Delivering On the Promise of Health For All Must Include Gender Equality and SRHR

Health workers are at the frontlines in the fight against the new Corona Virus. Credit: John Njoroge

By Ann Keeling, Divya Mathew, Deepa Venkatachalam, and Chantal Umuhoza
NEW YORK, Sep 29 2021 – Gender-responsive universal health coverage (UHC) has the proven potential to transform the health and lives of billions of people, particularly girls and women, in all their intersecting identities. At tomorrow’s kick-off to the 2023 UN High-Level Meeting (HLM) on UHC, Member States and stakeholders will review progress made on the 2019 HLM’s commitments and set a roadmap to achieve UHC by 2030. We, as the co-convening organizations of the Alliance for Gender Equality and UHC, call on Member States to safeguard gender equality and sexual and reproductive health and rights (SRHR) as part of UHC implementation, especially in light of the gendered impacts of the COVID-19 pandemic.

To move forward, it is crucial to remember our cumulative past promises. In 2019, Member States adopted a Political Declaration that contained strong commitments to ensure universal access to SRHR, including family planning; mainstreaming a gender perspective across health systems; and increasing the meaningful representation, engagement, and empowerment of all women in the health workforce. Further, 58 countries put forward a joint statement that argued that investing in SRHR is affordable, cost-saving, and integral for UHC. These commitments were the result of the advocacy and hard work of civil society organizations, including members of the Alliance for Gender Equality and UHC, and set out a clear path on the steps needed to make gender-responsive UHC a reality.

However, following the 2019 HLM, the deadly and devastating COVID-19 pandemic drastically changed how individuals around the globe could access essential health services. Fundamental human rights, including hard-won gains made for UHC, SRHR, and gender equality, are now at risk as health and social services are strained and political attention is diverted. The protracted pandemic underscores how gender-responsive UHC is more important than ever.

We call on Member States to renew the commitments made in 2019 and affirm that delivering on the promise of health for all is only possible by way of gender-responsive UHC.

To truly deliver gender-responsive UHC, we offer the following five recommendations:

1. Design policies and programs with an intersectional lens that places SRHR and girls and women — in all their diversity — at the center of UHC design and implementation. To be effective, UHC must recognize and respond to the needs of women in all their intersecting identities, including by explicitly addressing the ways in which race, ethnicity, age, ability, migrant status, gender identity, sexual orientation, class, and caste multiply risk and impact health outcomes. What’s more, COVID-19 has deepened inequalities for marginalized populations, and special attention is needed, now more than ever, to deliver UHC for those pushed furthest behind.

2. Ensure UHC includes comprehensive SRH services, and provide access to SRH services for all individuals throughout the life course. These services must be free of stigma, discrimination, coercion, and violence, and they must be integrated, high quality, affordable, accessible, and acceptable. The World Health Organization (WHO) provides guidance in the UHC Compendium of interventions and supporting documents for what this can look like. The pandemic has given way to multiple interruptions to SRHR care. For example, an estimated 12 million women may have been unable to access family planning services due to the pandemic. COVID-19 response and recovery and UHC implementation must address these issues.

3. Prioritize, collect, and utilize disaggregated data, especially gender-disaggregated data. UHC policy and planning can only be gender-responsive when informed by data that are disaggregated by gender and other social characteristics. In the current pandemic, not all countries are reporting disaggregated data on infections and mortality from COVID-19 to the WHO, and most countries have not implemented a gendered policy response. In June 2021, only 50% of 199 countries reported data disaggregated by sex on COVID-19 infections and/or deaths in the previous month.1 The number of countries reporting sex-disaggregated statistics has also decreased over the course of the pandemic. Without this information, decision-makers are unable to base policies on evidence affirming how to address the health needs of all genders — a critical lesson for UHC.

