Feminist, rights-based solutions to address NCDs: Scaling-up grassroots innovations to create equitable solutions for NCD prevention and control.

Towards a global call-to-action to close the gender health gap

At the 67th session of the Commission on the Status of Women (CSW 67) in March 2023, global leaders, researchers, and advocates highlighted the disproportionate burden of NCD and associated risk factors and persistent gaps faced by women and girls in accessing NCD-related information, prevention, timely diagnosis, services, and support.

In response, civil society raised a call to action, setting out four priority actions for Member States to achieve progress towards the Sustainable Development Agenda 2030 and improve health services and outcomes for women and girls.

The call-to-action outlines feminist solutions to addressing NCDs along four strategic areas:

1. Scale up grassroots innovations creating equitable solutions for NCD prevention and control;
2. Integrate NCD services, including digital health solutions, into primary health care;
3. Support the full, meaningful, and active participation of women and girls in health-related decisions, including health planning, programming, and monitoring, and
4. Strengthen the evidence base on sex differences and gender inequities.

This article is the first in a four-part series discussing key aspects and concrete examples of feminist, rights-based solutions to address NCDs outlined in the call to action.

Grassroots innovations to create equitable solutions: A WHO NCD Lab project in Kenya

Most countries are off-track to meet Sustainable Development Goal (SDG) target 3.4 by 2030, to reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being.. Women and girls are at greater risk of being left behind due to experiencing a disproportionate burden of NCDs and associated risk factors. New, innovative and context-specific solutions are needed if the world is to achieve equitable progress on NCD targets. 

“Grassroots innovations identify clear needs and gaps in local communities.” emphasized Her Excellency Clar Marie Weah, First Lady of Liberia during CSW 67. Led by and tailored to local communities, bottom-up innovation holds the potential to respond to NCDs in contextualized, appropriate and sustainable ways. Similarly, grassroots innovations that are designed by women are more likely to address gendered risk factors and barriers to NCD services in local settings.

Identifying grassroots innovations developed by and for local communities to address NCDs is a core goal of the NCD Lab, a platform established by the WHO Global Coordination Mechanism on NCDs. The NCD Lab focus on Women and Girls, co-chaired by The George Institute for Global Health, supports such ambitious initiatives that promote gender equity and recognise the role of gender in the determinants and impacts of NCDs.

One example of a gender-transformative project is The Healthy Woman developed by Dr Susan Onyango, a nutritionist working with women living with HIV in Homa Bay County, Western Kenya.

When she noticed a trend from underweight to overweight and obesity among her female patients, coupled with a rise in diabetes and hypertension, Dr Onyango started the project to teach women about NCD prevention and control. Her work to build women’s skills and knowledge on how to grow various crops on household farms and incorporate them into a healthy, diversified diet, has since improved nutrition and food security in several participating households and allowed for sales of surplus farm produce.

The Healthy Woman project is considered gender-transformative because it strategically addresses unequal gender roles. Through health education and hands-on training in agri-nutrition, women are empowered to regain control of the land – a domain where decisions were made by men –and make healthy choices around food and nutrition for themselves, their families and their households.

Background: Feminist, rights-based innovations, and solutions to address NCDs

The landscape of women’s health has transformed over recent decades. Improved maternal and neonatal health programs, demographic changes, urbanization and shifts in global dietary and behavioral habits mean that NCDs are now the leading causes of death among women and girls globally. Two out of three women die from an NCD  – including cancer, diabetes, cardiovascular diseases, chronic respiratory diseases and mental health conditions– accounting for 19 million deaths every year, a majority of which occur in low- and middle-income countries.

Gender is a major social and structural driver of inequity in health, which is both linked to and exacerbated by NCDs and their associated risk factors. In many countries, women face limited access to timely, safe, and quality health services and information. Similarly, they are often more exposed to NCDs and their risk factors due to persistent social, gender and economic inequalities. Globally, health conditions that affect women more than men garner less funding.

The right of women, girls, and gender minorities to participate in decisions concerning their health and wellbeing and access affordable, quality healthcare at every stage of their lives is a cornerstone of health equity. A feminist approach to addressing NCDs can reduce discrimination and support gender-equitable health and development commitments. To close the gender health gap, developing and supporting grassroot innovations and collaborations that harness new technology, context-relevant research and implementation on the ground offer promising initiatives to reduce premature deaths from NCDs that are worth supporting and scaling.

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Feminist, rights-based solutions to address NCDs: Integrating NCD services and digital health solutions into primary health care.