By Clare Winterton, Kati Collective team member & Senior Advisor, UN Women
The COVID-19 pandemic has amplified awareness of the gendered impacts of infectious disease. The work of feminist activists, economists, and academics proves that while the virus disregards gender, its economic and other impacts are anything but gender neutral.
During the pandemic, the world has seen accelerating levels of violence against women, and worldwide, women’s economic circumstances have taken a hit, due to increased and unpaid caregiving and the fact that women are more likely to work in insecure, low-paid, and informal jobs.
Over the past year, I worked with Kati Collective and Malaria No More to understand the gender dynamics of another infectious disease – malaria. The project started pre-pandemic but was rapidly illuminated by emerging data and thinking on gender and COVID.
The team working together at Kati and Malaria No More uncovered a story about malaria that is very similar to the emerging narrative on COVID and gender. Given equal exposure to the disease, men and women are infected by malaria in equal numbers, yet malaria’s economic and social impacts are disproportionately felt by women and girls. For example, women and adolescent girls do the majority of unpaid caregiving for family members sick with malaria, meaning that they are less likely to attend school, have work outside the home, or have the capacity to play leadership roles in their communities. As with COVID, women play the majority of paid and unpaid roles managing the disease (as community health workers, for example), but all too often their voices are missing in thought leadership and public conversations about how to address it.
Thanks to growing scholarship and leadership across the malaria community, we identified many emerging lessons about how a gender lens can help ensure that malaria response is responsive to gender and is therefore higher impact. Critical lessons also relevant to COVID-19 response include: creating more opportunities for women in healthcare leadership (particularly for women with community-level experience); making sure that data collected about the disease is “gender disaggregated”; and initiating research, programs, and advocacy that tackle the systemic barriers women and girls may face in managing and responding to disease (for example, malaria initiatives that tackle the lack of agency women may have in seeking healthcare for themselves or their children). For more on this topic, read Kati Collective’s recent blog post Paved by Women: Accelerating a Pathway to Eradicating Malaria.
Perhaps the biggest gender lesson that crosscuts COVID-19 and malaria is about investments in disease treatment and prevention and in building community resilience and recovery. Malaria shows us that repercussions of infectious disease can be hidden inhibitors of women’s rights and opportunities. This holds whole communities back. Solving the problems of disease can become intractable when gender is not part of the equation. A gender investment lens accelerates positive healthcare outcomes, and – by addressing the often hidden social and economic costs of disease – can unlock new community assets and resources.
As governments, health experts, and economists navigate the old and new battles against malaria and COVID-19, women and girls must be central to our analysis, our solutions, and to investments in “building back better.”
Graphic created by Jenny Soderbergh.
By Brooke Cutler
Vice President, Kati Collective
For those of us in the global health or broader international development field, our personal reckoning with the realities of social inequity and injustice may take on some additional dimensions.
For most of us, the core guiding light of why we do what we do is a commitment the principle of equity – in access to maternal health services, in malaria prevention treatment, in the ability to earn income, to use communication technology, to learn. It can be hard to acknowledge that the very field in which we have invested years of passionate effort may be at best, riddled with anachronistic and offensive terminology and at worst, actually be further exacerbating inequity.
There’s a lot to learn from and listen to as we strive to achieve the equity goals inherent in global health work and to do so in a way that is, in and of itself, equitable. We’d like to share an (albeit incomplete) roundup of a few resources that we’re taking to heart.
The first is the powerful and pragmatic keynote address by Solomé Lemma, Executive Director of Thousand Currents, as she opened the 2020 Global Health Council Summit this past November. During the session titled “Welcome & Unpacking Race, Privilege, and Intersectional Bias as Drivers of Global Health Policy,” Lemma’s remarks were jam-packed with concrete directives for decolonizing the field and grappling with racism and intersectional bias. Lemma encouraged us to “name the harm and own the responsibility,” and to “locate (our) work in historical and political context.”
