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Gender equality in the global health workplace: learning from a Somaliland–UK paired institutional partnership
  1. Roxanne C Keynejad1,
  2. Fikru Debebe Mekonnen2,
  3. Aziza Qabile3,
  4. Jibril Ibrahim Moussa Handuleh4,
  5. Mariam Abdillahi Dahir5,
  6. Mariam Mohamed Haji Rabi6,
  7. Cathy Read7,
  8. Edna Adan Ismail8
  1. 1 Health Service and Population Research department, King’s College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
  2. 2 Faculty of Public Health, Edna Adan University, Hargeisa, Somalia
  3. 3 Department of Obstetrics & Gynaecology, Kaah Community Hospital, Hargeisa, Somalia
  4. 4 Department of Psychiatry, Amoud College of Health Sciences, Borama, Somalia
  5. 5 Hargeisa Office, World Health Organization, Hargeisa, Somalia
  6. 6 Department of Internal Medicine, Hargeisa Group Hospital, Hargeisa, Somalia
  7. 7 King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK
  8. 8 Nursing & Midwifery, Edna Adan Hospital, Hargeisa, Somalia
  1. Correspondence to Dr Roxanne C Keynejad; roxanne.1.keynejad{at}


Worldwide recognition of gender inequality and discrimination following the #MeToo movement has been slow to reach the field of global health. Although international institutions have begun to address gender, the perspectives of front-line global health workers remain largely undocumented, especially in regions not captured by large-scale surveys. Long-term collaborative relationships between clinicians and educators participating in paired institutional partnerships can foster cross-cultural dialogue about potentially sensitive subjects. King’s Somaliland Partnership (KSP) has linked universities and hospitals in Somaliland and London, UK, for health education and improvement, since 2000.We collaboratively developed an anonymous, mixed methods, online survey to explore workplace experiences among Somaliland and UK-based staff and volunteers. We adapted the Workplace Prejudice/Discrimination Inventory to address gender inequality, alongside qualitative questions. Somaliland (but not UK) women reported significantly more gender prejudice and discrimination than men (medians=43 and 31, z=2.137, p=0.0326). While front-line Somaliland workers described overt gender discrimination more frequently, UK respondents reported subtler disadvantage at systemic levels. This first survey of its kind in Somaliland demonstrates the potential of global health partnerships to meaningfully explore sensitive subjects and identify solutions, involving a range of multidisciplinary stakeholders. We propose priority actions to address pervasive gender inequality and discrimination, including wider engagement of academia with gender-focused research, institutional actions to address barriers, national prioritisation and nurturing of grassroots initiatives, through institutional partnerships and international networks. Without sustained, concerted intervention across all levels, gender inequality will continue to hinder progress towards the vision of good health for all, everywhere.

  • gender
  • discrimination
  • workforce
  • health partnerships

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  • Handling editor Stephanie M Topp

  • Contributors RCK coordinated survey inception and design, applied for King’s College London ethics committee approval, coordinated thematic analysis, performed statistical analysis and led writing up. FDM contributed to survey design, applied for Somaliland Ministry of Health and Development approval, led survey dissemination, performed thematic analysis and contributed to writing up. AQ, JIMH, MAD and MMHR contributed to survey design, performed survey dissemination, thematic analysis and reviewed the final manuscript. CR provided senior advice on survey and study design, partnership working and ethics procedures and contributed to writing up. EAI provided senior advice on survey and study design, senior input to application for Somaliland Ministry of Health and Development approval, performed survey dissemination and reviewed the final manuscript.

  • Funding KSP receives funding from UK Department for International Development (Education), via British Council.

  • Disclaimer The funder played no role in study design, data collection, analysis, interpretation, writing-up or publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval King’s College London’s research ethics subcommittee (Ref: LRS-17/18-5508) and Somaliland’s national research committee and Ministry of Health Development director general (Ref: MOHD/DG:2/167/2018) approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All available data have been summarised in this article.

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