Addressing social inequities head on – Interview with Roopa Dhatt, Executive Director, Women in Global Health

Roopa Dhatt was interviewed by Katri Bertram

In this interview, we discuss how partnerships are all unique and not linear, how Covid-19 has increased the sense of urgency in global health, and what the future for collaborative work could look like.

Could you tell us about your background, and why you co-founded Women in Global Health?

As a global health advocate and a physician, I encountered health inequities early in my career. It was when I was exposed to senior leadership in my clinical training and in global health that the lack of diversity in health leadership really hit me. Women deliver health and men lead it, despite women being the majority in the profession. Initially, I fell into this trap of thinking that maybe it was me and I was just in the wrong room. From candid conversations with senior women I learned how they had fought to clear a path for women and then found that mid-career women were still facing the same barriers. It was clear to me that gender inequity in global health leadership would not solve itself.

Having studied social movements, especially the civil rights movement, I was convinced that collective action was the only way to break down the deep-rooted power structures that shape global health. Doing so could transform global health into an enabling environment for all genders which in turn would benefit health for everyone.

The first step was to inspire collective action through a movement, so in 2015 four of us, all early career women who had come to the same conclusions, met on twitter and formed Women in Global Health. We had not originally planned to establish an organization but within two years, women were contacting us from all over the world offering to set up national chapters. We realized our movement was meeting a need and we registered as a formal legal entity in 2017 to enable us to raise funds and provide a platform for the growing network of chapters. It has become popular to use the term “movement” in global health, but all movements need a shared vision with a common goal at their center to succeed. Women in Global Health addresses social inequities head on.

How much time do you spend working with external partners in your role at Women in Global Health?

Connecting with people, groups, and potential partners has been core to building and sustaining a global movement. We had no funds to run events or campaigns when we started Women in Global Health so we joined with others to share resources and maximize our impact. Our partnership model allowed us to grow the movement, working with over 200 partners. Women in Global Health operated for over four years entirely staffed by volunteers, mainly using their personal funds. We ran and still run on woman power supported by partners who amplify our messages.

When we first started, we had a saying: “Everyone can leverage their influence to achieve gender equality in global health leadership”. Now, we are asking every organization to leverage their power and resources to achieve gender equality in global health leadership. I not only believe in the partnership model, but know for a fact that without partnerships we would not have had the impact we have had. Good partnerships lead to a greater impact and have enabled us to create a more sustainable and inclusive Women in Global Health movement. Through partnerships we have gained opportunities that would not have been possible otherwise. 

“I not only believe in the partnership model, but know for a fact that without partnerships we would not have had the impact we have had.”

Roopa Dhatt, Women in Global Health

Has Covid-19 changed your approach to engaging with partners? If yes, how?

Absolutely! Covid-19 has fostered a new way of doing business at Women in Global Health. The sense of urgency that Covid-19 created made it imperative that we focus on engagements that have value and impact.

At the same time, Women in Global Health has a flat leadership model and the pandemic has created new opportunities to learn from our national chapters and bring their work into the global space. For example, our Women in Global Health India chapter has profiled female frontline health and community workers, reaching a global audience. Such frontline workers are typically the invisible and unpaid female workforce holding up the base of the global health pyramid. Suddenly, women in the health and social care workforce, as well as the unpaid work done by women at work and at home, is being recognized and applauded. We say, however, that applause is welcome but decent work and an equal say in decision making is better.

The Covid-19 era has resulted in greater connectivity than ever before. While the digital divide remains, it is probably the first time that a wide range of global health stakeholders (governments, private sector, and community organizations) and especially women, can connect without visas and funds to travel to meetings. Women in Global Health is a virtual organization and we have always worked across borders but plenty of women in our network were unable to get visas to attend meetings in cities like London and New York. In one way, working digitally as we are now, is quite democratizing.  

We have also seen feminists in global health coming together quite spontaneously in informal groups, such as a Whatsapp group #COVID5050 hosted by Women in Global Health and the Gender and Covid-19 research focused group that we are part of. These groups have hundreds of members, mainly women, sharing experiences, data, tools, research and materials to find solutions to the pandemic we are all trying to make sense of.

Many of the Women in Global Health network are women on the frontlines of the pandemic, engaged as I have been myself, in patient care. These are extraordinary times, stressful and uncertain for us all and it is inspiring to see women working collaboratively, with solidarity and with no egos on Covid-19. This is the style we need throughout global health, no seeking the limelight, putting the mission before self. It motivates me to continue the fight with them to get a new social contract for women in global health when this particular emergency has subsided.

