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Summary box
Despite various international commitments to gender equality since the 1970s, significant gender gaps persist across various dimensions of human development.
Countries and private foundations have shown limited progress in allocating funds towards programmes and initiatives aimed at achieving gender equality.
The meager funds currently allocated towards achieving gender equality often fail to fund local organisations and are targeted towards addressing immediate issues rather than creating sustainable change.
The under-representation of women in global health leadership prevents a systemic approach to addressing gender inequality.
Donor countries and funding organisations should collect sex-disaggregated data to understand existing gender gaps and reform internal policies to ensure gender equality within their own institutions.
Donors should require recipients of funds to establish guidelines and policies to achieve gender parity in their leadership structures and to address barriers to gender equality within their projects.
Donors should also prioritise funding research institutions that examine often overlooked women’s health needs and priorities and focus on projects that demonstrate gender parity in implementation and in outcome.
By doing so, donor countries and private foundations can pave the way for equitable health outcomes for all, regardless of gender.
Introduction
Since the 1970s, countries across the globe and various institutions have declared their commitment to gender equality.1 The United Nations (UN) held the First World Conference on Women in Mexico City in 1975, bringing together representatives from 133 countries.2 The conference that cemented the world’s commitment to gender equality was the UN Fourth World Conference on Women in 1995 which brought together 17 000 official participants and 30 000 activists to Beijing, China.3 Participants devised the Beijing Declaration and Platform for Action which outlines commitments to 12 areas of concern and serves as a crucial guiding document even today. We have also had various landmark moments such the adoption of the Millennium Development Goals in 2000, the creation of UN Women in 2010 and the adoption of the Sustainable Development Goals in 2015.2
Despite the call for gender equality during the Beijing Declaration and Platform for Action on gender equality in 1995, critical gaps persist, the shortage of funding and the lack of women in leadership being among the main contributors. These factors contribute to the fact that women today are paid 23% less than men,4 that women account for 66% of the 750 million adults without basic literacy skills,5 and that they only serve as heads of state or government in 11% of countries.6 The lack of funding focused on gender equality has multiple causes ranging from inequity in fund allocation to the lack of gender disaggregated data to monitor and evaluate the effectiveness of allocated funds in reducing gender gaps.
Public funding
In 2017–2018, US$48.7 billion of bilateral aid from Organisation for Economic Co-operation and Development (OECD) countries focused on gender equality as a significant or mainstreamed policy objective, accounting for 42% of bilateral aid.7 While this is an improvement from the amount disbursed in the previous decade, the remaining 58% of this aid fails to meet the bare minimum, as per the definitions of the three point Development Assistance Committee (DAC) gender equality policy marker (significant, mainstreamed, not targeted).8 In other words, this means that the remaining 58% of the bilateral aid funds projects that do not collect sex-disaggregated data or projects that do not address specific gender-based barriers to access to basic services such as health.
Disappointingly, only a mere US$4.6 billion was allocated to programmes with gender equality as the main objective.7 Within the area of health, nearly half of the aid does not focus on achieving gender equality in access to healthcare services or in health outcomes. It is important to note that this gender marker only highlights objectives and not outcomes, which is a more important indicator of progress towards gender equality. Moreover, given the overhead and administrative costs associated with bilateral aid, it is not clear how much of this money is directly funding the progress towards gender equality.
We can also see further limitations of this bilateral aid when we evaluate the recipients of these funds. Only 1% of OECD DAC members’ aid between 2016 and 2017 that was focused on gender equality and women’s empowerment in 2016–2017 was directly allocated to local women’s organisations.9 Failure to fund local organisations advocating for gender equality is often a result of strict bureaucratic requirements that need to be revised to ensure the funds reach effective local actors.10 Financing decisions should be driven by outcomes rather than the simplicity of transferring the funds.
