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Gender Equality in the Global Health Workplace: Learning from a Somaliland– UK Paired Institutional Partnership

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Gender Equality in the Global Health Workplace: Learning from a Somaliland– UK Paired Institutional Partnership Practice BMJ Glob Health: first published as 10.1136/bmjgh-2018-001073 on 7 December 2018. Downloaded from Gender equality in the global health workplace: learning from a Somaliland– UK paired institutional partnership Roxanne C Keynejad,1 Fikru Debebe Mekonnen,2 Aziza Qabile,3 Jibril Ibrahim Moussa Handuleh,4 Mariam Abdillahi Dahir,5 Mariam Mohamed Haji Rabi,6 Cathy Read,7 Edna Adan Ismail8 To cite: Keynejad RC, ABSTRACT Summary box Mekonnen FD, Qabile A, Worldwide recognition of gender inequality and et al. Gender equality in the discrimination following the #MeToo movement has ► Slow progress on gender equality has predominantly global health workplace: been slow to reach the field of global health. Although learning from a Somaliland– occurred in high-income countries. The long-term international institutions have begun to address gender, UK paired institutional commitment of health workers and educators on the perspectives of front-line global health workers partnership. BMJ Glob Health both sides of health institutional partnerships can fa- remain largely undocumented, especially in regions not 2018;3:e001073. doi:10.1136/ cilitate constructive, collaborative and interdisciplin- captured by large-scale surveys. Long-term collaborative bmjgh-2018-001073 ary exploration of the potentially sensitive subject of relationships between clinicians and educators gender inequality. participating in paired institutional partnerships can foster Handling editor Stephanie M ► Global health workplace gender inequalities are cross-cultural dialogue about potentially sensitive subjects. Topp common in low-income and high-income countries King’s Somaliland Partnership (KSP) has linked universities Additional material is alike. While overt gender prejudice and discrimina- ► and hospitals in Somaliland and London, UK, for health published online only. To view tion may be more prevalent in settings with limited education and improvement, since 2000.We collaboratively please visit the journal online education and awareness, subtler disadvantage per- developed an anonymous, mixed methods, online survey (http:// dx. doi. org/ 10. 1136/ sists at systemic levels in high-income settings. bmjgh- 2018- 001073). to explore workplace experiences among Somaliland and ► Priority actions include wider engagement of aca- UK-based staff and volunteers. We adapted the Workplace demia with gender-focused research, institutional Prejudice/Discrimination Inventory to address gender actions to address barriers, national prioritisation of Received 23 July 2018 inequality, alongside qualitative questions. Somaliland gender inequality and nurturing of grassroots initia- Revised 6 October 2018 (but not UK) women reported significantly more gender tives, through institutional partnerships and interna- Accepted 14 October 2018 prejudice and discrimination than men (medians=43 tional networks. http://gh.bmj.com/ and 31, z=2.137, p=0.0326). While front-line Somaliland ► Sustained, high-profile recognition by global insti- workers described overt gender discrimination more tutions, non-government organisations, publishers, frequently, UK respondents reported subtler disadvantage national governments, health and education sys- at systemic levels. This first survey of its kind in tems is required to harness grassroots momentum Somaliland demonstrates the potential of global health demanding gender equality at every level. partnerships to meaningfully explore sensitive subjects and identify solutions, involving a range of multidisciplinary on September 29, 2021 by guest. Protected copyright. stakeholders. We propose priority actions to address pervasive gender inequality and discrimination, including and discrimination. Gender is an important wider engagement of academia with gender-focused social determinant of physical and mental 3 4 5 research, institutional actions to address barriers, national health and mortality, increasingly recog- prioritisation and nurturing of grassroots initiatives, through nised at international levels. The fifth sustain- institutional partnerships and international networks. able development goal aims to achieve gender Without sustained, concerted intervention across all levels, equality and empower all women and girls, gender inequality will continue to hinder progress towards end gender discrimination and gender-based © Author(s) (or their the vision of good health for all, everywhere. violence and ensure women’s leadership at all employer(s)) 2018. Re-use 6 permitted under CC BY-NC. No levels of decision making. commercial re-use. See rights and permissions. Published by Gender inequality in global health BMJ. INTRODUCTION Recently, work in Syria and Democratic For numbered affiliations see From ‘silence breakers’ instigating the Republic of Congo addressing sexual violence end of article. #MeToo movement1 to legally mandating as a weapon of war received 2018’s Nobel 2 7 Correspondence to gender pay gap reporting, high-income Peace Prize. However, slow progress towards Dr Roxanne C Keynejad; countries have begun to acknowledge the gender equality in global health largely roxanne. 