Want to Improve the Health System? Focus on Gender Equality and Social Inclusion
Written by Stephanie M. Perlson, Associate, Health and Gender Practices
Ever wonder why you often hear about the need to focus on gender equality and social inclusion (GESI)? Isn’t it just a component that’s “nice to have” after we’ve reached the main goal of our programming, like icing on a cake? At its core, GESI means fair treatment of everyone, and this needs to be woven into programmatic approaches from the start. Within the health care system, this concept translates to everyone—no matter their ethnic or religious background, sex, age, gender identity, whether they live with a disability, where they live, or whom they love—deserving affordable high-quality health care tailored to their unique needs, without facing any barriers, stigma, discrimination, or unconscious bias when trying to protect their health. To enable this to occur, focusing on GESI also means that health care workers should receive fair treatment and compensation, feel safe in their workplace, not experience any harassment or violence, and have equal access to opportunities for career advancement.
How GESI Issues Impact Health
The centrality of both gender equality and social inclusion within health settings could not have been more apparent to me than while I was living and working in Botswana as part of a Peace Corps project under the President’s Emergency Plan for AIDS Relief (PEPFAR). During a meeting of a local community group that aimed to raise awareness of HIV/AIDS prevention and treatment approaches, one active, middle-aged woman told the group that if she asked her boyfriend to use a condom (to prevent sexually transmitted infections [STIs]), then he would beat her. This was not the only time I heard a sentiment like this. Working with several youth-led organizations, the young people in the community lamented not being able to obtain sexual and reproductive health (SRH) information or services at local clinics, leading to increased rates of STIs, HIV, and unplanned pregnancies.
We all have the right to protect our health through access to information and quality services; multiple international legal instruments have enshrined health as a human right.[1] Thus, we need the health system to ensure this for everyone, which increased attention to and integration of GESI can do.
Gender and social inclusion-based disparities in the health system are not unique to low- and middle-income countries. For example, Black women in the United States are at least three times more likely than white women to die of pregnancy-related causes, according to the U.S. Center for Disease Control and Prevention (CDC). Contributory factors include discrimination, marginalization, racism and implicit bias, socioeconomic factors, and lack of access to RH services.[2] We need more minority representation among health professionals to bring awareness to and help address these factors, whether through meeting with and listening to patients, designing curricula, or allocating funding for health programs. A more representative health work force, that is also equipped with equality and inclusion competencies, can serve to dismantle existing unconscious biases and strengthen the application of equity and inclusion in health care delivery, helping provide more comprehensive and more compassionate care to underserved and marginalized groups[3].
How LHSS Integrates GESI and Improves Health
The United States Agency for International Development (USAID)-funded Local Health System Sustainability (LHSS) Project aims to strengthen the health system in multiple countries to achieve Universal Health Coverage (UHC) by improving the quality of essential services, promoting financial protection and reducing financial barriers, and ensuring population coverage. To accomplish this, LHSS country activities integrate GESI in their health system strengthening (HSS) approaches, working with local populations to address the unique needs of women, migrants, persons with disabilities, LGBTQI+ individuals, and young people in each setting.
What To Do: Examples for Integrating GESI to Strengthen Health Systems
In Colombia, LHSS GESI Specialist Pilar Otero Galindo of Banyan Global has worked with local governments, health institutions, and community-based organizations (CBOs) across the country to reduce discrimination and barriers faced by migrants trying to access quality health care, particularly women, girls, and LGBTQI+ individuals, persons with disabilities and those from ethnic minorities. LHSS Colombia, in collaboration with the Ministry of Health and Social Protection and local health authorities, co-created a GESI Toolkit in Spanish to strengthen the knowledge and skills of the health authority staff and CBOs to address barriers to health services, such as xenophobia and gender-based discrimination. They also provided technical assistance to the Ministry of Health and Social Protection for the integration of GESI approaches into public policy instruments. These efforts have resulted in improved health care access for these populations since the participating CBOs and health authorities have demonstrated increased understanding of and empathy toward the migrant population.
In Nigeria, LHSS Senior Equity Advisor Umar Ahmed of Banyan Global has worked with State Health Insurance Agencies (SHIAs) and local government agencies to ensure more of the population, especially those in the most vulnerable situations, can access and afford quality health care. For example, LHSS Nigeria has conducted GESI trainings for several SHIAs to increase staff knowledge of various GESI issues in health care. They carried out these efforts in areas that might not be as receptive to GESI due to socio-cultural norms but because they know the communities in which they work, and first discuss community needs and then collaborate to develop approaches with local leaders, they have been able to increase recognition of GESI issues within health. LHSS Nigeria has also co-developed with the SHIAs and local government agencies actionable GESI policies, so their operations address barriers and discrimination faced by women, young people, persons living with disabilities, and others in vulnerable situations.
LHSS Colombia and LHSS Nigeria demonstrate that to help strengthen the health system it must be made more welcoming and inclusive to women, young people, LGBTQI+ individuals, migrants, persons living with disabilities, and other typically marginalized and underserved populations through approaches tailored to their communities and in conversation and collaboration with the stakeholders (those who need affordable, high-quality health services and those who provide the services). The COVID pandemic emphasized to the world how connected we all are, so it is imperative that we make sure everyone’s health is protected.
[1] CEDAW, CRC, and CRPD, as cited here: https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health