By Dr. Sylvia Sax

Health systems all over the world are failing to meet the needs of the people they serve, especially those women who are most reliant on health services.  My work as a Global Health consultant has exposed me to how women suffer from lack of reliable, effective and efficient healthcare services, most often not designed to meet their needs.  I undertook my PhD research in northern Pakistan on quality healthcare access and my research showed that women don’t have access to toilets at the primary care centers and any toilets that do exist are either locked or not clean. I presented my results to key leaders in the health system. Ironically I also noted that there was no toilet for females in the conference center selected for my presentation.  The staff at the conference center pointed out that it was inappropriate and unsafe for women to use a toilet outside of their house; my female Pakistani colleague and I disagreed and we ended up designating one of the toilets to be for women. While in Malawi, I noticed that pregnant women have to travel long distances to reach health facilities capable of managing emergency deliveries. Lack of access to transport can result in devastating health problems including death for the mother and child.  I remember standing outside a health facility listening to women wailing because they had lost their sister, daughter and friend to such a death.  These are just two of many experiences that  have driven me to continue to work into my 70’s and to found an NGO, Yarrow Global consulting, with my daughters.  Our company is a charity focusing on promoting gender equality in the world.  

At the core of my concerns is understanding how to stem these health inequalities. Women are the highest users of healthcare worldwide, not only for themselves but also upholding the health of others, such as children, parents and other relatives.   There is no doubt that if people, especially women, had more access to better healthcare this would improve not only their lives but also those they care for.  But often the solution is to throw money and outside “expertise” at the problem, rather than focus on the experts on the ground – in this case, the women themselves.

Access to toilets is an issue of gender equality not an issue of more money.  Providing timely assessment of pregnant women by skilled health workers can be influenced by money, but is often a matter of political and professional commitments.  The COVID-19 pandemic has exposed the fragility of weak health systems, including patchy planning for emergencies and inefficient supply chains resulting in lack of equipment. But it has also exposed violence against women, disrespect of the elderly, poverty, misuse of power, corruption, and a focus on profit over health.  A recent news story from Bangladesh highlights some of these issues.  A son took his Corona-infected father to a private hospital, believing that he would receive care superior to that of the public hospitals.  He was shocked when he saw that the staff did not have the appropriate personal protective equipment and he quickly realized there were multiple other quality of care gaps in the hospital.  This did not prevent the hospital from giving him a large bill when he discharged his father from the hospital, despite his complaints about insufficient care.  One would expect that a licensed hospital would ensure a certain level of care, but I know from experience that many of the hospitals and other health facilities in Bangladesh are not licensed or are, what can we say, “haphazardly” licensed, with incentives given to the licensing body for a positive licensing result.

And licensing of facilities is just one aspect of quality and safety that money can’t buy; the licensing of the professionals who provide care in the facilities might be another problem. Remember the recent, very tragic airplane accident in Pakistan which cost the lives of all those in the plane.  My hat goes off to the courage and diligence of the investigation team who identified that the pilot was not appropriately licensed.  They discovered that he did have a license, but someone else took the exam for him.  How can we be sure that this same thing doesn’t also happen in licensing of doctors, nurses and other health professionals? Can more money fix this problem? Or would more money provide a greater incentive for false licensing?  These issues occur around the world, not only in Bangladesh, and money isn’t a solution on its own.      

These examples show fundamental obstacles to strengthening health care systems that can be fixed primarily through clarity and honesty about the problem, collaborative solutions that fit the local context, and long-term partnerships with everyone working together.  The current approaches are often weak in taking account of the local context, don’t fully engage the government and other important stakeholders, and are more about scoring points academically (by universities in the richer countries) or politically (by the foreign affairs departments of the richer countries) or boosting someone’s social profile than about improving the lives of the citizens of these countries. 

If we are to strengthen health systems, as is the urgent message coming out of the Covid-19 pandemic, we need more honesty and transparency and practical solutions that focus on improving gender equality, disrupting blockages in communication and involving local people as equal partners, thus enabling local solutions to work. 

This is why we founded Yarrow Global consulting, because we are convinced that by working together, and taking seriously the expertise of people on the ground, especially women, we can contribute to creating fair and equal societies.

Dr. Sylvia Sax is a registered nurse and Global Health consultant with more than three decades of experience working in the field of maternal heath. She is also one of the founders of Yarrow Global Consulting