To measure concepts as contextual as diversity and equality with a standardised, simple methodology may seem a fool’s errand. We recognise what has been called the ‘violence’ committed to nuanced concepts such as intersectionality when we attempt to reduce them to measurable indicators. Nonetheless, we are all aware that what gets measured, gets done.
Sample and criteria for inclusion
This Report reviews 201 organisations active in global health. GH5050 defines “global organisations” as those with a presence in at least three countries. The sample includes organisations actively involved in global health and those organisations that aim to influence global health policy even if this is not their core function. Inclusion of an organisation does not signify GH5050’s endorsement of its activities, nor that GH5050 considers the organisation to be contributing to advancing population level health in a positive direction. Rather, organisations under review have been identified as having demonstrated an interest in influencing global health and/or global health policy.
Over the past four years, the sample has shifted in its composition to account for 1) the thematic focus of the report each year, 2) continued efforts to identify global organisations headquartered in low- and middle-income countries, and 3) the general evolution of the global health architecture.
Ten sectors are represented in the 2021 sample:
1. Public-private partnerships (PPPs), defined as those partnerships with for-profit and public sectors represented on their governing bodies
2. UN system agencies working in the health, nutrition and labour fields
3. Bilateral and global multilateral organisations, including the 10 largest bilateral contributors of development assistance for health in the period 2005-2015
4. Funding bodies, including philanthropic organisations
5. Non-governmental and non-profit organisations, which can include industry groups registered as charitable organisations (e.g. 501(c)(3) in the US)
6. Private sector for-profit companies: Corporate participants in the Business and Health Action Group of the Global Business Council that provided a platform for the engagement of business in setting the health-related targets of the SDGs,1 or companies that contributed to consultations on the Uruguay Road Map on noncommunicable diseases
7. Consultancy firms with an interest in the health sector
8. Research and surveillance institutions
9. Faith-based organisations
10. Regional organisations
We recognise the limitations of grouping organisations by sector, particularly in light of the unique features of many in our sample that preclude distinct categorisation. We have sought to establish clear rationale for the categorisation of each organisation, at times directly with the organisation.
Approach and methods for data collection
GH5050 has developed a rigorous methodology that is consistent with established systematic review research methods. At least two reviewers extract each data item independently, and a third reviewer verifies the data. The reviewers discuss any discrepancies in data extraction until they reach a consensus. Data are coded according to content, using a traffic light system established in advance of data collection and refined iteratively. The codes in the GH5050 2021 report were updated from previous years, to bring further nuance and accuracy and as a result of invaluable ongoing discussions with organisations.
The data collected and analysed comes from publicly available websites and is in the public domain. Transparency and accountability are closely related and by relying on publicly available data we aim to hold organisations and stakeholders to account - including for having gender-related policies accessible to the public. Aside from human resources policies (see below), we do not ask for confidential information, information of a commercially sensitive nature or information that would identify individuals in organisations (other than the gender of the CEO, for example, which is publicly available for all included organisations).
This year’s report covers human resources policies - some of which remain internal to the organisation itself and have not been published in the public domain. At the start of our data collection we requested organisations to share relevant policies with us. The policies have been coded and we have indicated, where appropriate, when these were internal rather than public policies. As per ethical approval (see below), these internal policies were stored by us on secure servers and will be destroyed from our servers after an agreed length of time.
Several variables assess the availability and contents of policies. We do not consider newsletters or blogs as evidence of policy. Further, for workplace-related policies, we do not consider the contents of job advertisements as evidence of policy, Rather, we look for evidence of actual policies or an overall commitment from the organisation. This decision is also drawn from our concern that some people may not get as far as the job ads if they don’t see any commitment to equality in the main pages of the organisation itself.
Some organisations follow the workplace policies of host organisations or parent companies. In these cases, we used the same code as for the host/parent. For example, several organisations employ the workplace policies of the World Health Organization (WHO), e.g. Partnership for Maternal, Newborn and Child Health and the Alliance for Health Policy and Systems Research. Other non-workplace policy variables (e.g. gender parity in leadership, stated commitment to gender equality, etc.) are coded for each organisation individually.
For the corporate alliances and federations we looked for evidence of policies that were normatively gender equality-promoting. We did not accept evidence from members alone (e.g. IFBA has membership including Coca-Cola; we did not accept evidence of gender-responsive programmes from Coca-Cola for coding IFBA).
Data analysis and scoring for the variable on sex-disaggregated data was updated for the 2021 report. Where in the past we allocated a Green to those organisations for whom we were able to identify a single example of reporting sex-disaggregated data, in 2020 and in 2021 we reserved the Green scoring for those organisations regularly reporting sex-disaggregated data, or where we found explicit policy commitment to sex-disaggregated data. During data collection, we looked at those sites where we would reasonably expect to find disaggregation (e.g. annual reports or specific reports relating to a health issue). If data were not disaggregated, then we coded accordingly.
