Co-authored by Huma Malik
Huma Malik is the co-founder and COO of Eniware. Ms. Malik has more than 20 years of experience in helping organizations achieve their objectives in project management, and inter-government and diplomatic interactions. She was formerly Deputy Director of the Islam Program at the Center for Strategic and International Studies.
As social entrepreneurs working to improve medical care in low-resource settings, we find ourselves perpetually faced with limitations created by the way that institutions talk about, think about, and fund global health. Instead of building health systems that can support the life-long health of citizens and withstand inevitable strain, we divide support into discrete categories that focus on addressing a specific issue -- HIV, Malaria, cancer, diabetes, mental illness, etc. If an innovative solution does not fit neatly into a category, there is no framework for funders to support its development and scale. In the wake of International Women's Day, with the lens focused on progress still needed for the wellbeing of women globally, we are especially struck by the ways in which this silo approach to healthcare has failed women.
"Maternal health," and "reproductive health," or even the more broad "women's health" categories do not encompass the full spectrum of a woman's medical needs. These can only be addressed by a functional, integrated health system. Reducing the health of women to narrow categories focused on pregnancy and childbirth misses the big picture. A woman cannot thrive in a system that provides obstetric care, but then cannot treat her child's birth defect with a simple surgical procedure, or cannot remedy her husband's debilitating chronic illness that erases her family's source of income. Global health has to move beyond the isolated categories. Our company is committed to being a catalyst for stronger health systems by providing a basic building block for safe medical care: sterile surgical instruments. On International Women's Day, I asked my co-founder at Eniware, Huma Malik, to reflect on some of the some of the stories she has heard from the women we meet on our travels around East Africa. Although everyone emphasizes the need for robust solutions to the problems of basic health infrastructure, the women demonstrated this need for Huma in particularly poignant ways.
As I traveled through Kenya, Uganda, and Tanzania, I heard numerous stories of women whose suffering was not relieved by a one-off interaction with the healthcare system. Someone who receives an emergency obstetric procedure would then contract a life-threatening infection because the clinic where the procedure was performed could not take the basic precaution of sterilizing the surgical instruments.
The intervention was correct, but a lack of resources for infection prevention (not specifically a woman's issue) made the intervention futile. In another example, a woman whose obstetric fistula was repaired was still unable to shake the trauma of being a social outcast, and the ostracism by her family and community. She got the appropriate treatment for her condition, but without the existence of any sort of mental health or public health education for the community, she was unable to reclaim her life.
The recent ravaging of the health systems of Liberia, Sierra Leone and Guinea by an Ebola outbreak demonstrates the urgent need for a focus on building strong systems to ensure the ongoing health of all citizens -- men and women alike. As these countries scrambled to respond to the immediate demands posed by the virus, any progress that had been made thanks to investment and attention to maternal and newborn health was nullified. Pregnant women were left without access to routine care regardless of their Ebola status, and death rates from completely preventable causes unrelated to Ebola sky rocketed. We must commit to strengthened health infrastructure across all categories of healthcare so that when systems are met with unexpected threats, essential care is sustained. Resources that have been funneled towards particular isolated causes can quickly be pulled away if there is an immediate deficit in a different part of the system. This instability threatens the health services that women receive in any country with a fragile system.
The Millennium Development goals are perhaps the most fundamental example of the silo effect in global health. While significant progress has been made in the broad goal of poverty reduction, two of the three goals that are directly related to healthcare are lagging far behind. The one healthcare goal that is on track is HIV and AIDS, which is the health problem that most successfully fits the categorical model. Reductions in maternal and child mortality, issues that cannot be addressed in isolation and require more than just a magic bullet treatment, are both way behind their targets. We hope that the next iteration of development goals will approach healthcare in more a holistic way, that will help to build strong health systems overall.
The true women's issue for global health is the development of strong health systems that can treat a whole person and their health needs, not just a few specific diseases. Of course, in countries that are cripplingly under-resourced, this might seem like too broad and ambitious an undertaking. But by focusing on the areas that will improve care across the spectrum of disease, and by moving away from the silos that have characterized global health goals to date, we can begin to make progress. We would suggest starting with a focus on increasing the healthcare workforce, and making basic surgery safe and accessible in all settings. Women (and men) all over the world are waiting.