Contain This: The Latest in Global Health Security

Dr Roopa Dhatt, Women in Global Health

September 21, 2020 Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade Season 1 Episode 16
Contain This: The Latest in Global Health Security
Dr Roopa Dhatt, Women in Global Health
Show Notes Transcript

This week Dr Lara Andrews, Acting Director at the Indo-Pacific Centre for Health Security talks to Dr Roopa Dhatt, Executive Director of Women in Global Health.

Roopa served as the President of the International Federation of Medical Students’ Associations and is now a practicing primary care physician in Washington D.C.

In this episode, Roopa talks about her identity as an Indian-born American woman shaped her motivation to help found the advocacy group Women in Global Health more than five years ago.

On the 17th of September, Women in Global Health held a virtual summit on the sidelines of the United National General Assembly where countries around the world, including Australia, reaffirmed their commitment to the Sustainable Development Goal number 5 - to achieve gender equality and empower all women and girls – and gender responsive leadership during COVID-19 response. 

Enjoy this episode with Lara Andrews talking to Roopa Dhatt.

For more information about the Indo-Pacific Centre for Health Security, visit our website

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Contain This Team

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

Adam Craig, Contain This Host

Welcome to Contain This.

This week Dr Lara Andrews, Acting Director at the Indo-Pacific Centre for Health Security talks to Dr Roopa Dhatt, Executive Director of Women in Global Health.
 Roopa served as the President of the International Federation of Medical Students’ Associations and is now a practicing primary care physician in Washington D.C.

In this episode, Roopa talks about her identity as an Indian-born American woman shaped her motivation to help found the advocacy group Women in Global Health more than five years ago.

On the 17th of September, Women in Global Health held a virtual summit on the sidelines of the United National General Assembly where countries around the world, including Australia, reaffirmed their commitment to the Sustainable Development Goal number 5 - to achieve gender equality and empower all women and girls – and gender responsive leadership during COVID-19 response. 

Enjoy this episode with Lara Andrews talking to Roopa Dhatt.

Dr Lara Andrews  1:16

Dr Roopa Dhatt. Welcome. And thank you for joining our Podcast Series Contain This. Before we talk about your work in Women in Global Health, I just like to start to ask you if you could share some of your personal story as a woman in global health and how you got to this point.

Dr Roopa Dhatt  1:38

So, my background is I'm actually a clinician as well, in addition to being a global health advocate. I started engaging with global health a little over a decade ago through student leadership, and I was the president of the International Federation of Medical Students Association. That's a mouthful. But through that really early on engagement, I was able to see Global Health at multiple levels. So at the frontlines, I was training and seeing women all around nurses, doctors, being majority of the health workforce and then, in the global health policymaking space. There were so many talented technical officers and other actors, experts all around, advocates. But whether I was in the hospital or whether I was at a multilateral, the World Health Organization or other UN agencies really noticed that women are not at the most senior levels. And we started unpacking that through Women in Global Health. 

But my personal journey is I always been really keen to work on health and equities. I am Indian American. So I was born in India, but I came to the US when I was five years old, and sort of just grew up between those dualities. For those of us that have, in a way two roots, we see the world really as one planet and interconnected. I just really had a drive to work on health inequities and through work and health inequities, it's hard to look at one intersection without looking at gender, racial, broader, socio economic and then contextualizing it with my heritage. Especially in India the idea of caste and religion also becomes more prominent. I've always approached global health really from that intersectionality lens. And, and that's shaped a lot of what I do. 

And I would say, there was really during clinical training when I was working those 80 to 100 hour shifts, and we're not supposed to work more than 80 hours. But we do end up doing that in clinical training. And seeing that just women were majority of the workforce but we're not in decision making. Where I trained we have still haven't had a single women lead as a program director or as a department of chair of medicine. And so these types of stark reminders just really showed me that, you know, as I see myself in the field of health, what can I do now to really make sure it's more equitable, and it's more diverse, and that idea that women like me can really shape health decision making because not only because it's the right thing to do, but it's really the smart thing to do as well.

