Gender, equality and social inclusion (Nov 2022)

TDDA strategy for ensuring health security efforts respond to the needs of everyone.


Why do Gender, Equality and Social Inclusion matter?


COVID-19 taught the world important lessons about health inequality. It is clear that the impacts of the pandemic have been experienced very differently by people in different economic, cultural and geographic circumstances.

Poorer, marginalized communities, women, children and disabled people - even where they were aware of the risks - were often unable to adapt their living and working conditions to avoid infection. Women, for example, are over-represented in frontline healthcare provision and often carry out informal caring roles within communities, meaning they could do little to reduce their exposure to the virus. Frequently, poorer people’s access to healthcare is limited and underlying health conditions put them at an even greater risk. In addition, emerging data show pre-existing sexual and reproductive health inequities were compounded by COVID, and stay at home orders left some women and girls more vulnerable to domestic violence, which intensified globally. In short: the consequences of the pandemic were far more severe for those in positions of vulnerability and with limited social and economic capital to fall back on.

Health inequalities are a form of social injustice. They can have a knock-on effect on all members of society and on economies. Without addressing the disparities in risk, access to prevention and treatment, as well as physical and economic resilience, infectious diseases will continue to spread to the detriment of everybody.


Health disparities are preventable and interventions to reduce health inequalities are shown to be cost-effective. Gender, Equality and Social Inclusion (GESI)

considerations, when not fully understood, can however be viewed as an unnecessary additional complexity for countries already dealing with multiple health security challenges with limited resources. Yet incorporating GESI considerations into health security strategies and implementation plans makes sense: it’s fair, and has a positive return on effectiveness.


What can be done?


Health security structures and systems need to understand how all people, including those with vulnerabilities, are affected by disease outbreaks. They need to recognize the interplay between social context, roles and increased risk. This understanding enables them to identify appropriate actions, so that everyone can access reliable information about health risks, prevention measures, and can benefit from response services, as well as the opportunities for all parts of society to contribute directly to better outbreak prevention and control.

TDDA developed a GESI strategy to support countries to develop and implement health security policies and plans that include a focus on the diverse needs of individuals and their communities.


Some of our actions


TDDA shared and promoted its GESI strategy among government stakeholders and other partners, who have key roles to play in integrating equity and inclusion into health security efforts for the long term. Most of our work in the time we had available centred on raising awareness and developing training and tools. We developed briefing notes, presentations and training modules to support equity within health security interventions, which we tailored to the needs and opportunities we had identified in each country.

  • Through our advocacy, TDDA built consensus among National One Health Platform (NOHP) members on GESI and its importance when prioritizing National Action Plan for Health Security activities. We also supported GESI-focused training for NOHP personnel.

  • Our capacity-building work with Civil Society Organizations included focused training on the importance of identifying GESI dimensions to their work in health. We also supported them to develop approaches for engaging disadvantaged and vulnerable people.

  • We helped train border officials in Cameroon, Chad and Uganda, integrating GESI content into existing training curricula and/or developing stand-alone GESI training modules. We also created simple, tailored guidance on safe and respectful handling of travellers with additional vulnerabilities.

  • In Uganda, we assisted the government to develop a roadmap for integrating GESI into the One Health documents, plans, and strategies. We also supported a wide stakeholder consultation, convened by the Ministry of Health and involving around 40 participants, to build commitment to follow the roadmap as these documents come up for renewal.

  • In Mali, the TDDA country team collaborated with the network of gender focal points, sharing analysis and jointly delivering GESI training for the One Health focal point network – another good example of the sustainable capacity-building approach that was integral to TDDA’s GESI strategy.

What next?


Many of the steps identified in our GESI strategy require a longer timeframe to be fully implemented. Through our discussions with country stakeholders, our work during the programme and the collection of resources we leave behind in country, we hope to have provided starting points for governments and partners to continue to implement the GESI-related actions after TDDA’s close. In this way, we hope our focus countries can significantly advance health security through policies, plans and actions that anticipate and respond to the needs of all people.