Focus Needed on Gender Equity on Eye Health

The latest Gender Equity in Eye Health survey has shown there has been a lack of progress in representation of women in leadership in the sector.

It also shows the importance of sex disaggregated data and the continued impact of COVID on eye health particularly for women.

Why is sex disaggregated data important?

The survey findings indicate that only 55% of respondent organisations disaggregate their data by sex – which is simply not good enough. Some of the challenges we face in getting sex disaggregated data include the additional cost; cultural barriers; often a poor understanding of why this is important and, sometimes, a lack of interest by governments.

And I’m not just talking about lower and middle-income country governments. Believe it or not, the official UK Government National Health Service COVID-19 data collection survey does not ask people to identify their sex.

We know that information gathered determines the way resources are allocated. So, if you don’t have prevalence of blindness disaggregated by sex, you can’t design services to support those disproportionately affected. In the case of vision loss, for the majority of countries globally, this means women, who make up more than 55% of the world’s blind and vision impaired people.

For those of us who fund or run programs, we must insist on disaggregated data in reporting. We need to explain why this is necessary to the Ministries of Health that we work with and bring them on the journey with us.

The Fred Hollows Foundation is on that journey. We now have only two out of 25 countries that do not provide sex disaggregated output data – Myanmar and Rwanda. The former because of political upheaval which has seen programming halted; and our Rwanda team is working to integrate eye health within the existing Government run performance-based financing system for health care – which we hope will translate into improvements in sex disaggregated reporting.

So, it is possible, but it takes time and patience.

How is COVID-19 continuing to impact gender equity in eye health?

COVID has significantly changed our world. It has exposed how fragile our systems are – particularly our health and education systems – and it has impacted progress towards gender equity. Interestingly, the survey shows that almost half of the respondent organisations have not made any changes to their gender equity-related policies since the pandemic stated. So, why is this happening?

Of course, change is hard, and to be fair, the pandemic has kept everybody busy. It is also great to see that around 50% of organisations have made changes – so it is possible.

Women are disproportionately affected by COVID, but they are not equally represented when it comes to being in roles that make decisions about change. This problem is widespread – I recently saw an article about the WHO where Director General Dr Tedros Adhanom Ghebreyesus said how proud he was of the gender and geographic balance in his leadership team – which is great. However, it pointed out that there is no gender balance on the WHO’s Executive Board, with women accounting for fewer than 10% of the 34 members.

A McKinsey survey from 2021 which looked at hundreds of US companies found that the pandemic has had a near-immediate effect on women’s employment. Many more women than men are leaving the workforce due to the impacts of COVID – particularly those with young children and those in senior management roles.

So, what to do? Look at your workforce, is turnover higher for women than men? Are you one of those organisations that has not made policy changes as a result of COVID-19? Maybe you should give this some serious consideration.

At The Foundation, we surveyed staff throughout the pandemic to get a better understanding of how our people were affected. As a result, we enabled our staff to work more flexibly during extended COVID lockdowns; we provided our people with an additional 10 days leave to care for their children needing to be home schooled or to care for elderly parents who couldn’t get the care and support they needed.  We also allocated an annual global mental health day for all staff so they could have a legitimate mental health day off and, at the same time, we were able to demonstrate how serious The Foundation was about the health and well-being of its staff – we walk the talk.

Why is women’s leadership in eye health so critical?

For me, it is about representation and decision making. We know globally, women make up 70% of the health workforce, but they hold only 25% of senior roles. Until this changes and we see strides towards parity in senior decision-making roles, gaps in access and uptake of services will continue to be exacerbated because those making the decisions do not represent the majority of those needing the services.  It is that simple.

I know that health systems will be stronger and health outcomes more equitable when the women who deliver them have an equal say in the design of national health plans, policies and systems. I believe that stakeholders at every level have a role to play in paving the path for a more equitable future in how people access services, how they are delivered, by whom and who is making decisions around such activities and resource distribution.

So, what action can we take?

Start by being intentional when recruiting at all levels, but especially senior roles and internal promotion at senior levels. Take a look at your Board, do you have parity and Board member term limits built into the governance structure? Make sure your organisation has a commitment to gender parity right at the top.

Where can you get assistance?

The IAPB Gender Equity Work Group has developed a Gender Equity Toolkit. It is regularly updated and in response to this survey report, several additional tools have been added.  Whether you are deep into your gender equity journey, or at the very beginning, members of the Gender Equity Work Group, as well as the toolkit, are here to support you, so please contact Louisa Syrett (our secretariat) if you would like some support.

We will be running this survey again in November 2022, please look out for the link.  If you responded in 2020 and/or 2021, please respond again this year. If you haven’t ever responded, why not make 2022 the year you choose to get involved!

In the meantime, please share the survey report with your organisation and start the gender equity conversation to build awareness and challenge unconscious bias.

Focus on Gender Equity, throughout the year, shares knowledge, inspiration and ideas from some of the world’s most innovative experts and inserts eye health and Gender Equality onto the agenda of the world’s most pressing development issues and is supported by Santen.

About the survey

In 2018, the Global Health 50/50 Initiative was launched with their first report on gender responsiveness of 140 leading global health organisations.  In 2020, the International Agency for the Prevention of Blindness (IAPB) received permission from Global Health 50/50 to use the same short set of questions which form a baseline that will be tracked annually. This is the second time the IAPB Gender Equity Work Group has run the survey; a survey which aims to provide a view of gender and equity related policies and practices of eye care organisations across the world. The survey is designed to inform discourse on gender equity in eye health, inspire a vision for a new normal and catalyse change to demands and deliver policies to deliver gender equity in eye health.

In 2021 the number of respondents more than doubled; however, it is important to note, that where comparisons across 2020 and 2021 have been made, these are based on the 23 organisations that responded in both years.