Women Leaders in Global Health 2019: Powerful Lessons from Kigali

Rwandans are a testimony to human resilience. Following the country’s darkest times, when around 800,000 Tutsis were slaughtered by ethnic Hutu extremists during the 1994 genocide, Rwanda has emerged as the “Switzerland of Africa”. In light of its tragic past, it is surprising to discover that Rwanda is now the 3rd best performing country in Sub-Saharan Africa, according to the Women, Peace, and Security Index. The index is a kind of report card on women’s well-being, ranking 167 countries from best to worst in three key areas: women’s inclusion in society, sense of security, and access to justice.

Since 2017, Rwanda has gained 29 places, jumping to 65. The tragic genocide played an important role in the development of gender empowerment trends in Rwanda. In its aftermath, Rwanda's population of 5.5 million to 6 million was 60 to 70 percent female. A new constitution, passed in 2003 under President Paul Kagame, the former commander of the rebel force that ended the genocide, established a quota allocating 30 % of parliamentary seats to women, together with a raft of other policies promoting advances in education for girls and empowering women to take up leadership roles. In the 2003 election, 48 % of parliamentary seats went to women and in the next election this number rose to 64 %. These numbers have made Rwandan politics a model of gender inclusiveness.

With this history in mind, I flew to Kigali, the capital of Rwanda, to meet more than 1000 women and men committed to advancing gender equity in Africa and beyond. The Women Leaders in Global Health Conference 2019 (WLGH19) took place on 9-10 November in Kigali. Hosted by University of Global Health Equity (UGHE), the event brought together representatives from more than 81 countries committed to health and gender equity.

In this article, I’ll share my experiences at the Women Leaders in Global Health Conference, highlight an area that promises to deliver greater synergies, and close with an invitation.

After Beijing, do we still need a platform to discuss gender equality?

Much has happened since the Fourth World Conference on Women was held in Beijing in 1995. This landmark conference saw the unanimous adoption of the Beijing Declaration and the Platform for Action and advanced a global agenda for gender equality. But do we still need to talk about gender equality in 2019? A big ‘Yes!’ is the answer! Many people roll their eyes when they hear about gender discrimination. They probably think that the world has done enough and that topic is…well, simply boring. In my view, this debate is not only electrifying but also essential for transformative policies towards a more sustainable and healthy future.

In Kigali, the focus was on global health as well as the continuing absence of women from top leadership positions across many different sectors; Women Leaders in Global Health (WLGH) was established by Dr. Michelle Barry of Stanford University to address this imbalance. Recalling the conference’s early days, Barry showed her audience several photos of meetings of top leaders in global health – the absence of women at these meetings was glaring. More worrisome, as she recalled, was that these meetings, led exclusively by men, directly affected women’s health by shaping decisions on maternal and child health policies. These powerful images leave no doubt that important gaps in gender equality remain, despite laudable progress in many countries.

But what specific measures are societies implementing to facilitate the role of women in positions of leadership? Where does discrimination actually occur? Let’s start with academic and institutions. It is well known that some of the factors that determine career advancement do not always work in favor of women. One key obstacle is a lack of support from senior staffing levels. With fewer women reaching the highest levels of management, younger women lack sponsors and mentors who can support their career development and lift them into senior roles. Another barrier relates to metrics. In many cases, women lack the appropriate recognition for their work, “even though they perform most of the academic research,” as one panelist declared. Experts have recommended four specific measures to enhance women’s representation in academic research: design adequate representation from the start; change the culture of metrics; and invest in capacity building and monitoring (not only for research).

Unsurprisingly, the issue of work-life balance remains a key obstacle to female leadership. As one conference participant noted, the aim now should not be balance, but integration. Improving the conditions for women to be moms is the most fundamental step towards effective gender equity policies. Among the measures proposed by participants at WLGH2019 to help women integrate their careers and family life were flexible hours, telecommuting, paid leave, travel support for child care and workplace nursing rooms. In this sense, it was laudable to see the conference leading by example and offering on-site child-care services, sign language interpretation and access to a prayer area.

Women’s health in the context of armed conflict

Without a doubt, the most powerful session was the one addressing the impacts of war on women’s health. Opening with dramatic testimonies from victims of the brutality of armed conflicts, notably rape and monstrous physical violence, this challenging session addressed solutions to rebuild affected women emotionally and physically. Dr. Josephine Odera highlighted the defining aspect of UN Resolution 18.20 on women, peace and security (2008), which placed women’s issues on the agenda at the UN Security Council despite strong resistance in the context of the conflict in the Democratic Republic of Congo. I could sense during this session that many people feel powerless in the face of such brutal violence. Even in a room filled with leaders, people seemed afraid to pose the hard questions, such as why in many countries some women do not show solidarity with the victims of rape and the diverse impacts of armed conflicts. It is worth highlighting that, while efforts to reduce maternal and child mortality have been successful, violence against women remains unabated. Efforts to change cultural patterns that facilitate violence and discrimination against women must be wide-ranging and should include educational offerings that target younger children.

During this panel, participants shared recommendations for building social resilience to empower women in areas affected by conflict. These include:

• Act and think in the long term: Don’t measure projects according to cycles. “Real change takes time,” panelists argued, while lamenting that donors often demand rapid outcomes and do not take into consideration the long term needs of investments in education and mindset transformation.
• Be holistic: Change requires a multi-agency process and multi-agenda. Health goes hand-in-hand with education, body and mind treatments, security, and nutrition policies.
• Enhance financial security: Women are frequently dependent on their husbands or immediate family for their livelihoods, making them particularly vulnerable to the impacts of armed conflict. One example of a successful effort to enhance financial security is the Cycle Bank in India. Managed exclusively by women, the bank was established in the wake of a regional conflict and has put mobility and power into the hands of women by enabling them to access markets and get loans.
• Another interesting recommendation was the use of specific sports to build peace. Frisbee, in particular, was identified as a useful tool in the context of peace-building efforts as it is an ungendered sport that boys and girls can play together and – because it is a sport played without a referee – requires players to engage in dialogue and conflict resolution.