“These are extraordinary times, stressful and uncertain for us all and it is inspiring to see women working collaboratively, with solidarity and with no egos on Covid-19. This is the style we need throughout global health, no seeking the limelight, putting the mission before self.”

Roopa Dhatt, Women in Global Health

We’ve seen an increase in the ‘taking the lid off phenomena’ happening in society. Black Lives Matter triggered a global outcry against racism. The impact of that has forced people to self-reflect, sometimes in very uncomfortable ways. It has also led to calling out of the culture and practices of global health organizations. For Women in Global Health, we look to our partners, to see whether they align with our gender transformative leadership values. We’re focused on our tagline, ‘Challenging power and privilege for gender equity in health’. This leads us to question constantly who, how, when, and on what terms we partner.

How has your approach to partnerships changed since founding Women in Global Health?  

Our original goal was to shift leadership to be more gender balanced and diverse. So, we wanted to connect and work with anyone that was willing to join the cause. We had ambitious targets, reaching nearly 100 partners in the first two years, before we had even formalized as a registered nonprofit. We asked three critical questions: 1) Do we have a shared vision?, 2) Do we align on values?, and 3) Do we have common goals we can achieve together?

Since then, we have added a fourth question: Do we both benefit from the relationship in an equitable manner? We have learned the hard way that if we do not go into partnerships with clear mutually beneficial relationships that partnerships can become unequal, and they break. In the work of gender equality, where change takes decades to occur, we cannot afford to have partnerships that are not mutually equitable. We want our partners to be with us for the long term.

“We have learned the hard way that if we do not go into partnerships with clear mutually beneficial relationships that partnerships can become unequal, and they break.”

Roopa Dhatt, Women in Global Health

What in your view makes a good partnership? 

Shared vision, common goals, an alignment of values – co-creation, collaborative and commitment. Also, mutual respect, trust, and transparency. Other things help, such as interdependency, an equitable pooling of resources – whether its capital or thought leadership – sustainability, and focus.

Can you provide an example of a success that has been achieved because you have worked in partnership?

Yes! The launching of the 7^th ASK last year stands out. In response to the glaring lack of a gender equality in the Universal Health Coverage (UHC) agenda, Women in Global Health felt compelled to mobilize in the lead up to the high-level political declaration on UHC to ensure gender equality was a central focus. Months of trying to advocate behind the scenes and publicly were failing to get traction. Despite all our efforts and the advocacy of others, the crunch came when the ‘UHC2030 6 ASKS’ were released in the lead up to the multi-stakeholder forum with no mention of gender as a cross cutting issue. Those 6 ASKS were going forward to UN member states as the priorities of the UHC movement and half the world’s population had been left out.

That inspired WGH to co-convene with Women Deliver and IWHC the ‘Alliance for Gender Equality and Universal Health Coverage’. In six weeks, the Alliance had mobilized 107 organizations from 57 countries at every level of global health policymaking, ensuring that gender equality was central to UHC. The 23^rd of September 2019, was a historic moment for gender and health equity advocates, as the UHC Political Declaration “Universal health coverage: moving together to build a healthier world“ was the most gender mainstreamed global agreement ever and at the highest levels of policymaking. That was made possible by partnerships.

Some joined the Alliance formally, and many more supported the Alliance through opening doors, disseminating our work, and using our work to advocate for the cause. The Alliance continues to work together and advocate for gender equality in UHC. In some ways I was disappointed because it’s not up to women’s organizations alone to fight for gender equality but in this case, it was clear it would not happen if we did not champion the cause.

How would you define ‘impact’ and how would you know that you have achieved it?

Impact is not linear and often it’s a collection of efforts that lead to achieving a goal. The ripple effects can go well beyond the goal that was set and that is also impact. As an advocacy organization, we define impact at multiple levels – influence, reach, but most importantly transformation.

“Impact is not linear and often it’s a collection of efforts that lead to achieving a goal.”

Roopa Dhatt, Women in Global Health

Impact for us is transforming the global health agenda to be gender transformative. For example, the ‘call out’ function has transformed how “expert panels” are perceived, so fewer men feel comfortable with being on all male panels. Another example is that our global network of 23+ chapters, with 40 percent in low- and middle-income settings, has created opportunities for women who would otherwise not have them, to shape the health agenda locally, regionally, and globally.