Among other key takeaways from the Global Health Council Summit, here are four concrete actions that we can make progress on starting today:
Second is the Racial Equity Index’s Global Mapping Survey to explore the dimensions of racial equity to help the sector create a true and authentic index and definition of racial equity for the global development space. The survey recent closed and analysis is underway. We look forward to sharing the results with our networks widely and hope to prompt frank and transformative dialogue.
On the topic of digital health specifically, it has become clear in the last several years that technology is neither equal nor equitable. Women often cannot access tech due to social norms and deep-rooted gender biases. Women who try to break out of the expected confined behaviors may face intimate partner violence or other unintended consequences.
USAID recently created a Gender Digital Divide Primer to introduce their staff to the basics of the impact of the effect on women by the digital gap. They broke it down succinctly:
The 4As: Affordability, Availability, Ability, and Appetite
Speaking of technology, a recent letter to the New England Journal of Medicine, “Racial Bias in Pulse Oximetry Measurement,” offers data that shows that “in two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients.” We cannot ignore the importance of who has a seat at the table during the entirety of the research and development lifecycle.
In an effort to further interrogate these topics and learn from the experts we recently convened a panel at the Global Digital Health Forum entitled “Using Digital Health to Help Dismantle Barriers to Health Justice.” The session was facilitated by Crystal Lander, Executive Director of Global Affairs for Pathfinder International who was joined by panelists Dr. Tabinda Sarosh, Country Director, Pakistan, Pathfinder International; Dr. Diana Nambatya Nsubuga, Regional Deputy Director, Policy & Advocacy; Africa Universal Health Coverage (UHC) Co-Chair, Living Goods; and Clare Winterton, UNWomen Senior Advisor, Strategic Communications and Stakeholder Engagement for the Generation Equality Forum and Action Coalitions.
We asked the audience, “What are the next steps that we as a digital health community need to take to move towards digital as a tool for health justice.” Responses came quick and fast, and included:
“Be inclusive not only in works, but in actions such as in planning, designing, implementing, and evaluation!”
“Provide deeper analysis and guidance on how to implement the digital development principles in a way that gets us to justice.”
“Don’t work with Facebook and other companies that profit from inequity.”
“Really think about potential unintended consequences and don’t proceed with design until you’ve planned for them.”
“Learn lessons from the gender justice community.”
“Create a better understanding of the intersectionality of race, ethnicity, and gender in the communities where we are working.”
“Expand stakeholders! Be more inclusive and ensure communities are at the table.”
What does this say? I think that we have a long way to go.
And finally, this quote from Ann Hendrix-Jenkins, advocate, researcher, author, and team member at The Movement for Community-Led Development.
“Whichever language we use, the words we select have ‘steering effects’ on roles and relationships, power differentials, and how activities and priorities get valued or ignored. At present, the many familiar terms and concepts in common use don’t set the stage for community-led development. They preclude co-creation among equals by impeding the recognition of people as experts of the own worlds, skewing power dynamics, and eroding the potential of independent, self-directed collective action.”
No doubt, there’s much to learn and onboard as we truly commit to dismantling the systemic determinants of inequity in the global health work that we do. Stay tuned as we sit in this discomfort and make the space for change. Pull up a chair.
For just over a year, Kati Collective has been working closely with Malaria No More to explore the urgent and differentiated impacts of malaria on the rights of girls, adolescents, and women. We were looking to see if there were particular needs or barriers that influenced the ability of women and girls to access malaria prevention and treatment and, if so, what were the broader impacts of those barriers?
There are 229 million cases of malaria annually and the world has made tremendous progress towards eradication, saving 7.6M lives since 2000.
We already knew that malaria disproportionately affects pregnant women and children, but what we found in this study was that malaria has a significant adverse “ripple effect” on women and girls across their lifecycle.
Applying a gender lens to malaria interventions and investments offers the possibility of accelerating efforts to eradicate the disease as well as the opportunity to take on the long-standing gendered inequities.
