Women-Write-Life: Partnerships for Advancing Global Health

Partnerships for Advancing Global Health

The What and How

It began with a simple yet powerful call: Professor Susan Elliott of the University of Waterloo reached out to Dr. Diana Karanja of COHESU Kenya and Mr. Kenneth Mugayehwenkyi of ROTOM Uganda, asking, "What were the major challenges women faced during COVID-19?" Without hesitation, their unified response echoed—teenage pregnancies. This marked the beginning of the Women Rise Together Across the Life Course (Write-life) project funded by IDRC to transform women’s health narratives in the wake of COVID-19. However, this moment wasn't the inception of their collaboration; it was a continuation of a partnership rooted in over a decade of shared dedication and impact. Professor Susan Elliot, who leads the Geographies of Health in Place (GoHelP) lab has extensive work in global water sanitation and hygiene (WASH), with a focus on the influence of geography on health and wellbeing. COHESU undertakes various activities in research and training to enhance the well-being of communities in Kenya, whereas ROTOM’s mission is to enable older persons to live a dignified and fulfilled life through various initiatives including empowering the children under their care.

The main goal of this research was to underscore the impact of work (paid & unpaid) on women’s wellbeing needs across the life course in Sub-Saharan Africa, while giving them a chance to write their futures and build back better after COVID-19. COVID-19 highlighted the disproportionate impacts of (global) health inequities on women and older persons, therefore, to address these challenges it was necessary to adopt a collaborative process that would support evidence-informed policymaking. The write-life project took an Integrated Knowledge Translation (IKT) approach which involved the researchers and the knowledge users working collaboratively throughout the project. Policymakers from both countries representing ministries of gender, environment, and WASH were included from inception as a commitment to making research findings applicable to knowledge users. Collaboration and meaningful engagement are key in advancing equity by facilitating evidence-informed policy and action. The research took place in Mukono, Uganda, and Kisumu, Kenya, to explore the political, economic, and sociocultural determinants influencing women’s health, work and well-being across the different spatial contexts. The implementation of the project across two countries constituted a unique aspect that was exclusively facilitated by the pre-existing collaborative partnership.

Partnerships for Advancing Health Equity

This long-term collaboration has been anchored in the principles of equity in global health research, which was reflected in the scope and methods used in this research project. The qualitative research methods adopted included life histories and engaging in deliberative dialogues, which encapsulated the participants’ subjective experiences and appreciated their tacit knowledge. Taking on a life course approach saw the inclusion of teenage and senior women, groups that have historically been marginalized due to their economic and social statuses, yet they were extremely vulnerable to the impacts of COVID-19. The shutdown of schools and urban-to-rural migration following the loss of employment had significant impacts on the psychosocial health and well-being of women by increasing the unpaid work and care burden in the household. Participants reported a rise in gender-based violence resulting in high teenage pregnancies, school dropouts, and early marriages. The effects of COVID-19 intersect with existing structural inequities and heightened vulnerabilities leading to adverse well-being outcomes. These findings corroborate previous research that pointed to the need for gender-transformative approaches for better health outcomes. 

Partnering authentically and building relationships with communities, local organizations, and policymakers, including focusing on reciprocity took the shape of supporting learning and capacity building for all project participants. In Uganda, the research assistants were ROTOM champions, a group of graduates who are the senior’s grandchildren. Beyond receiving training and capacity building in research, the champions also got opportunities for mentorship from other project members. Furthermore, this experience included an intercultural exchange with an opportunity to travel to Kisumu, Kenya, and engage in knowledge exchange with community health volunteers who conducted the data collection in Kenya.  For the research team, the project presented tremendous opportunities for learning, networking and collaboration among senior faculty, graduate students, community partners and other professionals. Moreover, the research team undertook skills development in Knowledge to Equity Action and Deliberative Dialogues with Dr. Katrina Plamondon of the Science of Health Equity lab, University of British Columbia.

Now What? Fostering Gender Transformation

The Write-life project supported gender transformative research on how women’s health and work (paid and unpaid) interact and intersect in the response and recovery of COVID-19. Gender transformation involves challenging and addressing systemic and social norms that perpetuate gender inequalities. In this regard, the project employed two strategies through community dialogues to promote shared decision-making in challenging traditional gender roles and by policy advocacy. Engaging in dialogues with community members and policymakers was particularly helpful in highlighting perceptions of gender roles and opportunities for individual and collective agency to enhance gender equality and community health outcomes.

Following the research findings, now what? The write-life project engaged in deliberative dialogues with the community and policy makers to discuss ways to respond to the causes of inequities. The dialogues’ goal was to present evidence to the community to take individual action towards transformation while guiding decision-makers to work with communities in resource-targeted problem-solving. Participants received a background document highlighting the findings from the research organized into respective categories; health, WASH, food security, work (paid and unpaid work), wealth, and seniors. The findings provided a spotlight on cross-cultural differences that produce place, influencing varied health outcomes between the two spaces: Kenya and Uganda. The relational design of the dialogues upheld participants' inclusivity by acknowledging each of their contributions with curiosity and humility. The facilitated roundtable discussions featured thought-provoking questions such as: ‘What learnings can we take away from this to better prepare for future pandemics?’ The conversations implored both individual and collective agency by asking participants to think about some actions they could take to improve their well-being following the presented research findings.

These dialogues integrated a practice of hope by empowering participants to utilize the resources within their reach to achieve their potential. The community participants remarked on the extent of impacts and challenges that women experienced, highlighting the differences between the two countries. They also underscored the intersectionality of different factors and the influence of cultural norms in shaping health outcomes for example in the case of gender-based violence, where victims often receive little support after reporting abuse due to a culture that shifts blame onto them. A resounding theme was the need for contextual policies and solutions that are designed and tailored to fit the specific needs of the communities. Policymakers emphasized the value of community participation in decision-making as well as the need to embrace a shift in mindsets and attitudes to enhance well-being. Both community participants and policymakers appreciated the need for changes in attitudes and social norms to enable progress in ending gender-based violence.

Conclusion

The write-life project drew on equity-cantered resources designed to ensure equitable engagement in global health research. All project activities focused on building an inclusive learning community that embraced a diversity in perspectives and positionalities, in both the research team and the participants. Taking on a relational approach reinforced that change happens in relationships and allyship is critical for achieving equitable global health.