In honor of International Women’s Day on March 8th and Women’s History Month throughout March, Deputy Country Director, Anita Kouvahey-Eklu, shares her thoughts about the challenges women face in seeking care, and how by placing women at the center of health system design, Integrate Health is addressing those challenges. Anita has been a women’s health activist for over 20 years, working first as a Physician’s Assistant and then with organizations that deliver reproductive health services. Anita joined the Integrate Health team in Lomé in April 2020.
A woman is also a young person, a teenager, a mother. She traverses these phases with pride, joy, and sometimes pain due to the challenges she uniquely faces as a woman. This injustice begins at birth. If you hear cries of joy, you know a boy has been born. The birth of a girl is met with silence. It can be a heavy burden to be a woman in a community where men are disproportionately celebrated.
Women face unique challenges in accessing healthcare.
In Africa, women play a central role in society, but they often receive inadequate support. Nowhere is this more prevalent than in health. The woman is the central pillar who organizes the family, and because of this she plays a determining role in the health of her family. She is the first person to be at the bedside of the sick, whether they are children or adults, often without basic protective equipment, exposing herself to illness.
Despite being at an increased risk of illness, when a woman needs to seek care, many obstacles may stand in her way. Low purchasing power due to the high cost of care and lack of autonomy over funds prevents her from accessing high-quality care. She may also face cultural hurdles, such as needing authorization to seek care from her husband, father, or in-laws. Well-equipped health facilities are oftentimes too far away, and even when she makes it to the health facility, she may not get a warm welcome from the staff, resulting in an unpleasant or harmful experience. These factors create a web of challenges that she must overcome just to ensure her own right to health, and we can see the consequences play out daily. Globally, 810 women die every day due to preventable causes related to childbirth,and two-thirds of all maternal deaths occur in sub-Saharan Africa.
Women’s health does not only impact women; it also plays a major part in the social and economic development of communities. We know that when a mother dies, there are long-term consequences for the family that reverberate throughout the community. These include financial instability, loss of education, and increased mortality among the children the mother left behind. These consequences extend beyond the borders of the family and the community and have lasting effects for the entire continent. Women in Africa represent just over 50% of the continent’s workforce and close to 33% of the continent’s GDP. Efforts must be made to right these wrongs by putting women at the center of designing the health system so that they can be the authors of change.
We must design health systems with women at the center.
Integrate Health’s mission is to make quality healthcare accessible to all, and central to this mission is tackling the unique challenges that women face in accessing care. To accomplish this big mission, we must listen to and engage with women to guarantee that their opinions inform our work. Integrate Health does this through routine community meetings. Integrate Health holds over 700 community meetings per year to listen to the experiences of patients using the health system. Community members, predominantly women, are empowered to voice their concerns during the community meetings. This allows us to understand exactly what women need and to continue to incorporate their needs into our work.
Second, we must enable women to take on leadership opportunities in the healthcare field, at every level. Over 70% of Integrate Health staff are women. This includes directors, managers, data analysts, and Community Health Workers. Integrate Health has long held the belief that there is untapped potential in rural women who may not have had the opportunity to obtain a formal education but who are fluent in the challenges that women face in accessing care. By prioritizing the hiring of women as Community Health Workers, we have found that there is an entire group of women who are capable, passionate, and motivated and have been left out of traditional jobs because of their lack of formal qualifications.
Today, Integrate Health’s staff and Integrate Health-supported Community Health Workers are beginning to rewrite the delivery of healthcare. They are using their roles, which once held them back, as a woman, a young person, a mother, a professional to improve access to care for thousands of people, including women, and they are setting an example for health systems beyond their community, region, and country.
We are seeing results.
This is not just an assumption; at Integrate Health we have real-world data to back this up. To date, since the launch of the program, Integrate Health-supported Community Health Workers have cared for 166,418 people and made over 422,000 home visits in Integrate Health-supported communities. More women are giving birth at the health center instead of at home; in one district the facility-based deliveries increased 77% one year after the launch of the program, dramatically improving women’s chances for a healthy birth.
Recognizing the challenges that women face, actively engaging them in discussion about their healthcare, and providing opportunities for women to deliver healthcare at every level is transforming the healthcare system. Women, who play a central role in the health of their families, communities, and more, are driven by the hope that one day they and their sisters will not die while giving life. This is a battle that must be fought together, with all men and women who are willing to challenge the current health inequities that exist today to save lives.
This article was written by Anita Kouvahey-Eklu, Deputy Country Director.