“We can get rid of malaria, but we’re going to need focused efforts, new approaches, and investment to do it,” says Michal Fishman, Managing Director, Global Strategic Communications at Malaria No More and our partner on this project.
Bringing partners together to find solutions is a tenet of both Malaria No More (MNM) and Kati Collective. Kati is working with MNM, UN Women, and the RBM Partnership to End Malaria to convene a series of workshops comprised of passionate and informed participants from the gender equity, malaria, and global health communities to generate new, cross-sector ideas and solutions.
These sessions are not public events, but rather a small invited cohort of senior and mid-level experts and civil society members with varied regional expertise who are excited to explore new avenues and brainstorm solutions, including a road map for action.
“We were very intentional about bringing together a diverse and engaged mix of participants,” says Fishman. “We wanted to focus on identifying solutions and building support for action to address the many intersections between malaria and gender.”
Over the next two months, on behalf of the convening partners, we are co-leading host four Action Workshops followed by a Leadership Workshop for leaders of malaria, global health, and gender/women’s rights organizations to debrief key insights and findings and to build momentum for emerging promising investments.
The goal is to create a new constellation of partnerships, identify initial investment opportunities, and build a strong case for advocacy and investment. We also intend to further the conversation for increased women’s leadership within the malaria community. Women make up 70 percent of community healthcare workers globally, many of whom are critical on the frontlines of the malaria fight. We want to catalyze action around creating more avenues to ensure we have more women – across disciplines and at every level – leading the fight.
“We have to develop an investment case that shows all the ways in which addressing malaria with a gender lens benefits women and girls, their communities, and their countries,” says Fishman. She points out that the U.S. government contributes one-third of global funding to fight malaria and that our job is to ensure that policymakers continue to see the tremendous value of the U.S.’ investment in the fight.
“Malaria has similar health and economic effects to Covid,” she says. “With the impact of Covid, we can now appreciate what happens – to a family, the health system, and the economy – when a debilitating and deadly disease is running rampant in a country.”
A public announcement of the outcomes of these action workshops and a cross-sector partnership on gender and malaria is planned for Spring.
You can read more about this work by reading the full learning paper Gender: A Critical Missing Lens in the Malaria Fight on the Malaria No More website.
Graphic created by Jenny Soderbergh.
While collaborating with funders and partners in the Electronic Immunization Registry (EIR) ecosystem, it became clear to us that the work Kati Collective was doing could be adapted for a more general assessment of a country’s readiness to implement digital solutions.
From that joint effort – which included The Bill & Melinda Gates Foundation, UNICEF, CDC, GAVI, PATH, Village Reach, and others – we created the Early Stage Digital Health Investment Tool (EDIT) in response to an outcome we kept seeing: the gap between the desire to implement digital health systems and actual readiness to do so.
EDIT identifies a set of critical indicators that must be met prior to planning and implementing a new digital health intervention. Countries often have needs for digital solutions and investors and partners want to understand how they can best target resources. With so many enthusiastic and committed partners ready to invest, EDIT is designed to identify areas that need improvement in order to ensure critical building blocks are in place so that solutions can be fully executed and positioned for scale and sustainability.
EDIT digs deeply into a set of five essential building blocks: human capacity, investments and funding, data capture and use, infrastructure, standards and interoperability, and governance and policy. With measurable results in each of these areas, health ministries and donors can address their issues and strengthen their foundation before approaching funders.
When we posted about this new tool last October, we noted that it was our goal to use EDIT for the greater good. Now, with a global pandemic severely hampering health care and access in LMICs, we have updated the EDIT, recalibrated it for Covid-19, and released the tool for public use. Using EDIT to plan for investing in a digital health system will help countries protect health workers, ensure continuity of care, and limit overall exposure during this crisis.
