Women in fragile and conflict-affected settingsPosted on Thursday, 08 Mar 2018
Photo credit: UN Women/Carlos Ngeleka.
By Sally Theobald, Valerie Percival and Kate Hawkins
Attention to fragile and conflict affected states is critical to achieving universal health coverage, along with progress on other Sustainable Development Goals on gender equity and social justice. We need to ensure that women’s needs are met during and war, and that we join up action here with longer term, sustainable solutions.
Gender inequities neglected
In our work on gender and post-conflict health systems – Building Better Back – we explored the extent to which gender had been addressed in health systems rebuilding in several post-conflict states, including Mozambique, Sierra Leone, Northern Uganda, Timor Leste, Zimbabwe, Cambodia and Bangladesh. We found limited attention to gender equity in rebuilding efforts, and that conflict-related inequitable health outcomes linger in the post-conflict health systems. These have wide reaching implications for the health of communities which need addressing urgently.
To borrow the strap line for International Women’s Day 2018 we need to “#pressforprogress” against pernicious gender inequities in health systems in fragile and conflict-affected contexts. Health systems are key employers and respected institutions within society; they both reflect and shape the social political and economic context that they are part of, and the lack of emphasis on gender equity within health systems is a significant missed opportunity. The health system could, and should, be an arena for building greater gender equity in all society. Policymakers assume that if you build health systems they will be equitable; yet there is little guidance for people who may want to take a gendered approach to planning and implementation. To help address this, we developed bench marks for gender equity to be addressed within the health system, and produced case studies to highlight change and promising practice, including indigenous efforts towards embedding gender equity, such as in post-conflict Bangladesh.
Supporting female health workers
Health systems strengthening efforts require a strong and supported health workforce. There are challenges here in fragile and post-conflict contexts, where health workers are few, due to death or out-migration. In these settings there is a particular need to recognise and support the vital work of women health workers at all levels of the health system. This was an area of focus in a recent webinar jointly hosted by the World Health Organisation, the Global Health Workforce Network and Women in Global Health. Our research on the ‘gendered health workforce’, conducted through the ReBUILD and RInGs programmes, was presented, highlighting not only the multiple challenges women health workers face in Sierra Leone, Zimbabwe, Cambodia and northern Uganda, but also the incredible resilience they show in continuing to deliver vital services despite threats to their own lives, and risks of sexual and gender-based violence. On International Women’s Day we call for women health workers working in contexts of ongoing crises and conflict, such as Yemen, to be recognised, celebrated, supported and kept safe.
Pressing for progress
The recent launches of Canada’s Feminist International Assistance Policy and DFID’s Strategic Vision for Gender Equality (which has a specific focus on protecting and empowering girls and women in conflict, protracted crises and humanitarian emergencies) shows increasing focus on this issue, which is welcome. “Pressing for progress” means that all actors need to focus seriously on gender in their work. Strong, joined-up and gender transformative approaches to health systems strengthening are required.
Sally Theobald is Professor of Social Science and International Health at the Liverpool School of Tropical Medicine. She leads the work of the ReBUILD RPC on gender and health systems in conflict-affected settings, and is on the Steering Committee of the collaborative RinGs Programme on gender and ethics in health systems.
Valerie Percival is Assistant Professor of International Affairs at the Norman Paterson School of International Affairs, Carleton University, with a current research focus on the relationship between conflict and health. She led the collaborative research between the Stockholm International Peace Research Institute and ReBUILD that produced the original paper on ‘Health systems and gender in post-conflict contexts: building back better?’
Kate Hawkins is Director of Pamoja Communications, and works on the RinGs programme and Building Back Better. She has a strong research uptake, advocacy and communications background, focused mainly on international development policy, gender, HIV, health systems and sexual and reproductive health and rights.
This blog will also be published on the Health Systems Global site, as part of a series to celebrate International Women's Day.
Read more here on ReBUILD's work on gender and post-conflict health systems.