Women’s Health

Using HER Voice in the Fight Against AIDS

This blog post was written by Sarah Hollis, Senior Communications Manager, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends).

On December 1, the global community will come together to mark the 30th anniversary of World AIDS Day. Organizations like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) have helped cut the number of AIDS-related deaths in half since the peak in 2005. But in many countries, HIV infections remain extremely high.

Adolescent girls and young women face especially difficult odds. In some African countries, young women aged 15-24 are up to eight times more likely to be HIV positive than young men their age. Around the world, a young woman is infected with HIV every 90 seconds.

But with support from the Global Fund, young women are starting to fight back. A new HIV Epidemic Response (HER) initiative – HER Voice – is working to empower networks of adolescent girls and young women across Africa. The HER Voice mantra, “Nothing for us without us,” is based on the principle that adolescent girls and young women have a vital role to play in driving and shaping the HIV response. Their experiences and needs must be central for policy making, program design and implementation.

The innovation and creativity of the young women involved in this initiative breathe new life into HIV/AIDS activism in Africa. Beverly Mutindi (left), a HER Voice Ambassador from Kenya, is using artificial intelligence to reshape the conversation around sexual and reproductive health. She created Sophie Bot, an app that she calls, “Siri for sexual health,” to combat the spread of misinformation among young people. Users can ask Sophie Bot questions and she uses artificial intelligence to respond, either by voice or text, based on information from Kenya’s National AIDS Control Council and the United Nations Population Fund (UNFPA).

Across the continent, in Cameroon, HER Voice Ambassador Brenda Fuen Formin is also using technology to amplify the voices of young women and girls. Working with friends and colleagues across sub-Saharan Africa, Brenda is creating new safe spaces online for victims of sexual violence and HIV positive women. Using an anonymous blogging platform and bringing medical doctors and psychologists to provide online support, she is helping vulnerable women connect, share their stories and receive psychosocial support.

Programs like HER Voice are essential tools for engaging hard-to-reach and underserved communities in the fight against HIV/AIDS. But these programs are only available when the international community comes together to support the Global Fund. Every three years, donor governments, the private sector and private foundations make pledges to the Global Fund – called replenishment. The next replenishment, which takes place in October 2019, will require a strong commitment from the U.S. to leverage increased support from other donors and help end this epidemic for good.

The Global Fund has set a bold target to reduce the number of new HIV infections among adolescent girls and young women by 58 percent in 13 countries in sub-Saharan Africa over the next five years. By supporting the Global Fund’s next fundraising round, we can make that target a reality and ensure that young women and girls have access to the essential treatment and prevention programs they need to thrive.

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Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends) advocates for U.S. support of the Global Fund, and the goal to end the epidemics of AIDS, tuberculosis and malaria. As an advocate, Friends engages U.S. policymakers and influencers in conversation about the Global Fund’s lifesaving work, and highlights the significant returns on health investment, both for global partners and for America. For more information about Friends of the Global Fight, visit www.theglobalfight.org.

Accelerating Efforts to Eliminate Cervical Cancer Around the World

This blog post was written by Chris Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN). ACS CAN is the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, and the nation’s leading advocacy organization helping to defeat cancer by educating the public, elected officials and candidates about cancer’s toll on public health. ACS CAN is a Global Health Council 2018 member.

Photo Credit: American Cancer Society Cancer Action Network

We have the opportunity to end deaths from cervical cancer. Through increasing access to preventive vaccinations and supporting diagnostic screening and testing which improve opportunities for the early detection and treatment of the disease, we can eliminate a cancer. According to the World Health Organization (WHO), an estimated 570,000 women will be diagnosed with cervical cancer this year, representing 6.6 percent of all female cancers. Almost 90 percent of deaths from cervical cancer will occur in low- and middle-income countries.

The opportunity to eliminate a cancer may sound like a herculean task, but coordinated efforts from governments, public health advocacy groups, NGOs, private industries and other interested parties can make it happen. That’s why the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society, was happy to join forces with a broad cross section of stakeholders in New York City last month for an in-depth discussion of what’s being done to eradicate cervical cancer globally. ACS CAN and five other sponsoring organizations hosted the panel on September 26, just as the United Nations General Assembly (UNGA) held its annual meeting.  The panel made  clear that while much work remains to be done, the appetite for action in this effort has never been greater. We have the resources and the tools; now it’s time to act.