1. keynejad@ kcl. ac. uk pervasive influence of gender inequality affects high-income countries.8 The World Keynejad RC, et al. BMJ Glob Health 2018;3:e001073. doi:10.1136/bmjgh-2018-001073 1 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2018-001073 on 7 December 2018. Downloaded from Economic Forum’s global gender gap report9 quantifies 817 and Sustainable Development Goal 17 to ‘revitalize economic participation and opportunity, educational the global partnership for sustainable development’.18 attainment, health and survival and political empower- In an ever-more globalised world, international, multi- ment in 144 countries. Rwanda, Nicaragua and Philip- disciplinary networks, aided by rapidly evolving online pines are unusual among low-income and middle-in- media and communications technology, offer advantages come countries (LMICs), being ranked in the top 10. to global health not readily accessible to large institu- The lowest rankings are occupied by countries currently tional bodies.19 In particular, the benefits of ‘bounda- or recently engaged in armed conflict, alongside more ry-spanning’ practices that foster cross-cultural learning affluent nations that limit women’s participation and networks and communities of practice that build local empowerment. Postconflict ‘success stories’ such as and national health institutions in LMICs are increas- Rwanda demonstrate how peace-building activities can ingly acknowledged.20 create political and wider gender equality, although 10 not without some negative consequences. A growing King’s Somaliland Partnership (KSP) literature supports gender-sensitive approaches to state KSP is one such link between universities and hospitals building in fragile and conflict-affected situations while in Somaliland, and King’s Health Partners, London, UK, emphasising barriers that can perpetuate entrenched 11 which aims to improve healthcare and its outcomes by gender norms. strengthening people, organisations and systems.21 KSP Since only countries able to provide data for 12 out of 14 has collaborated on clinical education in Somaliland since index domains are included in the Gender Gap Report, 2000,22 using a combination of face-to-face and e-learning 49 United Nations member states remain unaccounted via the low-bandwidth MedicineAfrica website,23 demon- for. These nations risk falling behind the current wave of strating knowledge and cultural exchange benefits.24 global support for gender equality. Their undocumented Building research capacity is evidenced by publications experiences may also offer important insights, relevant coauthored by female and male clinician-educators in to global health practitioners and policy makers. Neither both countries.25 A ‘strategic partnerships for higher Somalia nor Somaliland (a peaceful, postconflict nation education innovation and reform’ grant26 has expanded internationally unrecognised since 1991) was included in KSP’s work to multidisciplinary professionals. 2017. Several founding members remain active in KSP to Attempts by the WHO to prioritise gender inequality this day, and many volunteers have contributed for over have been challenged for neglecting its interactions with a decade. The long-term commitment of health workers other personal characteristics such as ethnicity, sexual 12 13 and educators on both sides affords working relationships orientation and disability. Intersectional theorists in which potentially sensitive subjects, such as gender emphasise that the impact of gender on health is deter- inequality, can be discussed. Responding to growing mined by ‘multiple axes of power relations’ resulting awareness of intersectional gender inequality, our from interactions between gender and other individual predominantly, but not exclusively, female and Somalil- http://gh.bmj.com/ categorisations. and-based team of KSP volunteers agreed to survey diverse staff in both countries, exploring gender-associ- Somaliland ated barriers and facilitators in the global health work- Somaliland, a former British Protectorate, is a self-de- place, focusing on solutions and best practice. clared independent state with an estimated 4.5 million population.14 Primary and secondary school enrolment is increasing, but in 2008/2009, one woman attended on September 29, 2021 by guest. Protected copyright. school for every three men.15 In 2007, enrolment was SURVEYING
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