The women's movement that started with a hashtag

MANILA — Tired of seeing men dominating panels and leadership roles in the health sector, four early-career women, complete strangers to each other, connected on Twitter via the hashtag #wgh300 in 2015 contemplating the question: How to change the reality for women in health? Months later, at one of the coffee tables at the Serpentine Bar at the Palais des Nations in Geneva, they launched Women in Global Health with an attendance of 25 people, said Roopa Dhatt, co-founder and executive director. The goal: advance women’s leadership and gender equality in the sector. “It doesn't make sense to see so many talented women around, but when you look at top leadership women are not being represented. And we felt that since we were aspiring to be in the field of global health, that we wanted to be a part of the change or really catalyze the change,” she told Devex. Ann Keeling, who has spent decades working in the sector, said it was the first time she heard of an organization campaigning specifically on these issues, and one that’s using the power of social media to effect change. She later joined Women in Global Health as a board member and senior fellow in 2017, just around the time the organization decided to register as an NGO. “What I wanted to learn was, how do you run a social movement for the 21st century?” she told Devex. “In my time … if I wanted to change an issue like this, you'd have to join a political party, you'd have to join a trade union, you'd have to join a hierarchy … You didn't have the direct access that we have today through social media to people like, you know, the DG of WHO,” she said. Seeding change The organization’s very first activity was to count the number of women leading member state delegations at the World Health Assembly. From there, it started engaging with organizational leaders. How did a small group of people running on volunteer support get a foot in the door? Dhatt said that partnerships are key. “We felt that the way to make gender equality everybody's businesses is to get people to recognize their sphere of influence as individuals and as organizations and say … how can you do your part with us to address these issues?” she said. “And so how we've been able to do so much? One is our volunteers.” The organization has had 70 volunteers. It has also partnered with different organizations for events and initiatives, most if not all of them established organizations. Katja Iversen, president and CEO of Women Deliver, underscored Women in Global Health’s use of data and communication to highlight the lack of diversity in the sector and “present an alternative to the status quo.” “It is important that they keep doing it in partnership with other organizations, as together we are stronger,” she said. One of their most important partnerships is with the World Health Organization, with which it co-chairs the Gender Equity Hub, said Keeling. In 2018, the first Women in Global Health chapter launched in Germany, and it was followed by six more national and regional hubs in Europe, the United States, and Africa. Amina Jama, senior policy and planning advisor to the federal minister of health in Somalia, said she founded the Somalia chapter of Women in Global Health after discovering just how underrepresented and excluded women are in important discussions about health in different parts of the country. Women were constantly absent in consultations to inform the government’s five-year health sector strategy, despite them representing over 80% of health providers there, she said. “When I asked why there were no women in these important platforms, I was told ‘women had no capacity.’ Remember I was the only woman in this task force as well ... This did not sit well with me, especially with my background as a researcher with strong equity and diversity background,” Jama told Devex. She initially reached out to the Women Leaders in Global Health conference, from which she learned of Women in Global Health and the opportunity to create a national chapter to start a domestic movement and address the unique issues faced by women in the country. While there are other national women’s movements for the health sector in Somalia, she said they are often limited to a particular profession, whereas Women in Global Health has a more interdisciplinary and cross-sectional reach. Asked what the advantages of being a chapter, however, Jama said it “remains to be seen. So far we have had access to [the] platform for networking but I hope the best is yet to come.” Dhatt said there are interests coming from Lusophone-speaking and Francophone-speaking countries in Africa that often find themselves being underrepresented in global health conversations within the continent. Some individuals have also approached Women in Global Health from Asia and Latin America, she said. “We really do hope that by 2030, we have 100 communities of Women in Global Health chapters around the world,” Dhatt said. “Getting more local is going to be a key direction for us.” A long battle ahead The reality however is still far from the clamor for change. When the organization first started counting the number of women chief delegates at the World Health Assembly in 2015, the figure was at 23%, and picked up to 31% in 2017. But in 2019, the rate was at 22%. The gender structure and policies of 198 global health organizations also remain lacking in many aspects, according to the 2019 report of Global Health 50/50 for which Dhatt is a member of the advisory council. Men continue to dominate positions of power, accounting for 72% of the heads of the reviewed global health organizations, and 71% of board chairmanship, according to the report. And despite considerable attention to sexual harassment in the aid sector, only 25 of the 198 organizations have comprehensive sexual harassment policies. Dhatt is convinced