ACS CAN’s advocacy efforts in the campaign to eliminate this cancer have largely focused on integrating HPV vaccinations and cervical cancer screenings into existing U.S. global health initiatives around the globe, particularly in Africa. Increasing access to preventive vaccinations, as well as screenings, will help stem the tide in the battle against cervical cancer. Because cervical cancer deaths are preventable, and interventions are proven and cost effective, we should be providing resources to protect women against this disease, just like we provide resources to save lives from AIDS. That’s why ACS CAN is so committed to engaging with federal policymakers on the issue, particularly by increasing education and awareness that global cervical cancer prevention is one of our mission priority issues.

It was a privilege to bring key stakeholders together for such an energized discussion on how we end this disease around the world. The meeting that was held in New York City on accelerating efforts to eliminate cervical cancer provided a comprehensive landscape of where things stand in the fight against cervical cancer. The global community needs to commit itself to this campaign and after last month’s meeting with such a diverse group of stakeholders, I’m confident we can take the action necessary to someday give every girl and women the peace of mind that cervical cancer won’t hold them back from leading a fulfilling life, regardless of where they live.

To learn more about ACS CAN’s efforts in eliminating cervical cancer worldwide, visit www.acscan.org/globalcervical.

About ACS CAN
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem.  ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.fightcancer.org

Ten Asks: Doing Things Differently in Gender Equality and Global Health

This guest post was written by Dr. Roopa Dhatt, Executive Director and Co-Founder, Women in Global Health and Kelly Thompson, Gender and Programming Director, Mehr Manzoor, Research Director, and Ann Keeling, Senior Fellow, Women in Global Health. The post was originally published on their website.

Reflections for the 73rd United Nations General Assembly and UN High-Level Meetings.

‘Good health is essential for sustained economic and social development and for poverty reduction. This requires universal health coverage, underpinned by a strong health system..’ – UN Secretary General August 2018 [1]

The 73rd UN General Assembly, which opened this week, represents a significant moment for the global health community.  For the first time in the history of the UNGA there are not one, but two UN High Level Meetings on health.  As momentum builds on addressing Non-Communicable Diseases (NCDs) and Tuberculosis (TB) – it is important to also look at the foundation that will support the achievement of the SDG 3 Health and Wellbeing targets, including Universal Health Coverage (UHC). If the WHO is able to achieve its Triple Billion Goal [2] – one billion more people benefiting from UHC, one billion more people better protected from health emergencies, and one billion more people enjoying better health and wellbeing –  #HealthforAll could be realized by 2030.

Global Health: Doing Things Differently

21st century global health challenges, however, require us to do things differently. The World Bank and World Health Organization (WHO) estimate that 40 million new jobs in global health and social care must be created by 2030 to meet rising demand. [3] 18 million new health and social care jobs are needed in low income countries alone, where the burden of disease is greatest and health worker shortages most severe, to meet SDG and UHC targets.2  There is a lead time for creation of such skilled jobs and in some low income countries the pipeline of youth, particularly girls, finishing secondary school is insufficient to feed into the tertiary training needed. We can harness IT, robotics, e-health, new medicines, better medical devices and task shift to release capacity but most health prevention and care will continue to be delivered by human beings. Without people to fill those new jobs the post 2015 global health goals will not be achieved and a global scramble for health workers is likely with low and middle income countries losing skilled health workers to richer parts of the world.

Although women are often portrayed as victims in global health, they comprise over 70% of the global health and social care workforce. [4] Women currently deliver health and social care to around 5 billion people and their work contributes around 5 % global GDP (approximately US$3 trillion). [5] Remove women from the global health system and there is no system. But the irony is that in this majority female profession, men hold an estimated 75% of global health decision making roles.[6] Men lead global health and women deliver it. It is also ironic that the gender pay gap in global health (estimated at 26% for high income countries and 29% for upper middle income countries) is higher than the global average for all other employment sectors.[7]  In other words, the men who reach the top in global health reward themselves well compared to the women segregated into the lower paid, lower status and less secure parts of the profession. And to compound that inequality, around half the work women in health and social care remain unrecognized and unpaid, seen as a natural extension of the caring role socially assigned to women everywhere. And the burden of that unpaid care work impacts their own health, income and life chances.

