Grounding Health Systems in Gender Equality to Achieve Universal Health Coverage / HealthChoice

00:00

hello everyone I think we are going to start now when I'm my name is deeper and I am with a feminist human rights public health organization called some resource which is based in Delhi in India and I'm delighted to welcome all of you to the webinar on grounding health systems and gender equality to achieve universal health coverage it is wonderful to have you all joining us today and a very warm

00:31

welcome especially to our speakers whom I will have the opportunity to introduce later before I move ahead I would like to share a few important logistical announcements all participants please type your questions throughout the webinar in the Q&A function and not in the chat box I repeat that please type your questions throughout the webinar in the Q&A function these questions will be

01:03

addressed after all the speakers have presented the webinar will be recorded and shared via email for those of you engaging on social media please use hashtags and there you Oetzi I repeat hashtag gender uxe for all of you engaging on social we also invite all participants to join me Alliance for gender equality and USC the link for

01:35

this will be shared in the chat box and by email after the webinar so we look forward to having one of you join us in the Alliance I want to start by introducing the Alliance briefly this webinar will being organized by the Alliance for gender equality and USC briefly the Alliance is poking me in currently by five organizations and

02:06

comprises over 200 diverse organizations and network from global regional countries the Alliance for gender Etsy has been a leading voice championing a strong gender focus to USC the Alliance was intensely engaged in processes leading to the 2019 political declaration of the high-level meeting on USC which many of you would have followed it continues to mobilize and build momentum for prioritization on gender responsive USC the inclusion of

02:38

sexual and reproductive health and rights for gender equal inclusive sustainable and resilient health systems this webinar is one such effort of the Alliance with regard to the context of the webinar briefly the webinar is situated in a context where as we all know there are threats to the health and rights especially of girls and women from marginalized communities this is the reality in most of our countries and regions while some progress was

03:09

reflected by the USC political declination last year there is a long way to go these threats include barriers to access determinants of health for girls and women and persisting global and local structural and intersecting inequalities health systems continue to grapple with inadequate budgets infrastructure skilled and adequately paying health care workers safe working conditions for them non prioritization

03:40

and opposition to HR HR and necessary information and services and the overall lack of strong gender responsive health systems have been historical and significant shock Falls the coop at 19 and the make which all of us are in the midst of right now is exacerbating these intersectional structural inequalities and exposing the fractures in health systems in India where I am from responses to prove it such as lockdowns

04:11

containments have aggravated social and economic deprivation many of you would be familiar with the media reports and images of lakhs of migrant workers including women walking miles to reach home with serious impact on the health and lives there is an increased burden of refractive and care work for girls and women and violence against thousand women in private and public spaces health systems are still mostly restricted to Corbett with non coverage services largely

04:42

unavailable availability of only skeletal sexual and reproductive health services on the ground has affected access to maternal health care abortion services for violence survivors mental distress etcetera these are probably these probably resonate with the context in many countries and we are going to hear in more depth from our speakers given this context the webinar objectives are meant to illustrate that

05:13

health systems based on USC and grounded in gender equality from decent work the financing pair sorry char will improve health outcomes role and force the strong resilient health systems it will to withstand crisis I deliver for the long term it will also we are hoping underscore the imperative for continued investment commitments and momentum for gender equality in USC including SRA child and in the health workforce and leadership I would like to now call upon

05:46

and invite our first speaker dr. no no Simon Leila from South Africa dr. simile life special advisor to the director general of strategic programmatic priorities at the World Health Organization prior to this role dr. Simon Laila was fools w-h-o is assistant director-general for family women children and at all lessons she has more than 30 years of experience as an obstetrician academic advocate and

06:16

government officials and has previously served as special advisor to the vice president of the Republic of South Africa on social policy where she supported the multi sectoral bound wide response for HIV dr. samuel ella over to you we look for what you hearing you especially your insights on SRH are in the context of you work thank you over to dr. Samuel MO thank you thank you very much deeper and

06:48

a warm welcome to all the speakers who are going to be part of this conversation and to all the participants I'd like to thank you all on behalf of wo the convenience as well as all our our friends and colleagues across the world the I indeed living living in an unprecedented time Kovach 19 has turned the world on its head and exposed the fault lines of our society if humanity does not learn from

07:19

this epidemic we are bound to be doomed but knowing that all of you sitting around this table are champions and fighters we do believe that we will triumph sadly this epidemic will impact disproportionately on the world's poorest as outlined by deeper all the issues that face young women and girls across the world are going to be really sharpened and much more exacerbated second slide please this is just some

07:53

data that comes from a report that has been published demonstrating the work that has been done by whu-oh with its partners women in in global health and many others that just shows the role women play in the global health and social workforce whilst we see these inequities we also recognize that there is some progress being made this report titled and

08:24

delivered by women and led by led by men does not pull pensions in terms of what needs to be done to achieve gender transformative policies and health systems that will really provide dividends to communities women families and society at large it's a double-edged sword to note to note that women constitutes 70% of the health work wells health workforce although this is good

08:55

we know that in the context of coded 19 this has meant that women are now facing the brunt of this epidemic being at the front lines of health care delivery and more importantly facing the brunt at home as you know that levels of violence have been reported to have increased drastically during this time we therefore see that although this the report I'm referring to project that there will be a need for up to 40

09:28

million more jobs in this sector by 2030 if we do not address the gender inequalities that persist in this sector women will still be disadvantaged so we really need to be putting every effort into and sorting that we deal with this as we speak today we are sitting at over five million people were confirmed with kovat with over three hundred and twenty eight thousand deaths and these numbers are not really that the most important

09:59

in that we know that we're talking about people who have been tested and that mortality is likely to be higher unfortunately we have yet to see the impact of this pandemic on Africa which has weak health systems as well as a triple in fact quadruple burden of disease next slide please what is WH all been doing to champion a UHC gender equality and the issues that pertain to women and and girls you all

