Gender and Health Systems in Fragile and Shock-Prone Settings

Dr. Wesam Mansour, LSTM & ReBUILD for Resilience

I am Dr. Wesam Mansour, a Health Systems Researcher at the Liverpool School of Tropical Medicine (LSTM) and Chair of the Gender, Equity, and Justice Working Group for ReBUILD for Resilience. Having grown up in the Middle East and witnessed the devastating impacts of conflict on health systems, I have dedicated my career to rebuilding resilient, equitable health systems in fragile and shock-prone settings. I am submitting evidence to support the International Development Committee’s exploration of this area, drawing on my extensive experience in health system research, workforce resilience, and gender equity to inform impactful UK policies and aid strategies.

Why should the International Development Committee examine this area?

The intersection of gender and health systems in fragile and shock-prone (FASP) settings is a critical, yet underexplored area that impacts the effectiveness of UK Official Development Assistance (ODA). Women and girls in these contexts face disproportionate health risks, exacerbated by limited healthcare access, gender-based violence, and systemic inequities. Women also comprise most of the health workforce but often face inequitable conditions, low pay, and limited leadership opportunities. Addressing these challenges is key to fulfilling the UK’s International Women and Girls Strategy 2023-2030[1], which aims to integrate gender equality into 80% of aid programmes by 2030 and align with SDGs 3 and 5.

Why is it the right time for the Committee to examine the area?

Global challenges, including climate change, protracted conflicts, and economic instability, are exacerbating vulnerabilities in FASP settings. The COVID-19 pandemic further exposed the fragility of health systems and highlighted the gendered impacts of crises[2], leading to setbacks in women’s health, education, and economic participation. The UK’s renewed commitment to gender equality through the Women and Girls Strategy offers a timely opportunity to shape policies and funding that address these compounded challenges. Additionally, the approaching Comprehensive Review Process[3] of the SDGs in 2025 make this a critical moment to reaffirm and enhance commitments to gender equity in health.

Why would this area benefit from parliamentary scrutiny?

Parliamentary scrutiny is essential for ensuring accountability and transparency in the UK’s health funding, particularly in fragile settings. While the UK has pledged substantial funding to global health initiatives, there is limited evidence of its gender-specific impact in FASP settings. Close examination can identify gaps in funding, implementation, and monitoring of ODA projects targeting women’s health and rights, as well as assess how effectively gender considerations are integrated into health interventions. This scrutiny can also highlight critical issues, such as the challenges faced by women health workers, driving targeted interventions and mobilising public support for more equitable, inclusive policies.

Why does the Government need to act in this area?

Neglecting gender equality in fragile health systems undermines the UK’s development investments and deepens global inequities. Women’s health and well-being are crucial for economic recovery and societal stability, especially in post-crisis settings. Without targeted action, the UK’s leadership in advocating for global gender equity is at risk. Actions are vital to ensure aid programmes remain adaptive and resilient to future crises, safeguarding the most vulnerable populations and strengthening global health security.

How could Government policy in this area be developed or improved?

The Government should adopt a more comprehensive and intersectional approach to strengthen fragile health systems, including:

1. Prioritising investments in gender-sensitive health programmes in fragile settings e.g., sexual and reproductive health.
2. Protecting women health workers by improving pay, working conditions, and leadership opportunities for women.
3. Supporting local women’s groups to ensure culturally appropriate, community-driven and sustainable solutions.
4. Leveraging research and innovations that examine the intersection of gender, health, and fragility to inform evidence-based policies.
5. Integrating gender-responsive frameworks into all UK-funded health programmes.

By focusing on gender and health systems in FASP settings, the UK can reinforce its global leadership on gender equality and ensure that its aid programmes are both impactful and inclusive, adapting effectively to a rapidly changing global health agenda.

2