Roadmap of the WHO Secretariat to advance gender equality, human rights and health equity 2023–2030
Roadmap of the WHO Secretariat to advance gender equality, human rights and health equity 2023–2030 Roadmap of the WHO Secretariat to advance gender equality, human rights and health equity 2023–2030 ISBN 978-92-4-008826-9 (electronic version) ISBN 978-92-4-008827-6 (print version) © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Design and layout by Annovi Design. iii Contents Introduction ....................................................................................................................... 1 Purpose ............................................................................................................................. 1 Principles and approaches ............................................................................................. 1 Six action areas ................................................................................................................ 2 1. Leadership, including advocacy and partnerships .................................................................... 2 2. Architecture ..................................................................................................................................... 2 3. Capacity-building ............................................................................................................................ 3 4. Resources, tools and technical assistance ................................................................................ 4 5. Organizational systems ................................................................................................................. 4 6. Accountability .................................................................................................................................. 5 Roles and responsibilities ............................................................................................... 5 Human and financial resources .................................................................................... 6 Contribution to the SDGs ................................................................................................ 6 Definitions ......................................................................................................................... 6 Considerations ................................................................................................................. 7 References ........................................................................................................................ 8 Annex 1. Monitoring and evaluation framework ......................................................... 8
1Introduction Significant progress has been made to improve life expectancy and other key markers of health and well-being in many countries around the world. However, many individuals and communities continue to be left behind. Gender-based and other forms of inequality, discrimination, human rights violations and abuses, as well as poverty and other determinants of health, underlie many health inequities and intersect in ways that limit people’s ability to make decisions about their own health, impede access to quality health services, and worsen physical and mental health outcomes (1). As a result, women and girls, gender-diverse people, Indigenous Peoples, minorities (national, ethnic, religious and linguistic (2)), people with disabilities, rural and remote communities, and others who experience discrimination, marginalization and deprivation, are often the least able to realize their right to the highest attainable standard of health. The need for action to address these injustices, reduce health inequities, safeguard human rights and prioritize the needs of those furthest behind has never been greater. In recent years, the impacts of COVID-19, conflict and climate change have highlighted and exacerbated many of these existing and pervasive inequalities, resulting in setbacks and undermining progress towards the Sustainable Development Goals (SDGs). The WHO Secretariat recognizes the need to better support Member States to advance gender equality, human rights and health equity to achieve their goals. This Roadmap describes the bold new action that the Secretariat will take to meet this need. Purpose The purpose of this Roadmap is to describe the actions that the WHO Secretariat will take to be fit-for-purpose to fulfil its commitment to support Member States to advance gender equality, human rights and health equity, and to ensure that no one’s health is left behind. The result will be that each relevant WHO programme, department and office is ready and able to support Member States to: implement gender-responsive approaches; respect, protect and fulfil the human right to health and health- related rights; and systematically identify, monitor and address health inequities. Principles and approaches In implementing this Roadmap, the WHO Secretariat will be guided by a set of principles and approaches that include intersectionality, evidence-informed action and people-centred health systems, and which do no harm. The Secretariat will ensure that gender-responsive, human rights-based and health equity approaches are integrated in all its work, including within responses to health emergencies, and will not deviate from these principles in times of crisis. 2Six action areas The bold steps required are grouped into six action areas: leadership, including advocacy and partnerships; architecture; capacity-building; resources, tools and technical assistance; organizational systems; and accountability. These areas for action are described below. 1. Leadership, including advocacy and partnerships For the WHO Secretariat to fully step into its role as an influential force for the promotion of gender equality, human rights and health equity, all relevant programme areas of the Secretariat will strengthen their leadership, advocacy and partnerships by: i) advocating for and promoting gender equality, human rights and health equity in its areas of responsibility; ii) promoting gender equality, human rights and equity in health in relevant inter-agency bodies; iii) contributing to global and regional United Nations (UN) policy processes and high-level development agendas to ensure consideration of gender equality, human rights and equity in the context of health; and iv) strengthening its partnerships with other UN and international health organizations, civil society and communities, academia and the private sector to leverage respective skills to advance gender equality, human rights and equity in health. 