4. Foster gender equality in the health and care workforce and catalyze women’s leadership. The approach to the health and care workforce in the pandemic has frequently not applied a gender lens, ignoring the fact that women are 70% of the global health workforce and powerful drivers of health services. Gender inequities in the health workforce were present long before the pandemic, with the majority of female health workers in lower-status, low-paid roles and sectors, often in insecure conditions and facing harassment on a regular basis. Moreover, although women have played a critical role in the pandemic response — from vaccine design to health service delivery — they have been marginalized in leadership on pandemic decision-making from parliamentary to community levels. In fact, 85% of national COVID-19 task forces have majority male membership. Urgent investment in safe, decent, and equal work for women health workers, as well as equal footing for women in leadership and decision-making roles, must be central to the delivery of UHC.

5. Back commitments to advancing SRHR, gender equality, and civil society engagement in UHC design and implementation with necessary funding and accountability. Now is the time to invest in health and the care economy, particularly in UHC. Governments everywhere are facing fiscal constraints from the pandemic. UHC is a critical part of investing in and building back resilient health and social systems to avoid catastrophic spending on future pandemics and global health emergencies. UHC must be designed intentionally, with appropriate accountability mechanisms, to reduce inequalities between and within countries — and especially gender inequality, which undermines social and economic rights and resilience.

We, along with our civil society partners in the Alliance for Gender Equality and UHC, stand ready to work hand-in-hand with governments, the UN, and all stakeholders to act on these recommendations on the road to the 2023 HLM on UHC. At this point in the COVID-19 pandemic, there is no time to waste in making the promise of health for all a reality, and this can only be achieved through gender-responsive UHC that centers gender equality and SRHR.

The authors are Ann Keeling of Women in Global Health, Divya Mathew of Women Deliver, Deepa Venkatachalam of Sama Resource Group for Women and Health, and Chantal Umuhoza of Spectra Rwanda. These four organizations are the co-conveners of the Alliance for Gender Equality and Universal Health Coverage.

1 Global Health 50/50 (


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The End of World Bank’s “Doing Business Report”: A Landmark Victory for People & Planet

The writer is Research Associate at the Oakland Institute in San Francisco, USA.

By Andy Currier
SAN FRANCISCO, USA, Sep 29 2021 – The September 16, 2021 announcement from the World Bank that it had discontinued publication of the Doing Business Report (DBR) marked a major victory for people and planet.

Since 2002, the DBR has scored and ranked countries on the “ease of doing business,” i.e. on regulatory changes and reforms that make them more attractive to private investors. These “reforms” have included lowering corporate taxes, slashing environmental safeguards, social and labor standards, cutting administrative procedures, and removing restrictions to trade and business.

Cancellation of the DBR comes after data irregularities were found in the 2018 and 2020 reports. Audits revealed serious ethical concerns of data manipulation – shattering trust in the rankings. An explosive external review delivered to the Bank’s Board of Executive Directors exposed how senior Bank officials applied pressure to manipulate data in order to improve rankings for select countries.

Notably, the independent report exposed how then-Bank CEO (and current IMF Managing Director) Kristalina Georgieva applied “pressure” to “make specific changes to China’s data points in an effort to increase its ranking for the 2018 DBR,” at a time the country was expected to increase its financial contribution to the Bank’s capital. Then-World Bank President Dr. Jim Yong Kim was also indirectly implicated in the effort to increase China’s ranking.

Simeon Jankov, one of the founders of the DBR and a senior Bank official was also incriminated in altering Saudi Arabia’s data to boost the country’s ranking, in an effort to reward the country for the “important role it played in the Bank community.”

Saudi Arabia had previously implemented a series of Reimbursable Advisory Services (RAS) projects – paid advisory services provided by the Bank, some of which focus on improving economic indicators scored on the DBR. Elevating Saudi Arabia to first place in the Top Improvers list was done to “demonstrate the effectiveness of the Bank’s efforts and validate the amount of money Saudi Arabia had spent on RAS projects relating to the Doing Business Report.”