Dr Lara Andrews  4:21

Yes, and you talked about both the inequities, but also the disparity in leadership. In your own experience. Did you face barriers as an individual and how did you overcome them?

Dr Roopa Dhatt  4:37

That's a really great question. And it's one that I think about, often has it, the answer does change as we go through deeper self-reflection and understand how gender norms and bias really are part of your life. They're sort of the invisible molecules that are floating around in every interaction, whether it is your own individual engagement with society, or the interpersonal, or within an organization or wider community and society level. And so I'd say that, for me early on I really found myself to be very privileged in the fact that I was able to pursue higher education and grew up in a cultural context where it was encouraged for me to really pursue higher education in the United States. Whereas where I come from, there is a lot more earlier marriage that happens there is less priority investment in girls. So I think that for a big chunk of my early years, I just felt like I was so privileged as a young woman. But it was really when I entered leadership roles that I started facing challenges that didn't quite make sense to me. And it was actually a friend of mine from Sweden, a colleague, who started really probing and asking questions, do you feel like this would be the same experience if you were a male? And I said that is a really great question. And this is again a little over a decade ago, that I started unpacking the experiences of what women face and what men face. Now it's to the point where I feel like every interaction whether it is you know, sharing household responsibilities, sometimes by my partner and I counting the hours like who's doing what just to make sure it's equitable or as we plan our future. So I think it is definitely all around. But it does take the effort to really put those glasses on and look at things from a gender lens in your own context.

Dr Lara Andrews  6:33

Roopa, you're absolutely right. And as I was listening to talk about privilege and equity, it really reminded me how important it is for us to bear in mind that as women around the world, we don't share the same access to opportunities. So thank you for raising that point about gender lenses. Roopa, Women in Global Health, you are a co-founder and executive director, can you tell me a bit more about the organization, what it's aiming to achieve and how it's grown?

Dr Roopa Dhatt  7:04

It really also came from the same passion that I was talking about seeing this pyramid of 70% of the health and social workforce are women but when you look at top leadership roles, women only occupy 25% and in the private sector that's less than 5% of senior leadership roles in Fortune 500 healthcare companies. And we found ourselves as early career women, seeing the talent but not seeing your representative leadership and wanting to do something about it and not just call it out, but really solution oriented. So I actually met two of my co-founders on social media through Twitter. This was in 2015, when Twitter was just starting to become a platform for those of us in global health engagement. A senior woman leader had launched a campaign on social media called hashtag WHG100 to name 100 women working in global health to counter the all-male panels that were happening or the manels that were happening in global health. And so there was a lot of noise in our global health community from senior women and clear frustration. 

And so a group of us early career women, we didn't quite know each other but we aligned on values and met through social media and connected through Skype calls from all around the world, decided to really take this online conversation into a global campaign. We went to the World Health Assembly in 2015, without any funding or resources, but just really a strong drive. And we used our existing networks from our student days and other groups that were part of, young professional groups to bring the conversation to the World Health Assembly sidelines. And so I often say that women in global health is a movement first and organization second. Our mission is really to challenge power and privilege in a way to challenge power and privilege for gender equity and health. And for us, what that really means taking the conversation from fixing women to fixing systems, looking at structural barriers, and really looking at how do we change the environment to be enabling for all genders. So this conversation for the 21st century for us is really about creating gender transformative culture as both an individual leadership practice but also an organizational way of doing things.

Dr Lara Andrews  9:29

And the, the support for the movement as you describe it, I guess, as evidenced in how much how many people have now got behind it and the reach that women and global health now has, which is really fantastic.

Dr Roopa Dhatt  9:43

The demand really comes from the women in this space. We never imagined that we would be forming chapters around the world. It was actually was women on their own that started creating communities of global health, and really wanting to create a platform in their local context. And so that's what really inspired the women in global health chapters to form.

Dr Lara Andrews  10:06

Great. And I understand that the Australasian chapter is in the process of being established.

