Roopa Dhatt is an internist, professor at Georgetown University, and the executive director of Women in Global Health (WGH). WGH is a 501(c)(3) organization with a network of over 35,000 supporters in over 90 countries with more than 40 chapters that aim to achieve gender equality in global health leadership.
Norma Magallanes, associate editor for Global Health News Wire, in conversation with Roopa Dhatt.
GHNW: Following the COVID-19 pandemic, female healthcare workers are considering leaving their positions in healthcare at higher rates than men. How can we avoid losing the talent and expertise women bring to healthcare?
Roopa Dhatt: Our health systems are designed by men for men, but women make up 70 percent of the healthcare workforce. The pandemic has magnified gender inequities, unequal access to healthcare services, and a serious healthcare worker shortage.
Women have faced an increased burden of unpaid work and caregiving responsibilities for children and extended family members. There are also greater demands for healthcare workers, including longer shifts and an increased patient load. Additionally, most personal protective equipment (PPE) is designed for the male body and is oversized for female healthcare workers which further exposes them to infection. Most healthcare workers at the bedside are women and they are disproportionately facing abuse from patients and visitors who refuse to wear masks, refuse vaccinations, and express their frustration with the handling of the pandemic. Healthcare workers are also facing mental stress but there is no support for healthcare worker’s psychosocial mental health needs in the workplace. Too often healthcare workers are told to build resilience, but resilience is not solely an internal process, it is also influenced by the work environment. There is also unpaid work in the healthcare sector. The community health worker (CHW) cadre, which many countries depend on for the uptake of COVID-19 vaccinations, testing, education, and other essential services is a volunteer or stipend-based role.
After almost 2 years of these challenges, women healthcare workers on the front lines of the COVID-19 response are facing burnout, are leaving the healthcare workforce, and are shifting to part-time work. A study from the Royal College of Nursing in the United Kingdom found that one third of nurses are considering leaving the profession for reasons including pay, low staffing levels, and lack of management support. A 2019 WHO report titled, “Lead by Men Delivered by Women” found 50 percent of female medical students reported having experienced sexual harassment from faculty or staff at one of the U.S. universities and that 30 percent of U.S. female medical academics reported sexual harassment in the workplace.
Healthcare workers are needed to achieve universal healthcare coverage and WGH is calling for safe and decent working conditions for healthcare workers. When we speak to women healthcare workers, they say, “what we really want is to have decent, safe jobs, equal pay, and to be protected”. Women want the means to have decent wages, safe working conditions, and leadership opportunities all of which is currently being denied in healthcare systems.
GHNW: Low-income economies with weak healthcare infrastructure can be ripe for new healthcare models that consider women’s healthcare a right, not a privilege. What role can WGH play to ensure that low-income economies with lower rates of women in leadership roles include women in the design of these new healthcare systems?
Roopa Dhatt: WGH was launched in 2015 and aimed to bring visibility to women’s global health contributions and highlight their underrepresentation in leadership roles in the global health sector. WGH formed chapters around the world, and half of the chapters are in low- and middle-income countries (LMIC).
WGH chapters advocate institutional and government policy change, creating gender quotas, gender responsive health systems, ensuring that healthcare is accessible to women and all genders, and gender parity in decision-making for health care systems. WGH also works collectively with chapters to disaggregate data by gender to learn about gender specific barriers to accessing healthcare services.
WGH performed a survey among 115 COVID-19 task teams around the world from 87 different countries and found that 85 percent of the task teams were male dominated and less than 5 percent had gender parity. The initial US COVID-19 task team with almost 20 representatives was composed of men and eventually reached 15 percent in women’s representation. This highlights the barriers to leadership for women.
The African continent is known for its gender quota system. In Rwanda, 61 percent of parliamentary seats are held by women. The gender quota system in Africa is an example of LMICs using policy as a tool for gender equity. High-income countries like the United States have been resistant to gender quotas and the United States currently ranks 67th in the world for women’s parliamentary representation, which demonstrates that women’s underrepresentation in leadership is an universal issue, not just an LMIC issue.
