On World Health Day, a Call for Equity, Justice & the End of Paternalism

Family planning counselor and nurse speaks to group at clinic in Nakuru, Kenya. Credit: Sala Lewis

By Joyce Banda and Nabeeha Kazi Hutchins*
WASHINGTON DC, Apr 7 2021 – The past year has forced many of us to address difficult truths about how we treat and take care of each other — among them is a reckoning with racism and injustice.

In the global health and development sector, this reckoning is not new. Black, Brown and Indigenous women have been at the forefront of driving efforts to end inequity, racism and paternalism for decades, but the threats remain.

As women and leaders in global health and development from lower income countries, we intimately understand the consequences of the enduring legacies of colonialism, discrimination and disinvestment across Africa, Asia, Latin America and the Caribbean.

The dominant, top-down and inequitable approach to health and development — coupled with underinvestment in flexible, community-based programs — can no longer continue. Nowhere is the impact more apparent and overdue than with lifesaving and life-changing sexual and reproductive health information, services and care.

We have seen people turned away from clinics due to programmatic pivots by international donors that have impacted health supplies and service delivery. We know of increases in household-level abuse and illness when community health worker networks are eroded due to funding and policy changes.

We worry about the vulnerability of girls to sexual abuse and violence when sexual and reproductive health education is banned in schools and they are fed misinformation about their own development and rights. We are pained when individuals and families have no say or control over if, when and how they will have children.

These experiences reflect those of the 4.3 billion people of reproductive age who will lack at least one essential sexual or reproductive health service during their lifetimes.

When anyone is prevented from making decisions about their health, and the services and resources for their well-being are piecemealed due to paternalism and political convenience, progress for communities is elusive.

It is time to dismantle prescriptive international controls and expand the kind of aid and philanthropy that prioritizes flexibility, mutual accountability and trust in local leaders and their decision-making.

The listening and learning mindset that a new generation of donors has displayed — and the formation of partnerships and community-led programs rooted in principles of trust and expertise of domestic partners and local grantees — works.

In Malawi, the Presidential Initiative for Safe Motherhood during the Banda administration led to the reduction of maternal mortality by 32%. International funders and the private sector invested in the needs identified by national and local leaders, such as building clean and comfortable maternity waiting homes for pregnant women at hospitals and health centers.

In addition, community members and chiefs were fully supported to drive local advocacy and change local child delivery norms and bylaws to improve the ability of women to deliver at hospitals and health facilities. Funding was highly flexible so that women and grassroots leaders could make the right decisions for their own communities.

PAI and its grantees have also been turning the tide.

In Kenya, Women Promotion Centre has advocated for the creation of youth-friendly spaces where young people can access evidence-based information and services in a supportive manner so that they can be in charge of their reproductive health futures. In Mexico, Indigenous youth have been supported by Observatorio de Mortalidad Materna to claim their right to quality, culturally relevant health care and push back against discriminatory providers and norms.

In India, efforts are underway by Sahayog Society for Participatory Rural Development to ensure access to family planning as part of the country’s universal health coverage plan.

In the spirit of World Health Day, we challenge ourselves and others working for the greater good. We challenge all global health and development donors — including private foundations and bilateral and multilateral institutions — to prioritize equity in supporting and sharing financial decision-making with community partners.

We challenge policymakers to ground their decisions in evidence and prioritize comprehensive sexual and reproductive health care in health reforms, policies and funding. We challenge civil society to continue to speak truth to power and drive expansive, inclusive health actions for everyone — not merely the fortunate few.

It is past time to correct systems that are misaligned with the aspirations of women, youth and groups vulnerable to health disparities. If we hope to reconcile our work with systems of oppression and deliver on our promises of global progress, donors and decision-makers must recognize and value the perspectives and lived experiences of the very communities they desire to serve.

*Joyce Banda is the former president of the Republic of Malawi and founder of the Joyce Banda Foundation; Nabeeha Kazi Hutchins is the president and CEO of PAI. Population Action International.

*PAI works with policymakers in Washington, D.C. along with its network of global partners, to advocate for accessible, quality health care and advance the sexual and reproductive rights of women, girls and other vulnerable groups.


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