The Power of Evidence: Transforming Health Systems for Gender Equality

Podcast Title: Power Of...Episode Title: The Power of Evidence: Transforming Health Systems for Gender EqualityWelcome to the Power Of...podcast, a production by the United Nations University International Institute for Global Health Podcast. In this collection of conversations, we dive into critical, thought-provoking, and contemporary content to stimulate debate and dialogue with the aim of driving gender equality in global health. Host, Johanna Riha, works at the UNU-IIGH in Malaysia and is passionate that the bold commitments towards gender equality in health must be met with changes to the underlying structural and systemic drivers for true transformation to occur. In this episode, Johanna converses with three health system experts - Sreytouch Vong, who works in Cambodia; Jean-Paul Dossou, who works in Benin; and Lucy Gilson, who works in South Africa - on health systems and what health system transformation for gender equality looks like. The first question Johanna wants to consider is how gender power inequalities manifest in health systems. Her guests have no shortage of examples. For one thing, while women represent 70% of the global healthcare workforce, only 25% of them hold senior roles. One result of this bias is that health systems are not designed to address the needs of women and girls and often reinforce gender inequalities. This under-representation also shapes everything from financing practices to types of services and is generally accompanied by a failure to appreciate or even be aware of multiple experiences, especially that of women and girls. Sreytouch also raises the point that while there are many indications of gender inequality at play in health systems, many shifts and changes have also occurred that provide positive progress. The COVID-19 pandemic has, for all its terrible ramifications, allowed for women to become more active and visible as health system leaders. Jean-Paul adds that advancing technology has also empowered women to have more pertinent information handy as they make everyday health decisions (though this also raises the question of who is providing the information), and Lucy comments on shifts in the profile of leaders. This profile shift has occurred across the health system, and has allowed women to gain both prominence and a clear sight of role models highlighting the possibilities for equality. Recent shifts have brought with them a slow (and necessary!) widening of the perspectives included in health system decision making. However, it is also important to question the very nature of this decision making. In other words, it remains important to ask what structures of decision making exist and should exist, rather than taking the status quo for granted. Positive moves for these structures would include the incorporation of more perspectives, as well as the decentralisation of power. Moving forward, Johanna raises the question of how to better build bridges across movements working towards equality – be they decolonising global health, health equity, etc - without sidelining any one agenda. Jean-Paul raises the point that it may be helpful, on a philosophical level, to conceptualise the whole pursuit of equality under one umbrella, possibly even the umbrella of a single word like “love.” This concept is itself hard to wrap one’s mind around, but it provides a sort of handle that people with different goals can latch onto together. These goals are, in fact, parallel, and leave much opportunity for people to learn from each other. Lucy and Sreytouch add that if those pursuing these different but related goals towards equality see their different aims as multiplying opportunities rather than competing goals, a great deal of change can be produced. There is still a long journey ahead in the gender transformation of the health system, but there is also much room for hope if those pushing for equality study...