EDIT is a rapid response tool -- the assessment can be done in approximately a week. Health ministries are focused on containing the spread of the coronavirus and there are funders ready to support them. Working together, they can begin the assessment immediately and quickly identify what must be in place to successfully implement a new digital health system, despite this tumultuous time.
Using a scale of one to five, the assessment results are used to guide conversations between countries and stakeholders to develop a roadmap to address readiness and begin building vital infrastructures to ensure positive outcomes. EDIT draws on and augments other frameworks and tools that are in the ecosystem and provides the targeted and comprehensive set of information required to understand where to pinpoint digital health investments.
On the Kati Collective website, you can access an explanation of how EDIT works and the gaps it addresses as well as the tool itself. We are available to provide a spectrum of support, a detailed report, and tailored recommendations for those who need assistance conducting EDIT for a particular situation.
We hope EDIT can be used by governments, donors, and other stakeholders to fully leverage the potential of digital technology for health and to quickly identify gaps, address urgent needs, and implement solutions.
Please contact us at firstname.lastname@example.org with any questions.
Last month, I wrote about how a major two-day, in-person meeting I was to facilitate in Washington D.C. had to quickly pivot to an online meeting due to our current world order. The meeting involved 20 people from multiple partners who needed to come together for generative work and rapidly devise a solution despite many moving pieces. Now I’ll tell you how our best-laid plans played out in real time.
We broke down our two-day meeting into four three-hour sessions over two weeks with an additional 90-minute small group working call after our third meeting. We needed to accommodate participants calling in from Geneva, Zurich, Abuja, Washington DC, New York City, and Seattle, and decided three hours would be the max amount of time we could reasonably overlap time zones without participants either being on the call incredibly early or late into the night. Additionally, we needed to be respectful of family time and conflicts as well as general weariness.
To be able to use our time the most efficiently, we sent out “pre-reads” in advance for participants to read and absorb. We asked them to be ready to answer, “What are the global trends you think will most impact our work over the next five years?” Instead of going around the virtual room when we gathered, I asked people to enter their responses into Mentimeter, one of the tech tools we were using. Mentimeter generated a word cloud with our responses, enabling us to jump right into a discussion of trends.
As we started, I established clear rules for engagement while being mindful that many people were not in optimal working situations. I encouraged people to use video but also was clear that I understood it wasn’t possible for everyone. Many people do not have dedicated home offices and were working at kitchen tables or had kids running through the room. Nor did they necessarily want their home lives on display.
Early learning moment: everything took longer. Figuring out how to meet was layered on top of the actual meeting agenda and both had to be accomplished. We needed more time up front to agree on the vision of what we were producing, who the audience was, and what success would look like. Determining this took two of our four meetings.
As a facilitator, I’m used to reading the room and feeling the energy as well as managing flow and content. Online, getting a feel for each participant’s engagement is much harder. As people came back from breaks, I ran a silly poll to keep them engaged, asking questions like “When did you last wash your hair?” and “How many of you are wearing pants with an elastic waist right now?” and asked them to use the hand raise function to let me know when everyone was back and ready to go. This set some accountability for people to get back on time as well as helped me to keep adapting my approach based on their responses.
One of the best things about long in-person meetings is the side chat where unexpected ideas are generated, but online, I asked that people not use the chat function unless it was to post a resource that was relevant. It’s too hard to keep the conversation going with the participants (and the facilitator) being diverted by scrolling side chatter.
For small group discussion, we used breakout groups in Zoom. The first day, we did not assign facilitators and although everyone liked the idea of small groups, once the groups got into their chat rooms, they were a bit confused about how to proceed. After that, each room was assigned a facilitator to keep the group on task as well as being responsible for inputting the group’s work into our purpose-built Google docs template. That gave us a document everyone could see and edit as well as being a tool most people know how to use.
One thing to remember about tech tools – be sure to do a quick review of what you are using and how you’ll be using them. Don’t assume everyone has the same level of experience. I had one participant spend way too much time trying to figure out how to virtually raise her hand in Zoom.
