Building Back Better: Reflections on gender in post-conflict health systems development
By Valerie Percival and Sally Theobald
The Liverpool School of Tropical Medicine hosted a provocative discussion, with participants from ReBUILD, RinGS and Carleton University, Canada, that examined if and how gender is integrated into health sector reform as societies rebuild after war. The goal: to launch a conversation on gender equity in health system reconstruction and reform and to share resources, including a website of resources and case studies from Sierra Leone, N.Uganda, Mozambique and Timor Leste.
“Building Back Better” after war means creating the foundation for peace and prosperity in post-conflict contexts. We know that countries with greater gender equality are more peaceful and prosperous. And we know that the post-conflict environment often presents a window of opportunity for change, with political opposition and vested interests often temporarily absent, and donor resources plentiful.
But we don’t know how to “build” gender equality.
In many societies, gender norms initiate boys into a culture of violence and domination that promotes excessive risk taking. Those same norms devalue women, undermine and restrict their life opportunities and freedoms, and subject them to a culture that promotes their submission.
Promoting equality is not like building a health clinic or a hospital. Gender norms are intertwined with culture and identity, resistant to change. It’s about altering the fabric of society – the roles of men and women and how they relate to one another.
How do gender norms transform? What is the role of the international community in supporting that change? And where is the health sector in this process?
Work conducted by ReBUILD, RinGS and NPSIA, Carleton University, and supported by the Stockholm International Peace Research Institute (SIPRI) shows that health system reform in post-conflict settings has been gender blind. Health systems research and policy documents provide little guidance on how to ensure that health systems are gender equitable. There is no definition of a gender equitable system and little effort has been made to ensure gender equity in human resources, in financing, in medical technologies, or service delivery.
Our case studies show that despite the best efforts of many activists, gender norms are stubborn and slow to change. Even the recent effort to strengthen the Sierra Leonean health system in the wake of the Ebola crisis did not include gender.
And many health professionals shy away, or are unsupported in their role as an agent of change.
Our resources and interactions challenge health professionals, donors and policy makers to rethink their role. Health systems reflect their context. But they can also shape their context.
People interact with the health system constantly. Health workers continuously engage in efforts to improve health. They engage with people at all ages. Why not expand that role to discuss how gender norms affect health? Why not inform women of their right to decide when and with whom they have children? Why not explain to men the importance of respecting women and girls?
Those of us taking forward the Building Back Better agenda struggle with how translate its findings on the importance of building a gender equitable system into a practical tool for policy makers. Can over-stretched health systems and health workers be tasked to take on the challenge of building gender equity? And what are the concrete and realistic steps that need to be taken?
While many questions remain to be answered, our hope is that the Building Back Better work has laid the foundation to discuss not if, but how, health systems can contribute to more gender equal societies.