2. Architecture The WHO Secretariat will renew its architecture to better serve Member States by: i) establishing a high-level steering committee composed of WHO senior leaders to oversee and drive implementation of this Roadmap across the Organization, set organizational priorities and inform the Global Policy Group of progress, challenges and proposed remedial actions; ii) establishing a programme on gender equality, human rights and health equity (GRE Programme), led by a small dedicated department at headquarters and teams in regional offices, to strengthen collaboration, coordination, capacity-building and learning across the Organization, while developing and implementing technical and policy guidelines, norms and standards, and supporting Member States, on request, regarding gender equality, human rights and health equity; iii) establishing a network of gender equality, human rights and health equity staff (Global GRE Network), across all relevant technical and enabling departments at headquarters, regional offices and country offices, to drive implementation of the Roadmap across the Organization in support of their directors or WHO Representatives; iv) increasing the recruitment of staff with competencies and expertise in gender equality, human rights and health equity at the three levels of the Organization and ensuring that these staff are accountable for the integration of gender equality, human rights and health equity in their department’s or office’s work; v) strengthening the Secretariat’s human resources policies and practices to support a diverse, equitable, inclusive and gender-equal workplace at the three levels of the Organization; vi) promoting gender balance as well as diverse and inclusive representation and leadership in the Secretariat’s own advisory groups and panels; and vii) establishing an external advisory group to provide technical inputs to the GRE Programme for implementation of this road map. 33. Capacity-building The WHO Secretariat, led by the GRE Programme, will: i) develop and implement a capacity-building plan, renewed every three years and based on periodic all-staff capacity self-assessments, that includes online and in-person training courses, workshops for specific programmes and offices, webinars, opportunities for peer-to-peer learning, documenting and sharing of good practices, a roster of experts to be tapped for specific technical areas, and a one-stop-shop of key resources and reference materials; and ii) track the uptake of capacity-building opportunities by all relevant programmes and offices across the Organization and periodically review and report on the constraints, particularly related to the Global GRE Network members, composed of the GRE Programme at headquarters and regional offices, together with headquarters and regional office departmental focal points and country office focal points. All relevant programmes, departments and offices of the Secretariat will take responsibility for building their capacities to support Member States to: y Implement gender-responsive approaches, in the following ways: i) conduct gender analyses and respond to findings through the design of gender-responsive health policies and strategies, financing, information and education, and services; ii) increase understanding of sex and gender differentials and inequalities related to risk factors, exposures and manifestations of ill health, severity and frequency of diseases, health-seeking behaviours, access to care and experiences in health care settings, and outcomes and impact of ill health, as well as their root causes; and iii) advance equality and non-discrimination within the health workforce, including through supporting diversity and inclusion, strengthening women’s leadership, ensuring decent work free from all forms of discrimination, violence and harassment, addressing gender pay gaps and occupational segregation by gender, and increasing the capacity of health workers to deliver high-quality health services that are people-centred and responsive to diverse needs. y Respect, protect and fulfil the human right to health and health-related rights, in the following ways: i) identify and reform laws and policies, including discriminatory and punitive laws, that establish barriers to health and well-being, and implement existing laws and policies that promote gender equality and protect human rights; ii) strengthen legal recognition of and protections for the right to the highest attainable standard of health and implement recommendations from global and regional human rights mechanisms, including treaty bodies, universal periodic reviews and special rapporteurs, that impact health; iii) strengthen national health standards on culturally competent and human rights-based models of care and support their integration into health service delivery to ensure that services are universally available, accessible and acceptable, and of high quality; iv) strengthen labour standards and the protection of workers’ rights in the health sector; v) address systemic and structural causes of stigma and discrimination, including harmful social and cultural norms and practices, and provide options for positive change within the health sector and as part of multisectoral action; vi) establish and strengthen national mechanisms for the increasing citizens’ voice, including through the involvement of civil society, women’s and feminist groups, and community-based organizations in health governance, to increase health system responsiveness, transparency and accountability, and ensure that no one is left behind; vii) integrate human rights-based approaches in primary health care strategies towards the achievement of universal health coverage, and in health emergency preparedness and response; and viii) increase accountability and transparency of information on the quality, availability and pricing of essential medicines and health services, an essential component of human-rights based care. 4 y Systematically identify, monitor and address health inequities, and work to prevent