gender

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

Integrating the Leadership Development Program into Guyana's national nursing school training (watch video): Guyana HIV/AIDS Reduction and Prevention, phase two (GHARP II), a PEPFAR-funded and USAID-supported project.

Developing Strong Health Leaders Saves Lives, the newest edition of MSH's Global Health Impact e-newsletter (subscribe), features:

Mary Ngari, Permanent Secretary of Kenya’s Ministry of Medical Services, addresses conference attendees on the first day. {Photo credit: MSH.}Photo credit: MSH.

In my 35 years working in international health, I've attended hundreds of conferences. Conferences are opportunities to exchange ideas and form connections. They’re often fascinating. But once in a while a conference itself can be a pivotal moment. A great example was last year’s International AIDS Conference, the first held in the United States after President Obama finally lifted the longstanding travel ban against foreigners living with HIV.

And recently, people around MSH, and throughout the Kenya health community, have been talking about Kenya’s First National Conference on Health Leadership, Management and Governance. The conference, held in early February, demonstrated the long-term vision of the Kenyans who are running the health system. These leaders understand the value of training health systems managers to improve the quality of service delivery.

I was circumcised when I was eighty days old, as is the tradition in Ethiopia. My sister was three. My mother had tried to spare us, but her aunt discovered that we were not circumcised and took it upon herself to have us circumcised.

Years later, I asked my aunt why she did it. Her response was not defensive. On the contrary, she responded very matter-of-fact: My sister and I were circumcised so that we could find a husband, have children, and become women. This is the cultural ideology that most Ethiopian women believed at that time, and unfortunately, that many still adhere to in the 21st century---an ideology and practice that is detrimental to a woman’s health.

Female genital circumcision alters or causes injury to the female genital organs for non-medical reasons. There are no health benefits for girls. On the contrary, the procedure can lead to severe bleeding, infections, and problems urinating, during sexual intercourse, and complications in childbirth, as well as later cysts and increased risk of newborn deaths---not to mention the severe pain and shock of the procedure.

Seven-year-old Ladi Muhammed. Nigeria. {Photo credit: S. J. Garlora / MSH.}Photo credit: S. J. Garlora / MSH.

Seven-year-old Ladi Muhammed wants to become a teacher. The third of five children ranging 3 to 20 years old, Ladi and her family live in a poor Nigerian village.

The likelihood of Ladi attending primary school is low.

Public primary education is free in Nigeria, but Ladi’s parents can barely afford to feed their children. The children supplement their parents’ income with menial jobs, such as street trading, which leaves little time or energy for schooling.

Her father, Ahmadu Mohammed, wants to send all of his children to school, but does not have the financial means to do so. “It is my heartfelt desire to send my children to school, but I can’t support them due to the meager salary I earn from my work as a gateman. Our situation is tough; we can barely feed ourselves,” says Mohammed.

Without an education, Ladi’s desire to one day become a teacher appeared a distant dream.

While global health and policy efforts to protect young girls from early or forced marriage are increasing, millions of girls are forced into early marriage every year. Pictured: four Senegalese girls. {Photo credit: S. Galdos/MSH.}Photo credit: S. Galdos/MSH.

If you think that child marriage is not an issue in the twenty-first century, think again.  In developing countries, 82 million girls who are now ages 10 to 17 will be married before their 18th birthday. Over the past decade, 58 million girls in developing countries -- one in three -- have been married under the age of 18; 15 million -- one in nine -- were married by age 15.

These girls are often married against their will, despite national laws that prohibit marriage until the age of 18, and numerous international declarations, conventions, and global conferences that “guarantee” the rights of girls, like the Universal Declaration of Human Rights.

Senate Passes Preventing Child Marriage Act

Child marriage is increasingly becoming a hot topic within the realm of global health -- and influencing U.S. domestic and global policy.

The International Protecting Girls by Preventing Child Marriage Act (S. 414) -- reintroduced in the U.S. Congress in February 2011 --- passed on the Senate floor by way of voice vote on May 24, 2012. (The bill also passed the Senate unanimously in December 2010.)

Women and child in Tambura, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Nearly 50 countries, including Afghanistan, Democratic Republic of the Congo, Haiti, Liberia and South Sudan, are considered a fragile or conflict-affected state -- a state that is in conflict, recovering from conflict or crisis, or a state that has collapsed or has a strong and repressive government. Over nearly 40 years of working in fragile states, Management Sciences for Health (MSH) has identified best practices, lessons learned, and appropriate interventions for a myriad of situations in fragile states.

MSH takes an integrated approach to building high-impact sustainable public health programs that address critical challenges in leadership, health systems management, health service delivery, human resources, and medicines. Wherever our partnerships succeed, the positive impact of good health has a ripple effect, contributing to the building of healthy nations.

MSH works collaboratively with health care policymakers, managers, providers, and the private sector to increase the efficacy, efficiency, and sustainability of health services by improving management systems, promoting access to services, and influencing public policy.

Speakers at the Inaugural Conference on Global Health, Gender and Human Rights. {Photo credit: PAHO/WHO.}Photo credit: PAHO/WHO.

Health is a human right and should not be denied based on any factor, including gender, ethnicity, or socioeconomic status.

On March 21 and 22, 2012, law students, global health professionals, and human rights experts gathered at the Inaugural Conference on Global Health, Gender and Human Rights at American University to discuss tackling global health issues from a human rights perspective.

Co-hosted by the American University Washington College of Law, the Pan American Health Organization (PAHO), and the Royal Norwegian Embassy in Guatemala, the two-day conference focused on six crucial topics: disabilities, women's and adolescent girls’ health, gender identities, older persons, access to medicines, and tobacco control.

Speakers and participants articulated the important role gender and human rights play in the promotion of health around the world.

A midwife in Wau, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Josephine, a wife and mother of six living in rural Uganda, tried to soothe her 3-year-old daughter. The girl was suffering from diarrhea and a high fever and her crying filled the home. Recognizing that the girl's health was in danger, Josephine summoned the courage to ask her husband for permission to take their second-youngest child to the local health facility unit -- and pleaded for money to cover the travel and treatment expenses.

Requesting permission from her husband to travel to the facility was not her only choice, however: choosing to take her daughter for treatment also meant leaving her other children -- including her youngest -- unattended at home. Once at the health center, she continued to navigate the challenging road to treatment for her daughter, communicating her situation to the health providers and negotiating the financial and provider aspects of the health center system, without assistance. Relieved and exhausted, Josephine returned home safely with her daughter, oral rehydration salts, and knowledge.

Recognizing women leaders

What makes a person in the health system a good leader? Who determines that he or she is a leader? How do we empower leaders to improve the health of those around them?

Women learning about family planning at Bikone Health Center II, Western Uganda. {Photo credit: MSH.}Photo credit: MSH.

This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.

I felt a bit overwhelmed in the first few days. Is there any way we can address all these challenges? Can we make a difference?

Visiting communities and health centers in Kampala, Eastern and Western Uganda -- and seeing first-hand the impact MSH is having across the country -- quickly re-inspired me.

I had the pleasure of meeting a particularly passionate and committed Clinical Officer, Rodger Rwehandika, at Bikone Health Center II in Western Uganda. As a health center II, Bikone is an outpatient facility, but the staff of the facility can also conduct outreach programs to educate and serve the community.

Rodger and his two staff facilitate health education programs at the local schools and also host youth-friendly programs on using condoms.

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