Women’s Health

Where is HER voice in the Global Fund’s next Executive Director?

This post originally appeared on the Women in Global Health website. This guest post was written by Kelly Thompson, Ann Keeling, Roopa Dhatt, and Caity Jackson from Women in Global Health. Established in 2015, Women in Global Health (WGH) was founded with the values of being a movement. WGH works with other global health organizations to encourage stakeholders from governments, civil society, foundations, academia and professional associations and the private sector to achieve gender equality in global health leadership in their space of influence. 

**Update: The original version of this blog featured data points from 2008 and early 2017. The graphic has been updated to reflect the most recent data from the GFATM Secretariat.

Infographic Courtesy: Women in Global Health

Last Tuesday, without much fanfare, The Global Fund to Fight, AIDS, Tuberculosis and Malaria (GFATM) unceremoniously announced the 4 short-listed candidates for its next Executive Director (ED). In contrast to the World Health Organization’s (WHO) recent attempts at developing a more transparent and open process for the selection of their Director General, the GFATM process has been shrouded in secrecy. The first attempt to select its ED, set to replace Dr. Mark Dybul, who stepped down in May, was abruptly aborted. With rumors swirling and one of the candidates, Helen Clark, suddenly removing her candidacy, the GFATM Board noted that due to problems encountered in the recruitment process they were going to draw that round to a conclusion and restart the process (1). In this new round, 3 men and 1 woman have been shortlisted, also harkening back to the WHO election where gender parity was not reached in the final candidates. There is also a startling lack of geographical diversity in the final candidates with two from the United Kingdom, and one each from the USA and Tanzania.  

In one way, we should not be surprised that the shortlist is dominated by men, every previous ED has been a man, with the exception of Dr. Marijke Wijnroks, who is currently serving as the Interim ED. But since women are the majority of the workforce in the sectors of health the GFATM covers it is surprising that the shortlist is not 3 women and 1 man or at least 50/50 women and men. In the lead up to the second round the names of some outstanding women leaders in global health were circulating as being in the race. Talented women are out there and we should be surprised that the final shortlist is not gender balanced. It goes without saying that whoever is selected, regardless of gender, needs to have a strong understanding of the interplay of gender within the three diseases and how to apply a gender transformative approach to their leadership.

The GFATM’s own 2017 report notes the variety of ways in which the three diseases are gendered (2). Some of the key examples include, in some parts of Africa, young women (15-24 years old) are eight times more likely than young men to be living with HIV, and in the hardest hit countries 80% of new HIV infections are among adolescent girls. Those same adolescent girls are also more likely to be impacted by tuberculosis. Whilst malaria greatly affects pregnant women and children under 5, in some areas, like the Mekong, malaria greatly impacts men, who make up the migrant and mobile population. GFATM has adjusted its funding and programming to reflect these gender needs, with 60% of current investments being targeted at women and girls, and the announcement of the HER Voice fund to be launched in November 2017. However, as noted by Hawkes, et al there are still major gaps in transforming this policy into reality and often ‘too few grant agreements are found to specify, fund or monitor gender-sensitive or transformative activities’ (3).

We urge the Board to prioritise these considerations in the ED’s selection:

1) Strong development background and connection with the reality of the context of the GFATM’s work.
2) Strong commitment to gender equality essential to delivering GFATM’s work and Universal Health Coverage (UHC).
3) Commitment to reform of the GFATM including promoting diverse leadership.
4) Commitment to partnerships and building/engaging civil society particularly from the global south.


In closing, we ask all ED candidates, how will you address gender equality in the Global Fund?  


(1) Zarocostas, John. Controversy embroils selection of new Global Fund head The Lancet , Volume 389 , Issue 10072 , e3.

(2) Results Report 2017. The Global Fund. https://www.theglobalfund.org/media/6773/corporate_2017resultsreport_report_en.pdf

(3) Hawkes, Sarah. Gender blind? An analysis of global public-private partnerships for health. Globalization and Health 201713:26

U.S. HOUSE OF REPRESNTATIVES INTRODUCES LEGISLATION AIMED TO SAVE LIVES OF WOMEN AND CHILDREN AROUND THE WORLD

Washington, DC (October 13, 2017) – On October 10, Global Health Council (GHC) applauded U.S. Representatives David Reichert (R-WA), Betty McCollum (D-MN),Barbara Lee (D-CA), and Daniel Donovan (R-NY), who reintroduced the Reach Every Mother and Child Act (H.R. 4022) in the U.S. House of Representatives. This bipartisan legislation aims to accelerate the reduction of preventable child, newborn, and maternal deaths, putting us within reach of the global commitment to end these deaths within a generation.