We closed every session with a poll first asking what went well during the meeting and then asking what could be improved for the next session. The poll made it simple for feedback to be given and responded to anonymously. Whether in person or virtual, I end all meetings with a verbal overview of agreements and next steps, plus a follow-up email.
Compared to a two-day meeting, this revised model had the unexpected benefit of increased productivity as we actually we got much more done between sessions. The participants and the facilitators had a chance to reflect on key pieces of content, synthesize the information, and figure out how to integrate it into the work moving forward. In a packed two-day schedule, you just can’t do that. While coming together in-person continues to be valuable, this alternative virtual meeting option can relieve pressure on travel while still accomplishing your goals.
Image: Word Cloud in Mentimeter from our second session. Courtesy of Kati Collective.
February seems very, very long ago, doesn’t it? When news of a highly contagious virus overseas broke, it was of interest to many Americans, but not necessarily a great concern. Those of us in the global health arena, however, watched with an eye not just on infection patterns and rates, but also on each countries’ perceived preparedness for handling a mass outbreak.
When the spread of the virus proved rapid, it became clear that previously successful ways of tracking the disease were not going to be enough in this hyper-connected global community. The issues we are facing now underscore the need for investment in health systems worldwide.
ICTWorks shared an article last week about how ICT4D can support rapid response rates for communicable disease outbreaks. South Africa, Nigeria, and Liberia used mobile technology to connect with and educate their citizens. South Korea employed GPS data for travel patterns as well as other means of tracking their citizens to trace migratory patterns. While you may or may not agree with South Korea’s methods, the digital tools they used proved effective. And in order to use the tools, a digital infrastructure must exist.
Kati Collective is working with a global funder on a toolkit aimed at helping countries identify their readiness for and the types of digital interventions they could use to solve specific health system bottlenecks. Investing in a digital infrastructure is a significant undertaking when a country is not in crisis. During a pandemic? The stakes are higher, but one can argue that it is even more necessary to proceed with establishing national digital health strategies which allow for faster, better, and more accurate capture and use of critical data.
With a health security perspective, we are looking at our current global health situation and asking:
Is it possible to catch up? Can we forecast health needs three to six months into the future and build a digital system that will integrate with current methods?
When planning to engage in or expand a digital health system, we suggest studying these resources:
We, as a global community, now must come together to ensure citizens of LMICs and first world countries have the information they need to successfully implement strategies to keep themselves safe from Covid-19 today and from whatever future viruses follow this current outbreak.
Image: A regional hospital in Tanzania. Photo: Kirsten Gagnaire
One thing that COVID-19 has not changed for me is the hours I log on phone calls and video chats. As my clients and colleagues are located across the globe, I am well-versed in online collaboration and technology.
While a good deal of Kati Collective’s consulting work is with governments and funders, and often in-country, one of the other services we provide is stakeholder engagement and facilitation. I am often asked to plan and facilitate meetings with leaders representing global health organizations and foundations who need to discuss and work overtime together on an issue for which they want to take collective action.
This week, I was supposed to be in Washington DC to facilitate a two-day meeting with participants from WHO, UNICEF, the CDC, PATH, the Bill and Melinda Gates Foundation, Gavi, JSI, CHAI, and Village Reach to discuss immunization data and prepare a framework for future action. To no one’s surprise, we are not in DC.
As things evolved, we quickly adjusted to transform the in-person meeting to a “virtual hub” meeting with hubs in Seattle, DC, and Geneva dialing in over the two days. Very quickly, in response to tighter travel restrictions and social distancing, it became 20 people calling in from their homes in Geneva, Zurich, Abuja, Washington DC, New York City, and Seattle.
The point of this meeting was to really dig in and do some iterative work together. As many of you may now be experiencing as you attempt big group meetings from your sofa, an in-person meeting has a different flow and format from an online meeting. Part of the pivot was realizing that we needed to create guidelines and expectations for participation that is circulated before the meeting starts so that everyone understands the process and how to show up differently than if we were in person.