The 40 million new health and social care jobs needed by 2030 will not be created without urgent and serious investment in the female health and social care workforce. Doing things differently does not mean creating more jobs on current terms and putting more women into underpaid or unpaid roles in health and social care systems overwhelmingly led by men. Business as usual will not achieve the transformation needed to deliver #HealthforAll.  Currently global health is flying on one wing, not drawing its leadership from 100% of the talent pool. Evidence from other sectors show that diverse leadership teams are likely to be more innovative and more successful.  We have untapped potential in global health. Quality and outcomes suffer because the women who deliver health and social care are too often unable to contribute diverse ideas and perspectives from their professional experience and lived experience as women. As women form the majority of medical and allied health graduates in an increasing number of countries, we cannot afford to lose female health workers due to the pressure of insecure job terms, discrimination, harassment or violence. New and existing health and social care jobs must be created as decent work for women where women and men enter leadership posts based on merit. Gender equality must be a goal in health outreach, programs and delivery, as well in leadership at all levels.

Realizing the Triple Gender Dividend in Global Health

Since our formation in 2015, Women in Global Health, has advocated for gender equality in global health leadership at all levels. In 2017, recognizing the crucial role of the health workforce in health systems and achieving UHC and the SDGs, WGH formed the Gender Equity Hub with WHO, under the umbrella of the Global Health Workforce Network. The Gender Equity Hub, convenes a critical group of partner organizations and experts to:

‘accelerate large-scale gender-transformative progress to address gender inequities and biases in the health and social workforce through evidence and data, policy tools, advocacy and implementation.’

Last month, a report issued by the UN Secretary General [8] recognized that:

’…..as 70 per cent of the global health workforce is female, creating jobs in the health sector is an investment in women’s empowerment and gender equality.’

We welcome this statement and argue that as member states meet in the UN General Assembly and UN High Level Meetings on NCDs and TB this month, investment in the female health and social care workforce must be an urgent priority. NCDs and TB both shift the focus to the primary health care level, where prevention and management is generally carried out by female nurses and community health workers.  Moreover, investment in the female health and social care workforce has a wider multiplier effect, offering a Triple Gender Dividend comprised of:

1) Health Dividend: since expanding women’s work in health and social care is the only way to fill the millions of new jobs that must be created to meet growing demand and reach UHC and health related SDGs by 2030;

2) Gender Equality Dividend: investment in women and the education of girls to enter formal, paid work will increase gender equality and women’s empowerment as women gain income, education and autonomy.  And in turn this is likely to improve family education, nutrition, women’s and children’s health and other aspects of development.

3) Development Dividend: New jobs created will fuel economic growth.

Image courtesy: Women in Global Health

This gender dividend, if realised, will improve the health and lives of people everywhere. The health and social care worker shortage is global. This is everybody’s business.

We are delighted to see growing commitment to invest in the health workforce, including women, but IS THE TIDE TURNING? Will greater investment in the female health and social care workforce be agreed at the 73rd UNGA and UN High Level Meetings on NCDs and TB? Such commitments must then follow through into the G20 in Argentina,  the “Working for Health” five-year action plan for health employment and inclusive economic growth, created by ILO, OECD and WHO and into national health workforce plans. [9]

Ten Asks: doing things differently in Gender Equality and Global Health

Finally, we have 10 asks for UN Member States and international organizations meeting at the UN in New York this month:  

1) Change the narrative:  women in global health are change agents and drivers of health, not victims.
2) Shift the mind-set: take advantage of 100% of the talent pool, especially women, all genders, marginalized groups and people from diverse backgrounds.
3) Include voices from the South: especially women from the South, as central to global health decision making.
4) Record and value unpaid health and social care work by girls and women in order to move that work into the formal labor market.
5) Adopt gender transformative strategies with programs and policies that are enabling for all genders in global health work and organizations. Focus on changing the environment, not on fixing women to fit into unequal organizations and cultures.
6) Root out inequity: address the power relations and structures that promote inequity in our work and organizations, especially all forms of discrimination, harassment and violence, which commonly affect women.
7) Close all gender gaps including the gender data gap, gender pay gap, and gender leadership gap.
8) Customize policy solutions to fit the societal and cultural context, but do not comprise on the goal.
9) Support collective action through movements and partnerships, to accelerate progress, particularly on employment rights such as parental leave to enable all parents to take paid work.
10) Understand that gender equality in global health is everyone’s business: this is not a ‘women’s issue’, it applies to all sectors, countries and people.

Image courtesy: Women in Global Health

Business as usual will not achieve the transformation in global health needed to kick start long term change. Too much is at stake and the price is too high – in addition to the human cost of preventable death and suffering, the World Bank estimates gender inequities cost US $160 Trillion in wealth and social capital. [10] To do things differently and deliver #HealthForAll, we must invest urgently and seriously in the female health and social care workforce.

