To Deliver Health for All We Must Prioritize Gender Equality: A Q&A with Dr. Tedros Adhanom Ghebreyesus

This week, global health leaders meet in Astana, Kazakhstan for the Global Conference on Primary Health Care to renew their commitment to primary healthcare as the basis of Universal Health Coverage (UHC). As programs and policies are discussed, the health, rights, and wellbeing of girls and women must be prioritized. Women’s involvement, sexual and reproductive health and rights, and gender equality must be part of the equation. This is the only way the world will achieve #HealthforAll.

Looking back 40 years, global health leaders met for the first International Conference on Primary Health Care and signed the Declaration of Alma-Ata which committed to ensuring access to quality healthcare for all by 2000.

Nearly two decades past the target date, much work remains to achieve this ambitious goal.

As commitment builds toward achieving health for all and UHC, governments have a responsibility to establish effective systems that provide quality, affordable, and accessible care to all girls and women throughout their lives. Without an intentional, relentless commitment to gender equality, even well-meaning plans to advance UHC can leave girls and women behind.

To further examine the critical link between primary healthcare, gender equality, and the SDGs, Katja Iversen, President/CEO of Women Deliver spoke with Dr. Tedros Adhanom Ghebreyesus. As the Director General of the World Health Organization, Dr. Tedros is the leading expert on what it will take to finally realize the quality healthcare we need for the future we envision.

Katja Iversen: As I have said before, “girls’ and women’s health and rights are more than a measure for progress on UHC. They are a prerequisite.” Dr. Tedros, in your experience, what are the strongest links between gender equality and health – and how can we work to ensure UHC delivers for the unique health needs of girls and women?

Dr. Tedros Adhanom Ghebreyesus: When women and girls are socially, economically and politically empowered, they are more likely to be free from discrimination, violence and coercion, which put them at risk of sexual transmitted diseases, injuries and mental health disorders. When the right conditions prevail, they are more likely to control their sexuality and fertility, and more likely to be healthy. When women and girls have access to quality and comprehensive health care, information about their health and bodies, and the financial protection to be able to access services, it contributes to gender equality.

Universal health coverage (UHC) is about “leaving no one behind” – something I am convinced we can achieve if we start from strong primary health care systems. Women and girls (as well as men and boys) have specific health needs including those related to sexual and reproductive health, so any package of essential services must include sexual and reproductive health services, going beyond maternal health, to include contraceptives, prevention and treatment for cervical cancer and sexually transmitted infections, prevention and response to gender-based violence and safe abortion services where legal.

WHO’s approach to UHC means designing, planning and delivering health services to meet all the needs of women and girls, including mental health and non-communicable diseases as well as reproductive health. And these gender norms and practices will have an influence on the health of men and boys too.

Even when services are available, girls and women may not be able to access them. The causes of this might be diverse, but include lack of access to or control of economic resources, discrimination, harmful gender norms and practices, or lack of information.

Lastly, the road to UHC must include women as key partners and decision-makers. We know that much of the progress in the health of women and girls can be attributed to the tireless efforts of women’s health and rights organizations. Their voices must be heard in creating policies and legislation for health, and in monitoring progress.

Katja: Many governments and organizations have committed to advancing Universal Health Coverage for all – yet there is still debate around the inclusion of sexual and reproductive health and rights. What argument do you make to ensure sexual and reproductive health and rights are prioritized on global health and sustainable development agendas?

Dr. Tedros: The SDGs goals include ambitious global targets for health, including universal health coverage (target 3.8); and universal access to sexual and reproductive healthcare services (target 3.7). Each country make its own decision about what services are included in UHC benefit packages, but WHO is committed to making sure that sexual and reproductive health and rights are prioritized.

Policy-makers often want the economic or financial argument and there is data, for example, that investments in contraceptives are extremely cost-effective. The evidence for SRHR is airtight: when SRHR is protected, preserved and promoted, it contributes to significant improvements in overall health and well-being, especially for women and girls. Investing in SRHR pays dividends across the rest of the SDG agenda, in gender equality, economic empowerment, and social development.

