Nooryana is a midwife in Indonesia supporting pregnant patients who tested positive for COVID-19. Rosa Panggabean/CARE

What women on the frontlines have taught us about pandemic preparedness

At the beginning of the COVID-19 pandemic, people stood on the streets every night and cheered for frontline health workers. That spirit of solidarity has long since passed. Health workers are getting sick, burning out, going on strike, or leaving their jobs altogether.

We must invest in people and health systems that don’t just meet the needs of today, but so we're resilient in the face of future shocks as well. This means ensuring health care workers everywhere—the majority of whom are women—receive fair pay, decent working conditions, recognition, and leadership opportunities in the long term.

COVID-19 vaccine initiative project in Bangladesh. Asafuzzaman Captain/CARE Bangladesh
COVID-19 vaccine initiative project in Bangladesh. Asafuzzaman Captain/CARE Bangladesh

The evidence shows that we must invest in gender equality in health systems to prepare for and respond to the next pandemic. Gender equality raises life expectancies across entire countries, improves quality of life for everyone, and is even good for the economy. Investments in health workers could provide a $10 return for every $1 invested in the system.

There are three areas for investment that will lead to success. First, support women’s skills, leadership, and confidence. Second, connect women to each other and to men, leaders, and others in their communities. Third, ensure systems are more equal—from access to leadership roles to accessible childcare to social norms that support women’s mobility.

How have women kept systems running?

By building on investments that came before COVID-19, women have found innovative ways to keep systems running. They have  continued, and sometimes increased, health services during COVID-19 and other overlapping shocks to the health system. 

Globally, millions of women lost access to basic services because of COVID-19 and resources being diverted to pandemic response. When they had a foundation to build from, here’s what health workers accomplished:

  • Providing services and information. Women in savings groups in Myanmar used their own savings to become first responders and midwives during COVID-19 lockdowns so they could still get health services. In Bangladesh, skilled health entrepreneurs became certified vaccinators to administer COVID-19 vaccines and provided services for 2.8 million people. 
  • Innovating with technology. In Syria, health workers used telemedicine consultations to provide sexual and reproductive health (SRHR) services. In Cameroon, peer educators provided consultations and services for more than 32,000 HIV positive people in just 3 months, expanding services by 59% using WhatsApp, SMS, and other online platforms. 
  • Holding systems accountable. In Malawi, women and young people used community scorecards to advocate for an increase in the national budget for sexual and reproductive health, even as most countries were cutting those budgets to make room for COVID-19 response. In Niger, women’s groups negotiated for lower rates for women’s services at health centers so that the economic impacts of COVID-19 didn’t prevent refugees and those hosting them from getting the services they needed most. 
  • Building solidarity. In Colombia, women worked to get mental health services to health workers who were suffering from burnout and other impacts of COVID-19. In Tanzania, health workers focused on building trust with community members—especially young people—to ensure that people could access services and get the support they needed. In Benin, women in savings groups supported adolescent brides and survivors of gender based violence access health and legal services.
Mirwais Nasery/CARE
Mirwais Nasery/CARE

What investments are needed:

  1. Demand a more inclusive definition for Frontline Health Workers (FLHW)
  2. Co-design programs with and for women frontline health workers, including community health workers. Those doing the work must be at the decision-making table
  3. Require adequate protection, fair pay, and respect for frontline health workers
  4. Invest in gender-transformative, multi-dimensional empowerment approaches to unleash the full potential of frontline health workers
  5. Prioritize, invest in, and develop equity and inclusion-based local partnerships led by affected communities, particularly women, refugees, and other marginalized populations
  6. People-centered, inclusive, and accessible technology solutions
  7. Expand gender-transformative, market-based approaches for health system resilience

When more women lead in health care and in all sectors, we all benefit.