While shocking, these revelations are not the first charges of data manipulation brought against the Bank’s flagship publication. In 2018, the World Bank’s then-Chief Economist, Paul Romer exposed how DBR scores for Chile were skewed and politically manipulated to disfavor Michelle Bachelet’s progressive government.

While Romer admitted “business conditions did not get worse in Chile” under Bachelet, the country’s DBR rank fell from 25th to 57th while she was in power. The Bank denied Romer’s allegations and he subsequently resigned.

The blatant evidence of manipulation of the rankings is a slap in the face of the poorest countries that deregulated their economies to gain favor with the Bank. Consumed by climbing the rankings, policy makers around the world prioritized reforms that would improve their score instead of pursuing policies that would benefit people or the environment.

Even before the extent of the data manipulation came to light and destroyed any credibility of the DBR, the rankings were built on a flawed premise that rewarded countries for reducing their labor standards, destroying the environment, and providing easy access for corporate pillaging and land grabs.

For instance, the DBR ranked Sierra Leone, as one of “the top 15 economies that improved their business regulatory environment the most” after the country implemented policy changes that fast-tracked land leases, attracting foreign investors eager to develop large-scale oil palm and sugar cane plantations that deprived local communities of the land essential to their livelihoods.

Similarly, the DBR ranked Liberia as a “top ten global reformer” in 2010 after it prioritized lowering tax rates for corporations, provided guarantees to investors “against unfair expropriation,” and “ensur[ed] the ability of investors to repatriate capital and profits,” among other pro-corporate reforms. These policy changes resulted in giant palm oil and rubber producers acquiring more than 1.5 million acres of land – once again at the expense of community livelihoods.

Sustained Civil Society Mobilization Driving Force in Ending DBR

The Bank and IMF’s structural adjustments programs (SAPs) implemented in the 1980s and 1990s, impoverished millions in developing countries after imposing the withdrawal of state intervention and sweeping liberalization of economies as conditions to receive loans. The same year sustained mobilization from civil society finally ended SAPs, the Bank created the DBR to repackage and push the same neoliberal doctrine.

Over the past 18 years, the DBR has been met with strong resistance from the global labor movement and groups advocating for more equitable development policies in the Global South. Since 2014, the 280-organization strong Our Land Our Business campaign – comprised of NGOs, unions, farmers, and consumer groups from over 80 countries – has called for the end of the rankings.

For over seven years, Our Land Our Business has waged a steadfast advocacy campaign, including letters, petitions, and mass protests around the world. Coordinating the campaign, the Oakland Institute has produced dozens of reports and advocacy materials providing in-depth analysis and monitoring the impact of the DBR for people around the world.

Pressure on the Bank to end the DBR grew in March 2021 when the Rights Not Rankings Campaign – comprised of over 360 civil society organizations, academics and trade unions ¬–called on the Bank to end the program given that the “underlying premises of the Doing Business Report are not supported by evidence and contradict the objectives of a just recovery,” from the ongoing COVID-19 pandemic.

While a landmark victory, these campaigns remain vigilant as the World Bank continues to leverage its influence and pressure countries to prioritize reforms that benefit corporate interests over true development. The scandal that derailed the DBR reveals ingrained institutional flaws in the World Bank and the biased, pro-corporate ideology and development pathway it continues to promote.

Next, the Bank should end the Enabling the Business of Agriculture (EBA) Program. Created in the image of the DBR, the EBA rewards countries for implementing reforms in the agriculture sector that benefit agribusiness over the small farmers who actually feed the world. The revelations that have ended the DBR undeniably discredit the EBA and add to the Program’s crisis of legitimacy. The Our Land Our Business Campaign will continue its unwavering advocacy until the EBA joins the DBR in the dustbin of history.

Despite the work ahead, the end of the DBR should be widely celebrated as it marks the end of a tool wielded on the behalf of global capital interests for nearly two decades. Its demise was long overdue and clears the way for policies that serve people and the planet first.


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The writer is Research Associate at the Oakland Institute in San Francisco, USA.