesis report were produced in collaboration with Women in Global Health and the Wagner Foundation. The content of this report does not represent the views of the editors of Foreign Policy magazine, ForeignPolicy.com, or any other FP publication.