Our vision for an inclusive pandemic recovery - led by women, with a new social contract for women

Women in Global Health represented at the Grand Challenges Annual Meeting

On 10 November, Roopa Dhatt, Executive Director of Women in Global Health was invited to address senior leaders from health, philanthropy and politics at the Grand Challenges Keystone Symposium Meeting, there to action change on the world's most urgent global health and development problems.

After almost two years of a global pandemic that has caused more than 5 million deaths and devastated lives, health systems and economies, the meeting theme focused on a better future - "Pursuing an inclusive recovery: what it looks like and how we get there."

Interventions centered around lessons learned from Covid-19, pandemic preparedness and vaccines, with women's leadership and gender equality raised as central to pandemic recovery by Melinda French Gates, Co-Chair of the BMGF, Anita Zaidi, President of the Gender Equality Division at BMGF, Roopa Dhatt and other speakers.

Melinda French Gates called for more gender equity in health. She underscored the importance of strengthening primary health systems and ensuring women have continued access to family planning services. "Without urgent and concerted action to support an inclusive recovery, a generation of progress will be lost," she said, showcasing the disproportionate loss of jobs by women due to the pandemic. She also mentioned data collection and research as key to the prevention of future pandemics and recovery from the COVID-19 pandemic and called on leaders everywhere to adopt a "new, equitable model for doing business in global health," underlining the importance of including the voices of those living in the most affected areas, especially women and girls, and ensuring that countries work together in order to achieve an inclusive recovery.

"The importance of women's leadership, ensuring that women's voices are heard and women's needs catered. Women make up 70% of the global health workforce but are only 24% of the COVID-19 task forces" is how Anita Zaidi opened the annual meeting with her welcome remarks. She went on to outline how women have carried the social, care and economic burden of the pandemic, with women twice as likely to lose their jobs. The only way to reach the Sustainable Development Goals by 2030 is to ensure girls' and women's needs are met. Anita Zaidi outlined three key ways in which countries can achieve these goals: through public policy, namely through Care, Cash and Data.

Firstly, countries must build sustainable care-giving infrastructures to ensure women's care work does not go unpaid.
Secondly, cash must reach women directly to ensure that the economic burden on women is reduced.
Thirdly, gender-data gaps must be closed to better identify the needs of women and girls.

The key role that women play in health systems globally and ensuring that they are given a platform to speak, was also highlighted by Anita Zaidi. Shining a light on the underrepresentation of women in Covid-19 task forces globally, she called on leaders to empower women and address gender inequities in global health delivery. Her message is especially relevant in relation to vaccine equity, as the Covid-19 immunization campaigns in many countries are not reaching women equitably, with estimates from Sudan showing women are only 26% of those vaccinated. Women and girls are also missing out on other routine immunizations, such as the HPV vaccine to prevent cervical cancer, critical to protecting their health. Including women health workers equally in decision-making is likely to lead to more gender-responsive policies and programs and increase vaccine equity for women and girls.

"As women health workers, we have appreciated the applause, but more than anything, we want our health systems to enable us to do the jobs we were trained for," said Roopa Dhatt during her intervention at the meeting, underscoring the grim reality most health workers face globally. Women - who comprise 70% of health workers - are clustered into lower paid and lower status jobs, providing an estimated USD$3 trillion in health and care work, of which USD$1.5 trillion is in the form of unpaid work. Although women are the majority of the health and care workforce, they hold only 25% of senior leadership roles. The Covid-19 pandemic has illustrated once again that women are the experts in the health systems they largely deliver, yet men still make the majority of decisions.

In her talk, Roopa Dhatt showcased the rapidly expanding Women in Global Health movement including 40 Women in Global Health chapters, half of which are located in low- and middle-income countries. She also outlined the immense stress on health systems, and the burnout many health workers are facing after nearly two years on the frontlines of a pandemic that is far from over. This particularly impacts women health workers who have taken on the vast majority of patient facing roles and, in addition to the surge of very ill patients at work, have faced increased unpaid work and caring responsibilities outside work.

She highlighted the mounting evidence of a great resignation" of health workers, especially women nurses and midwives, against the backdrop of a global health worker shortage. In order to achieve Universal Health Coverage, an additional 18 million health workers are needed in low-and middle-countries. Yet there are very real fears that trained health workers will be attracted to migrate from low income countries to fill vacancies in the Global North. Women in Global Health is therefore calling for a new social contract for women in the health and care workforce based on equal leadership, pay and career opportunities and safe and decent work. Women cannot be expected to return to business and gender inequality as usual when this pandemic is over.

As we near the World Health Assembly's Special Session on a Pandemic Treaty, where global leaders will meet to discuss the viability of a legally binding international instrument to guide future pandemic prevention and recovery, Women in Global Health will work to ensure that the issues of gender equity in health raised at the Grand Challenges annual meeting are central to the discussion. Countries must recognize the unprecedented burden the pandemic has had on women and girls, the leading role women health and care workers have played in delivering health services, and finally the importance of including women in decision-making processes.

Gender equality is not just a "nice to have" or a marginal "women's issue". The pandemic has shown loud and clear the central role women play in the wider economy and the care economy through their typically unpaid work and in health systems. Addressing the gender inequities in the health workforce that currently undermine the contribution of women and threaten to lead to a "great resignation" will strengthen health systems for everybody. Moreover, the gender equal health and care workforce that is central to pandemic recovery will lead to a wider "triple gender dividend":

Health dividend: equal opportunities and decent work will attract and retain women health workers, helping to address the 18 million global health worker gap.
Gender dividend: as more women enter better paid, formal sector jobs in health they will gain more income and decision-making power.
Development dividend: new jobs created in health will fuel economic growth and strengthen health systems and outcomes, all contributing to UHC and the SDGs by the 2030 end date.

It is time for a new social contract for women health and care workers that recognizes women's contribution to global health security, through decent and safe working conditions, equal pay and leadership opportunities. This is everybody's business, it is now urgent and must be a central building block of inclusive pandemic recovery.

By Becca Reisdorf, Policy Associate at Women in Global Health