10:31

know about the landmark declaration that was adopted at a UN high-level meeting in 2019 what was important about that declaration is that a heads of states made very very important commitments to provide better opportunities for women to mainstream agenda perspective to include sexual and reproductive health three of creation and discrimination and violence and these are important things because as a community we can hold

11:01

governments to account for all of these commitments that they have made these decorations really show that there is no development without health and certainly no sustainable development without investing in quality as a HR services for women young girls we are not excluding the boy child in men but we really want to focus on women who have been consistently disadvantaged the ratio also launched the UHD report

11:34

which was the first time had a gender chapter and that is very important out age clinics to go and look at the specific issues that got highlighted in that report we also had a launch of the global action plan very important because here in the section plan 12 and agencies that together are responsible for 1/3 of development 8 going to need LMI C's have agreed to work together this is very important in the context of this pandemic because it will lessen

12:05

pressure on governments to deal with AIDS and help us streamline all the issues that we need to focus on in addition that will show in partners like the World Bank and others continue to provide the relevant information on financing on best buys and on how governments can continue to improve access to services for the most marginalized and for women and girls in sports particularly next slide please lessons learned from Corbett 19 I think

12:37

deeper mentioned some of those but we have seen across the world developed and developing countries the weakness of health systems therefore this must be a lesson for all governments and ourselves as stakeholders that we need very very strong health systems and primary health care as the best defense against outbreaks the BHO is looking to review in international health regulations after an assessment of how the world has

13:08

responded to this pandemic has been conducted we will strengthen those rules to make sure that we do not ever expose the world to such a we have seen that countries have really neglected ensuring the continuation of essential health services and this is something we must continuously remind governments to do several documents guidance documents and all the relevant information government's need to sustain these services have been provided by partners but they will show and would

13:39

like to encourage all participants to visit our website amplify those messages demand those services and help women access care next slide is how do we intend to take this work forward as whu-oh and you know that since the the pandemic really visited the world the wh all under the leadership of the DG has launched several very critical initiatives we've got the Solidarity response fund that has got multilateral

14:11

international financial institutions to learn trapeze and private sector many many partners working together to ensure that developing countries and those that have under humanitarian conditions everywhere across the world there is equitable access to the commodities that countries need the Solidarity trials give us comfort because they are spread across the world testing different and therapeutics vaccines treatment and

14:43

diagnostic commodities and people working not just from whu-oh but with other partners who have expertise in supply chain to make sure that countries receive the commodities they need health care providers women in particular on the front lines have PPE and all the things they need to ensure that they respond appropriately we've got the accelerator which is already moving forward all players involved communities

15:14

will be part of this as well to ensure that anything that comes out of these trials and is made accessible to everybody equity transparency accountability solidarity being the principles that continuing to drive the rituals leadership in this area so there are many lessons that we are going to be learning that we are already learning and we believe as doubly true that the

15:45

world will not be the same it will not benefit us to go back to business as usual all these partners that have now corralled to move the world forward must stay permitted because the impact of this pandemic is going to be felt for many more years to come so we believe that these new relationships set a new standard for how to do business in a global health community across the sectors of society most importantly

16:15

maintaining women and children and young people across the world in the center of the things that we do next like this I think we're out of time so bring back some of these issues going the Q&A thank you thank you very much thank you thank you so much for your presentation

16:54

now I would like to invite our second speaker miss Rosario Valadez Fernandez from Chile she is a midwife and President of India foundation mr. Mendez has practice midwifery in Chile and Uganda and she founded the syndicate foundation with the mission to support midwifery training and services in Iran while you Kenda over to you is are you hello well as I was just in turtle

17:27

introduce my name is Rosales I'm a Chilean professional Midwife and today I'm going to be speaking about how is to be a front light Midwife and how is gender equality in Chilean health system what had we already achieved and what the goals that we are still missing if we can go to the next slide please um well first of all and just get you into the context of Tia's situation with Clyde virus this last week we got into

18:02

the peak of the curve just just the day we had the day with more new cases reaching over 4,000 of them which get us over the 53 thousand cases in total in a population of 19 million habitants situation that has already collapsed hospitals they the quarantine has been extended and has been tougher day by day and now hunger is becoming an active problem so in between all this situation I think we as midwives had realized of

18:34

three challenges in woman health first of them is the incivility invisibility of women today we have no programs to guarantee our patients family planning or respecting their sexual and reproductive rights during the pandemic for example at the beginning there were no statistics that included pregnant woman Kovach positive knowing that the management and treatment of pregnant woman are always different from other patients that kind of all we do not have

19:04

an efficient ministry protocols or the treatment of pregnancy labor a newborn to assure them the correct treatment and a positive experience in reproductive context even during a pandemic and finally on the third point is how we midwives have not been recognized as frontline health workers actually in the latin-american ICM statement faith 58 percent of the professional midwives do not feel safe

19:36

enough with the first personal protective equipment provider so we could say that most midwives are professional woman taking care of women patients not enough value it to be assured with correctly personal protective equipment not just because midwives are important in health system but because our main patients that are pregnant woman a newborn should always be considered critical patients now if we go to my personal emotional experience there are

20:07

two main things that I think that had been like the tougher ones the first one is that the covets when the Kabat started spreading in Chile visitors upset hospitals including the world the one that I work at they had been forbidden including by visitors the father or the older next of kin from the patient during the whole hospitalization so attending a delivery with a patient that it's already alone and in a context that the physical context contact is not recommended you leave that woman still

20:38

alone and you're not able to contain her that's something that really tears you apart as a midwife and then in the second situation that has been in my experience like the tougher one is to see all my colleagues being apart from their kids being afraid of touching or even getting near to them and spread them or their families so my colleagues that had little houses and families are really tearing apart well of course in being frontline

21:09

there's hundreds of feelings and frustrations that you have to deal with their day when you're afraid like um I could be hours speaking about it I just think that now we shot which all have to work out our empathy and take care of each other as well we all know in health show must go on so if we can go please to the next slide I would like now to speak to you about our second theme that would be the gender equality in children