Acknowledgements: WGH would like to acknowledge the global health civil society and workforce organizations also voicing the importance of addressing the gender dimensions of the health workforce, RinGS, FIP, Intrahealth International, Frontline Health Workers Coalition, JPHIEGO, HRH2030, Nursing Now and many other members of the Gender Equity HubGlobal Health Workforce Network.

References

[1] UN General Assembly 73rd Session Report of the Secretary General ‘Implementation of the Third United Nations Decade on the Eradication of Poverty (2018-2027)’  8 August 2018

[2] WHO Draft thirteenth general programme of work 2019–2023, Accessed at: http://www.who.int/about/what-we-do/gpw13-expert-group/Draft-GPW13-Advance-Edited-5Jan2018.pdf 

[3] WHO- Global Strategy on Human Resources for Health Workforce 2030 (2016). Note: Health workers data refers to physicians, nurses, midwives and a limited group of other health occupations, based on WHO databases.

[4] Improving employment and working conditions in health services – ILO 2017. Accessed at: https://www.ilo.org/wcmsp5/groups/public/—ed_dialogue/—sector/documents/publication/wcms_548288.pdf

[5] Langer, Ana et. al. (2015). Women and Health: the key for sustainable development. The Lancet , Volume 386 , Issue 9999 , 1165 – 1210

[6] Women in Global Health 2018

[7] This refers to an unadjusted gender wage gap. Data available from 40 countries (27 high-income; eight upper middle-income; four lower-middle-income; one low-income); latest available data: 2011–13. Source: ILOSTAT based on national labour force surveys and official estimates of each country.

[8] UN General Assembly 73rd Session Report of the Secretary General ‘Implementation of the Third United Nations Decade on the Eradication of Poverty (2018-2027)’  8 August 2018

[9] Working for Health: A Five-Year Action Plan for Health Employment and Inclusive Economic Growth (2017–21), WHO, 2018. Accessed at: http://apps.who.int/iris/bitstream/handle/10665/272941/9789241514149-eng.pdf?ua=1

[10] Globally, Countries Lose $160 Trillion in Wealth Due to Earnings Gaps Between Women and Men, World Bank  2018. Accessed at: https://www.worldbank.org/en/news/press-release/2018/05/30/globally-countries-lose-160-trillion-in-wealth-due-to-earnings-gaps-between-women-and-men

More than an Outbreak

This blog post was written by Global Health Council (GHC) President & Executive Director Loyce Pace

I had the privilege this month of traveling with members of U.S. Congress and other global health stakeholders to Sierra Leone as part of a CARE Learning Tour. Such trips are designed to expose policymakers, donors, the media, or other leaders to foreign assistance in action. Our visit was especially timely, considering Sierra Leone’s recent Ebola crisis and warnings about new infections in Democratic Republic of Congo. I arrived wondering what I would learn about Ebola’s aftermath and anxious to understand not only how a community or country responds to an outbreak but also how people recover.

Learning tour participants watch as local staff provide care and instruction to new and expecting mothers. Photo courtesy of CARE International

The direct effect of Ebola in Sierra Leone and its neighbor, Liberia, has been well-reported in terms of lives lost. But what came into focus for learning tour delegates during our time on the ground is the impact Ebola had on those left behind. Now that the 2014 crisis has come and gone, clinics have had to replenish resources and bolster systems that were strained under the weight of emergency response. It was inspiring to witness firsthand the resilience of health workers – many of whom lost coworkers to the disease – and see how village clinics have been able to rebound, with the support of local and international actors. This means a young pregnant woman seeking maternal care can once again access important services that would save her life. Or that a child could be treated for malaria, diarrhea, and other conditions that contribute to premature death. We forget these basic needs are at risk in a crisis.

A village savings and loan program in action. Photo courtesy of CARE International.

Beyond health, there are other important considerations following such a significant tragedy in Sierra Leone, a country with high poverty rates and a number of unfavorable human development indices. Learning tour delegates met Ebola survivors as well as widows or widowers and orphans to hear their profound accounts of fear, loss, and stigma and how they reestablished their lives after diagnosis. CARE’s flagship village savings and loan program has proven invaluable to these individuals, giving them the ability to restore capital and regain independence. Participants in local associations spoke of using funds to start businesses, pay school fees, and address family health care needs, bringing it all full circle.

So, as we think about global health security, it is critical that we view our investments and response as part of a continuum of global health and development, one that encompasses a range of priorities. After all, people are more than a disease. They have lives that require multiple resources and avenues of support. Only by acknowledging how their various needs are interconnected can we make lasting progress on the ecosystem of issues they face. I am grateful to CARE for helping me see beyond the Ebola outbreak to what the future holds for affected communities throughout Sierra Leone and beyond.