Funding from private foundations
We also need to see progress towards gender equality in the budget allocation of private foundations. One hundred and forty-three foundations included in the 2018 OECD survey of Private Philanthropy for Development donated over US$3.7 billion between 2013 and 2015 to support gender equality work, amounting to 16% of all philanthropic flows over these 3 years.11 While this is indicative of progress in the allocation of financial resources to address gender equality, this is not sufficient. Data on private philanthropy for development show that only 15% of funding from 26 of the world’s largest foundations had the objective of gender equality and women’s empowerment, while only 6% had the objective of gender equality as a primary objective, and another 9% as a secondary objective in 2017.11 In addition, a large volume of the resources of philanthropic arms are channelled through well-established civil society organisations and multilateral institutions focused on ‘gap-filling philanthropy’.11 This means that the allocation is provided to address immediate needs rather than to ensure structural, sustainable changes.
Women’s leadership in global health
To shift gears from gap-filling philanthropy to aid that promotes sustainable change, we need to empower more women into leadership positions. Women leaders are more likely to invest in and support policies and programmes that address issues which disproportionately affect women.12 Unfortunately, funding institutions remain disproportionately male led, making it clear that funding organisations are also lagging behind in ensuring gender equity in the recruitment for senior positions. Over 70% of chief executive officers and board chairs of organisations active in global health policy are men, while just 5% of leaders in low-income and middle-income countries are women.13 At the rate the world is progressing, we will not be able to see gender parity among Chief Executive Officers (CEOs) and senior management of these organisations for the next 40 and 50 years, respectively.14
Way forward: honouring the commitment to gender equality
Various organisations and individual advocates for gender equality have outlined several steps that countries and institutions must take to achieve gender equality. Among these leaders were attendees of the third Women Leaders in Global Health conference held at the University of Global Health Equity in 2019. These leaders designed A Call to Action to challenge gender inequities and advance equal opportunities for women.
Sex-disaggregated data collection internally and externally
Prior to implementing strategies to address gender inequality, foundations first need to understand existing challenges. The first step would be to collect sex-disaggregated data that reflects the extent to which women and men are considered in the identification, design and leadership of projects and the extent to which their specific needs and priorities are addressed in the design and implementation of various projects. By collecting such data, the projects supported by foundations will be able to respond to the challenges of gender inequalities and propose context-specific solutions to address them.
Reform in financing organisations
While we advocate for funding institutions to demand more from the organisations and projects they fund, we also acknowledge the fact that they must also lead by example. For instance, they must eliminate the gender pay gap and reevaluate hiring policies to ensure gender equality within their institutions. Organisations that adopt and implement policies that promote gender equality internally are more likely to reflect those values in the programmes they support or take part in. This will need deep institutional, organisational and systemic reform.
Strict conditionalities for recipients
Financing institutions can promote gender equality in recipient institutions by attaching clear conditionalities to the funds they provide. All institutions—whether private, public or public–private partnerships—need to establish guidelines to only fund and support institutions that have clear plans for gender parity (50/50 balance) in their board, leadership committee as well as in their staff composition with timelines that will make them accountable. Moreover, an immediate consideration for funders is to finance institutions that implement regulations to address the gender gap in wages and labour market participation. While we understand that this won’t happen overnight, we urge financing institutions to start these conversations with their recipient organisations.
Prioritisation of gender equality in funding of research institutions
In order to bridge the gap between commitments and gender equality outcomes in reality, all funding and research institutions should establish guidelines to devote 50% of health research funding to support projects and innovations that focus on women’s health needs and priorities. They should also ensure gender equality in the recruitment of subjects for clinical trials as women represent nearly 50% of the global population.15 Lastly, financing institutions should prioritise projects that demonstrate gender parity in implementation and in outcomes (with the exception of those projects which are established to address the special needs of one gender).
Conclusion
While many developments have ensued following multiple global commitments to achieving gender equality, we are far from reaching the goal of gender parity. The remaining gap is far too wide. It is our hope that recognition of the identified issues and the consideration of the recommendations put forth will incite a reevaluation of the structure and priorities of financing organisations based on gender disaggregated data and outcomes. This will promote gender-sensitive allocation of resources to finally honour the decades long unfulfilled commitment to gender equality.
Data availability statement
All data provided in the article can be found in the sources cited.
Ethics statements
Footnotes
Twitter @agnesbinagwaho, @Kedest_M, @bayinganaa
Contributors All authors contributed to drafting and reviewing the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.