The big picture: Empowering, not just reaching, all women and girls

The following post was originally published at Devex on May 10, 2016. 

We are at a pivotal moment for women and girls everywhere. March saw the 60th session of the Commission on the Status of Women, the first major intergovernmental test of the gender-focused 2030 development agenda and global health strategies set in September.

Next week, the global community will unite for Women Deliver, the largest conference of the past decade on the rights and well-being of women and girls. These milestones represent much more than trendy development topics — they are important opportunities to measure and highlight global work underway to meaningfully reshape women’s health, education, safety, and social and economic well-being.

In this environment, it is imperative that we in the global health community demonstrate measurable progress in our work to target women and adolescent girls — two crucial populations in efforts to end HIV and AIDS, tuberculosis and malaria as epidemics by 2030. This will be accomplished through evidence-based investments in quality, comprehensive health and social services programming. Most importantly, women and girls need integrated services and programs, which will require strong collaboration among all partners.

Quality programming reaching all girls

Women and girls face serious burdens in accessing services for HIV and AIDS, tuberculosis and malaria, and their risk of HIV and TB is exacerbated by structural and gender-based inequalities. More than 1,000 adolescent girls and young women become infected with HIV every day. Women in southern Africa are twice as likely to be living with HIV as are men their own age, and HIV and AIDS and TB are among the leading causes of death for women of reproductive age. Women who are pregnant are also at particular risk for malaria; in Nigeria, for example, 11 percent of all maternal deaths are attributed to the disease.

Global Fund spending to address these gender-related challenges has increased significantly in the past six years, reaching today about 60 percent of the organization’s total investments. And we’re seeing significant returns on those investments: between 2005 and 2014, AIDS-related deaths among women experienced a 58 percent decline in the African countries hit hardest by the epidemic. The impact is also visible in the improvement of life conditions for millions of women and girls. According to UNAIDS estimates, about 40 percent of pregnant women in low- and middle-income countries receive HIV testing and counseling, and the proportion of pregnant women living with HIV who receive antiretroviral therapy increased from 11 percent in 2009 to 62 percent in 2014.

However, attaining global targets to end HIV and AIDS, TB and malaria will require a different way of working; it will require delivery of health services in ways that reach the women and girls who suffer most from the effects of gender-based inequalities. Self-testing and community-based testing services can be very effective in high HIV burden settings, as well as pre-exposure prophylaxis, which can prevent HIV infection, particularly among adolescents.

Integrating services or scaling up community-based approaches are another big part of the answer. In Kenya, Global Fund investments helped integrate TB screening into programs focused on preventing mother-to-child transmission of HIV. As a result, there has been a 43 percent increase in the number of women screened for TB during these antenatal visits. The Global Fund is also investing in increased intermittent preventive treatment in pregnancy to reduce pregnant women’s susceptibility to malaria.

In Ethiopia, where 60-80 percent of the annual mortality rate is due to preventable diseases such as malaria, pneumonia and TB, the impact of our investment has been impressive. The Global Fund contributed more than $28 million to the government’s health extension workers program, which has trained tens of thousands of community-based health workers, mostly women, to provide basic health services to hard-to-reach women in rural areas. As a result, the proportion of women using a family planning method jumped from 15 percent to 40 percent.

Looking at the big development picture

Integration of programming across development sectors is critical. As the Lancet illustrated last year, growing evidence shows the link between education and HIV prevention for adolescent girls.

A study conducted in Botswana last year showed that for every additional year of schooling there was an 8 percent reduction in the risk of HIV infection. A 2014 study also showed the link between investment in existing Global Fund malaria programs and the impact on children staying in school; it estimated that if the Global Fund is able to increase its yearly per-capita disbursement over a child’s educational career by just 50 cents, students would receive nearly an extra grade level of education. Extra schooling means reduced risk from HIV, early pregnancy and other health risks — and every extra year of school for a girl translates to an increase of 10-20 percent in future earnings as an adult.

As highlighted by Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, partners such as PEPFAR, the U.S. President’s Malaria Initiative, the U.K. Department for International Development, World Health Organization, UNAIDS, Stop TB, UNICEF, ONE and the Bill & Melinda Gates Foundation are working more collaboratively on such programming. PEPFAR is looking to increase both the availability and use of data to help drive innovation through its DREAMS initiative, which focuses on women and girls as the heart of a push for an AIDS-free generation.

More sex and age-disaggregated data will better allow us to understand gender issues in health, and respond to critical needs in real time. That’s why the Global Fund is investing in improving national data systems in more than 50 countries. For example, in South Sudan, Global Fund support allowed the country to build a health management information system platform customized to function with its poor telecommunications infrastructure. As a result, 100 percent of South Sudanese states have reported results into the national system, including sex-disaggregated data.

Next steps

Looking to 2030, the global community must come together to fund development and health programs that provide comprehensive, holistic care. Understanding how to reach women and girls with such services will determine our success.

But all of these efforts will be wasted without addressing the harmful gender norms and discrimination that make a girl’s life less valuable than that of her male peers, and too often make her a victim of violence. Ultimately, our investments need to empower girls and women to make decisions about their own lives. Their health and well-being is the key to unlocking better health and well-being for everyone. That is how we are going to end epidemics, prevent diseases, fight poverty and continue saving lives.

Heather Doyle is an international public health and human rights expert, currently the Senior Coordinator on Gender at the Global Fund to Fight AIDS, Tuberculosis and Malaria. Previously, she led the Sexual Health and Rights Project (SHARP), a grant-making and advocacy initiative at the Open Society Foundations. In more than 20 years of international experience, Ms. Doyle has worked on health inequities with a focus on women’s health at the Catholic Relief Services, Medicines sans Frontiers among other national and international organizations. She holds a Master’s degree from the Johns Hopkins School of Public Health.