Soumya Swaminathan: a global role model with her feet firmly on the ground
One year after her appointment as Deputy Director-General for Programmes at the World Health Organization, Dr Soumya Swaminathan spoke to Elmien Wolvaardt Ellison about the value of women in global health.
You are responsible for WHO’s global health efforts. How do you approach this enormous brief?
My role is to ensure that there is a synergy, a coherence and a focus, and that we are working closely with our regional centres to ensure that what we translate everything we produce into actual health impacts on the ground. WHO is a normative agency for health. Countries around the world depend on WHO to produce guidelines and strategies for health to inform their own health policies. Sometimes, there is a gap between what we are asking people to do and their ability to actually implement things on the ground. This is for a variety of reasons: a lack of capacity in the country, financing, or there could be other reasons. So the focus of our work is to ensure that everything we do translates into health impacts and population benefits in countries.
What is the importance of gender in global health?
Gender plays a very big role. Over 60% of health care providers are women. In some countries this is even higher, because a large proportion of the community health workers and nurses who provide health care are women. If you want to conduct a programme successfully, therefore, it is very often linked to how you can empower these women more, in order to do their work more effectively.
WHO also applies the gender lens to programmes and to use data to drive policy. Gender is one of the indicators of equity in the way that health programmes cover populations. Next year we will be putting a lot of emphasis on measuring gender equity so that we can ensure that no-one is left behind.
Do you think it is important to have women leaders in global health?
Yes, I do! Women bring a different perspective to the delivery of services because, being a health care worker and a woman, you know what it means to balance your family and professional life, and you understand more about the triple burden of home care, child care and outside professional careers that women face. If there are places where women are not accessing care, female health workers have better insight into how certain cultural or social customs may be preventing women from accessing care.
When I sit in a boardroom, and there are mostly men, I have often noticed that women bring a very different perspective, dare I say perhaps a more humane and caring perspective, to the topic under discussion.
When did global health really start to matter to you?
I remember a visit to a remote area in Africa in 2009, when I worked as Coordinator of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). I saw patients with mycetoma, a chronic infection that is debilitating and painful, and will eventually completely incapacitate the person affected by it. When I saw whole villages of people with this disease, with hardly anything being done to treat them, I realised that there are lots of communities, far away from the eyes of people, who are suffering.
How important is it to you to get out there and visit communities? Do you still find the time to do that?
I think that is what keeps me going. I would die of frustration if I couldn’t do that! It’s been difficult to manage travel and a lot of responsibilities, but whenever I go to a conference or an official visit to a country, I make sure that I do a day trip and go into a rural area if possible, or just into the urban slums, to see what life is like and what the real problems are. It is very important to be grounded in that reality.
Do the difficulties women face relate to their lack of power, particularly in rural or traditional communities?
Yes, I think women are definitely disempowered. They are long-suffering and would rather prioritise the health of their men-folk and their children. This we see in many communities, but it is especially so in the more patriarchal ones.
There are also barriers for women in some cultures. For example, it may not be acceptable for a woman to go on her own to a health centre; she has to wait for her husband or brother to accompany her. It’s also not appropriate for male health workers to visit the homes of women when they are alone at home. Women cannot do this work either, because they are not allowed out and about independently. So there are many challenges for women, and this is something to keep in mind when we develop health programmes.
On the other hand, we have seen examples of many countries where female community health workers have become empowered because of the responsibilities that they now have, and because of the respect this generates in their own communities. The ASHA health workers in India and the Women’s Development Army in Ethiopia are examples of large programmes that have resulted in a lot of empowerment for women. Giving women that responsibility, that trust, and that position of some authority, is very important for the community to start respecting them.
Do you see any movement towards improved equality between women and men in the global health community?
I think leaders are definitely making an effort and beginning to commit to this. It is a process that takes place over a period of time and progress is not always visible. There is much recognition, and at least the issue is on the table when recruitment is done and positions filled, both in-country and globally.
Although I believe that important positions should be based on merit and the person’s capabilities for that role, not based on gender, there is also the question of women not applying. I’ve even seen this in my own career: when I’ve seen positions or job opportunities being advertised I haven’t felt confident enough to apply for them. I’ve always rated myself as needing more experience or needing to grow a little bit more in stature or maturity; whereas my male counterparts never hesitated to apply for positions that were clearly way above what they could have aspired to. So I think there is an issue of women’s self-assessment perhaps being more conservative, or women not having as much self-confidence as men in the same position. That is something we should work on.
Having a role model is so important. You won’t believe the number of letters and emails I have received from young women in medicine or public health who write that they see me as a role model and an inspiration: if a woman can make it to this position, then they have hope and a lot of optimism for staying in public health. It is really important to have role models from your own community and your own country as well, because you relate much more to that person. This is just as important as having global role models. In some countries, if you can see that – against all the odds – someone has become a health leader, that gives a lot of hope to young people.
Dr Soumya Swaminathan will be speaking at the Women Leaders in Global Health Conference 2018 in London. For updates, interviews and features, keep visiting our website or follow us using the hashtag #WLGH18.
About Elmien Wolvaardt
Elmien Wolvaardt is the Editor-in-Chief of the Community Eye Health Journal, an international publication for health workers, clinicians and policy makers responsible for eye health and the prevention of blindness in low- and middle-income countries. The Journal is published by the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine and is distributed free of charge in print and electronic formats, in three languages, to over 23,000 readers in 134 countries, thanks to the generous support of charitable organisations and foundations.