Do you think organizations can have an impact without partners?

Yes, and no – I would say it depends on the type of impact and how you define partners. There is the rigid way of defining partners such as those with which one has a formal agreement. Using the movement mindset however, we consider everyone we collaborate with as partners. If we use that way of thinking about it, impact is limited without partners. 

“There is the rigid way of defining partners such as those with which one has a formal agreement. Using the movement mindset however, we consider everyone we collaborate with as partners.”

Roopa Dhatt, Women in Global Health

Partnerships sometimes run out of steam. How have you dealt with such situations?

Cultivating partnerships is an art, and all are unique. Those that are built on a deep understanding and created with a long-term vision don’t ‘run out of steam.’ Sometimes it’s fine to let the engine cool down and refuel for the next collaboration. Other times, it’s fine for the vehicle to venture off or circle around several times before it stops again in the same place. And it’s also totally fine if paths never cross again. Partnerships are meant to be dynamic and some are meant to end or transform or inspire new partnerships. It matters most what you do with the partnership when the vision and goals match, values align, and everybody is ready to get on board. 

When partnerships run out of energy, in an ideal scenario there is a clear exit. Regardless of the end, we have always made a point to acknowledge the work we did together. Too often history is written by those that claim it. We struggle a great deal with that in a global movement that is a movement first and organization second. At Women in Global Health, we try to leave the door open, so regardless of how the partnership ends, we remain open for dialogue, and future engagement.

If you look forward 5 to 10 years, would you hope that organizations work differently together? If yes, how?

Yes. Collaboration should be a measure of organizational success from strategic planning to implementation to evaluation. We are still struggling in global health to fully partner with each other and there can still be petty competition between people and organizations. Covid-19 has reminded everyone that global health is not a game, it’s not something that happens somewhere else or that can be divorced from economic or social progress. If we get this wrong, lives are lost and cut short. I am reminded every day that I see patients that health is socially and politically determined. To confront inequalities within and between countries in health we have to work together. Organizations are going to have to work differently, the world is becoming specialized and with that, collaboration will be the cornerstone of nearly any work.

“We are still struggling in global health to fully partner with each other and there can still be petty competition between people and organisations.”

Roopa Dhatt, Women in Global Health

Partnerships allow a way for organizations to pool resources and create outcomes and impact that would not be possible otherwise. Competitiveness and fear creeps into every aspect of global health work and leads us to be inefficient, ineffective, and vulnerable to profiteering entities. That way we lose important opportunities for impact. Covid-19 has to be the wake-up call that propels us to build back better equitable and gender responsive health systems. We have to make the death and devastation count for something.

Women in Global Health (WGH) is a global movement with the largest network of women and allies working to challenge power and privilege for gender equity in health. A US 501(c)(3) founded in 2015, WGH has grown to include over 25,000 supporters in 90 countries and has 23 official chapters, with a strong presence in low- and middle-income countries. The global team and its network of chapters drive change by mobilizing a diverse group of emerging women health leaders, by advocating to existing global health leaders to commit to transform their own institutions, and by holding these leaders accountable. WGH chapters have been established in Australasia, Canada, Chile, Finland, Germany, India, Ireland, Norway, Pakistan, Portugal, Somalia, Sweden and USA, with Cameroon, China, Malawi, Nigeria, South Africa, UK and Zambia under development. WGH also has regional affiliates in East and West Africa. WGH chapters have been established in Australasia, Canada, Chile, Finland, Germany, India, Ireland, Norway, Pakistan, Portugal, Somalia, Sweden and USA, with Cameroon, China, Malawi, Nigeria, South Africa, UK and Zambia under development. WGH also has regional affiliates in East and West Africa. You can find out more about WGH’s approach to partnerships here.

Summary of key takeaways:

• Partnerships and movements need a shared vision with a common goal at their center to succeed.
• Focusing on an organizational mission or tagline helps determine who, how, when, and on what terms to partner.
• Partners should share a vision, align on values, have common goals that can be achieved together, and both partners should benefit from the relationship in an equitable manner.
• Partnerships allow a way for organizations to pool resources and create outcomes and impact that would not be possible otherwise.
• For an advocacy organization, impact can be defined at multiple levels: influence, reach, transformation.
• When partnerships run out of energy, in an ideal scenario there is a clear exit.