them, in the following ways: i) gather and use timely, reliable and disaggregated data and evidence on barriers to health and health determinants to help to identify health inequities and their causes (including those related to gender, human rights and critical emerging global threats), inform evidence-based health policies and decision-making, and drive progress; ii) monitor, analyse and report on health inequalities to provide evidence on equity, gender inequality and human rights at the global, regional, national and subnational levels, through collecting and analysing data disaggregated by sex/gender, age, geographic location, place of residence, education level and economic status, where applicable, and other factors relevant in local contexts (e.g. migrant status, civil status, disability, race and ethnicity as social constructs, indigeneity) using health information and other data systems; iii) consider populations and communities that face structural and systemic barriers to access to health services and which experience disparate health outcomes, address the impacts of multiple and intersecting forms of discrimination and deprivation on their health, and promote human rights-based approaches to health for all; iv) develop equity-oriented health policies, strategies and programmes that are informed by equity analysis, barrier assessments and social participation approaches/cross-sectoral dialogue; v) identify and address social, economic, environmental, commercial and political determinants of health, including through multisectoral action and with due attention to global challenges such as climate change and rising social inequities; and vi) strengthen the interface between community systems, traditional medicine systems and the wider health system to better reach and meet the needs of people and communities left on the margins of health systems. 4. Resources, tools and technical assistance 4.1. To further support Member States to advance gender equality, human rights and health equity, all relevant programmes of the WHO Secretariat will: i) generate evidence on health inequalities, inequities and barriers to health; ii) use evidence in technical documents, technical assistance and reports; iii) share best practice with and between countries; iv) set the research agenda related to gender equality, human rights and health equity; and v) apply the Sex and Gender Equity in Research (SAGER) guidelines to clinical and health research. 4.2. To facilitate access and uptake, the GRE Programme will: vi) establish and maintain a repository of relevant resources and tools from across the relevant programmes; this repository will also include a roster of consultants with technical expertise in specific technical areas to support the integration of gender equality, human rights and health equity in the work of the Secretariat across the Organization. 5. Organizational systems The WHO Secretariat will ensure that: i) the biennial planning process supports the inclusion and tracking of budgeted activities on gender equality, human rights and health equity across all relevant budget centres, including the introduction of a gender marker, a human rights marker and a health equity marker to track and increase qualitative contribution of WHO products and services to gender equality, human rights and health equity andrelated expenditure in the budget centres over time; ii) all WHO programmes, departments and offices plan relevant top tasks and apply the gender marker, human rights marker and health equity marker, supported by the GRE Programme and the WHO Department for Planning, Resource Coordination and Performance Monitoring; iii) all financial resources available across the Organization from core, thematic or voluntary funding will increasingly fund activities that 5advance gender equality, human rights and health equity; and iv) all funding proposals from any programme area will dedicate some percentage (UN target is 15%) of total costs to advancing gender equality, human rights and health equity. 6. Accountability The WHO Secretariat will ensure accountability for the implementation of this Roadmap by: i) strengthening and making mandatory annual reporting on gender equality, human rights and health equity in organizational reporting mechanisms, including through the Output Scorecard dimension for impactful integration of gender, equity, human rights and disabilities; ii) commissioning evaluations to assess institutional performance on gender equality, human rights and health equity every five years and ensuring that WHO Secretariat-supported evaluations meet the UN Evaluation Group’s norms and standards on gender equality and human rights; iii) consistently reporting findings relevant to the Secretariat’s work on gender equality, human rights and health equity in institutional and targeted audit reports, including on implementation of this road map; iv) reporting on progress on gender equality, human rights and health equity, as relevant, through existing UN mechanisms including the UN System-Wide Action Plan (UN-SWAP) on Gender Equality and the Empowerment of Women (GEEW), the UN Secretary-General’s Call to Action for Human Rights, the UN Shared System Framework for Action on leaving no-one behind, the UN System-wide Plan of Action for the Third United Nations Decade on the Eradication of Poverty, the UN Disability Inclusion Strategy (UNDIS), and the UN System-Wide Action Plan on the Rights of Indigenous Peoples; v) producing a flagship global report biennially that captures the Secretariat’s work in implementing this Roadmap and the related impact in countries; and vi) tracking specific indicators against targets related to implementation of this Roadmap (see Annex 1). Roles and responsibilities WHO Representatives and all WHO directors are responsible for the implementation of this Roadmap and related reporting within their areas of oversight. They will ensure adequate staffing, budget space and funding to implement activities focused on gender equality, human rights and health equity, as well as integration of these issues throughout their work, and are held accountable for progress. WHO’s GRE Programme, which is being established in conjunction with this Roadmap, will: strengthen collaboration, coordination, capacity- building and learning across the Organization; develop and promote