Research for stronger health systems during and after crisis

Women leaders for health, peace and security.

Posted on Monday, 20 Jun 2016

Leadership can take many forms and be shown at different levels. Nick Hooton, from the ReBUILD Research Consortium, reflects on some inspiring examples of women’s leadership in health which were heard at a recent side event at the World Health Assembly in Geneva, on Health Systems Strengthening; Women’s Leadership, Peace and Security.

While the full World Health Assembly was adopting the Global Strategy on Women’s, Children’s and Adolescents’ Health, looking at the challenges of leaving no-one behind in achieving all the health-related SDGs, and dealing with the particular challenges of emergencies and crises, this side meeting brought much of this together, reflected through experiences of women leaders in a range of very challenging contexts, and showing leadership in health at all levels, from the community-level to the top ministerial positions, from leading physicians to community health workers.

Dr. Bernice Dahn, Minister of Health in Liberia, recounted her experiences in the Ministry during recovery from conflict in 2006, and the progress made despite many challenges, including defending the health budget against strong challenges from government colleagues, and having to improve financial management to regain donors’ trust – one person with a single flash drive held all the financial data in the Ministry at one stage. And then Ebola hit, revealing the continued weaknesses in the health system. Dealing with the fear and denial associated with this new disease and the fragmented international support, required further innovative leadership to keep health centres open, and train and motivate health workers, while keeping their safety paramount.

Dr. Margaret Mungherera may have been president of the World Medical Association, but her challenges started before she qualified as a doctor in Uganda, having to hide her white coat during Idi Amin’s regime. Having chosen psychiatry as her field, she continued working through the ‘years of trauma and years of chaos’, setting up Hope After Rape to provide mental health support for victims, and dealing with colleagues questioning the ‘fuss’ she was making over the issue. She has been a strong advocate for the rights of girls and women in speaking out against gender-based violence, both for Ugandans and while working with South Sudan refugees. She vividly recounted the impact of hearing, amid gunfire, from a woman who wanted to leave her husband, and realising that was the work for her – to address gender-based violence in whatever settings it required.

A strikingly courageous example of leadership was described by Laura Hoemeke from IntraHealth, who told the story of Fatimata Touré  from Mali. The founder of an NGO supporting women affected by obstetric fistula, she stayed in her Gao home through the chaos of conflict in northern Mali, when most were fleeing, helping patients relocate when extremists attacked the hospital. Despite being on the rebels’ list and warned to leave, she kept hiding women and continuing publicly to denounce perpetrators of gender-based violence. After receiving one of the 2014 International Women of Courage Awards from Michelle Obama, despite offers from international NGOs, she went straight back to Gao, as she saw that the real need was for local strong role models in her community and the country. Her actions showed how leadership is not just a title – it’s an agent of change.

Sally Theobald used examples from the research of the ReBUILD and RIngS programmes to show how health systems strengthening in fragile settings has been largely blind to gender. But the use of life histories, for example, was helping to highlight the voices and realities of being male and female workers in conflict-affected settings. This approach had highlighted the experiences from health workers at all levels – especially low to mid-level cadres who frequently stayed with their communities through conflict and were important role models in their communities.

And during all the contributions, we consistently heard of the leadership shown by numerous unsung heroines: health workers – especially community health workers – dealing with the huge challenges of conflict-affected settings, women working day in day out, not paid, extending outreach and building trust between the community and the health system.

The session highlighted that supporting women leaders was not just about numbers, but looking at how to we address the systemic barriers and discrimination that women face at all levels which disempower girls and women. It challenged us to support women by questioning power and politics at all levels. Education is critical. We need to keep young women in school despite the challenge of teenage pregnancy, the manner in which child bearing is valued over other roles, and lack of access to safe and sanitary menstrual hygiene products.  The panel also stressed the need for women leaders in non-health sectors, with understanding of health and equity issues and how they link.

Having women leaders and challenging stereotypes and inequities in health could be a powerful tool for wider achievement of equitable and peaceful societies. Health can be a neutral ground, with potentially powerful role models who people come into contact with throughout their lives. The examples we heard showed the critically important role women have in health, peace and security, and how addressing disempowerment at all levels, bottom to top benefits us all.

And how to do it when you’re there? After moderating the discussion, Jonathan Quick summed up the final tips from Dr Dahn and Dr Mungherera: Keep on being a woman! Don’t follow expectations of behaving like men when you get into leadership. And men are learning!

This meeting was co-hosted by Women in Global Health a global movement that brings together people who strive to achieve a more gender balanced health leadership and as a route to achieve gender equity in global health, and the Global Health Council, as part of the Women Leaders in Global Health Initiative.

 

Nick Hooton is Research, Policy and Practice Advisor for the ReBUILD Research Programme Consortium, which is working on approaches for health systems strengthening in post-conflict settings.

This blog post was originally published on the Global Health Council blog.