“We are in reach of ending preventable maternal and child deaths—a great accomplishment in part due to U.S. leadership and investments in maternal and child health programs. Although we have drastically reduced the number of maternal, newborn, and child deaths, every day, 800 women die from complications of pregnancy and childbirth and more than 16,000 children still die from preventable causes,” said Loyce Pace, GHC President and Executive Director. “The Reach Every Mother and Child Act is an important step to ensure that we end these preventable deaths within a generation.”

The Reach Act builds upon the success of such global health initiatives as PEPFAR and the President’s Malaria Initiative (PMI), and would enact key reforms that increase the effectiveness and impact of USAID maternal and child survival programs. The U.S. Senate reintroduced the Reach Act in August.

Specifically, the legislation would require a coordinated U.S. government strategy that addresses ending preventable child and maternal deaths, as well as institute reporting requirements to improve efficiency, transparency, accountability, and oversight of maternal and child health programs. In addition, it would establish the position of Child and Maternal Survival Coordinator at USAID and ensure that the return on U.S. investments are maximized through a scale-up of the highest impact, evident-based interventions. The legislation would also allow USAID to explore innovative financing tools.

The Reach Act is supported by more than 50 diverse non-profit and faith-based organizations working to end preventable maternal, newborn, and child mortality at home and abroad.

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Microbicides: Innovative Solutions to Help Women Stay HIV-Free

This guest post was written by GHC Member International Partnership for Microbicides (IPM). IPM is a nonprofit organization dedicated to developing new HIV prevention technologies for women and making them available in developing countries where the epidemic has hit hardest. IPM collaborates with a global network of public, private, philanthropic, academic and civil society partners to develop products designed to empower women with the tools they need to protect themselves against HIV and improve their sexual and reproductive health, so they can live healthy and productive lives.

Why do women continue to be at high risk for HIV? Social expectations, cultural norms and economic inequities all limit women’s ability to negotiate safe sex practices, or even select their partners or the timing of sex. Condoms, while highly effective, are simply not a feasible option for many women. Women are also biologically more susceptible to HIV infection than men.

As a result, HIV/AIDS remains a serious epidemic among women. It is the leading cause of death globally in women ages 15-49. In sub-Saharan Africa, infection rates among women are alarmingly high—young women there are at least twice as likely to become infected with HIV as young men, putting their sexual and reproductive health at risk.

How can we stem the tide of HIV infection among women?
Women urgently need new prevention options, particularly discreet methods they can use without partner involvement. Among the most promising women-centered products are vaginal microbicides, biomedical products being developed to protect women from HIV during vaginal sex. They could come in different forms—such as a monthly vaginal ring developed by the International Partnership for Microbicides (IPM) recently shown to reduce women’s HIV risk—and other products in early development like films and tablets.

The flexible silicone ring, which women insert and replace themselves each month, slowly releases the antiretroviral drug dapivirine over the course of a month.

IPM’s dapivirine ring is the first long-acting HIV prevention method shown to safely reduce HIV risk and is under regulatory review.

What are the next steps for microbicides?
Several vaginal microbicides are being studied in preclinical studies or early-stage clinical trials. The most clinically advanced microbicide is IPM’s dapivirine vaginal ring, which is currently in open-label studies following late-stage efficacy trials. At the same time, IPM is seeking regulatory approval to license the product for public use. The monthly ring is under review by the European Medicines Agency and will be submitted to the South African Medicines Control Council and US Food and Drug Administration in 2018, followed by applications to additional regulatory agencies in Africa. The first regulatory decisions on the ring could come as early as 2019 in some African countries. If approved, the dapivirine ring would become the first microbicide licensed for HIV prevention.

Multipurpose products are also being developed that would offer women increased convenience by combining STI prevention and contraception in a single product. IPM has designed a three-month HIV prevention-contraceptive ring that entered its first safety clinical trial earlier this year.

 

How do microbicides fit in the HIV prevention landscape?
No one product will end the HIV epidemic. Women need multiple prevention options that they can choose from that makes sense for their lives, from monthly vaginal rings to daily oral ARV pills to products still in development like vaccines. Modeling studies show that a safe and effective microbicide like the dapivirine ring would have a significant impact on the epidemic while empowering women with tools they need to protect their sexual and reproductive health. And when women are healthier, so are their families and communities as a result.

The Reach Act: Investing in Maternal and Child Health

This post was written by Melissa Chacko, Policy Associate at Global Health Council.