Overall, this powerful panel was a courageous one. It highlighted the broad spectrum of work needed to empower voiceless women in vulnerable areas with the goal of improving their health and wellbeing.

Sharing the good news

While the Beijing Process became a landmark for gender empowerment, a panel on its progress concluded that many setbacks remain, justifying the continuous efforts of networks to enhance women’s representation in top positions in the health sector.

On the other hand, the Kigali gathering offered many examples of progress. It was encouraging to see how creative economies can boost holistic solutions for resilience and wellbeing. The arts and humanities are playing a greater role in health delivery and this deserves to be celebrated. One powerful example was the creation of a research chair in philosophy at a major hospital in Paris. Professor of philosophy Cynthia Fleury detailed the growing willingness of hospitals to engage with her discipline. Fleury’s work brings her into close contact with medical doctors involved in the delivery of treatments and expands the notion of health beyond the physical body to tap into the power of mindsets and values when dealing with life and death.

Filmmaker Lisa Russel also shared her inspiring journey. Using the seventh art to advance the 2030 Agenda on Sustainable Development and its 17 Sustainable Development Goals (SDGs), she recalled her journey in two “very male industries” – film and global development – to give “real” voice to female victims of sexual violence in war zones. While delegates agreed that art is progressively being seen as an important aspect of development policy, many cautioned against remaining obstacles, notably: “tokenism”, when artists and youth representatives are a “nice to have”, and weak representation at the UN negotiation tables.

One conclusion that met with widespread support was that the next battle for gender equity will involve fixing the institutions that were created by men for men. Indeed, the time to “fix women” is over, as participants repeatedly noted. We will only achieve transformative change when society as a whole grasps the fact that empowering girls and women benefits everyone. Gender bias is still tolerated to an unacceptable degree in most workplaces. The WLGH attendants were bold in their ultimate goal: zero tolerance for gender biases and sexual harassment in society.

Gender empowerment for people and the planet: the missing link

The conference was a real success. It was attended by the First Lady of the Republic of Rwanda, Her Excellency Mrs. Jeannette Kagame, Her Royal Highness Princess Dina Mired, Ministers, development partners, researchers, and community health workers. But the best part was the conference’s commitment to engage men. Across the two-day conference, a man sat on every panel. This was a smart decision and reflects the fact that empowering women benefits the whole of society and is not about disempowering the other gender.

Most impressively, the conference delivered two concrete outcomes: First, the University of Global Health Equity in Rwanda announced the upcoming launch of the Center for Gender Equity, an initiative aimed at addressing gender-based barriers to health goals and a place where research to design and execute gender equitable community engagement activities and academic programs both in Rwanda and beyond can take place. The second was the launch of WomenLift, an organization supported by the Bill & Melinda Gates Foundation that will work to empower women in the health sector.

As a woman from the South, I still see the need to include more voices in the debate on health and sustainability. This is not simply a conversation for women. Rather, these issues are fundamental given that we all deserve equal opportunities to thrive.
 

Join us at Women Leaders for Planetary Health at COP 25

As participants at WLGH2019 noted, women must stop being afraid of speaking up or of causing “discomfort” with their demands or ideas. Dr. Senait Fisseha (WHO) offered perhaps the best advice on this, suggesting that we should not apologize for making other people uncomfortable in the conference room or in society. “If they don’t invite you to the discussion table, bring your own chair.” I couldn't agree more and in the spirit of expanding the wonderful work that has been done so far, I suggest that the agenda of women empowerment could gain even more traction if combined with another one: environmental justice.

With only one session focusing on “Environmental changes and risks to women’s health,” I felt that many participants wished there were more room to discuss the environmental determinants of health. Leadership is not about power, but empowerment. After a wonderful week, I left Rwanda convinced that a platform to empower women who work both for people and the planet is one of the most sensible and cost-effective ways to accelerate the implementation of the SDGs. Luckily, my experience in Rwanda went beyond the nice meeting rooms. I was privileged to travel to the North of the country to meet the famous mountain gorillas, a rare global conservation success story. After spending one hour with them deep in the forests of the Volcanoes National Park, I headed to the local villages to learn how these gentle giants are saving thousands of lives in the rural areas of Rwanda. I will tell the full story in my next post, but this visit was a powerful example of how a healthy environment provides the conditions for healthy people.

Leaving Rwanda was hard. I attend so many conferences but I rarely feel as inspired as I did after the 2019 Women Leaders in Global Health. My experiences there offered me new and inspiring insights into the opportunities afforded by action around gender equity, biodiversity and wildlife conservation to promote planetary health and peace. Transformative leadership starts with each one of us. If you are attending the UN Climate Summit in Madrid (COP 25) in December 2019, I will be hosting a frank and open dialogue about the benefits of empowering women for planetary health. This debate will take place at the IASS space “Dialogue and Reflection Space”. The space is open to all COP participants who wish to explore alternatives to the flood of information available at the Climate Conference and to reflect on and discuss sustainability challenges with other attendees.  If you are passionate about nature and care about your health and gender equity, join us and be an ambassador for planetary health!