By Sylvia Ezenwa-Ahanene
Whenever any part Nigeria experiences a health emergency such as cholera outbreak in the riverine South, diphtheria outbreak in the Middle belt, or measles outbreak in the North, there is one group of health workers that is predominantly on the frontline, and it is women.
Women are caregivers, volunteers, community health workers, and nurses who, in many cases, put their safety on the line to tend to others.
According to reports from the United Nations, women make up around 60% of Nigeria’s health workforce. However, they are under-represented in health leadership. Women have the highest population in the frontline and bear the heaviest burden during outbreaks.
Their dominance in the act of providing healthcare extends to the household and community levels where women spend more time with the children. Women are blessed with the power of observation and empathy which is needed for taking care of the sick.
In the absence of women in leadership, the strategies used to respond to disease outbreaks may be less inclusive and responsive respectively, therefore being less effective. An example can be seen in the proper considerations of the hygiene and health needs of females living in a community suffering from a infectious disease outbreak.
Women in leadership also ensures that the welfare of frontline workers who are majorly women are taken into account. Provision of facilities and materials needed for optimum service delivery is imperative and this includes addressing some of the peculiar needs of women.
The COVID-19 pandemic in Nigeria saw women in key roles of patient care, health education, and community mobilisation. However, they were underrepresented in major decision-making organs, such as state and national emergency task forces. Other female frontline humanitarian responders such as women’s rights and women-led organizations should be supported to be in the fore-front of response in their communities.
The result of the imbalance in gender representation was that vital considerations such as impacts of lockdown on access to antenatal care for pregnant women and immunization for new born babies were no appropriately considered. This exposed the gaps in having a male-dominated healthcare leadership.
Adopting gender sensitive policies in the constitution of health intervention teams and planning will ultimately improve efficiency in healthcare provision.
Adequate representation of women in leadership positions during outbreaks will help address some easily overlooked challenges in the field such as gender-based violence, lack of access to essential sexual and reproductive health care services. It will also take care of psychosocial supports, menstrual hygiene products and other social protection measures.
The Federal and State Ministries of Health should set targets for women’s representation in emergency response decision-making teams. More training and mentorship programmes should be provided to equip more women in preparation to hold leadership positions in the management of outbreaks, epidemiology and health policy. Gender impact assessment needs to be incorporated as part of all the response plans so that interventions can be responsive to the needs of all the people impacted. Gender impact assessments should be standard in outbreak planning and it is better implemented when there is adequate female representation.
The United Nations Women’s Policy Brief No 18 reports that “across the world women are on the frontlines of the COVID-19 response, as Heads of State and Government, health-care workers, careers at home and community leaders and mobilizers, among other roles. Women leaders in several countries are excelling in the response, providing powerful examples of how women’s leadership and participation can bring more effective, inclusive and fair policies, plans and budgets to address the pandemic.
During the Ebola outbreak in 2014 – 2016, Liberia used women groups for community surveillance. Studies afterwards showed that having women groups in the communities led to very high chances of reporting early warning signals of the cases. This led to quick detection of cases.
Rwanda achieved remarkable success in its gender-sensitive approach during the fight against COVID-19. More than half (55.6%) of their COVID-19 responses were gender-sensitive which is higher than the average globally. Their gender-sensitive response committees made sure that the needs of both men and women were considered during times of the COVID-19 lockdown.
These results from other countries of the world can be replicated in Nigeria for more effective outbreak preparedness and response. Emergencies do not usually give time for correction of such gender under-representation hence, the urgent need to intervene now.
Any emergency preparedness and response lacking gender equity may likely produce suboptimal result. Ignoring gender equity weakens Nigeria’s epidemic response.
Increasing the population of women in leadership positions in the health sector will ensure inclusivity and improve efficiency of health teams. Women need to move from the frontline to the decision-making table where their voices can be relevant.
Sylvia Ezenwa-Ahanene (MPH) is a Senior Surveillance/Health Emergency Preparedness and Response Officer at the Nigeria Centre for Disease Control and Prevention (NCDC). She is also a fellow of the Empower her Fellowship, African Health Communication Fellowship, Nigeria Malaria Modelling Fellowship and SACEMA Measles and Polio Policy Modelling Fellowship.
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