Dr Roopa Dhatt  10:14

Yes, it's an incubating phase right now. And what we have done is we want to provide all of our communities that are forming around the world and opportunity to engage with a movement. Some of them will, you know, go on to become formal chapters. And so they have about a year and to come together and identify what are their local objectives and goals, and how they plan to bring all actors together under the women and global health agenda. And one of the unique things about our networks as if we really want to engage all women working in health and all allies from all different genders. And so that means whether you're a physician, a nurse, a health worker, researcher, policymaker, someone that works in communications, private sector, government person, we want everybody to be really engaging together. There's too many siloed things that happen in our field. And so, for us to work on gender equality and women's leadership, we really wanted this conversation to be bringing everybody under one umbrella of the women and global health movement. And that we're really seeing how we can again, collaborate and use collective action as a key pillar to driving social change.

Dr Lara Andrews  11:28

And we are really looking forward to the Australasian chapter connecting a network of leaders across our region. And this comes at a really critical time in the middle of the COVID pandemic, of course. Roopa, Women in Global Health have issued five hours for health security, can you talk me through those five asks and why they're so important?

Dr Roopa Dhatt  11:45

Yes, and you know, these five asks are really grounded in what we felt based on what we were seeing in the early weeks of the COVID-19 disease outbreak and what in the pandemic was really around the fact that there is gender blind aspects to the response, but there were also gender implications. To COVID-19, that we're not getting visibility, we're not getting measured. And so what we did is we really brought these paths together based on Women in Global Health's unique position to connect with women in health, as well as our partners that are working closely on these issues. So are five aspects. One is probably around ensuring that there is equal representation in decision making around COVID-19. This is about ensuring that women are represented in equal numbers in all decision making COVID-19 task teams, working groups. And right now what we're seeing is a very stark gap. As I mentioned, it's about 25% of the senior leadership roles are women. But in COVID-19, we're seeing that women are representing less than 12% of these roles and COVID-19 task teams we've looked at about 87 countries 114 task teams - the data will be published shortly. So that is a very high number. It means that more than eight out of 10 task teams are majority men making decisions. 

The second is really around what we call it is that it's about time to really make sure that applause is great but safe and decent work is better for health and social workers. We are seeing a global recognition of health workers and all those applauses and all the applause and all the sort of lighting candles is appreciated, but we need to make sure our health workers are protected. They have appropriate physical protective equipment PPE, often designed for male bodies, and not for female bodies. Oversized, we've seen photos of women having to use duct tape to have them fit their body. We also know that a lot of the working hours are not designed in a way to realize that women have a triple shift, they have their health worker job, then they also have the added responsibility of taking on COVID-19 pandemic and then they have increased home and social care responsibilities often for children, elderly, community. And so we're not backing this in when we are looking at the decent work conditions for health workers. And then the psychosocial support and mental support for our health workers is significantly lacking. So this is really about how do we create safe and decent work conditions. We've heard from some of our frontline workers in Pakistan and India, that they're facing violence when they're going into communities because of just the intensity of how long this pandemic has been going on and the financial insecurities and food insecurities. There's a lot of frustration and anger and it's usually the health workers that face the brunt of it. And these are again, women are the frontline. 

A third ask is really around ensuring that we compensate and end unpaid work and really formalize the informal jobs in the health sector. Currently, women's contributions in the health sector 50% of them are unpaid, which is 1.3 trillion US dollars. And I'll say that again, half of what women do in the health sector is currently unpaid work. And so this is really something that the pandemic has showed a lot of spotlight on in most countries where we're seeing jobs being lost first are the informal jobs and mainly women. And so we really see that this is a critical ask to make sure that the House of Cards doesn't come tumbling down. We're counting on the poorest women to subsidize global health. And in some countries, we're seeing women are waiting even up to six months to get hazard pay or even just get their baseline stipend as community health workers. 