the numerous initiatives and conversations that are taking place in the sector today shows people are willing to come together and tackle the issues confronting gender inequality in health. But she agrees there’s still a lot of catching up to do. “We see that there [are] a lot more organizations thinking about these questions and willing to try to work on solutions. But are we seeing it translate into the change that we'd like? not yet,” she told Devex. Keeling said there’s still a lot to fix in the system. “We've been engaging with the UHC process for at least a couple of years now. And it's been really frustrating, because it's one of those areas where women's rights and gender equality should be absolutely central. Everybody knows that. There should be absolutely no question about it now. And yet every time … it just slips off the agenda,” she said. The draft political declaration on UHC has to date been stalled primarily over paragraphs on these issues, she said. But they were surprised to find the civil society convening bodies for the UHC high-level meeting this September didn’t include it in their initial “asks.” When UHC2030,a multistakeholder platform promoting health systems strengthening, announced six asks for the high-level meeting, gender equality wasn't on there at all and neither was SRHR. “We said, you know, we fully endorse the six asks that you've come out with, but we want a seventh ask, and that seventh ask is around gender equality and women's rights,” she said. Githinji Gitahi, global CEO of Amref Health Africa and co-chair of UHC2030, said the problem was that the issue came after it received approval from the Steering Committee on the asks. But it decided to add the gender dimension after as a cross-cutting issue, urging political leaders to “re-commit to gender equality, redress gender power dynamics and ensure women’s and girls’ rights as foundational principles for UHC” in the document. “It’s an issue that will continue to haunt us,” he said. Women in Global Health has since banded with like-minded organizations such as Women Deliver and the International Women’s Health Coalition to create the Alliance for Gender Equality and UHC, which is now joined by over 100 NGOs across continents. Still, Keeling is upset that they still had to do this to highlight the importance of gender equality and women’s rights in UHC. “It's a huge failure of the system that we had to do this. It's a huge failure that we once again have had to step aside as feminist organizations, and do something separate because we couldn't get this into the mainstream,” she said. Other issues that need to be addressed in the health sector are inclusion and diversity, said Keeling. At the Women in Global Health conference in London in November 2018, a number of women from low-income countries who were supposed to participate weren’t able to simply because they didn’t get a visa. There are also the issues of occupational segregation, for example seeing nursing as a profession mostly for women than men, and women’s unpaid contribution to the health sector. “Many of those unpaid women are community health workers,“ Keeling said. “We have big organizations, we have governments, still making the assumption that some of these incredibly poor women, because they don't have formal sector jobs … have nothing to do. In my experience, those are the busiest women on the planet and not only some of the poorest women on the planet.” A vision for the future When Dhatt and her co-founders started Women in Global Health, they made an initial commitment to the movement for three years. Her co-founders have since left the organization, but Dhatt stayed. And with a growing team and footprint, and clearly a long battle ahead, Dhatt said they’ve started thinking about how to sustain the organization’s work. But getting there has been a challenge. For one, funding from traditional donors aren’t as forthcoming. “We have realized that ... while people are so motivated and inspired to be part of social change and be part of movements and really participate ... in reality, funding for movements and particularly women's movements is in global health [an] uphill ... path,” she said. Because the health sector is populated by women, it’s not often clear for donors what the need is for the organization to operate in the sector. Dhatt said they would often get comments such as, “oh, there's women all around. Why is this an issue to work on?' or “they will eventually get there,” referring to women reaching leadership positions in the future. “Funding for this has been very tough,” she said. The organization has been operating on volunteer support since its founding. In 2017, it decided to register as a nonprofit in the United States, but funding remains in short supply. In 2017, the organization was operating on a budget of $10,000. In 2018, it was below $50,000. In 2019, it’s grown twice to $100,000. It has received some small grants from foundations, such as Medtronic and Johnson & Johnson, and some personal donations. But all of the revenue goes to the events and activities the organization’s doing, Dhatt said, who shared that she and Keeling aren’t getting any salary as well for the work they do at WIGH. Despite having numerous volunteers, Dhatt said they lose great talent every three to six months to salaried opportunities. They are hoping to change that, and have looked into different funding models. But are yet to find the one that works and lives up to its values, she said. They have deterred from models such as charging membership fees out of concern about its impact on access to those unable to afford the payment, particularly those from low-income countries. “We really see ourselves as a global movement and we recognize the realities are very different [in different places],” Dhatt said, arguing that it don’t want to create barriers for anyone to engage with the movement.