21:39

health system I divided this part of the chart in three main parts that is how is Chile today then what are we missing and finally which are our goals in the future well by the definition of the World Health Organization essential health services reproductive maternal newborn and child care should be measuring four categories with our family planning antenatal care and delivery food and immunization and health seeking behavior of No

22:11

Anja Chile achieved with the four of them and if you can see other slide we also count with a woman program that includes health prevention with Papanicolaou on mammography testing both of them helping us in prevention of cancer then you can see the reflection on point number two the reflection of the pump Family Planning work with really good breaks at adolescent pregnancy with all your statement twenty-eight of Atlas is a pregnancy

22:41

rate also you can see have been known in Chile as having low maternal and neonatal mortality rate which could lead us into a really good state in health but if we can go to the next slide please you we are still missing a free and safe abortion law in Chile woman are shouting for it in the streets I think is trying to hear them I respect their sexual reproductive health and rights today

23:14

until you we only count with three causes for leverage interruption of the pregnancy but if this is certainly not enough one are not feeling respected in their sexual life then the second point it's sexual education where I must say that it really embarrassed me because Sheila does not count with sexual education in anytime of a student life not in school not in university and this gets us straight into the next point that is the outbreak that we are living

23:43

in about HIV in between 2010 and 2009 teen there were the double of new cases number that it's shocking but it actually responds perfect to a population with not sexual education so if we can see is not just about the stench the essentials that the World Health Organization's define is so much more I think that when it comes to maternity and newborn care the World Health Organization universe and the universal care coverage should we always

24:15

be talking about quality not only essentials if we can go to the next one please yeah now if we try to see which is the future and the hope that we have for gender equality in Chile from my midwifery approach I hope that we continue growing in health prevention we are having a huge challenge especially in HIV as I just mentioned we need professional and personalized care of the delivery actually until we have ninety seven percent of the births are

24:47

art and part professional the thing is that the personal side attention we have not arranged to because we are usually over world in work so we cannot manage to the doula personalized work we are needing a birth houses just close to the hospitals but not in depth so we can try to decrease our instrumental stations is really hot like one of the highest rate in c-sections well if you can see there are a lot of goats in this light

25:18

and actually I think that when you talk about maternity care and you're born there will never be enough goals if we can go to the last slide please well allow I would like just to make a reflection about what I've been talking about I think all these programs of prevention we health systems sexual and reproductive rights and gender equality in Chile are run by midwives midwives that most of them are woman woman it is represented seventy percent of the

25:49

health workers but all your twenty percent of us are included nowadays in decision making we as midwives need to be included in preparedness response and recovery faces of risk and disaster management programs and consider as part of the health care teams during a health emergency or disaster we must assure our patients a positive experience in the reproductive context even during a pandemic so I think as long as they include us in the Chilean a

26:22

health system would be stronger and support the achievement of gender responsive link to the universal health coverage goals so this is more or less value questions during the Q&A okay thank you so much Rosario for that presentation and for sharing your

26:59

experiences as a midwife and the challenges for frontline health care workers in Chile I mean the challenge for frontline workers has been huge across the world during this time to make and it also reflects the situation otherwise for them so we hope there will be more questions for discussion during the Q&A I'm very pleased to invite dr. Lea that they say our next speaker say became the minister of health of the federal Democratic Republic of Ethiopia

27:29

in March 2020 prior to this appointment she served as state minister of health since November 2018 and led the National health programs under the health sector transformation strategy dr. that they say has extensive experience prior to joining the Ministry of Health and in including serving as program director at the University of Michigan center for international reproductive health

28:01

training and a CEO and vice provost of st. Paul's Hospital millennium Medical College in Addis Ababa thank you thank you doctor that they say and we really look forward to your presentation over to you thank you very much deeper and greetings everyone I would first like to thank the audience for gender equality and UHC and the convening organizations for organizing

28:32

this important webinar and for inviting me to take part to share a little bit of the ETA past experience and this is really a timely meeting during this unprecedented times when we are facing a global pandemic which is putting our health systems to test and our collective responsibility and we all I think I agree the current realities have exposed social disparities on many levels and even though women are serving at the fourth the forefront they

29:02

continue to bear the brunt of the economic and has impact of this crisis and additionally enduring domestic violence an exiled piece just to say a few words on Ethiopia it's a country with 110 and above million and above with 2.6 population growth rate total fertility rate has now at the current data shows four point to end we're progressively improving our contraceptive prevalence rate with a

29:34

current data of 40 next this next slide please in the past two decades it appears made significant progress in creating access to health Roo mainly decentralization in to the lowest level and forging partnerships with different stakeholders and focusing on real universal health coverage has been the primary grounding specially through a

30:11

strong primary health care system and the foundation has been also really making this health system gender responsive and some of the things we are we have been doing in the health sector strategies to ensure equity quality and compassionate care has been one of the main agendas and also ensuring that the reproductive maternal and newborn and child services are the core of he HC and really ensuring that

30:42

this is provided in life cycle approach for women and the Community Health Program of the through the health Extension Program which is up to the household level at the lowest level has really progressed the access to women's health and these are all woman has extension workers and making services for reproductive health services free of child free of charge at all level of the

31:14

Health System has been one of their achievements to ensure improvement access to services for women next slide please and there has been an improvement and progressively in the political commitment to ensure gender balance at especially at the higher leadership level and there has this is really visited a step in the right direction for Ethiopia with really increasing the role of women significantly and today we

31:50

have our first female president and a gender balanced cabinet in the history of the country however as I say this is a step in the right direction because as you go down to that hair system the gender balance still is a big issue that we are working on and that the Ministry level there is a lot of initiatives and we have good gender balanced leadership other but when we go down to the regions up to the district and health facilities

32:21

level we see there is still a long way to go in terms of improving women's involvement in the healthcare leadership next slide please and to facilitate this continued growth in leadership of women in different levels that they should also be and the health and well-being must be secured and interventions outside of health care also are crucial in improving gender equity in accessing women's education