WGH believes that it is our responsibility to use policies and programs to create enabling environments that increase women’s representation in health leadership. While there is taboo associated with quotas, it is an effective policy. If there is no set target, it is impossible for women to be represented in equal numbers, especially in LMIC countries. Collective action can drive policy change and legal frameworks can be used to ensure that gender parity is embedded into constitutions and laws. In places where policy level changes are a challenge, a good starting point is institutional level change.
GHNW: How can U.S. healthcare providers who are children of immigrants make an impact in healthcare systems in their parent’s country of origin?
Roopa Dhatt: First and second-generation immigrants can have several advantages. They often speak the language, may have extended family networks, and can be a bridge to promote cultural understanding, dispel myths about immigrants, and about other parts of the world. Additionally, they can use their own experiences to connect with communities locally to address health disparities.
Telemedicine projects that advise health practitioners on disease diagnosis and provide knowledge exchange are examples of projects that were brought to scale during the COVID-19 pandemic. Other ways to contribute include establishing NGOs, scholarships, and academic collaborations.
My family moved to the U.S. from India and while I am a member of the diaspora, I don’t want to overestimate my knowledge and cultural understanding of the day-to-day realities in India. When the WGH India chapter was formed, I traveled to India and worked with my colleagues to ensure that colleagues and women working in global health have access to a global platform and are part of global health discussions that are typically led by global north countries.
GHNW: How do you improve access to health initiatives such as cancer screenings, and maternity and reproductive health services to women in countries with high rates of violence towards women such as Mexico and countries in Central America? What type of support is needed for health workers delivering health services in these communities?
Roopa Dhatt: The pandemic has magnified inequalities in gender-based violence. Most violence against women is intimate partner violence (IPV) and there is often stigma associated with gender-based violence and IPV and it needs to be recognized as a public health issue.
Often female health workers from these communities are facing similar IPV issues as the communities they serve. Health workers also face violence and harassment at work and unfortunately it has increased during the pandemic. Healthcare workers targeted for violence include CHWs who are going door-to-door to provide services in communities, and nurses and midwives working at the bedside. Health workers need to feel safe and protected to be able to provide care for those who are also facing violence. They are also often the least represented in decision making.
The Generation Equality Form took place virtually in Mexico City and Paris and announced a 5 year action plan to accelerate progress towards gender equality which included USD $40 billion of confirmed investments as well as policy and program commitments from governments, philanthropy, the private sector, and other stakeholders.
WGH co-launched the Gender Equal Health and Care Workforce Initiative with the World Health Organization and the government of France to commit to improving gender equality in the healthcare workforce around four themes:
- Increase the proportion of women in health and care leadership.
- Promote equal pay for equal work and recognize unpaid care work.
- Protect women in health and care from sexual harassment and violence at work.
- Ensure safe and decent working conditions for women health and care workers, including access to PPE and vaccines against COVID-19.
WGH believes that ratifying commitments to gender equality and creating protections for all workers is a strong step. WGH is a network of women and allies that advocates organizational level measures to address violence against women, gender and social norms, stereotypes, and other issues.
GHNW: Over two decades, Afghanistan has achieved a decline in child and maternal mortality. What role if anything can your organization play to ensure that progress in public health in Afghanistan is maintained? What can we do to support women health workers in humanitarian crises?
Roopa Dhatt: We are worried about the state of health in Afghanistan, especially health workers. Over the last decade of progress, there has been an increasing number of women who have become physicians, nurses, and midwives. These women are being targeted by the Taliban.
WGH is working on global and national advocacy efforts to protect women working in humanitarian crises. We have humanitarian exchange groups where we share the latest information, knowledge exchange, and joint advocacy opportunities. WGH also launched a call to action for women health workers in Afghanistan in the British Medical Journal.
We also hosted the Heroines of Health Gala. Too often, there is a narrative that women cannot lead in conflict or crisis situations, and we are trying to challenge that by bringing visibility to women’s contributions especially in difficult conflict humanitarian settings. Women have unique contributions to healthcare by providing essential health care services such as maternal and neonatal care and providing care to survivors of sexual violence.
Before the current collapse of Afghanistan’s government, we were planning to form a WGH Afghanistan chapter which is currently on hold to protect the safety of these women. We hope that one day we can have a WGH community in Afghanistan.
