Are global health organizations gender responsive or gender blind?

MANILA — A new report examining the gender structure and policies of 140 global health organizations shows that men dominate leadership positions. It also reveals that the majority of these organizations lack concrete gender policies in the workplace and in their programs.

Of the 140 organizations featured in the Global Health 50/50 report, 43 are headed by women and only 25 have women as board chairs. Organizations here include public-private partnerships, NGOs, bilateral and multilateral donors, United Nations agencies, philanthropic foundations, private companies, and consulting firms.

When it comes to senior management, 32 organizations have achieved 45 - 55 percent gender parity, and 23 have achieved similar parity at board level.

The disparity is most widespread in the private sector. Only five of 44 private sector companies are headed by a woman executive. Only one organization — The International Food and Beverage Alliance — has a female board chair, though this position is shared with a male board chair. Three organizations have achieved gender parity in senior management, and two at board level.

“The initiative was established with the aim of promoting dialogue on two issues. One is blindingly obvious, namely that men rule global health,” said Kent Buse, one of the authors of the report and co-lead of Global Health 50/50, an initiative launched last year with the aim of advancing action and accountability for gender equality in global health institutions.

But the report went further to examine to what extent organizations have committed to and taken action on promoting gender equality in the workplace as well as in their programs. They did this by reviewing how organizations fared across five gender-focused variables:

1. Do they have a publicly stated commitment to gender equality?

2. Do they have a definition of gender that is consistent with global norms in their institutional policies?

3. Do their program strategies have a gender focus?

4. Do they have workplace policies and specific measures in place that promote gender equality?

5. Do they collect and report on sex-disaggregated data in their programs?

A common bias is that when women take the helm, gender equality in the workplace and programs follow suit. Unfortunately, this is not always the case. Several of the organizations that are led both by a female executive and a female board chair are lacking in workplace policies that promote more diversity, gender equality, and support women in their careers. Meanwhile, there are organizations led by men that are shown to be doing well in advancing these issues.

“Having a female head is not necessarily representative of a whole cultural shift in an organization; having a woman run an organization or a country has not historically always translated into gender equality for everyone else,” Buse said. “That’s why we promote the need to address equality of opportunity and career progression and support all the way through the career structure of an organization.”

But policies alone are not sufficient. As the authors stated, “having the right policies in place is essential, but insufficient for ensuring a safe, respectful, and equitable working environment and organizational culture.” This is particularly true amid the sexual harassment and abuse scandals plaguing the development sector today, with some of the organizations involved included in the report.

A missing gender lens

For Buse, one of their most striking findings has to do with the limited focus of global health NGOs. Most of them are still “primarily and almost exclusively” focused on health issues covered in the Millennium Development Goals, such as maternal and child health, and infectious diseases such as HIV and AIDS, tuberculosis and malaria.

While these continue to require significant attention and investments, by focusing only on these issues, others such as noncommunicable diseases, including mental health, which are part of the broader agenda of the Sustainable Development Goals, are being left behind.

What that has to do with gender equality may not be immediately clear. But Buse suggests that’s where the problem lies.

Fourteen NGOs focus exclusively on the health needs of women and girls, according to the report. But many of them are only focused on maternal, child, newborn, and reproductive health. They fail to take into account the other diseases that are increasingly affecting women, such as NCDs, which, according to the World Health Organization, is now responsible for 2 in every 3 deaths among women each year.

In addition, by conflating gender with women, organizations are potentially leaving other people behind. None of the NGOs featured in the report, for example, have an exclusive focus on the health of men and boys, “despite long-standing evidence of higher disease burden and lower life expectancy among men,” which again is reflective of the social construct of gender roles and norms. Men are often more exposed to physical hazards as part of their occupations or risk-taking attitude. They are also less likely to report symptoms of illness or visit a doctor, compared with women.

This is the second issue Buse hopes will inspire dialogue among organizations: “It is the persistent failure of the global health system to consider, let alone address, the highly gendered nature of exposure to health risks, health seeking behavior, health care service delivery and therefore health outcomes,” he said. “As a result, global health fails to intervene effectively and fairly to ensure the health of women, men, boys, girls, and transgender people.”

Only six organizations — ABinBev, AmfAR, The Global Fund to Fight AIDS, TB and Malaria, Jhpiego, Open Society Foundations and Stop TB — have mentioned the needs of transgender people in their program and strategy documents. In addition, only about a third of the organizations report sex-disaggregated data or require its reporting among programs they support.

To Buse, this disconnect between global health NGOs’ priorities and the burden of diseases affecting men and women are likely driven by the absence of a clear and broad gender definition and strategies in organizations’ programming, as well as sex-disaggregated data.

“It’s likely … they do not understand the problem; and they do not apply a gender lens; and they don’t have the data to do so in many cases,” he said. “But [it] is also a reflection of other factors, such as who funds the organization or how they feel they need to ‘frame’ global health to the general public. It is easier to raise funds for women’s maternal health than for example to support work on men’s health risks. Sad but true.”

Lack of a gender strategy in programs and gender-disaggregated data may also be contributing to the challenge of combating public health issues such as NCDs and TB. Action on Smoking and Health and the International Union Against TB and Lung Disease are both focused on these health problems, but they perform poorly on these two dimensions, based on the report.

“We know that both smoking and TB have gendered dimensions to them. For smoking in particular this has been recognized by industry for decades — note their gender-targeted campaigns ‘you’ve come a long way, baby’ and the ‘Marlboro man.’ Failure to recognize the contribution of gender to these public health issues may well be adding to the challenge of combating them,” the co-author said.

Differing workplace policies

Workplace policies such as flexible work arrangements, paid parental leave, and publication of gender pay gaps help promote a culture of gender equality within organizations. But the report shows a huge disparity among different types of global health organizations. For example, more than half of 40 NGOs do not have any policies promoting gender equality in the workplace, and when they do, it’s mostly based on what is required by law.

In contrast, only 13 of the 44 private sector companies showed similar approaches. In fact, most of the 19 organizations reporting on gender pay gaps are private sector organizations based in the United Kingdom.

“It certainly deserves further research as to what lessons the NGO sector could learn from the private sector and vice versa for some issues,” he said. “In some ways it calls into question why the PPPs [public-private partnerships] aren’t doing better here and what cross-learning should be happening in those realms,” he said.

This could very well add to the list of initiatives or plans the team behind the report aims to achieve in future Global Health 50/50 reports, which will include a wider range of organizations, from the “global south” and academia. They also plan to analyze the work of organizations in countries; examine other data sets, such as organizational data on the existence and enforcement of policies against sexual harassment; and better understand how organizational policies are being applied in practice.

“It’s very clear to all of us that policies in place are a necessary but insufficient step to seeing workplace culture and action on gender equality change. We haven’t had the resources to assess implementation beyond the measurements of parity in leadership where we see a disconnect between policy and outcomes. It would be great to have the time and resources to investigate these issues more closely in our 2019 report,” Buse said.

In the meantime, for organizations lagging or unsure how to adopt more gender-inclusive policies in the workplace, the report recommends using the “How To” checklist created by International Gender Champions. It also proposes donors to make gender diversity and workplace policy requirements as a funding eligibility requirement for organizations.