One expectation that may sound obvious, but often isn’t, is that participants need to say what needs to be said. There’s not the same opportunity to clarify something in the hallway or have a side conversation as there is in an in-person meeting. But in a virtual meeting, participants must discuss and ask questions in the moment so the working group can align and collaborate as effectively as possible. It’s important to set this tone early and for the facilitator to give space for this to happen – even if it means encouraging people to connect with you via text or email if there’s something they aren’t comfortable with sharing in the full group.
As we prepped for this intensive two-day meeting, we started to realize that our usually diligent group of attendees wasn’t responding as we’d hoped to our pre-meeting surveys and outreach. As we received messages from them with concerns about caring for kids and partners and recent office closures, we realized we not have enough time to adjust the content to ensure it was ready for online use nor were we as up to speed on all the tools necessary for a multiple time zone/multiple tech tool meeting to go smoothly.
Most importantly, our read was that people were still trying to figure out how to juggle their newly disrupted lives and felt daunted by 12 hours of meetings over two days. How were they supposed to digest and synthesize all this important information in a short time with no chance for side talk with colleagues? How were they going to juggle six hours a day online (plus other meetings they likely had) with kid schedules and/or their partner also working from home in, what for many, is a cramped space? We recognized that postponing the meeting would give people a little more time to settle into this new “not so normal” and be able to come to the work with more focus.
So, we adjusted. We broke up our two-day agenda into more manageable chunks so the meetings will now take place in five three-hour sessions over two weeks. This allows time for participants to absorb the ideas and data presented between sessions and refuel before we come together again. As we learn, we’ll tweak the process from session to session as necessary. We’ve asked everyone to keep coming to this work with a sense of flexibility and maintaining communication with us so we can do what it takes to move this important work forward in the most extraordinary of times!
As the sun rises over my home on Vashon Island (a ferry’s ride from Seattle), I plug in my camera and click to call colleagues in Europe, Malawi, and Ghana. As we talk, the sun sets on their day.
Before founding Kati Collective, I managed a large social change organization and worked as a consultant in large consulting firm. With this firsthand knowledge of both client needs as well as the innerworkings of the consulting business, I figured out what worked – and what didn’t – in international development consulting. Using these experiences, I created a firm with a different kind of model; one where we could stay lean, flexible, and responsive to ever-changing client needs.
With Kati, I wanted to be able to move quickly and without constraints. By tapping into my global network of experts across a variety of topic areas and at different stages of their careers, I am able to strategize and take action much more swiftly than if I was still working in a larger, more formal structure. I have built a trusted team of frequent collaborators who are independent contractors and whose expertise complements my own. I can bring in the right perspective for the right project at the right time.
The issues our clients face are often complex and, while connected to global issues, they are just as often specific to a region and/or a particular topic areas. When considering what a project needs, I pull in people who have the best skill set for each project and fit them together in the right balance. Some of our collaborators – who range from early to mid to seasoned professionals – are full-time consultants, others are looking for flexibility in their lives, and others are interested in applying their skills on project work during a break between longer-term leadership positions. I am always excited to find a new opportunity on which we can work together.
Recently, I needed someone with a deep understanding of the gender justice landscape so I connected with Clare Winterton, the former Chief Operating Officer of Global Fund for Women. Clare has a deep knowledge of humanitarian issues facing women and girls across the globe as well as the growing network of funders, advocates, and programs that is working to support a variety of gender-related causes. She was able to plug into our project work and bring a deep and important perspective to our client.
Katie Schlepp Zatorski has been working with me for nearly a year on a variety of projects. With her background managing high-level cross-sector partnership engagements, Katie keeps projects moving smoothly while quickly synthesizing vast amounts of project data, goals, and aspirations. She works with the team to create a project plan for programmatic strategies and then facilitates putting that plan into action. Katie is the management “glue” on our team; nothing slips by her.
