A Reality Check On Gender and Intersectionality In Global Health: Where Do We Go From Here?

You wouldn’t know it just by looking at her, but Angela Kisakye has just about seen it all when it comes to the most glaring gaps in health systems that are supposed to work for everyone.

I first met Angela as part of the Emerging Voices for Global Health fellowship, where she opened up to me about her experiences as a young, female health researcher in Uganda. One story she told stood out because it perfectly portrays the complex web of barriers that prevent the world’s most vulnerable communities from accessing essential primary healthcare, of which women’s health is a core component, as well as the importance of gender and intersectionality among health professionals in expanding health services.

During a visit to a rural clinic in northeast Uganda, Angela arrived to find a long queue of patients frustrated that the health worker on duty was nowhere to be found. After tracking him down, she was shocked to discover that the man the entire community depended on for healthcare was listed as the clinic’s security guard. Investigating further, Angela learned that for weeks no health workers had showed up at the clinic. Seeing this, the security guard took it upon himself to act, diagnosing each patient with malaria rather than treating them accurately.

His explanation for this? “Well, what else could I do?”

Angela (second from left) shares her experiences as a young, female researcher from rural Uganda addressing gaps in health systems.

Angela (second from left) shares her experiences as a young, female researcher from rural Uganda addressing gaps in health systems.

Angela’s story uncovers some hard truths about just how far we are from eliminating health inequalities.

Here are three gender-inclusive, intersectional approaches NGO partners can use to strengthen primary healthcare while ensuring no one is left behind:

Step 1: Empower community voices, particularly those of young women.

Health systems are most successful when we put people at the center, but civil society organizations (CSOs) have a spotty track record of doing this, largely because we fail to engage those who have been marginalized the most.

Because her supervisors empowered Angela, a young female researcher living close to the communities she served, chronically-overlooked gaps in health systems were brought to the fore during her explorations. Also, by empowering local communities to speak up themselves, Angela could determine sustainable, people-centric solutions more effectively.

The voices of those that are young, female, impoverished, and/or living in rural areas are far too often left out of decision-making, ultimately leading to massive fractures in health systems. Men, particularly those in power, have a big role to play in passing the mic. An important first step can be making commitments with groups like Women in Global Health. By spotlighting less-visible voices at all levels, CSOs will progress much faster on reducing health inequalities.

Step 2: Value the key role of frontline health workers by supporting their needs.

Without frontline health workers, delivering healthcare is impossible, but simply employing health workers doesn’t yield adequate primary healthcare either. Angela’s story highlights the countless barriers that prevent health workers from effectively doing their jobs. Particularly because the health sector is 70% female, investments in frontline health workers yield massive gains in women’s economic and social empowerment.

Programs must meaningfully consider the needs of health workers  — including addressing the gender pay gap, providing decent and safe facilities to prevent rural to urban migration, and developing strong data systems (disaggregated by gender and age) to track changes in the health workforce, following examples from organizations like IntraHealth International. Furthermore, because only 30% of women in the health sector make it to leadership positions, training, mentorship, and professional development programs are essential to encouraging women to take ownership of healthcare in their own communities.

Step 3: Commit to an intersectional approach. Always.

A paradigm shift is needed to ensure global health partners understand that their impact on all Sustainable Development Goals (SDGs) impacts progress on healthcare. For example, it’s not enough to develop reproductive health programs for women if they continue to marginalize LGBT+ communities or ethnic minorities. Health worker training programs must meaningfully engage the growing youth population and those in poverty with decent jobs and employment. Vaccine campaigns partnering with pharmaceutical companies that discriminate against women in management are simply not sustainable.

It can be challenging to advocate for multiple issues at once, but being committed to intersectionality accelerates progress on all global goals, particularly in the provision of primary healthcare. If we don’t develop programs that highlight intersectionality in health systems, we cannot expect policymakers to develop holistic solutions either.

The vision of universal healthcare is ambitious, and the SDGs go even further, but the right to health for all hinges on these shared global goals — and a renewed focus on women’s empowerment and intersectionality.

Recognizing that investing in the traditionally female-dominated health professions as a pathway to improving health systems is paramount, and by placing those long removed from decision-making at the center of the table, whether young and female like Angela or rural and poor like the security guard, we can learn vital lessons that accelerate progress toward universal health coverage. Combine this with an intersectional lens that truly commits to leaving no one behind, and we might actually have a shot at meeting our global health targets by 2030.

Universal health coverage is possible, but the status quo we’ve relied on will no longer work, and it will take an army of young, female leaders like Angela and intersectional civil society partners that support her to make it happen.

Arush Lal is a master’s student in Health Policy, Planning and Financing at the London School of Hygiene and Tropical Medicine and the London School of Economics. A Gates Foundation Goalkeeper and Primary Health Care Young Leader, he currently serves on the Board of Directors for Women in Global Health, where he is helping push for gender equality in leadership positions. Arush recently completed fellowships with Global Health Corps and Emerging Voices for Global Health.