I’ve always wanted to be a member of the Emerging Voices for Global Health network. I remember when it was set up it all seemed really exciting and an excellent way to learn from each other and influence others. I am sadly too old to ever get my chance at being in your very special club.

But that hasn’t stopped me from plotting ways to become a ‘pseudo member’. And I think I may have stumbled on a way we could collaborate by working together to increase the strength and profile of work on gender and health systems.

 

A need for a stronger position on gender and health systems

One thing that strikes me about EV4GH is that you do not shy away from the politics that is inherent in health systems research. Whether this is at local, national or international level, your blogs ask challenging questions about the state of the world, power, money, and the role of better health in potentially shifting inequitable systems, norms and dynamics.

Key to the politics of health systems research is a focus on gender and the ways that it intersects with other forms of inequity based on sexuality, (dis)ability, ethnicity, age etc.  RinGs is a partnership that brings together health systems researchers from around the world and aims to galvanise gender and ethics analysis in health systems.  We’ve been running a small grants programme and developing tools that support health systems researchers in thinking through and applying a gender and ethics lens at different points in the research process.

Gender matters. It effects vulnerability to ill-health and how decisions are made within households about how and when to seek care and what money will be spent on this. Gender impacts on people’s ability to access and use health services, for example, men have abysmal access to sexual and reproductive health care (beyond some medical interventions related to HIV).

Medical products and technology are still being developed to fit some mythical ‘everyman’ rather than the diverse populations that need them. Gendered norms affect the health workforce, for example: whether informal care provided at home is recognized and supported; with regard to staff security in remote areas, places effected by conflict, or dangerous informal settlements in urban areas; and in a range of workplace policies and procedures related to recruitment and retention, parental leave, workplace harassment etc.

Gender also has implications for health financing. As Rob Yates put it in our recent webinar on the topic, “Women are a high-need population group with often low access to financial resources and therefore have a low ability to pay. Many services that benefit women are extremely cost-effective and should be a top priority for universal coverage.”

 

Doing things differently

We’d like to see a body of health systems research that is much more gender focused and nuanced. Gender disaggregation of data is a vital first step, but beyond that we could:

• Be careful about using terms like ‘Community Health Workers’, ‘village health committees’, and ‘insurance schemes’ as if they are gender-neutral even if their composition and consequences are not
• Do research that considers the social context in which gender power relations operate
• Better understand who participates in our work as respondents and who might be excluded (because of gaps in education and literacy, women having to seek permission from male household members, women having less leisure time due to the double burden of care, men and boys may not want to openly talk about stigmatizing issues such as sexual violence against men etc.)
• Acknowledge that the research process itself can be imbued with power relations and biases (Who decides the research questions? Who’s collecting data? What biases and assumptions underpin their analysis?)

 

Ideas for collaboration

The Sustainable Development Goals relate to both health and gender equality. There are some overlaps between the two areas, for example the focus on sexual and reproductive health and the inclusion of the unpaid care agenda (which is propping up inadequate health systems all over the place). However, to really capitalize on these goals will take synergistic and ambitious new modes of thought, enquiry, service delivery, and political bravery.

It is great that EV4GH is now an official Thematic Working Group in Health Systems Global. I am co-coordinating the one on community health workers and we really look forward to collaborating with you. There is a lot we could do in all of the groups to raise the profile of work on gender. We’re in a great position vis-à-vis the next Symposium because we have a theme that explicitly addresses gender this time – and we hope this is going to prompt some really strong panel and individual abstracts on the issue. We’ve been chatting with some of the EV governance team members about the possibility of providing some gender and ethics training for the next cadre of EV4GH. We have a blog and we would really love to hear reflections on gender and ethics from your work, particularly in the lead up to International Women’s Day (Tuesday March 8), just email me. If you can identify any other opportunities for capacity building and networking do let us know. We are open to ideas.