technical and policy guidelines, norms and standards; and provide technical assistance to Member States and technical programmes, on request, regarding gender equality, human rights and health equity. The Global GRE Network of focal points across the Organization will be the agents of change within technical and enabling departments and programmes. They will have primary responsibility for increasing the integration of gender equality, human rights and health equity into their areas of work, including through their programme’s leadership and advocacy activities, briefs and talking points, technical products and country support, as well as in strategies and plans, resource mobilization efforts, programmatic design and implementation, research, and policy dialogue with Member States. They will track their programme’s work in this regard, promote relevant guidance and tools, support the collection and analysis of disaggregated data and evidence, coordinate reporting and liaise with other programmes. All WHO staff will uphold and promote WHO’s values, commitments and positions on gender equality, human rights and health equity, and apply these lenses to their work, integrate actions on these issues into their work plans and implementation, and participate in opportunities to expand their own learning and competency to implement this work. 6Human and financial resources The WHO Secretariat will ensure the resources necessary to deliver on this Roadmap. The GRE Programme, and relevant departments and offices across the Organization, will mobilize additional voluntary funds to support their work in this area by including a budget line for gender equality, human rights and health equity in all donor proposals. Contribution to the SDGs This Roadmap is grounded in the WHO Secretariat’s commitment to support Member States to achieve the SDGs. By leveraging the Secretariat’s leadership, country support and technical expertise to accelerate progress on gender equality, human rights and health equity, the Secretariat will make a specific contribution towards achieving the goals to: ensure healthy lives and promote well-being for all at all ages (SDG 3); achieve gender equality and empower all women and girls (SDG 5); promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all (SDG 8); and reduce inequality within and among countries (SDG 10). It will also advance progress towards many of the other goals, particularly those that are linked to social, economic and environmental determinants of health, including poverty, nutrition, education, water and sanitation, energy and climate change. This Roadmap also underpins the achievement of WHO’s Thirteenth General Programme of Work (GPW13) by 2025, which aspires to ensure that more people are benefitting from universal health coverage, better protected from health emergencies, and enjoying better health and well-being. The GPW13 makes it clear that addressing gender equality, human rights and health equity through the Secretariat’s work at all levels, in all areas of health, is key to driving impact and improving health and well-being for all people, everywhere. Definitions Equity is the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, geographically or by other means of stratification. “Health equity” or “equity in health” implies that everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving it (3). Health inequality refers to a measurable difference in health across population subgroups defined according to dimensions of inequality. Health inequalities can be practically measured and monitored over time (4). Gender refers to socially constructed norms, roles and relations of and between women, men, boys, girls and gender diverse people, as well as expressions and identities of women, men, boys, girls and gender-diverse people (3). Gender norms, behaviours and roles influence people’s ability to access health care services, information and education; their experiences within health care settings; abilities to make and act on decisions about their health; and people’s roles, responsibilities, opportunities for leadership and pay within the health sector. Gender equality in health means that women, men and gender-diverse people have equal opportunities for realizing their full rights and potential to be healthy, free from violence, discrimination and coercion, contribute to health development, and benefit from the results (5). Gender-responsive approaches recognize and respond to gender differences in health and seek to address the underlying factors that contribute to gender inequalities in health. The human right to the highest attainable standard of health is recognized in the WHO Constitution as “one of the fundamental human rights of every human being” (6). Member States are obligated to progressively realize this right using the maximum available resources, while taking action to ensure non-retrogression. In doing so, they must also ensure: that people can enjoy this right equally, without discrimination; meaningful participation of stakeholders, including civil society and communities; and accountability. 7A human rights-based approach to health ensures that health policies, programmes and services are guided by human rights standards and principles (7). Intersectionality: Individual’s health and well-being are influenced by a range of factors, including their identities, relationships, income and other social factors, which intersect to create privilege or experiences of oppression, discrimination and marginalization, depending on their context. Intersectional approaches put intersectionality at the centre of decision-making, recognizing the impacts of multiple and intersecting forms of discrimination on health and actively seeking to address imbalances in power and inequities. People-centred: Individuals and communities are both beneficiaries of health care systems and active participants within them. People-centred approaches aim to empower individuals and communities with education, information and resources so that they can make and act on decisions about their health and actively participate in their own care; and design health systems to meet the needs and expectations of the people they are intended to serve. Evidence-informed: Evidence and data should be used to guide health policies and decision-making, increase understanding