We used an earlier version of this methodology to review a small number of global health organisations and global PPPs in health. These reviews were published in peer-reviewed journals (The Lancet and Globalization and Health4) prior to 2017.
Engaging and validating results with organisations
We contact each organisation at least twice during the course of data verification. Initially we inform the CEO and head of human resources, or their equivalent, about the project and the start date of data collection, using email addresses found online. In that correspondence, we request the nomination and contact details of a focal point in the organisation who can review and validate the data once collected. Following completion of data collection, we send each organisation their preliminary results and ask them to review and provide any additional information, documentation or policies to review. In order to amend organisational scores, we request that organisations show us evidence in the public domain to support their amendment. Throughout the process of data collection, GH5050 encourages organisations to contact us to discuss queries about the process and the variables. Final results are shared with all organisations before publication.
The methods described above have been approved by the ethics committee of University College London, where GH5050 is housed. Consent from organisations was explicitly sought and received before internal, non-publicly available, policy documents were shared with GH5050. All confidential documents were stored on secure servers and will be destroyed after an agreed length of time.
Strengths and limitations
As far as we know, this is the only systematic attempt to assess how gender is understood and practiced by organisations working in and/or influencing the field of global health across multiple dimensions (commitment, workplace policy content, gender and geography of leadership and gender-responsive programming). While our efforts may have omitted relevant measures and do not include all active organisations, this method provides the opportunity to measure status quo and report on organisations' progress. This method has allowed us to shine a light on the state of gender equality in global health and organisations across all sectors have begun to respond to our call. We believe that the collection of data and information for measurement and accountability is a fundamental first step to change.
Research on the gender-responsiveness of organisations COVID-19 pandemic response activities: methods
We focused on programmes and activities that aim to control the health impacts of COVID-19, undertaken by the 201 organisations covered in this report. While we recognise the gendered impacts of COVID-19 across a range of social and economic areas, assessing these were beyond the scope of our review.
We performed a standardised review of publicly available information on organisations’ activities, published on organisations’ websites, and used the WHO Gender Responsive Assessment Scale to apply a standardised evaluation.
Our review focuses on organisational responses to COVID-19 within five pandemic control areas derived from the WHO Strategic Preparedness and Response Plan. The five areas of focus of the review were selected on the basis that: (i) they target the direct health impacts of the pandemic; (ii) prior evidence suggests that using a gender-responsive design would improve outcomes in this area; and (iii) they are relevant to the roles of global health organisations (not only national bodies). With these criteria, five areas from the WHO recommendations were identified and included:
- Research and development of vaccines, diagnostics and treatment
- Reducing exposure, promoting preventive behaviour, encouraging positive health behaviours
- Facilitating access to health services and systems
- Ensuring the protection and care of healthcare workers
- Supporting national and global COVID-19 surveillance.
We identified information on interventions related to the health impacts of COVID-19 in 140 of the 201 organisations.
We categorised the work of the organisation into at least one of the five pandemic response areas. Many organisations undertake activities in more than one area - and we assessed each programmatic area separately. To assess the gender-responsiveness of the programmatic areas, we applied the WHO Gender Responsiveness Assessment Scale which defines a set of criteria for assessing programmes and policies, ranging from gender unequal to gender transformative.
Each organisation was reviewed by at least one researcher. A random sample of 50 organisations were reviewed by two researchers. Any discrepancies were discussed and verified by a third researcher.
One limitation is that the sample only includes data that is published online by organisations. We recognise that, given capacity and resource constraints faced by some organisations in recent months, some of their activities may not be reported or regularly updated, and therefore this review likely does not include all relevant activities of organisations.
Some organisations are implementing programmes addressing the secondary impacts of the COVID-19 pandemic, such as gender-based violence, disruption of health services, and food and financial security - which are gender-responsive. These fall outside of the scope of this review which focuses on primary health impacts and therefore these organisations and/or activities have not been included.
1 GBCHealth. Business, Health and the SDGs. http://www.gbchealth.org/focal-pointroles/post-2015-workinggroup/
2 World Health Organization. (2017). Governance: Development of an outcome document for the WHO Global Conference on NCDs. http://www.who.int/ncds/governance/outcomedocument-global-conference/en/
3 Hawkes, S., & Buse, K. (2013). Gender and global health: Evidence, policy, and inconvenient truths. The Lancet, Volume 381 (9879), pp.1783-1787. https://www.thelancet.com/article/S0140- 6736(13)60253-6/pdf
4 Hawkes S, Buse K, & Kapilashrami A. (2017). Gender blind? An analysis of global public-private partnerships for health. Globalization and Health, 13 (1) pp.1-11. https://globalizationandhealth. biomedcentral.com/articles/10.1186/s12992-017-0249-1