Anitha Moorthy, Ph.D. has recently joined our team to help us think creatively about designing and implementing digital health systems in LMICs. Her rigorous approach coupled with her interest in human-centered design centers the humanitarian approach while still allowing for creative exploration of new technology.
When I need someone to do due diligence in the digital health landscape, I call in Ruthie Bryant. Ruthie is an MPH candidate at Johns Hopkins and was a critical part of my team at MAMA. I knew that she had a deep understanding of digital health and, as a graduate student, was adept at conducting rapid research and analysis. She is right in the thick of new discussions and innovations in the field and brings a fresh, academic perspective to the team.
In order to ensure that Kati’s work is amplified to the world, I work with communication strategist Dana Van Nest and graphic designer Audrey Nezer. They ensure Kati is reaching its target audiences with strong content and clean, arresting visuals.
It’s no accident that Kati collaborators tend to be women who are passionate about creating a flexible lifestyle that supports their career goals as well as meeting family and personal needs. This is important to me personally and is ingrained into the ethos of the company.
When building our network, I look for content expertise, compassion, intelligence, curiosity, and a strong commitment to Kati’s three pillars: women, digital, and partnerships. All of Kati’s collaborators believe in centering women and girls to affect systemic change in LMICs and globally. By bringing in these expert, targeted perspectives for specific pieces of work, Kati Collective can offer reliable, flexible, highly skilled, and scalable resources for our clients.
Earlier this year, I was invited to attend a gathering of minds at Wilton Park, a 16th century estate and think tank located in West Sussex with 15 acres of formal English gardens and surrounded by 6,000 acres of parkland. Of course, I said yes.
The week of Thanksgiving, I joined colleagues from around the globe to discuss the promise of digital health to address noncommunicable diseases (NCDs) in low- and middle-income countries.
The idea behind dialogues held at Wilton Park is to bring together diverse stakeholders from government, healthcare, private foundations, corporations, and the social benefit sector to bring their unique experiences, education, and perspectives to the table to not just further the conversation, but to spark innovative paths and solutions. We spent three days discussing how to employ digital health strategies and tools to prevent and control NCDs.
As we have discussed in these pages before, however, applying a digital solution in LMICs requires digital tools that are culturally relevant, in the language of the user, and in a method that they have the skills and time to actually use.
The digital world converged on LMICs in the last decade. Many countries in sub-Saharan Africa had limited landline phones. Instead, they went straight to cellphones. These countries did not have the opportunity to catch up with technology methodically or in bite-sized increments, but rather experienced technology leapfrogging over their current systems and demanding adherence to a new reality. This can cause a serious disconnect for a country and its inhabitants.
As we address the issue of prevention of NCDs, we have to ask who we are designing for and how digital can augment, not hinder, current or longstanding systems that may not be technologically advanced but do work.
It is also important to be very clear: which part of LMICs are we talking about? Though we refer to low-income and middle-income countries under the same banner, the two can require different outreach strategies. What is the population of a particular country? What is realistic and viable given the different socioeconomic levels in each country?
AI apps that offer healthcare advice and guidance can be the right step forward for middle-income countries, but people in low-income countries (where they earn less than $5/day) often do not have the functional literacy to properly access and use digital health tools.
At Kati Collective, our lens is on the people that are hardest to reach. How much can and do countries spend on healthcare per month? For many countries, the true cost to provide thorough healthcare is not viable. And for individuals, being sick – and the ramifications on their families and ability to work – can lower their socioeconomic status. Treatment is expensive.
Our global conversation is about prevention, but in these countries, healthcare workers are focused on diagnosing and treating. We need a different kind of healthcare system: one in which national digital health care strategies and systems are implemented by knowledgeable healthcare ministries who understand their populations and allocate proper funding to educate healthcare workers and the general public about how to prevent NCDs.