32:54

access to jobs in poverty reduction among the the achievements through the Health Extension Program also addressing unsafe abortion has also resulted in massive gain in women's health and reducing mortality in Ethiopia however we also see that improving access to care is not enough services should be also of high quality respecting women's rights and privacy so this is also one of the key areas that we're trying to

33:26

work on in addition to bringing men into leadership positions at all care system next slide please so we have still a lot of challenges remain and while we are seeing a lot of progresses still the service utilization by women and girls you know we need to improve the quality of care although it has progressed a lot in terms of them reducing maternal mortality and improving access to

33:56

contraceptives we still have one of the highest maternal deaths and unmet need and also issues like child marriage and gender-based violence next please so when we come to the Corbett time so it has it is already showing impact on SRH with shifting of leadership focus and also facilities and professionals hesitancy to also service provide those services due to PPE and other issues so there is a key initiatives we are taking

34:32

to ensure that facilities are prioritizing key social services like error message and SRA services that should get attention in this outbreak and also trying to introduce we're planning also to introduce other innovative approach with other partners like home based self care package as well as tailor consultations to ensure women are accessing services in this critical time so we hope to learn more

35:03

from other partners thank you so much to say for the Q&A but we thank you when we hope to hear and really learn more about

35:48

the experience which has taken quite a while to reach where it is but it has been an extremely insightful experience and presentation thank you once again I would like to now invite an ex speaker mr. Armel mr. Irish lad from the board of directors for women in global health where he pushes for gender it could say an intersectionality enviable health

36:20

leadership he is also currently and in Consulting at ho pho and the World Health Organization supporting member states to improve access central medicines and public health supplies including in Corbett 19 response mr. lile has previously worked with intra health international the u.s. HHS Office for global affairs and inmates and emerging threats division and Friends of

36:51

the Global Fund for AIDS TB and malaria over to you Irish thank you thanks so much for having me and it really is great to hear from so many colleagues who are engaged in this work in different ways and from different perspectives I just want to take a moment first to know just how important these issues are today in the context of co19 health emergencies in crises really do put an incredible strain on health systems and they bring into stark relief

37:23

the the major gaps that may have been lying under the surface for decades even nations that I've been lauded as the gold standard for readiness have been caught flat-footed and though it's still early countries that have taken the time to invest in UHC may actually be faring better and equity is I think one of the most important of these issues that we see how we choose to respond moving forward will determine our ability to ensure high quality care for all while breaking while being resilient to future public health threats next slide please so I want to preface you know so the

38:00

first important section to look at is gender inclusive decision-making for UHC and I want to preface it to preface this by first noting the need for sex disaggregated and intersectional data you know simply put right now we are working with we're working blind and we don't have necessary data it seems that fewer than 40 countries are reporting sec desegregated data on infectious disease and mortality and this really inhibits our ability to you know ensure more in gender inclusive response i looking at women's leadership i know

38:30

many folks have touched on this so I'm just kind of gonna go over the the main areas that might have been missed so women you know as others have said represent about 70% of the health workforce and even 90% of frontline health workers who have actually been responding to cope at 19 but they represent less than 30 percent of leadership roles even while delivering health services around five billion people and this is a real shame especially when you note that women have a triple burden when it comes to epidemics they face high risk of exposure do you didn't know so do 2

39:02

clinical infections and their role as health workers they have lost opportunities to use school closures and on an unpaid family care and they have heightened risk due to ill health from diverted resources and that impact women in particular and and in the context of co19 we've also seen a much higher risk of women with gender-based violence and they're more like they're more likely to have to be responsible for the 1.5 billion children that are out of school today this drastically impacts their

39:31

ability to be financially independent and an interesting study that that a few colleagues had done recently women Global Health showed similar sectors that peace processes led by women were 35 percent more likely to last and yet only 13 percent of peace negotiators are women similarly in business women have been shown to have higher innovative and ethical decision-making yields and yet they're often excluded from leadership similarly though men's health is an important issue that's not considered

40:02

when men aren't included in gender equity conversations you know it's time that we take a gendered approach to see where men are over representative over representative and where they're underrepresented in the health workforce the global action on men's health has done some important work highlighting this and they see a lack of participation in gender equality making a minority of Nursing and social care positions almost around 10 percent of nursing positions are held by men and we need to address the gendered norms and stereotypes that determine from entering

40:33

female majority professions and this is a real issue for men in particular with Cova 19 because we're seeing early data showing higher numbers of male deaths from this this may be due to biological behavior factors where looking at maybe higher smoking rates and underlying conditions lower life expectancy for men also men's behavior in terms of increased isolation depression anxiety even high rates of suicide are major issues that men have in health that are often underappreciated due to lack of focus on

41:06

gendered impacts and I want to note that in both these KQ ler men also are less willing to seek medical health help and this makes it really difficult for men to get the care they need on time and I want to note especially for both of these issues that minority groups are discipuli underrepresented in in gender decision-making and may be more susceptible to these impacts W expert advisory panels show that only 11 percent of members were from the Africa

41:38

region and patterns of inequality and decision-making are reflected in who sets of research priorities that inform policy and who makes these decisions racial minorities and lower socioeconomic groups are also similarly seen to have lower rates higher rates of underlying conditions and yet are excluded from decision-making and next slide please so when we look at decent working conditions the High Commission for health employment and economic growth showed a lot of important information on how

42:09

UHC has been some of the gaps in UHC especially as it relates to health workforce we see around 400 million people worldwide lack access to health care and 18 million health workers the world will face a shortage of 18 million health workers by 2030 and this is critical to you agency because it relies on these health workers when it comes to you know we see when we look at the equipped workforces we've seen terrible stories in Cova 19 a lack of personal protective equipment for health workers and even seeing young health workers having to make difficult decisions about

42:42

who should live and who should die due to limited PPE in addition when you look at gender PB personal protective equipment is often made for women is often made for men and not designed to account for women which is a huge issue when it comes to protecting health our health workers there's also a major issue of unpaid care women make up an unequal or take the unequal burden of care em and which would require access to child and elder care and they make up the majority this unpaid work which drastically limits their ability to have