GHNW: Most clinical trials are conducted on predominantly Caucasian populations. How do we ensure that clinical trials include underrepresented populations in developing economies where there is an absence in infrastructure for clinical trials including study sites to recruit research participants?
Roopa Dhatt: Underrepresentation of people from diverse backgrounds in clinical trials is a universal issue. I would like to acknowledge Henrietta Lacks whose family was presented with the posthumous award by the WHO for her world changing contributions to medical science. She was an African American woman diagnosed with cervical cancer whose cells were used without her consent and became an immortal cell line known as “HeLa.” HeLa cells have been described in over 110,000 publications and have been used to advance biomedical research including cancer biology, infectious diseases, COVID-19, and others.
HeLa cells are from an African American woman, yet the highest burden of cervical cancer is seen in regions with diverse racial/ethnic populations such as Asia, Latin America, and Africa. This is a health equity issue. We must understand why there is mistrust in research among diverse racial and ethnic communities. These communities have experienced racial discrimination, lack of consent for participating in research, and more significantly research performed in these communities does not always benefit them.
There was an effort by the Africa CDC and African Union to build tech hubs for current and future pandemic preparedness including vaccine and testing manufacturing as well as other pandemic detection capacities. However, there has been an unwillingness in transferring knowledge and intellectual property (IP) from the private sector. Moderna is a recent example of this and their arguments against knowledge and IP transfer were racist and colonial in nature. However, countries like India and Brazil are examples of countries leading vaccine production and other medical technologies.
Diagnosis is also very skewed, and most guidelines have been developed for a white male population even though they are not representative of most of the world’s population. One example is heart attack guidelines, which were based on studies with majority white male populations. The classic white male symptoms are left sided chest pain, pressure, and excessive sweating. Female symptoms are considered atypical which is very problematic. This bias is going to scale, particularly in digital health. Companies like Google and Microsoft are working on AI tools for healthcare. The databases are guided by a minority group population that may inform AI in medicine for the world. With technological advancements moving forward so quickly, we must ensure that there are active efforts to fill this gap.
WGH calls for clinical trials to be representative of the populations who will use the medications and vaccines. We use a power and privilege lens to acknowledge that global health is skewed to the global north and often white male perspectives. WGH aims to bring visibility to these gaps in medicine and healthcare, and we are advocating partnerships with our colleagues in LMICs to ensure that resources are distributed to them, that knowledge transfer is taking place, and that they are leading and designing the infrastructure for conducting research.
GHNW: Many global health organizations have initiatives to advance women’s health. Most of these initiatives target similar populations and issues and aim to achieve the same results. Should we and how might we coordinate these initiatives?
Roopa Dhatt This is a major issue in the global health sector, and it is not unique to women’s health.
From WGH’s perspective, there is a shortage of resources and investments dedicated to addressing women’s health issues. Less than 10 percent of global health innovators in the classic tech space are women and less than 5 percent of research and development resources are allocated to women’s health issues.
Even though women’s health is a limited funding space, there is a dearth of research for women’s life-course health issues such as infertility, menopause, and aging. There is a lot of focus on women’s access to reproductive health and family planning services.
WGH believes that coalitions and partnerships are critical to coordinating women’s health initiatives. One example is the Alliance for Gender Equality and Universal Health Coverage, which was co-created by WGH. It is composed of 150 member organizations from around the world who advocate knowledge exchange and advancing gender equality and universal health coverage in health systems.
Sharing resources and expertise is also needed. The 2015 Lancet Commission on Women and Health highlighted the latest research and identified gaps in women’s health. Efforts like landmark reports on women’s health performed by peer-reviewed journals like the Lancet, BMJ, and more importantly organizations like the WHO are critical to coordinate initiatives for organizations. We are calling for the WHO to develop a new global strategy and a roadmap to achieve gender equality.
I know it is worrisome when you ask, “why do we have so many different fragmented groups out there?” It is because too often women’s needs are ignored, and mainstream health approaches don’t often create space for women or women’s health. Women often resort to creating NGOs or other platforms to bring awareness to and prioritize women’s health issues. I hope we can reduce fragmentation through effective gender mainstreaming and that all health initiatives and efforts create space for women and women’s needs.
– Norma Magallanes, Global Health News Wire