Saving Women and Girls
I remember the green metal doors of the hospital where I worked in Islamabad flying open. Like a whirlwind, paramedics and nurses wheeled in a woman called Dilshad, who was in her fifties and was delayed coming into the hospital because family members had dismissed her chest discomfort as indigestion. Then came the split-second pause as my team took a collective breath — vivid and clarifying — before working together, against the clock, to save her life.
She was in the middle of a major heart attack. At the time, in the late 1990s, I was the first female cardiologist in Pakistan. Inside the Coronary Care Unit, gender norms quickly become less relevant. Adrenaline makes quick work of the status quo.
In May, the World Health Assembly will elect a new Director-General of the World Health Organization. There’s so much for the next Director-General to do inside and outside the health system, to improve the health and wellbeing of women and girls.
A reformer throughout my career, I am the candidate best positioned to drive the reforms needed to keep WHO and the people it serves, fit and healthy. International Women’s Day is a moment to savour the gains made but reflect on the many challenges that women and girls still continue to face at home and at work.
As a doctor, it wasn’t just heart attacks like Dishad’s that I witnessed and treated. I saw the challenges of women with obstructed labour carried on bull carts for hours coming to the local health facility with life threatening complications. Sometimes they’d make it, often they and their newborn baby wouldn’t.
My first patient on the first day of my first internship in a surgical unit was a young woman who never lifted her veil from her face. Her husband had chopped off her nose on the suspicion of adultery. And I still remember the anguish of pregnant refugee women in an outpatient clinic in my hometown Peshawar, home to one of the largest refugee populations in the 1980s.
As a founding chair of the Independent Accountability Panel of the United Nations for the Global Strategy for Women’s and Children’s health, or in my civil society advocacy role, I have always thought about and acted for the women that were failed by the health system and the need for greater accountability and governance.
One of the first things you learn as a cardiologist on the front lines is that much of what you do could be prevented, which is why I joined women (and men) around the world to champion prevention. In each of my roles, from contributing as Founding Chair of the World Heart Day initiative, to writing a National Plan of Action on NCDs and co-chairing a WHO commission to halt the rising threat of global child obesity, I have not forgotten the faces of women who must be helped.
To help address the gaps in the health system that women like Dilshad faced, I have taken leadership roles in the Pakistani government and at the global level. In describing the mixed health systems syndrome, and books and publications such as Choked Pipes, and leadership of the Pakistan Lancet series on health reform, I have strived to outline the central systemic weaknesses, which constrain the ability of developing country health systems to deliver.
Access to the essential services such as family planning has been a core part of my advocacy and analytical work, as I pushed to overcome constraints, which hampered the ability of heath systems to deliver for women and girls. Last week, it was heartening to see European donors come together in Belgium and commit €181 million to women’s health.
It’s critical to look for practical solutions to increasing access to health services for everyone. I have seen many elderly women taken away from the hospital bedridden for life, simply because families cannot not afford to pay for hip operations. This is why I created Heartfile Health Financing, a mobile phone-powered innovative financing programme, which has been described as a potential Amazon for healthcare. It provides the needy financial access to treatment in a dignified manner. Beyond its humanitarian mission are a range of broad lessons for universal health coverage in mixed health systems.
It’s not just about health services though. What happens in societies and workplaces in particular is critical to breaking the chains of gender inequality. As an employer, I’ve seen first-hand how young women are trying to multitask and juggle their careers with their roles in patriarchal cultures. As WHO’s Director-General I would ensure gender mainstreaming across the whole organisation and as a policy priority for global health and development overall. Women are the face of the global health system and health workers are key to the development of universal health coverage globally, which would ensure that everyone, everywhere can have access to quality health services.
Gender, along with the equity and sustainability, must be part of the overarching lens and a basis for the development and implementation of all policies and programmes. Sustainable Development Goal 5 focuses on gender and I recognise the importance of women’s and girls’ education as the best investment a government can make in its own future. With a team that reflects gender equality (this is 2017 after all) I would ensure that we collectively advocate and communicate this message everyday of my term.
Dilshad was lucky, against all odds the team managed to save her life. This international women’s day, I vow to ensure that all women and girls, no matter where they’re from, can access quality education and the health services they need. There’s been enough words spoken already, now is the time for action.
Dr. Sania Nishtar is nominee for the Director-General of the World Health Organization