43:12

economic opportunities we also see a lack of women you know as I mentioned in diverse leadership roles and they must be hard minority leaders in particular that come from different backgrounds and skill sets have to have their voices heard if we're if we're gonna continue relying on them as health workers that are effective in their in their jobs and when you look at protected and safe health workers many many frontline nurses and midwives are women that can come from already vulnerable groups in crisis settings like refugee camps there have been reports of targeting women

43:44

health workers and there's a concerning trend in rising attacks on health workers in the DRC even in West Africa Ebola crisis in Syria and this is a huge issue when it comes to universal coverage because the deteriorates trust in the health system and we finally have to manage the health worker migration ensure that workers are incentivized to remain in country next slide please so contextualizing you h-scene Cove in nineteen there's four kind of main areas that I see as key issues the first is

44:18

vulnerable groups are particularly impacted and they have specific needs that need to be addressed with a new HC LGBTQI groups are routinely left out and these groups often have mental health issues which are one of the major unmet unmet needs for these groups in particular but in UHC they're often excluded from discussions vulnerable populations may require access to SRH a sexual reproductive health services and emergence in lockdowns can impact LGBT

44:48

groups the hardest where they face a higher rates of gender-based violence and stigmatization as well as I've mentioned previously how race and ethnicity plays a role in this black adults have a at least 50% more likely to die from heart disease and stroke than non-hispanic white adults and they're also shown to have lower rates of health insurance which makes them more susceptible to issues like co19 ongoing routing services we've also seen in Koba 19 a lack of access to

45:19

healthcare with disrupted routine health services and inequity in resource allocation and this is concerning because during the West Africa Ebola crisis more women died from an excess maternal mortality than from Ebola itself and this is primarily due to disrupted health services we've also seen a 50% drop in heart attacks reported to the NHS we've seen a lack of access interrupted service for HIV medications cancer screenings breast cancer for women and these may be unreported which may cause huge issues

45:50

to health system down the line one of the most concerning issues we've also seen in terms of access is a lack of equity we've seen high home countries racing to stock up and stockpile resources while long-term countries have to ensure that they can stay right they can maintain what limited resources they have and we have to ensure there's a plan to ensure vaccines and other resources are equitably shared and redistributed based on need fragile systems many countries have have a lack of public health infrastructure and

46:21

ongoing crises and even high-income countries like the US and UK have struggled due to lack of political leadership and delayed action and then finally with misaligned priorities in governance we see vertically siloed systems that can make a focus on services for women like sexually directive health and maternal health an easy target for funding cuts and we have to ensure that should have - sure sure sure no no problem I'm just the last slide if you could go to that so just

46:53

the for me yeah so just the four main areas we want to look at our sexy target disaggregated data having more gender responsive health systems looking at the social determinants of health and having more global solidarity when it comes to gender equity it's time that we have a real shift in gender equity for UHC and this can ensure a more resilient universe health systems and deliver more inclusive care using a hell for all mindset and I can address some questions down the web thank you yeah thanks Irish

47:25

sorry - kind of but we will have time during Q&A I'm sure we love any questions coming in Rhonda thank you so much I think you drew attention to one of the communities including health there's fragile systems and of course the politics of health priorities very relevant points and hope to discussing this further I would like to invite our last nickel but this webinar is Patricia Moody she is the advocacy and policy lead at

47:56

his Summa medical and education trust Kay met in Pina she holds a Bachelor of Laws degree has vast experience in health law she has managed advocacy related projects on sexual and reproductive rights family planning gender-based violence and accountability and mobilization but to share this room is all yours Thank You Deepa thank you everyone for joining this will be nice coming in at a very timely coming in very timely

48:32

because it comes at a time where our health system has been greatly tested with women bearing the greatest brunt just like in most pandemic we have witnessed before so I will begin by really sharing our Kenyan experience and go down to our Corbett situation currently next like most countries are the drivers for inequality it's the implementation in Kenya lies in gender inequalities and power dynamics in both cases we have seen that women are

49:03

greatly disadvantaged and so I will kick off with the five point that I came up with in regards to what really is our experience as a country the first one is SRH our sexual reproductive health financing we have noticed that women income more out-of-pocket expenditure than men this could be in fact attributed to women specific health needs related to pregnancy childbirth contraception and among others but we have also seen that public financing doesn't really factor

49:35

in these realities so we witness frequent commodity stock-outs inadequate budgets where it matters and you know a social issue in scheme as a country we have noticed that post natal care for example doesn't really look at the issue of what natural contraception because it has standard reimbursement although in Pepa it is say that they cover post natural conscious its own but in reality and when money is now involved there is really no money that is outside to contrast it shown after

50:06

post natal we've also seen cases where cumin and methods are only available for c17 that is in our social insurance cream so it gets you to a point where you realize that financing doesn't really factor in most of the crucial things that women would would require in the essential benefits package it is key to know that family planning for example is not included in the Kenyans UHC package it is very concerning that we have seen women

50:37

that needs our being narrowed down to my channel health so so long as you can go to the facility and deliver for free the system assumes that you are fine and you should not be complaining about lack of Rights we've also seen that diverse needs of women are not taken into account during policy development and implementation and this is even when services are available girls and women may not be able to access them and we've seen please across board but these lack of access to and control of economic

51:08

resources among the women there is discrimination we still have harmful gender and cultural norms and practices and still continue lack of information and and we've seen that age socioeconomic status decision-making power education level are all determinants of health in Kenya for example we have met the HP 2020 contraceptive prevalence rate of 58 well married women in northeastern parts of Kenya still at 2 percent so the disparities are huge

51:40

adolescents are still unable to access services easily because there's a number of bottlenecks in the system the ceiling validates their capacity to consent to services and policies and decision-making doesn't really reflect such realities as we see the second-last issues on the coverage versus quality and in addition to ensuring the coverage are through financing and demand creation health system factors such as health workforce supply service delivery