The fourth is what we're really saying we're currently operating blind, and we need to have gender responsive data collection, which is having both sexes disaggregated but also gender data. And the more we can get disaggregated right now, there are only 52 countries around the world that are providing sex disaggregated data to WHO, the World Health Organization and many multilaterals are really trying hard to get this data. So we at least know who is getting infected, who is getting tested who is dying. We don't have data based on health workers infections. And so there's a lot of call for ending the fact that we're currently working fine. 

And the fifth part is really around, ensuring that we fund women's movements and community led initiatives. Right now in a pandemic, it is really critical that social protections are there and most countries don't have strong social protection systems. We know very few of us even have 1% of their budget for health. And so a lot of what we're asking for is around, making sure that money gets into the hands of women's groups, especially in low and middle income countries and currently, over Overseas Development Assistance shows less than 1% goes to women-led initiatives in LMIC country. So it's also about making sure investments in COVID-19 are gender responsive, getting into the hands of women, and ideally, everything includes a gender marker. 

Dr Lara Andrews  17:39

Roopa, you mentioned in those asks you mentioned about the unpaid work, and it's certainly my eyebrows raised with the 1.36 billion that is in unpaid labor by women. Can you give some examples of the sort of unpaid contribution that women give to the health workforce?

Dr Roopa Dhatt  17:59

Yeah and the number is 1.3 trillion US dollars annually. And that is really a number that is to learn more about it you can go to the Lancet Women and Health Commission from 2015, which was worked by health economists that came to these numbers. They actually say that it's an underestimate. It's probably even more than that. And examples include, we'll take a look at the country India is dependent on what's called frontline workers, ASHAs, auxiliary nurses. They don't get a salary. They're given stipends. And stipends are based on how often you deliver a particular service, whether it is giving a vaccine or doing a screening. And these are often priced at pennies. So it all depends on, how much you can cover. And it's non reliable or unreliable ways of getting income. In other places we've also seen, just pulling now from the other continent of Africa, we know that instead of getting actually financial stipends, the compensation is in the form of getting access to a mobile, like a cell phone, or some sort of technology and or access to being able to distribute drugs and we know how problematic that is because it means that those people have to find other ways of making income. It also does set up all sorts of circles of just unethical aspects and in many different ways. And so this is what we mean by some of the unpaid work in the health sector. And in case there are any sort of, let's say, issues such as, like what we're seeing in the pandemic, like the health systems are changing or stopping services, these health workers have no mechanism to ask for compensation or to ask for wage coverage during this time of periods because they're not considered part of the health system, even though they're the ones at the frontline doing all this screening in COVID-19.

Dr Lara Andrews  20:27

And I think that speaks to that issue of intersectionality of in these cases, people in poverty without the power and the voice to be able to speak one, negotiate for formal recognition of what they're contributing.

Dr Roopa Dhatt  20:40

You know, it's also just physical risk they take too we were hearing from a community health worker organized by our India chapter. These power dialogues mean some of these women have no PPE, no physical protective equipment are expected to cross rivers, become soaked in their clothes and then have no place no sanitation hygiene to clean themselves. And then they're expected to take the test for COVID-19 and then come all the way back across these rivers. And, you know, they're going to the hardest to reach places, whether it's taking a motorbike in Western Africa, or whether it is crossing rivers and then they're not even getting compensated. So it's all, I think there's really a wake up call during this pandemic. Can we continue to build health systems if they work really secure when this is how we're setting our health systems up to be?

Dr Lara Andrews  21:37

Absolutely. Roopa, I was gonna ask, you've identified problems and solutions in the five asks, Do you have examples of where countries or organizations have implemented these solutions, and we have seen change?

Dr Roopa Dhatt  21:56

So one of the really inspiring stories is actually what's taking place in Somalia. So Somalia is where we started our second Women in Global Health chapter and it was all led by women self organizing. Somalia is a fragile state currently, you know, considered to be five governments for any one country. So quite a complex place with still active conflict going on. And our Somalia chapter, started engaging with the global campaign on five asks and realize that there were two things that weren't how thing in Somalia that they really wanted to work on. And the first one was really around the data fact, data aspect, they noticed that the government was not reporting back sex disaggregated data nor looking at the gender implications. 

