Many women living in low- and middle-income countries don’t receive timely diagnoses for breast and other cancers. This is the result of limited health infrastructure and human resource capacity; many countries in sub-Saharan Africa average less than one pathologist per 1 million people. The stigma attached to women-specific conditions can also act as a barrier to detection and treatment. Stage one cancers can rapidly progress to a later stage before being identified, increasing the likelihood of largely preventable, premature death.
It’s time for the global health community to wake up and recognize this reality. While significant gains have been made in reducing maternal mortality, the NCD epidemic poses a serious burden on women's health, threatening the most vulnerable girls and women who are left exposed through persistent social, gender, and economic inequalities. Too many women lack access to the life-saving treatment they need.
On Sept 23., the world’s leaders will gather in New York and commit to accelerating progress toward universal health coverage. Leaders should not waste this opportunity, and ensure that the declaration they sign recognizes the right of all women to access affordable, quality health care at every stage of their lives. We demand concrete, actionable measures, and accountability mechanisms to ensure that women are not left behind.
These are the three key commitments that we, the Taskforce on Women and NCDs, are calling for.
1. Include women in decision-making
To ensure UHC investments are aligned to needs, women must be involved as decision-makers in every step of the design and delivery of health services. Women are uniquely impacted by NCDs — as patients, mothers, and caregivers — and can be change agents in increasing the equity of health systems.
Mark your calendar. On Tuesday, Sept. 24, Devex is convening a day-long UHC Pavilion on the sidelines of the U.N. General Assembly in New York City, hosting a series of events focused on the critical topic of universal health coverage. Sign up for the livestream on UHC here.
Community-led groups that empower women to self-manage conditions such as breast cancer or type 1 diabetes can be powerful mechanisms in supporting women living with NCDs at home and in the community. Efforts to invest in female leadership in clinical and policy spheres can also be effective.
In Rwanda, for example, steps are being taken to increase the enrollment of women in medical school and the government is intentional about promoting gender equity at all levels of leadership. NGO-led initiatives such as NCD Alliance’s Our Views, Our Voices project to amplify the voice of people living with NCDs, and Women in Global Health’s Heroines of Health awards to recognize women who are the leaders and drivers of health in their communities are also critical to transforming a more equitable system.
2. Promote a rights-based approach to health systems strengthening
All women must have access to high-quality sexual and reproductive health services, as a fundamental requirement for gender equality and women’s empowerment. In addition, NCD services should be integrated into existing programs for girls and women, such as maternal and child health services.
For example, Jhpiego has been working with health ministries throughout sub-Saharan Africa and Asia in partnership with Gavi, the Vaccine Alliance to increase access to human papillomavirus vaccination and cervical cancer screening and treatment by integrating services into family planning, HIV/AIDS, maternal health, school health, and routine immunization programs.
Likewise, providers with Partners In Health in the central plateau of Haiti have been working to integrate services across women’s health and NCD clinics to ensure that pregnant women and those of childbearing age at risk of possible complications of cardiomyopathy, high blood pressure, diabetes, or other chronic diseases receive quality follow-up care and have access to community education and screening in poor and vulnerable communities.
One woman’s experience
Nigist Dageto is a 35-year-old mother from the Wolayta district of Ethiopia who was diagnosed with breast cancer a few years ago. She was told she needed surgery to have her breast removed; an operation that would cost her $200, well beyond her means.
Eventually, Dageto managed to raise the money through her church community, and — with no cancer services available nearby — left her family and traveled the 400km journey to Addis Ababa for treatment. When she arrived, she discovered that there was no care available.
Dageto’s story is perhaps only unusual in that she received a diagnosis.
Roselene Bosquet Jean, 46, has been working with PIH in Haiti since 1993. Immediately after giving birth to her second child, she experienced excessive bleeding and visited the hospital in Cange. She was hospitalized for 17 days, during which she received transfusions and a constant IV drip. Tests revealed that she had Stage 3 cervical cancer and would need radiation therapy. Such treatment doesn’t exist in Haiti, so PIH sent her to the Dominican Republic in October 2002. She stayed for five months to undergo daily radiation until her bleeding stopped. She hasn't had a recurrence of symptoms since that time and feels healthy.
Bosquet Jean talks about her experience with others. At the time of her diagnosis, she believed that there were no other choices but to "wait to die." Now, however, she advises friends and family to go to the doctor if they fear they might have cancer. Her faith pulled her through the most difficult times: "Pray and God will do everything for you."
3. Commit to the routine collection and analysis of disaggregated data
This will help to build a better understanding of gender differences and intersecting disadvantages in risk factors, treatment, and outcomes. Only then can we design effective, targeted, age-appropriate interventions and measure progress in reaching all groups — particularly those most often left behind such as women.
To take heart disease as one example, we know that diabetes increases the risk of heart failure in women more than in men; that there is evidence that women are under-treated for heart disease; and that female patients of male cardiac physicians have been found to have worse outcomes than their male counterparts.
If we are to protect the hard-won health and development successes achieved over the past decades, we must make the High-Level Meeting on UHC count. Governments must commit to providing effective, gender-sensitive health services; addressing all barriers to care, including a lack of health information; and prioritizing the needs of the most marginalized women and girls. We have an opportunity to prevent millions more women from suffering needlessly like Dageto. We cannot afford to waste it.
For a closer look at the innovative solutions designed to push for progress on universal health coverage around the globe, visit the Healthy Access series.