52:12

governance and as strong information system with disaggregate data has not been strengthened to a point that we can say that we are giving quality services and the non-discrimination factor still comes in a lot in our system when women get to access services and lastly we in Kenya we have a free maternal health and I put three in quotes because we still find that it has been met with a number of inadequacies

52:42

on Pepa for example it covers maternal health comprehensively but in practice it covers women till they give birth so any complications thereafter or any newborn needs that arise there after our because of the clients attains clamps are forced to buy razor blades and cotton or when they go to a facility women share beds and some still deliver on the floor it is a it is a teaser and acceptable it when you get to talk to some of these

53:13

hospitals they claim that they don't get their reimbursements on time and that is basically what the government has been investing at the most giving women maternal care next so we have seen that governments are still bears the greatest responsibility to ensure that all those issues are worked out properly and so we have been engaging governments if we find that the ownership is important especially for sustainability of our

53:45

projects although they I have very many challenges when engaging comments one of our strategies that we have employed is that we've left government lead the process of the implementation and so we make them aware that it is their role to make sure that these services gets to reach the the community and women and get to reach them in good quality and so when we have projects within and ensure that we let them that entire process of implementation and that our

54:15

interventions are backed up with data I might not go into all those because of time so we'll go to the next slide the next pillar that we've also noted is a coalition building is a great addition to our work as civil society organization and so most of our work has measures we engage government we also have very keen to build on the Alliance's that we already have to ensure that we get to our voice

54:46

amplified even at that level so that the government will then listen to some of the issues that we are raising our experience particularly as sort of the seer Souls organizations must work in alliances to currency optimum results we have implements in alliances for purposes of sharing information that is clue very crucial in in influencing policy and budgets we have gently amplified the community voices because at the end of the day the communities are not the beneficiary of

55:16

what we do then what we do is in vain so we've met made sure that we bring the community voices to the voice to the table and that the policymakers gets to listen to what the community saying and go ahead in monitoring progress and ensuring accountability and accountability for example is more effective when done as a group as opposed to done as an individual because in certain cases you will be victimized as one a civil society organization going head-on with with government as

55:46

opposed to us coming in as a team so that they will be no one really to be out there at the line of attack in most cases the work that we do at times is very it is viewed by government has not very good to them and so there is always lines of attack you're invalidated your records are looked into your tax returns and all that and so we have found that when you work within those spaces as fierce oaths jointly then it is more effective for us going forward so last

56:19

slide kindly I'll go briefly on the copy the impact I would not want to dwell much on it as most of it has been said previously and we have seen some of them in the news but to note in Kenya we have slashed our universal health coverage budget because when the process of rolling out the country are the country's ulc and that budget has been slashed off to then now kabah our response for copied we have seen health workers threaten to go on strike because some are being given allowances

56:50

some are not being given allowances for even in that stays a little bit of inequality is going on there but as my patching short I would like to a bring us to the attention that copied 19 is here to remind us that the health sector is more important in the economy because it's like it can bring many cano it can bring an entire economy down and that is what we have been trying to engage with governments are to no avail I hope that these dance sounds and alum that if you don't take care of our

57:20

health sector the economy that we we sweat so much we take care o of can go down in a minute and lastly sexual reproductive health rights must go beyond maternal health that is what we have seen being given more attention to include contraceptive prevention and treatment of cervical cancer situations knitted infections prevention and response to gender-based violence and stiff abortion services where legal these a tendency to assume that maternal health programs are an adequate response to addressing

57:52

differences in health between sexes they wrote to you yet see however must include women as key partners and decision makers we know that much of the progress in health has been attributed to work the tireless work that women and girls organizations are put in but there are voices right now more than ever must be had in creating policies and legislation for health and in monitoring progress we must remember that even in the middle of a pandemic like the one we are experiencing right now they are

58:24

situated at signals rights can not wait because even in times of crisis sexual activity will continue personal autonomy and so it will be compromised and pregnant women will deliver and complications will arise so we need to make sure that we factor in even as we go on into the closet 19 debate that s are a child is not left behind thank you very much thank you so much Patricia and for raising some very critical issues and

59:02

reminded reminding us about the importance of health in terms of how you know you said it's how we can bring in anti all the way down and all those critical issues that you've raised on SR HR we look forward to having more discussions only where Patricia was our last speaker on this webinar and so we will now enter the Q&A we have already

59:33

received some questions in the Q&A bar and we will try and I will try and specifically flag these two but to begin with I would like to invite no no to topple talked briefly about the key messages I think dr. no no I need to cut you short because we were running out of time but if you could just flag those are very

01:00:05

important key messages that you will not be able to present at that time over to you doctor thank you thank you very much deeper for this opportunity I think you know the most important message of messages that I would like to share which have also been amplified by other speakers it's first of all solidarity solidarity not only at the global level not only for

01:00:45

global health institutions but for ourselves we as a community must remain committed and together in doing the things that we need to do holding governments to account and you holding us as the ratio to account for the things that we are meant to do that we are not doing well the second thing that we need to really be focusing on is ensuring that we use the experiences and lessons learned from this pandemic to

01:01:17

strengthen the provision of comprehensive services for women I know that we all feel strongly about the issue of access to as a retiree services especially in the face of so much pushback we have to amplify this I think we were very saddened by the fact that we had to postpone Beijing past 25 but I think we go to Beijing plus 25 now with

01:01:47

solid evidence of why countries and governments must invest in primary health care services that are equitable that are community centers that are orientated to you the needs of people so women don't have to fit themselves into a rigid system but the system is pliable and agile to respond to the needs of women the third important thing is that we have reinforced multilateralism at the top but that does not mean that the

01:02:20

role of other critical players which is communities through society women the faith-based sector and everybody across the continuum across all sectors must be part of this multi-sectoral action is the most important ingredient for taking the work that we are doing in the health sector forward we've got to focus on those things and I think as members of this coalition we individually have access to