I was honored to be invited to participate in this conversation. My own perspective was expanded, and I was able to share my knowledge and experience to expand that of others. As we end this year, I am grateful for all the colleagues and thought partners with whom we have listen, debated, learned, and worked with in 2019. Together we are identifying and working to solve the major healthcare and humanitarian issues of our age. Thank you.
Images: The Wilton Park grounds and meeting room. Photos by Kirsten Gagnaire.
Two weeks ago, Jennifer Schlecht, a leader in the field of family planning and the mother of a five-year-old, was brutally murdered by her estranged husband. He also murdered their daughter before hanging himself. Jennifer was like many of my global development colleagues: smart, passionate, and dedicated to humanitarian causes. She devoted her career to women and girls in crisis situations. And she was experiencing ongoing intimate partner abuse. She was afraid to stay and afraid to leave.
Gender-based violence knows no societal boundaries. It affects women (cis-gendered, trans, and genderqueer) in all socio-economic levels, all ages, all sexual preferences, and in every country. And gender-based violence isn’t just about physical abuse – it’s sexual and psychological abuse, financial coercion, and withholding a woman or girl’s ability to go to work or school. This is not a female problem – it is a human problem. It’s rooted in the attitudes, cultural norms, and behaviors of men worldwide. When men and boys are educated about ingrained sexist and systemic biases, they begin to see how they can stop these behaviors and practices from harming the next generation.
The LGBTQ community is also affected. Rates of intimate partner violence is actually higher than in heterosexual relationships and often underreported due to fears of discrimination and bias.
We have made progress towards SDG 5 and SDG 10, but we have an immense amount of education and work to do to meet our 2030 goals. It’s not only about helping survivors; it’s about changing the entire paradigm. SDG 5 not only sets the goal to end all forms of discrimination against all women and girls everywhere but also to eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.
Last week at the Global Washington conference, I moderated a panel of experts on gender justice and gender-based violence. Joining me were Puja Dhawan, Director, Initiative to End Violence Against Girls and Women at the NoVo Foundation; Rebecca Hope, Founder and Executive Director at YLabs; and Zainab Ali Khan, Founding Working Group Member of Every Women Treaty. The discussion was engaging, honest and informative, and, it helped me to understand that while women are inherently powerful and leaders for the solutions to this issue, at its core this is a human issue, and everyone needs to be involved in understanding and stopping gender-based violence.
The Every Woman Treaty mandates that nations enact interventions that have been proven to reduce rates of violence. There are five points of action: legal, training and accountability, violence prevention education, services for survivors, and funding.
New data from the Women, Peace, and Security Index shows that in some countries, women still report up rates of intimate partner violence in the 40th percentile. One rapidly growing of harassment is tech-based – mobile phones and social media, in particular. Almost three quarters (73%) of women have endured some form of online violence.
While there are challenges and ethical issues in putting a dollar amount on such a complex issue, several studies have calculated the financial burden of GBV. The United Nations Population Fund estimates that the annual cost of intimate partner violence against women in the US exceeds $8 billion in medical and mental health care and lost productivity. A study of the cost of GBV in Bangladesh amounted to 2.05% of national GDP with majority of this cost borne by survivors and their families.
Gender-based violence only stops when women speak out and are treated as equals, not commodities. We need to establish violence prevention education to teach boys and men how to build and navigate healthy relationships. On a local, national, and global scale, we improve lives and outcomes when we believe and protect the survivors as well as insisting on transparency, domestic violence laws, education, and funding.
Whether you are in the U.S. or elsewhere, if you see a woman who is experiencing gender-based violence, ask her what is happening. Use your voice so she can find and use hers.
If you are experiencing gender-based or intimate partner violence in the U.S., please call the National Domestic Violence Hotline at 1-800-799-7233. They are experienced, resourceful, and will help you right now.
Image: Habiba Osman carries a placard denouncing violence against women during a march in Lilongwe, Malawi, Sept. 14, 2017. (L. Masina/VOA)