And the second thing was really around ensuring that women were part of the decision making that was happening in Somalia. So what they did is they started mobilizing, including working with other women networks and other community health workers, networks in Somalia, engaging with the media and also debriefing the ministry on how. One, that it was a problem and to how could they start collecting data and use the talent of the research talent that existed in Somalia or part of the diaspora. 

And so the sort of positive outcome is that the Ministry of Health is working with our chapter and the women that are connected to each chapter to start looking at both sex and gender disaggregated data. It's not complete yet. It's a work in progress and they've started providing some information so that it's been really great. 

The second one, which they're facing some challenges on is really getting women into decision making roles. What's happened is that there are now at least one or two women and some of the task teams working groups. But it is a bit more tokenistic representation and quoting the words of Amina Sharma who leads the code of the Women in Global Health chapter, she says, you know, no, no more tokenism. No more window dressing. And that's sort of the slogan that she's been championing in Somalia. And she actually shared that with Dr Tedros at WHO. That, you know, we don't want to tokenism or when addressing, we really want women in leadership roles. 

So that's an example where it's working in progress. And we have seen with that, where there are quotas in place, that's where women are getting opportunities and we know that you have to reach a critical Massive, at least getting 30% women for it to start really showing some of this environment where it is truly gender inclusive.

Dr Lara Andrews  24:41

They are both really excellent examples, and particularly on the data to hear that the work of the women in engaging with the ministry is actually progressing. And also in the context of what you raised before that only 52 countries are reporting sex disaggregated data. So I think that's really inspiring to hear how much progress they're making, particularly, as you mentioned in a country that is incredibly complex. So I think that's the lesson to us all about what you can achieve when you really work together and you decide the issue is important enough to advocate strongly on. Thank you for that.

Women in Global Health have written that coronavirus will define our time and fundamentally reshape our world. For many World War Two was also a defining event in global history. For women in the US, Europe in particular one of the consequences of men going off to war was the opportunity for women to engage in formal paid work, a demonstration that women had the capacity and ability to perform what had previously been considered men's work. Do you think we will see unplanned but positive changes for women as a result of the COVID pandemic?

Dr Roopa Dhatt  25:52

Lara, you know, one of the things that is happening around COVID-19 is that women are mobilizing in so many ways, and the woman power is out there. I am confident that we are going to be building back better and seeing those headlines in almost every newspaper around the world of how women leaders are outperforming male leaders as head of governments. And I'm not here to say that women are better than men, but there's something about the leadership style that is really being recognized. So I'm very confident that we're going to be coming out of this pandemic recognizing women and valuing women, but you know, this is not going to happen on its own. So I encourage everyone to really continue to break out of the echo chamber and ensure that we truly recognize women's leadership and gender equality. You know, everything that we're asking for, and we've been discussing, and today's conversation, these are not new things. These are all commitments have been made before. But right now is the opportunity to build back better and really build back in a gender responsive way. So I'm very confident on the other side of all this that this time, it's not just going to be in high resource settings, but really in all settings around the world that we have more gender equitable health systems.

Dr Lara Andrews  27:17

Roopa, thank you for that, and I think the messages are clear. We will look forward to seeing this work being progressed in our region through the Australasian chapter as it becomes established. And I think you're right. If there is a, there's an opportunity and a window for us now to move forward, particularly with women in leadership and the work of women in global health is inspirational for us all. So I'd like to thank you for your time joining us for this interview, for sharing with us your story, the work of women in global health, and we look forward to hearing and seeing more and also contributing to the very, very important agenda of greater gender equality in global health. Thank you, Dr. Roopa Dhatt.

Dr Roopa Dhatt  28:07

Thank you for this opportunity and platform and really look forward to engaging with you and others in the in the community because only through collective action can really achieve gender equality.

Dr Lara Andrews  28:17

Great. Thank you very much.