01:02:51

power we've got access to opportunities and we need to use those to ensure that we bring everybody on board and we continue to amplify our our work we will be coming out very soon with new estimates on gender-based violence establisher continuing to provide this evidence that the world needs to see the impact of violence on women and girls and to continue to fight these destructive laws that prevent women from from getting

01:03:24

access to care so for us quality health services integrated responsive across the life course but women centered people centered equitable and high-quality as part of camera health care but most importantly without creating financial catastrophe for women but I've just heard happening around Kenya is something that we really need to take forward and see how we can resolve this limitation it's not just

01:03:55

Kenya and many many countries that don't provide comprehensive packages packages of care for women then the second and last thing that I really wanted want to emphasize is the importance of ensuring that we maintain adequate appropriate high-quality and correct information for communities and for people who are responsible for the services that women receive and more information I think is

01:04:29

available on the inside I hope that any questions that concern you WH all we'll be able to take and if not we will send my information to the colleagues that are participating in this very nice thank you very much thank you dr. nanu for flagging these very important issues and I would like to flag the next questions to Rosario the

01:05:02

questions that have been raised about the fact that you mentioned low neonatal and maternal death rate as well as lower dollars in pregnancy but also that Chile lacked sexual education and abortion laws so the question is how have those things been achieved and what interventions have been successful roses are you over to you if you could keep your responses brief so that we can

01:05:34

cover more questions that'd be great thank you of course well I think that the main facts that are helping us in our rates be your that we don't have sexual education is two main things two main actions one is that in Chile every woman upon 16 years can ask for a mid works a consult in the primary health care when we provide different

01:06:03

kind of anti content anti conceptive methods and they are provide them for free so there we have but like just like a little short education and more than education we just like give medical prescription of it and give it to the patient and also the other fact that has helped us a lot especially in adolescent rates pregnancy rates is that we achieved a few years ago to start the emergency article 30 peel in pharmacies with no

01:06:37

medical prescriptions and our patients are really using it so that has helped us a lot so the thing is that in Chile what I realized is that woman and Ferrand like couples especially young couples are taking care of not getting pregnant but they are not realizing because they don't have sexual education that the act of sex is not only reading them pregnancy also to diseases that's why our HIV rates are in

01:07:08

outbreaks I don't know if I make it more or less clear further questions or clarifications on that we could come back to you yeah thank you that there are a couple of questions to dr. today sim and I think she has already left so she won't be able to respond to those Irish there are there is a question questions for you which I'll flag him so one of the

01:07:47

questions was about you know the USC States's if you think that a country's USC status has influenced their ability to manage you know the various issues that were raised in the presentations today do you have any kind of reflections on that and the second one I mean there were actually three questions where I'll just flag two for now and to see if we have any other questions the second was if you could elaborate on the

01:08:19

vertically sliced funding streams points over to you sure thanks so much I think that question on you know how UHD status has influenced countries is a really really pointed one because we're seeing how countries that have strong history of UHC and the type of culture that comes out of that process has actually really improved their ability to manage kovin 19 and other outbreaks in the past you know just for an example Kerala has

01:08:50

a strong that karolides estate in India has a very strong history of UHC they have a very strong commitment to health workforce they are I think by no coincidence led by a state minister that's a woman and they have a strong commitment to education as well and these factors we've seen has made made care less response really stand out in a positive way out of the rest of India states they've had the most effective response they've been very cautious they've been proactive and they've also done what I think is important is a is

01:09:22

is they've addressed the social determinants of health as well they've they've provided housing for migrant workers they provided cooked meals they've done advanced pay on pensions these kinds of things that are often you know inherent in stronger UHC systems are really good in helping mitigate crises like Kobe 19 as well and we're also seeing this similar thing play out and I think us is a very standard example that a country that does not have strong UHC has very big fragmentation and does not have a

01:09:54

history of trust in in health systems and health services is one of the largest you know has one largest caseloads and so I think that definitely has a big role to play in terms of the vertically siloed funding streams I was mentioning I you know priorities and governance are have a huge impact on public health and often not included when you look at assessments on preparedness and readiness or UHC but the way we fund the UHC systems has a huge impact because during crises as

01:10:25

well it can offer an opportunity to really you know have a target on certain certain sources so when you are funding HIV specifically or sexual reproductive health services specifically or TB and these not are not integrated in a UHC kind of continuum they become easy targets during a crisis because you say you know well we need to focus an emergency response we don't have time to focus on these routine health services and very quickly you see rising rates of in access to medicines lower lower rates of you know reported health heart

01:10:57

attacks and breast cancer screenings these things which are going to have larger impacts primarily for women and vulnerable populations down the line so I think vertical systems are a huge inhibitor to stronger comprehensive UHC that's equitable in the long run thank you thank you so much I'm sure I might come back to you later with a question if you have some time the next question Patricia if I may direct the next question to you this is a question by

01:11:29

Marissa from research and the question is as we are witnessing increase emergency powers criminalization punitive and mandatory measures related to forward prices globally how do we ensure that these measures are not impacting women's health and frh are the broadly is especially for already signifies and marginalized communities including learning from the dangerous histories and parent situations of criminalization of HIV transmission and exposure for

01:12:00

example over to you Patricia thank you diff I think that is a very good question and one of the things I've said repeatedly since coffee'd started you that human rights cannot be suspended just because we have to deal with kovat 19 and that is what we have seen in Kenya and in other countries that human rights have been suspended in Kenya for example we are currently facing floods as well people have been displaced

01:12:32

sexual violence is on that rise and and and and we have curfew that has been imposed so between 6 to 5 a.m. 7:00 to 5:00 a.m. you cannot be seen outside and so we have found police beating up people we have found quarantine facilities people do not have masks in quarantine facilities people do not have sanitizers they are bundled up in a room if you are arrested during a few hours you are taken in for quarantine by force

01:13:04

initially we were we were being subjected to paying for quarantine and what we did was to come up together a civil society organization and to say that we will not pay for lawful detention because that is illegal but people paid for close to three close to three weeks before it was scrapped off so I would say that we need to be vigilant as civil society organizations we cannot suspend human rights to deal