But it’s a rights issue first and foremost: investments in contraceptive availability and access will not be realized unless women and girls have the right to choose whether and with whom they want to have sex; the right to refuse sex; and the right to choose when and if to procreate.

Katja Iversen: Achieving Universal Health Coverage and Health for All is a complex and ambitious goal. How do you personally remain committed and resilient in this work?

Dr. Tedros: I see it happening. All over the world there are examples of countries making bold steps towards universal health coverage: India and Kenya are just two recent examples.

I am a firm believer in the right of every person to the highest attainable standard of health. This is what WHO has stood for since its founding. No-one should die because they are poor. Universal health coverage is the means by which that right can be realized – it is an achievable goal, although countries follow different pathways to reach it. The foundation of universal health coverage is strong primary health care, with a focus on health promotion and disease prevention.

I also see unprecedented political commitment to achieving UHC. The strongest expression of that is the Sustainable Development Goals, in which the governments of the world have committed to achieving universal health coverage by 2030. The Global Conference on Primary Health Care in Astana, Kazakhstan this October will be a key moment to renew a commitment to primary health care as the basis of universal health coverage.

Finally, it’s what our Member States want. At the most recent World Health Assembly, they approved our five year strategic plan for 2019-203 (the General Programme of Work or GPW13); it includes an ambitious target to see one more billion more people benefitting from UHC by 2023.

Katja: Dr. Tedros, what is your one, tweetable, commitment to advancing gender equality and the health, rights, and wellbeing of girls and women?

Dr. Tedros: #HealthForAll means health for all, including every woman and every girl. Universal health coverage is the best way to ensure all women and girls get the health services they need, without facing financial hardship. It improves health and moves us all closer to gender equality.

Katja: When we spoke before you were elected the Director General of WHO you said that we need to put health at the center of the gender equality agenda and gender equality at the center of the health agenda. What are specific examples showing the way the WHO is doing this?

Dr. Tedros: WHO applies gender equality principles in its technical programmes, evidence and data work, and also in tracking progress towards the SDGs by increasing the capacity of countries to measure health inequalities with more disaggregated data.

WHO focuses on promoting health through every stage of every person’s life – an example is the implementation of the Global Strategy on Women’s Children’s and Adolescent’s health, where WHO is working with Member States and partners to expand access to services and programmes that cut across sexual, reproductive, maternal, newborn, child and adolescents health.

Another example is our global plan of action on strengthening health systems to address violence against women and girls and against children. WHO is working with Member States to strengthen their capacities to prevent and respond to violence, given it’s often health workers who are the first responders to violence and deal with its consequences.

Another example is our work on improved investments in the health workforce. Around 70% of the global health workforce is female, so investments in creating jobs for health workers are also investments in gender equality.

Katja: Within your first several months at WHO, you made a commitment to achieve gender parity in the organization – and now, a little over a year later, 60% of WHO leadership is now women. Why have you prioritized this and what value does it add to advancing UHC, gender equality, and the broader WHO goals?

Dr. Tedros: We must walk the talk when it comes to gender equality. We cannot advocate for gender equality or expect that our normative guidance on gender equality and health will be implemented, if we don’t do it ourselves.

Furthermore, we have evidence from many organizations that having more women in leadership and management is not just the right thing to do, but a smart thing to do. Having more women in leadership positions is shown to bring positive changes in organizations, from improved performance to innovation, creativity, resilience, morale and productivity. It also provides role models for other women in the work place, and it reduces tolerance for toxic workplace behaviors such as sexual harassment. So gender parity in senior leadership is a no-brainer, if I want to make WHO fit for the present and future.

Likewise, just as goals for UHC cannot be achieved without progress in ensuring equality for one half of the planet, similarly, the goals of transforming WHO will not be achieved without harnessing the talent of qualified and experienced women.