Loyce from the U.S. meets Loyce from Sierra Leone. Photo courtesy of CARE International

The End of Cervical Cancer

This guest post was written by Vivien Tsuan Associate Director in the Reproductive Health Program at PATH. It was originally posted on PATH’s website on May 21. For 40 years, PATH has been a pioneer in translating bold ideas into breakthrough health solutions, with a focus on child survival, maternal and reproductive health, and infectious diseases. PATH is a 2018 Global Health Council member.

Aisha Nanyombi was among the very first girls in Africa to receive an HPV vaccine. There is now increased urgency to expand screening and prevention programs to eliminate cervical cancer worldwide. Photo: PATH/Will Boase.

When we started working on cervical cancer prevention at PATH 25 years ago, most people were sceptical that much could be done. It was clear that Pap smears (a test to check for cellular abnormalities) were not feasible in low-resource settings where most cases of cervical cancer occur. Even 10 years ago—when new screening and pre-cancer treatment options were becoming available—no one was using the “e” word with cervical cancer. We simply weren’t convinced elimination was possible. But that’s all changing now.

Eliminating a disease means that the number of cases has fallen so low that the malady is no longer considered a public health problem. Elimination is different from eradication; in the latter case, the human papillomavirus or HPV—the bug that causes cervical cancer—would no longer exist in the population. We still don’t believe that HPV can be eradicated, but with the tools now at our disposal—HPV vaccination and screening and treatment of cervical precancer—PATH and our partners feel confident that we can dramatically reduce levels of disease to achieve new elimination targets.

A global tragedy

Cervical cancer kills an estimated 285,000 women each year, mainly in low-resource countries. It is an awful disease—very painful and drawn-out—with an offensive odour that drives women to remove themselves from their compounds and villages to avoid causing discomfort to their friends and families. If they do seek treatment, it is usually too late to benefit much and the expenses may drive the family further into poverty. They suffer, and eventually pass away, often secluded and stigmatized. Every two minutes a woman dies from the disease.

It doesn’t have to be that way. Over 270 million doses of HPV vaccine have been administered, mostly to young adolescent girls, and it works so well—even better, in fact, than we had anticipated—that they can expect to be nearly free of the threat of disease as adults. HPV vaccines have been proven to be safe and effective for use in adolescents. Unfortunately, only a small percentage of girls who need the vaccine, and boys who would also benefit from vaccination because of the other cancers caused by HPV, have been immunized so far.

The vaccine is less effective when given to women once they become sexually active, and are likely to have already been infected with HPV. For those women, screening, and pre-cancer treatment when necessary is crucial. The good news is that we have reliable tools for that as well, including exciting new options for women to collect their own sample for testing for HPV infection.

A new era with a new goal

This week, Dr. Tedros—the Director General of WHO—threw down the gauntlet asking all nations to join in bringing an end to cervical cancer during the World Health Assembly in Geneva. This is the latest in a series of moves the UN has made to mobilize against the scourge—the first being in 2016 when then Secretary-General Ban Ki-moon called for elimination. Last year, leaders of major health organizations and professional societies added their voices to the call for an end to cervical cancer. In 2018, the World Health Organization (WHO) began the process of officially defining what would constitute “elimination,” and PATH was invited along with other technical experts to contribute to the process. For example, in order to certify a country free of cervical cancer, it is necessary to set a threshold like “fewer than X cases per 100,000 population per year.” This already has been done for malaria, newborn tetanus, and other diseases.

Because we have the tools we need to end cervical cancer, it is clear that the barriers to elimination are primarily economic and political—a deficit of will to allocate the funds needed to achieve this important goal. So advocacy aimed at urging Health Ministers, Parliaments and other decision-makers to focus on the issue at the national level is the next big hurdle. Countries also need technical assistance in designing appropriate and affordable national programs to ensure that all girls, and boys if possible, are vaccinated and that all women have access to screening programs.

Allowing the current situation to continue—with hundreds of thousands of preventable deaths occurring each year—violates universal ethical and social values. Furthermore, it does not make economic sense because losing women in the productive prime of their lives cripples families, communities and nations (see an analysis of the investment case). With this new focus on elimination, countries can join with PATH, the WHO and other global partners to advance the fight against cervical cancer, a victory that we think is achievable with concerted action in the next decade or two.