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 who they love—deserving quality, affordable health care tailored to their unique needs, without facing any barriers, 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 the 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, under PEPFAR, as part of a Peace Corps project. During a meeting of a local community group that aimed to raise awareness of HIV/AIDS prevention and treatment approaches, one active, middle-aged member told the group that if she asked her boyfriend to use a condom [for health protection], 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 among adolescents and youth.
We all have the right to protect our health through access to information and quality services; the Universal Declaration of Human Rights and multiple international legal instruments, which the majority of countries have signed onto, 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 to die of pregnancy-related causes compared to white women, according to the U.S. Center for Disease Control (CDC). Discrimination, marginalization, racism and implicit bias, socioeconomic factors, and less access to RH services contribute to this.[2] If representation of health professionals and health professions faculty from minority groups increased, and more health care providers and decision-makers in the health system possessed an awareness of and applied this learning to dismantle the biases they hold, whether meeting with patients, designing curriculum, or deciding how to prioritize funding allocations for health policies and programs—which social inclusion-focused efforts such as allyship training and implicit bias literacy promote—they will be equipped with the skills to start providing 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 Care by improving the quality of essential services and meeting all clients’ needs, promoting financial protection and reducing financial barriers, and ensuring population coverage. To accomplish this, multiple LHSS country activities integrate GESI in their health system strengthening approaches, working with the local population to address the unique needs of women, people migrating, people with disabilities, LGBTQI+ individuals, and young people in each setting.
What To Do: Examples for Integrating GESI to Strengthen Health Systems
In Colombia, Banyan Global’s and LHSS GESI Specialist Pilar Otero Galindo has been working with local government, health institutions and community-based organizations across the country to reduce discrimination and barriers faced by people migrating when trying to access health care, particularly women and LGBTQI+ individuals, people with disabilities and those from ethnic groups, so that they can get the quality care they need. LHSS Colombia, in collaboration with the Ministry of Health and local health authorities, co-created a GESI Toolkit in Spanish to strengthen the knowledge and skills of the health authority staff and community-based organizations 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.
LHSS Nigeria, with technical support of Banyan Global staff member Umar Ahmed, Sr. Equity Advisor, has strengthened its focus on GESI with local government agencies and state health insurance agencies (SHIAs) to ensure more of the population, especially those experiencing the most vulnerability, can access health care. For example, LHSS Nigeria has collaborated with several SHIAs to integrate GESI into their operations by conducting GESI trainings with these agencies to increase staff knowledge of various GESI issues. The project staff also delivers ongoing technical assistance to build their capacity to address these issues. LHSS Nigeria carried out these efforts in areas that might not be receptive to GESI, 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 currently guides these entities in the states in which they work to develop practical, actionable GESI policies to integrate into their operations, ensuring their processes address existing barriers and do not uphold discrimination faced by populations experiencing vulnerability, such as women, young people, and people living with disabilities.
Both of these examples demonstrate that to effectively strengthen the health system, it must be more welcoming and inclusive to women, young people, LGBTQI+ individuals, people migrating, people living with disabilities, and other typically marginalized and underserved populations. This is accomplished through approaches tailored to the communities where they are implemented and in conversation and collaboration with the stakeholders (those who need health services and those who play a role in providing health services that are affordable). The recent global 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; https://www.un.org/en/about-us/universal-declaration-of-human-rights