Over the past few decades great strides have been made in maternal and child health: since 1990, the deaths of mothers and children under age 5 worldwide have been cut by more than half. The decrease in maternal and child mortality rates is a product of simple evidence-based solutions and inexpensive interventions. However, there is still a significant amount of work to do to ensure that no woman or child dies from a preventable death in our generation. Nearly 300,000 women continue to die annually due to complications during pregnancy or childbirth and 99% of these maternal deaths occur in the developing world. Access to quality care is essential for women and children as they are an integral part to building strong and prosperous communities. To reach the overarching goal of ending preventable deaths may seem idealistic, but it is achievable if we maximize the return on U.S. investments in maternal and child health programs.

In 2014, an advisory panel analyzed USAID’s Maternal and Child Health program, and found areas of improvement that would maximize the progress of the program. Since then, the program has undergone the process of implementing reform and exploring innovative financing tools to bring new resources to the field. However, with these measurements and expansion, also comes a need for greater coordination and accountability.

The Reach Every Mother and Child Act (S.1730) would create that accountability and coordination, as well as codify the reforms, all of which will keep USAID on track to reach its goal of reducing preventable child and maternal deaths and maximizing impact. In early August, Senators Susan Collins (R-ME) and Chris Coons (D-DE) led a bipartisan group of 10 Senators in reintroducing the Reach Every Mother and Child Act.

The Reach Act:

1) Requires a coordinated U.S. government strategy for contributing to reducing preventable child and maternal deaths;
2) Establishes rigorous reporting requirements to improve transparency, accountability, efficiency, and oversight of maternal and child health programs;
3) Ensures USAID focuses on the scale-up of highest impact, evidence-based interventions to maximize the return on existing U.S. investments;
4) Establishes the position of Child and Maternal Survival Coordinator at USAID to reduce duplication of efforts and ensure that resources are being used to maximum impact; and
5) Helps USAID explore and implement innovative financing tools, such as pay for success contracting, to leverage additional public and private resources, complementing existing U.S. assistance.

A similar version of the legislation was introduced in Congress last session (S.1911 and H.R. 3706) and received strong bipartisan support in both chambers.

In almost every field of health, women and children are the most vulnerable in areas that lack essential healthcare resources and systems. We can change this narrative by passing the Reach Act. The lasting impact of this legislation will be seen through the thousands of women and children who will live longer and healthier lives, due to access to quality care. With the Senate back in session, outreach for Senate cosponsors on the Reach Every Mother and Child Act is in full swing. It is important to rally support on this issue and vocalize the importance of bipartisan support on the Reach Act.

We encourage you to contact your Senators to voice your support for the Reach Act. You can find contact information for the Senate here.

Advocacy Update ~ May 1, 2017

This post was written by Global Health Council Senior Advocacy Manager Danielle Heiberg.

Congress Passes Short-Term CR to Keep Government Open
Despite being six months into Fiscal Year (FY) 2017, Congress needs another week to finish the spending package for the year. On Friday (April 28), Congress passed a short-term Continuing Resolution (CR) to keep the government open until May 5. Senate and House negotiators were expected to work through the weekend to negotiate the remaining riders and finalize a final bill for the remainder of the fiscal year which ends September 30. House Republicans have a rule that legislation must be available for review at least three days before a vote, so text could be available by Wednesday for a Friday vote.

Draft FY18 USAID and State Budget
On April 28, Foreign Policy published a draft document with FY2018 budget figures for USAID and the State Department. The document is dated April 6, and there is the possibility that these numbers have changed, but it is another signal that the Trump administration has not made global health a priority. While exact figures are not given for most global health accounts, this document has a recommended total of $6.8 billion (a 20% decrease from FY2016 levels) for global health programs at State and USAID (with $5 billion to State programs, including PEPFAR and The Global Fund to Fight AIDS, Tuberculosis, and Malaria and $1.8 billion to USAID programs). The full budget is expected to be released in mid-May. Read the Foreign Policy article or Kaiser Family Foundation’s analysis of the draft document.

Release of Mexico City Policy Guidance
The guidance on how the Mexico City Policy (also known as the Global Gag Rule) will be applied to global health assistance is expected to be released on May 1. It is expected that the policy will exempt The Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, The Vaccine Alliance; humanitarian assistance is also not likely to be included. According to the Kaiser Family Foundation, foreign NGOs face losing approximately $8 billion in U.S. foreign assistance due to the policy. GHC will host a community discussion on the policy on May 10. For more information on the community meeting, please email advocacy@globalhealth.org.