Celebrated but not supported: The need for a gender equitable health workforce

By Lynda Keeru

On May 24th 2020, CNN published an article titled “Coronavirus is killing more men. But the lockdown is disastrous for women and their rights.”

“The novel coronavirus seems to be more deadly for men. But in many other ways, women are bearing the brunt of this pandemic. From a spike in domestic violence and restricted access to family-planning services to disproportionate economic impact, the lockdown measures put in place to stop the outbreak are hurting women and their basic rights a lot more than men. Previous epidemics of Ebola and Zika have resulted in major setbacks for women and girls in the regions most affected by the outbreaks — and experts and activists are warning the same thing is happening globally right now,” CNN London.

The article’s theme is similar to a webinar hosted on 22 May 2020: Masked Heroines? Building Resilience Begins with a Gender-Equitable Health Workforce. In this webinar, we heard that 70% of the health workforce is still made up of women and only 25% of senior global positions are held by women.

COVID-19 response in Sierra Leone

Dr Haja Wurie, a health systems’ researcher who is part of the ARISE Consortium spoke about COVID-19 in Sierra Leone and highlighted the lessons learnt from the Ebola outbreak that also affected her country.

“Health Care Workers are tired of being celebrated and not supported. They are often likened to frontline soldiers which begs the question of why we send them to the frontlines without preparing them,” was her opening statement.

In Sierra Leone, many patients are asymptomatic and once identified, they are isolated and managed in community health care centres which is something that was started during the Ebola outbreak. The challenge with this is that some of these patients are in denial about testing positive because they have no symptoms, and this makes them largely uncooperative. Women health workers, who predominate in Sierra Leone, face the challenges of supporting different patients in this new pandemic.

Almost all the frontline workers interviewed, are facing psychological stress and an increased fear of contracting COVID-19 but essentially what is the scariest for them is passing the virus on to their loved ones. For this reason, psychosocial support should be offered to all health workers at all levels including community health workers. Primary health workers are so important because they bridge the gap between communities and health systems. We also have to ensure that we have supportive supervision in place that uses problem solving approaches to  respond to health care workers’ different gender needs. Supporting health workers helps in building trust.

Having been part of both the Ebola and COVID-19 pandemic, Haja was engaged on what she thought was the best way to prepare for future pandemics.

Community engagement is vital: The voices of the right people need to be heard and captured; including bringing the importance of  gender in the conversations. Right from the onset, the right stakeholders who bring the right perspective to the table should be engaged and should be in the conversation well into the policy formulation and implementation stages. Their voices should be heard and brought to the table (and not just paying lip service). It is vital to ensure that gender dynamics are considered in policy development, formulation and implementation process.

Noteworthy, she advised that what they do with the ARISE research consortium should be replicated in  as many countries as possible. ARISE works in partnership with vulnerable groups in informal settlements, together building platforms to speak on their priorities and what is required for them in terms their health and wellbeing. This should ensure that decisions made at the highest levels are informed by evidence and that marginalized voices are captured using a gender lens. Data should be disaggregated by gender.

COVID-19 response in India

Dr Sneha Krishnar from India highlighted that ASHAs (Accredited Social Health Activists) have been going house to house carrying out surveillance since the onset of the COVID-19 pandemic. The use of digital technologies to help the ASHAs do their work was being tested. Zoom is being used by public health officials to pass information on COVID-19 to the ASHAs and they are in turn expected to use WhatsApp and Facebook to disseminate information as well report their findings to their respective health centres. In addition, it has also become mandatory for them to download the contact tracing app by the government.

The challenge however is that most of them (less than 25% of those interviewed) own smartphones. This then makes them rely on their husbands and sons to download the apps so that they can attend these calls and provide their daily reports. This disempowers them and is a hurdle in their work. With the right enabling environment, digital tools can aid community health workers to deliver in their work and it is hence imperative to empower ASHAs with the means and technology to carry out their work themselves.

The realities for health care workers

Michelle McIsaac from the World Health Organization noted that there’s a lot of recognition of health workers at the moment but the truth for them is that it really is a lot of hard work. Women make up the majority of the health workforce, and are unfortunately the ones that are least paid and put to serve on the least secure roles in the health system. There’s a fear that the shortage in Personal Protective Equipment (PPE) will affect some groups of health workers more than others. We need to address the burden of care that women face not just in the work place but also domestically because we know that much of the domestic care falls on women as well. Women who are health care workers are dealing with increased responsibility both in their homes and at work. These are very challenging times for them as they attempt to find balance.

Gender data gap

Shirin Heidari, who was the last of the speakers, talked on a very vital topic: the gender data gap and how to close it. Due to the fundamental gender implications of this pandemic, it is critical that we  collect and ensure that we have accurate gender data to inform our policies and guide our actions. Unfortunately, when it comes to health care workers, we have very little data. For example, countries are not producing data on COVID-19 infection rates and mortality rates among health workers. In some settings we have up to 20% of health workers infected but this data is not released. Data from Italy and Spain for example, show that among infected health workers 60-70% of them are women and this excludes health care workers outside the formal heath care workers as well as workers within the health system that are not counted as health care workers. Moreover, we are limited on data that captures the experiences of health care workers like their experiences with violence, sexual harassment stigma and discrimination.

We are aware that that COVID-19 affects health workers in different ways. For instance, we all know that COVID-19 is a potent stressor yet we have very little data on how it impacts female frontline health workers who are exposed to a lot of stress over the long period of time. Female health workers are likely to feel it more due to their caregiving roles. A study from the early period of the epidemic in China shows that female nurses, frontline health workers working with COVID-19 patients have a higher risk of mental health concerns and report much more severe degrees of mental health symptoms such as severe depression, anxiety, insomnia and distress in comparison to other health workers. There is need for accurate data and not just quantitative, but also qualitative and experiential data if we are to really understand all the dynamics and nuances fully and formulate evidence based policies. She concluded by saying, “I think we need to apply feminist perspective in data collection.”

In the face of the COVID-19 crisis, existing gender inequalities may worsen, as was seen in previous large-scale health shocks such as the 2014-2016 Ebola epidemic. To avoid this, gender must be a key consideration when implementing the COVID-19 response.