of, and ensure effective responses to inequities and gender- and human rights-related barriers to health to ensure that no one is left behind. The UN approach to “leaving no one behind” entails reaching the poorest of the poor and combatting discrimination and rising inequalities within and among countries, and their root causes. The principle is grounded in UN normative standards and human rights, including the rights to equality and non-discrimination. The principle of “do no harm” aims to avoid exposing people to additional risks through the Organization’s actions or perpetuating or exacerbating inequities, gender inequalities, or human rights violations and abuses, including through efforts to prevent and respond to sexual exploitation, abuse and harassment. Considerations This Roadmap is established for and applied by the WHO Secretariat, which will implement the Roadmap in accordance with applicable WHO rules, regulations and procedures, including the Framework of Engagement with Non-State Actors. In establishing this Roadmap, the WHO Secretariat is mindful that application of the standards and principles reflected in the Roadmap (which may include, without limitation, international human rights law) in a specific setting will depend on factors such as States’ policies and ratification of relevant human rights instruments, which the WHO Secretariat will take into account as applicable. This Roadmap will be implemented and applied in a manner consistent with related WHO policies on preventing and addressing abusive conduct, preventing sexual exploitation and improving diversity, equity and inclusion, among others. 1. 8Annex 1. Monitoring and evaluation framework The WHO Secretariat will measure implementation of this Roadmap through the indicators listed below. Percentage increase in scores on the following UN action plans related to gender equality, human rights and health equity: UN-SWAP on GEEW, UNDIS and UN-SWAP on the Rights of Indigenous Peoples (when available) 10% annual increase Percentage of WHO’s expenditure against the Programme Budget to advance gender equality and human rights 2025: 10% 2027: 15% 2030: 20% Percentage of gender marker scores at 2 or 3 2025: 50% 2027: 70% 2030: 100% Percentage of budget centres with a score of 3 on the Output Scorecard dimension for gender, equity, human rights and disability 2025: 30% 2027: 75% 2030: 100% Percentage of staff with capacity increased by at least 10% per biennium (definition TBC through biannual capacity self-assessment) 2025: 30% 2027: 70% 2030: 100% Percentage of Global GRE Network members with capacity increased by 10% annually (definition TBC through biannual capacity self-assessment) 2025: 50% 2027: 70% 2030: 100% References 1 For example: Williams DR, Lawrence JA, Davis BA, Vu C. Understanding how discrimination can affect health. Health Serv Res. 2019;54(Suppl 2):1374–88. doi:10.1111/1475-6773; Springer KW, Hankivsky O, Bates LM. Gender and health: relational, intersectional, and biosocial approaches. Soc Sci Med. 2012;74(11):1661– 6. doi:10.1016/j.socscimed.2012.03.001; Hawkes S, Allotey P, Elhadj AS, Clark J, Horton R. The Lancet Commission on Gender and Global Health. Lancet. 2020;396(10250):521– 2. doi:10.1016/S0140-6736(20)31547-6; Wright IA, Reid R, Shahid N, Ponce A, Nelson CM, Sanders J et al. Neighborhood characteristics, intersectional discrimination, mental health, and HIV outcomes among black women living with HIV, Southeastern United States, 2019-2020. Am J Public Health. 2022;112(S4):S433–43. doi:10.2105/AJPH.2021.306675. 2 In keeping with the Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities. General Assembly resolution 47/135. New York: United Nations; 1992 (https://www.ohchr.org/ sites/default/files/Documents/Publications/ GuideMinoritiesDeclarationen.pdf). 3 Innov8 approach for reviewing national health programmes to leave no one behind: technical handbook. Geneva: World Health Organization; 2016 (https://www. who.int/publications/i/item/9789241511391). 4 Handbook on health inequality monitoring: with a special focus on low- and middle-income countries. Geneva: World Health Organization; 2013 (https://www. who.int/docs/default-source/gho-documents/health- equity/handbook-on-health-inequality-monitoring/ handbook-on-health-inequality-monitoring.pdf). 5 Gender equality in health: improving equality and efficiency in achieving health for all. Washington, DC: Pan-American Health Organization; 2014 (https://www. paho.org/en/documents/gender-equality-health- improving-equality-efficiency-achieving-health-all). 6 Constitution of the World Health Organization. Geneva: World Health Organization; 1946 (https://apps.who.int/ gb/bd/PDF/bd47/EN/constitution-en.pdf). 7 The Right to Health. Geneva: Office of the High Commissioner on Human Rights, World Health Organization; 2008 (https://www.ohchr.org/sites/default/ files/Documents/Publications/Factsheet31.pdf). The WHO Secretariat will review progress in countries (as made available by the UN system) as a proxy for successful implementation of this Roadmap through the SDG targets and indicators below. SDG target Indicator Achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all (SDG target 3.8) Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, noncommunicable diseases and service capacity and access, among the general and the most disadvantaged population). 1.1.IND.17 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation (SDG target 5.2) Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months, by form of violence and by age. 3.1.IND.5 Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences (SDG target 5.6) Proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care. 3.1.IND.6 By 2030 achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value (SDG target 8.5) Number of countries reporting occupational health workforce data by gender/sex and by age (reported by Member States through the National Health Workforce Accounts data platform). 1.1.5IND.1 (by gender and age) Ensure equal opportunity and reduce inequalities of outcome, including through eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and actions in this regard (SDG target 10.3) Number of countries that have reformed/updated laws or policies to address gender- and human rights-related barriers to health World Health Organization 20, Avenue Appia 1211 Geneva 27 Switzerland