01:13:36

with a pandemic and we must make sure that we let a cup and know that as much as you are dealing with at acceptable you cannot kill people just because they have been found outside during curfew hours you cannot ban those people into rooms as if they are not human beings just because that is what you and also as a quarantine facility so there is need for us to regroup and there is need for us to be extremely

01:14:07

vigilant our civil society organizations so that we do not let any injustice pass without us saying something because it's that little voice that we can come up with jointly to make sure that action is taken up and for us as a country we have seen that every time we've come up together to to rally behind people that are suffering people that are victims and survivors of this of this pandemic then we are stronger together and we can ensure that government listens and so I

01:14:39

think that would be that would be my input on that human rights cannot be suspended because of a pandemic thank you so much Patricia for your answers and also providing us some examples thank you so much I I think we have time for maybe questions so Rosario if I may direct this question to you the question is how

01:15:19

do we ensure care and support and empower frontline frontline women both us over to you sorry can you repeat the question how do we ensure care and support and empower frontline workers especially women frontline workers yeah well I think that if for ensure the AP

01:15:52

start really needing us for example midwives I think we must work like in teams for example here in Chile since we had felt invisible eyes as midwives we organized like all Chilean midwives and asked and speak to the ICN the International Confederation of midwives to inform them how is our situation and ask for support so they can help us to be visualised like by the help of

01:16:22

Minister here in Chile of course social medias always help but I think that the most important thing is to work as a team we need to see a team of woman of midwives they are exposing their needs and in the empowerment of woman I think that's like really different in the case of every country of Tours Thank You Rosario dr. nanu can I direct

01:16:59

a question to you this question is about whether all countries are collecting and analyzing data with regard to you I think this is with regard to prove it 19 and maybe a higher charge and also if you put specifically I mean kind of really elaborate about the Solidarity

01:17:34

fund this is Courtney from women delivered doctor no no had to jump off the call so perhaps this is something we can direct as a follow-up question and share answers in writing yeah and I was wondering if Irish you wanted to take

01:17:53

that sure I think you raised it in your presentation yeah sure yeah I think I mentioned yeah I mean fork over 19 at least in particular we've seen only about 40 countries are tracking sex

01:18:38

disaggregated and even a few of the fewer of them have disorientated but data by the social determinants that I think you're mentioning like different tracks of structural inequities makes it a huge issue and and it's it's also kind of perplexing to see this because you know we've seen largely initial data show that significantly higher mortality for co19 among men almost around twice the rate in some countries as women but you know Qatar has has almost 91 percent of men that that seemed to have

01:19:10

cover 19 and yet other countries do not Finland actually seems to have more cases in women and what does this mean we don't know because we are large looking at this blind there's not a lot of comprehensive data and especially transparent data sharing it is an equally large issue because a lot of these things are not shared publicly so I I don't know that answers the question but I think that the root of that issue is we do need more data and there just has not been as much as there should be dr. noon was not on the call but an

01:19:46

additional to the question was also why that Babloo actual data does not really reflect disaggregated data especially gender disaggregated data so we could possibly direction of these questions to hell and she probably be able to respond later so yeah those were some of the questions and do we have some time I think we should probably wrap it up now because we don't have much time left so

01:20:17

I just want to say that there were some very critical issues and summarize it's impossible for the range of issues and that were raised but I think that a few things that came up and what the Patricia said with me and in my head that human rights cannot be compromised at any cause just because you know there's a pandemic that we are dealing with right now and I think that is something that all of us in our

01:20:49

countries need to remember and be accountable to and the other thing was that there are no shortcuts when we talk about USC and gender equality and sexual health and rights and this is very original in the experience of Ethiopia and as all our collective experiences on which show us en gen we're responsive systems are imperative in both non panther makers pandemic situation so this just cannot

01:21:20

happen overnight but it needs to be worked in sustainment and strong health systems and primary health care as experience indicates is a key strategy for defense against outbreaks a lesson three wetsy from Ovid 19 it is imperative for all of us to acknowledge and implement acknowledge that as our HR policy and implementation of services are essential and that these are rights these are human rights and those who seek them in the context of the pandemic

01:21:50

and other situations of conflict or disasters but also in one price is situations must be address and the importance of health care workers especially frontline health workers and a majority of whom are women women was reiterated throughout this webinar and I think it's a very critical issue and we really need to see how this can be have been treated historically but also

01:22:22

during the pandemic which is a reflection of that historical kind of you know fault lines can be really address and challenge I think dr. nono probably said that health is a pathway to development prosperity and security was reflected by the speakers and that global political leadership must acknowledge and build back better and it cannot be business as usual and unfortunately however like the country

01:22:53

that I come from which is India we just had an announcement of budget for health and it's abysmal it's really poultry and we see what's coming or not coming in the next year's so that's really sad multilateralism and global solidarity to combat structural global inequities is critical and this is something that also was flat during the webinar political commitment was another very important issue along with the availability of desegregated intersectional data and

01:23:25

when we talk about data I think there are also huge concerns about surveillance and privacy so he didn't have much time to talk so in this context the fight against indifference I think it was Rosario had flagged is so relevant and the experience of Ovid and their response to it has reflected political and social indifference and many of our parts and apathy in many parts of the world and

01:23:56

this situation really needs to be transformed and we need to move beyond today's context which is unlikely to happen automatically and require sustained momentum so on this note let me remind interested participants wanting to join the Alliance for gender equality and yet see that the link was shared in the chat box and it will be shared by email after the webinar so please do join the alliance in the struggle for gender equality and USC to

01:24:27

all the speakers participants for making time to be part of this webinar and to the many alliance colleagues who have been working tirelessly to make this webinar happen a very big thank you stay safe and take care when you all for taking time out to be part of this webinar and I would like to say goodbye and one wishes on behalf of the Alliance to all of you

Grounding Health Systems in Gender Equality to Achieve Universal Health Coverage

Table of Contents

More in Lectorium

SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE