Integrating

equity,
gender,
human rights
and social
determinants into
the work of WHO

Roadmap
for
Action
(20142019)
WHO/FWC/GER/15.2

World Health Organization 2015

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.
int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27,
Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).
Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial
distribution should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/
copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the expres-
sion of any opinion whatsoever on the part of the World Health Organization concerning the legal status of
any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundar-
ies. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full
agreement.
The mention of specific companies or of certain manufacturers products does not imply that they are endorsed
or recommended by the World Health Organization in preference to others of a similar nature that are not men-
tioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital
letters.
All reasonable precautions have been taken by the World Health Organization to verify the information con-
tained in this publication. However, the published material is being distributed without warranty of any kind,
either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader.
In no event shall the World Health Organization be liable for damages arising from its use.
Cover design and layout by Jean-Claude Fattier
Printed by the WHO Document Production Services, Geneva, Switzerland
Contents

Summary iii

1. Introduction 1

2. Directions for Organization-wide integration of

WHO core values and approaches 2

Direction 1 3

Direction 2 7

Direction 3 11

3. Architecture for Organization-wide integration 15

4. Assumptions and adjustments 16

Summary

This document presents a Roadmap for Action, i.e., corporate integration of equity, human rights,
gender and social determinants across the World Health Organization (WHO): all programmes, offices
and key management processes. The Roadmap has three main directions:

1. provide guidance on the integration of sustainable approaches, which advance health equity, pro-
mote and protect human rights, are gender-responsive and address social determinants in WHO
programmes and institutional mechanisms;

2. promote disaggregated data analysis and health inequality monitoring;

3. provide guidance on the integration of sustainable approaches, which advance health equity,
promote and protect human rights, are gender-responsive and address social determinants, into
WHOs support at country level.

The primary audiences of the document are WHO programmes and offices, required to integrate WHO
core values and approaches, into the way they think, plan and operate. A secondary audience consists
of Member States and other contributors of resources who are knowledgeable about the 201617 Pro-
gramme budget and want to know how it links to roll-out of mainstreaming in practice.

The Roadmap for Action describes how the integration of equity, human rights, gender and social deter-
minants will be rolled out, including strategic milestones. A companion document, the Unifying Frame-
work Guide explains what integration of WHO core values and approaches means and provides illustrative
examples. The Roadmap for Action is expected to be adjusted in synchrony with WHOs management
cycle, i.e., the next adjustments will be in early 2016.

The Roadmap covers actions in four programme areas of the Twelfth General Programme of Work and
the Programme budget, i.e.: programme area 3.31 in full, and programme areas 3.42, 4.43 and 6.14
in part1. While the Roadmap is facilitated by the team, it is not the workplan or responsibility of a single
organizational entity or level. It should be noted that headquarter units and regions may have additional
actions depending on their specific mandates, circumstances and needs. Not all these actions are not
captured by the Roadmap.

1
3.3 Gender, equity and human rights mainstreaming; 2 3.4 Social determinants of health; 3 4.4 Health systems, information and evidence; 4 6.1 Leadership
and governance.

iii
1. Introduction
Health outcomes are not equal for people throughout the world, or even within countries. The under-
lying reasons are complex. Those differences that are avoidable and unacceptable are inequities. For
example, noncommunicable disease deaths occur at younger ages in low- and middle-income countries
compared to high-income ones (1); blindness prevalence is two to three times higher in women than
men in areas where trachoma infection is common (2); deaths among children under five years of age are
notably higher in rural than in urban populations (3); and the risk of complications of childbirth among
girls under 15 years old is much higher than for older women (4). While much work is already ongoing,
WHO has increased its commitment to support countries in reducing health inequities through policies
and programmes with which it is involved. In keeping
with its constitutional commitment that the highest
attainable standard of health is one of the fundamen- Of all forms of inequality,
tal rights of every human being (5); and in response
to a call from Member States to learn from and more
effectively utilize earlier efforts, the Director-General
injustice in health care is the
Margaret Chan has prioritized the mainstreaming of
equity, human rights, gender and social determinants
most inhumane.
across the Organization. The GER team, the Social
Determinants of Health (SDH) unit, the Health Statis-
Martin Luther King
tics and Information Systems (HSI) department, and
the Country Cooperation and UN Collaboration (CCU) department share a focus on tools. They and
their counterparts in the regional offices work together to reach out to programmes across WHO at all
three levels: Headquarters (HQ), regional offices and country offices. The approach to implementation
will promote cross-programme, cross-regional and cross-country collaboration and learning as well as
support for regional leadership.

This Roadmap aligns with the six leadership priorities of WHOs Twelfth General Programme of Work
(12th GPW):
1. universal health coverage;
2. the International Health Regulations (2005);
3. increasing access to medical products;
4. social, economic and environmental determinants;
5. noncommunicable diseases; and
6. health related Millennium Development Goals (MDG).

It also aligns as well as with WHOs commitment to wider UN mandates, including the United Nations
System-wide Action Plan for Implementation of the Chief Executives Board (CEB) Policy on Gender
Equality and the Empowerment of Women (UN SWAP), the UN Common Understanding on the Hu-
man Rights-Based Approach to Development Cooperation and the post-2015 Sustainable Develop-
ment Goals (SDGs) (6).
1
 The proposed SDGs are formulated much more holistically and comprehensively than the MDGs, have
a strong equity focus and suggest data disaggregation with a broad range of stratifiers: income, sex,
age, race, ethnicity, migratory status, disability, geographical location and other characteristics relevant
to the national contexts. With this focus, SDG 3 Ensure healthy lives and promote well-being for all
at all ages puts health at the centre-stage of sustainable development and confronts WHO with the
challenge of providing global public health leadership.

In a context of growing inequity, competition for scarce natural resources and a financial crisis threat-
ening basic entitlements to health care, it would be hard to find a better expression of health as a fun-
damental right, as a prerequisite for peace and security, equity, social justice, popular participation and
global solidarity... (6).

Integrating equity, human rights, gender and social determinants into all WHOs policies, programmes
and institutional mechanisms will build on lessons learnt in previous efforts to enhance the organization-
al culture and ability to support Member States in making sustainable health and development gains.

2. Directions for Organization-wide integration of

WHO core values and approaches
Integration of equity, human rights, gender and social determinants is expressed in the WHO 12th GPW,
in the Gender, Equity and Human Rights Mainstreaming Programme Area, Outcome 3.3: Gender,
equity and human rights integrated into the Secretariats and countries policies and programmes.
Three main directions as described in the following pages will be pursued in order to guide roll-out to
all programmes, offices and countries. The work is spearheaded by the GER team, in collaboration with
the HSI department, the SDH unit, the Planning, Resource Coordination & Performance Monitoring (PRP)
department, the CCU department, the Evaluation unit and the Office of the Director-General (DGO),
and reaches out through networks in programmes and offices.

2
Direction 1: Provide guidance on the integration of sustainable approaches, which
advance health equity, promote and protect human rights, are gender-responsive and ad-
dress social determinants in WHO programmes and institutional mechanisms

This direction will contribute to the delivery of 20162017 Programme budget (PB) outputs 3.3.1 Gen-
der, equity and human rights integrated in WHOs programme areas; 3.4.2 A social determinants of
health approach to improving health and reducing health inequities integrated in national, regional and
global health programmes and strategies, as well as in WHO2; and 6.1.1 Effective WHO leadership
and management in accordance with leadership priorities. Successful integration will begin with inte-
gration into key corporate processes and strengthening institutional capacity through technical guidance
and information dissemination networks to promote organizational change and culture transformation.
Cultivating dialogue and monitoring change will ensure commitment and accountability.

How (with examples of ongoing / planned action) Examples of achievements

Facilitate integration in key WHO corporate processes - Now included in the WHO Country Cooperation
- Essential mainstreaming criteria for operational planning and Strategy guide
monitoring - Now included in the WHO evaluation guide
- Integration into end-of-biennium review guidelines for - Now included in the WHO Handbook for
201415 guideline development
- Integration into guidance for PB 201819 preparation, including - The PB 201617 now includes GER in the
for outcome and output indicators and deliverables category and programme area narratives

Provide technical and capacity - building support for integration - E-learning course
in WHO programme areas and normative functions - New HQ staff induction briefing
- Unifying framework with examples and glossary - Briefings and training conducted in some coun-
- Briefing package for programmes and country offices try offices
- Seminars on how practically to integrate GER into guideline - Now included in the WHO representative hand-
development book (7).

Create WHO-wide focal point, collaborating centres and other - Regional and category focal points in place
external partner networks during the PB 201617 planning
- Develop a network guide
- Setting up and managing a comprehensive network

Foster multilateral, intersectoral dialogue for commitment to

integration and corresponding policy
- Policy panel discussions
- Collaboration with other UN agencies, including using the
informal UN Platform on social determinants of health

Review and document best practices for integration - 15 country and two cross-regional case studies
- Commissioning of studies on implementing human rights policies and
- Publication of experiences actions commissioned

Measured in indicator 3.3.1

2

3
 Direction 1 milestones until the end of 2019:
n Number of WHO programme areas that have integrated (PB 201617 output 3.3.1 indicator)
by 2017: 15 out of 30 programme areas
by 2019: 30 out of 30 programme areas

n Progress towards meeting the targets in the United Nations System-wide Action Plan (UN SWAP)
requirements (indicator for PB 201617 Outcome 6.1)
by 2017: 14 out of 15 performance indicators met or achieved. (Target 10 gender architecture
and parity will not have been met.)3
by 2019: (provisionally) 15 out of 15 performance indicators met or achieved

WHO-UN SWAP performance indicators: accountability (1) policy and plan; (2) gender-responsive performance management; (3) strategic planning; (4) results-based
3

management monitoring and reporting, oversight; (5) evaluation; (6) gender-responsive auditing; (7) programme review; human and financial; (8) resource tracking and
(9) allocation; (10) gender architecture and parity; (11) organizational culture; capacity; (12) capacity assessment and (13) development, coherence, knowledge and informa-
tion management; (14) knowledge generation and communication; (15) coherence.

4
Gender predicts misdiagnosis of mental disorders

Gender stereotypes affect health care providers

diagnosis of mental health disorders. Even when
presenting with identical symptoms, women are
more likely to be diagnosed with depression than
men, as they are generally viewed as more emo-
tional, and men are less likely to disclose symp-
tomatic information regarding their emotions
because of the gender construction of mascu-
linity. Similarly, men are more likely to be accu-
rately diagnosed with alcohol dependence than
women, as substance abuse is typically considered
a male issue. These stereotypes, which often
dwell unconsciously in the mind, demonstrate
the need for gender-awareness training in health
care providers to allow for more accurate diagno-
ses and treatment.
Gender disparities in mental health. Geneva: World Health
Organization
(http://www.who.int/mental_health/media/en/242.pdf)
5
Direction 2: Promote disaggregated data analysis and health inequality monitoring

This direction will contribute to delivery of PB 201617 outputs: 3.3.1 Gender, equity and human rights
integrated in WHOs programme areas; 3.3.2 Countries enabled to integrate and monitor gender,
equity and human rights in national health policies and programmes; 3.4.3 Trends in, and progress
on, action on social determinants of health and health equity monitored, including under the universal
health coverage framework and the proposed sustainable development goals4; and 4.4.1 Compre-
hensive monitoring of the global, regional and country health situation, trends, inequalities and deter-
minants, using global standards, including data collection and analysis to address data gaps and system
performance assessment.

Only by disaggregating and analysing data can populations in need of health services be identified and
included in informed policies and programmes. The global GER team together with the HSI department
and SDH are developing instruments and interactive tools for monitoring health inequalities, and inequi-
ties, providing the foundation for further integration.

How (with examples of ongoing/planned action) Examples of achievements

Develop materials to aid data disaggregation and integrated - WHO Health Equity Monitor
equity, human rights, gender and social determinants analy- - Handbook on health inequality monitoring in
sis across all levels of WHO English
- Monitoring intersectoral factors influencing equity- - Advocacy booklet on monitoring health inequal-
oriented progress towards Universal Health Coverage (UHC) ity and the accompanying video-clips
and health equity - PowerPoint lectures based on the handbook
- Handbook on health inequality monitoring, in Spanish, - The e-Learning module on health inequality
Arabic and French monitoring
- Advocacy booklet on monitoring health inequality, in
Spanish
- PowerPoint lectures based on the handbook, in Spanish

Facilitate equity, human rights, gender and social determi- - Interactive visualization report State of
nants situation analysis of existing quantitative and qualita- inequality
tive national data - Extensive capacity -building through regional
- Case studies being finalized for four countries: Bangladesh, training of trainers and HQ workshops on
Brazil, South Africa and Viet Nam health equity analysis
- Health equity assessment toolkit (HEAT)

Support capacity -building, including strengthening of health - Training of trainers

information systems, for country health inequality monitor- - Equity data analysis and interpretation capacity
ing with data disaggregated by pertinent strata -building workshops
- Global network of institutes for capacity -building on health - UHC PLoS equity paper (English)
inequality monitoring among Member States
- UHC PLoS equity paper in Spanish

Indicator/milestone to be determined.
4

7
 Direction 2 milestones until the end of 2019
n Additional countries monitoring inequalities in reproductive, maternal, neonatal and child health
indicators through data disaggregated at a minimum by age, sex, place of residence and wealth5
by 2017: four additional countries
by 2019: (provisionally) four additional countries

n Additional programmes6 monitoring inequalities through data disaggregated at a minimum by age,

sex, place of residence and wealth
by 2017: one additional programme
by 2019: (provisionally) one additional programme

5
93 countries are currently reporting reproductive, maternal, neonatal and child health indicators based on data from Demographic and Health Surveys/Multiple Indicator
Cluster Surveys to the Global Health Observatory Health Equity Monitor http://www.who.int/gho/health_equity/about/en/ (accessed 18 Aug 2014)
6
This could, e.g., be tuberculosis, noncommunicable diseases, ageing and health. However, this would require new resources something that might be feasible given the
focus on equity in the SDGs, including capacity building for data disaggregation (SDG17.18).

8
9
Direction 3: Provide guidance on the integration of sustainable approaches, which
advance health equity, promote and protect human rights, are gender-responsive and
address social determinants, into WHOs support at country level

The third direction builds on the first two and contributes to delivering on PB 201617 outputs: 3.3.1
Gender, equity and human rights integrated in WHOs programme areas; 3.3.2 Countries enabled
to integrate and monitor gender, equity and human rights in national health policies and programmes;
3.4.2 A social determinants of health approach to improving health and reducing health inequities in-
tegrated in national, regional and global health programmes and strategies, as well as in WHO; 4.1.1
Improved country governance capacity to formulate, implement and review comprehensive national
health policies, strategies and plans (including multisectoral action, and health in all policies and equity
policies); 4.2.1 Equitable integrated, people-centred service delivery systems in place in countries and
public-health approaches strengthened; and 6.1.1 Effective WHO leadership and management in ac-
cordance with leadership priorities.

Direction 3 requires working with disease- and condition-specific programmes as well as with health sys-
tems strengthening programmes at all three levels of WHO and aligned with the UHC goals. The global
GER team together with SDH, HSI, and CCU among others will work with regional offices depending on
the regional and country circumstances and requests, including facilitating multistakeholder review pro-
cesses leading to programmatic changes that address avoidable health outcome and access differences.

How (with examples of ongoing/planned action) Examples of achievements

Provide technical and capacity -building guidance for WHO - The review methodology has been applied in six
regional and country office support for action in countries countries previously and the revised version with hu-
- Finalization of the methodology for reviewing how na- man rights and gender strengthened is now being
tional health programmes can better address equity, human piloted in an additional eight countries.
rights, gender and social determinants - Regional and country focal points are systematically
- Change in global treaty monitoring process to ensure reviewing all draft Country Cooperation Strategies
health measures consistent with SDGs (provisionally SDG 3, for integration of equity, human rights, gender and
5, 10 and 17) social determinants

Provide technical assistance to Member States on integrating

equity, human rights, gender and social determinants into
national health policies, strategies and plans
- Materials and enhancing capacity for input across all three
levels of the Organization

Review and document best practices for rolling- out integra-

tion in countries
- Operations and action research in pilot countries

11
 Direction 3 milestones up to the end of 2019:
n Number of countries implementing at least two WHO-supported activities to integrate into their
health policies and programmes (PB 201617 output 3.3.2 indicator)
by 2017: 32 countries (up from 6)
by 2019: (provisionally) 56 countries

n Percentage of WHO Country Cooperation Strategies developed during the biennium that are explic-
itly guided by the Organizations core values and approaches based on equity, human rights, gender
and social determinants
by 2017: to be determined.
by 2019: to be determined

n Number of countries improving planning, implementation and monitoring of health programmes by

integrating social determinants of health and health equity in line with WHO-supported tools and
guidance (PB 201617 output 3.4.2 indicator)7
by 2017: 25 countries (up from 11)
by 2019: to be determined

SDH Unit has confirmed that the 3.4.2 indicator double-counts the review tool, i.e., the numbers in the 3.3.2 indicator milestone. However, the indicators appear in the
7

PB 201617 under two different Programme areas (3.3 and 3.4) in the version going to the World Health Assembly.

12
Ethnic minorities often excluded from health
programmes

Countries need increased capacity to revise and

reorient their health programmes to account for
the shortcomings that exclude vulnerable popula-
tions from equitable access to care.

An equity study conducted in Macedonia showed

that Roma women, who make up Europes
largest ethnic minority group, were more likely to
be excluded from a government maternal health
programme because of: lack of access due to
inadequately distributed physicians; lack of
appropriate documentation; and low levels of
education which inhibited their ability to access
care. They were also less likely to seek services
because of fear of discrimination by health
workers and fear of physical examinations for
cultural reasons.
13
3. Architecture for Organization-wide integration
Effective integration becomes a responsibility for the whole Organization from top to bottom and across
all programmes and offices. Organizational leadership and corporate services form the backbone of
successful mainstreaming of values and approaches to equity, human rights, gender and intersecting
social determinants in all areas of work8. Further, one of the proposed outcome indicators for the
Leadership and governance programme area is Proportion of WHO country cooperation strategies
developed during the biennium that are explicitly guided by the Organizations core values and ap-
proaches based on equity, human rights, gender and social determinants .

Systematic integration requires a multipronged approach combining organizational leadership capaci-

ties, hierarchies and accountability mechanisms as well as formal and informal networks across the
Organization. The facilitating centre for coordination is the global GER team. The Family, Womens and
Childrens Health Cluster collaborates closely with DGO and the General Management Cluster to sup-
port integration through their forums and processes, e.g., the Global Policy Group of Regional Directors
(GPG), the meeting of Assistant Directors General, Organization-wide planning, reporting and account-
ability processes, Category Networks and Programme Area Networks. This will include equipping these
with knowledge and instruments to exercise their leadership roles in integrating equity, human rights,
gender and social determinants into their respective domains of responsibility.

The GER team will expand and facilitate an Organization-wide network building on the lessons learnt
from the Priority Public Health Conditions Knowledge Network of the Commission on Social Deter-
minants of Health and other documented Organization-wide network experiences. This network will
include staff in key positions and functions as well as staff who have an interest in being champions of
change for the integration of equity, human rights, gender and social determinants. As a key tenet of
the network GER will encourage and foster cross-programme, cross-office and cross-country learning,
experience sharing and support.

8
PB 201617 Category 6, Corporate services/enabling functions.

15
 4. Assumptions and adjustments
A key assumption of the Roadmap and in particular its milestones is that the PBs 201415 and 201819
will be fully funded at the level of outputs and that there will be sufficient flexibility of the funding to
allocate the resources to the activities, staffing and budget centres as required.

Integration of equity, human rights, gender and social determinants of health requires cooperation of a
large and diverse group of actors across the Organization. Lessons from past experiences suggest that
having the right tools and structures is not enough continuous attention to the peoples part and ad-
justments to the process are required.

Further, the SDGs will be finalized by the UN General Assembly starting in September 2015. These goals
are likely to shape resource flows as well as demand from countries for the years to come.

Therefore, the Roadmap for Action will be adjusted at regular intervals according to WHO management
cycles with the first review scheduled to take place in early 2016.

References

1. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014 (http://www.who.int/nmh/
publications/ncd-status-report-2014/en/, accessed 23 June 2015).
2. Trachoma Fact sheet N382. Geneva: World Health Organization; 2015 (http://www.who.int/mediacentre/factsheets/fs382/en/,
accessed 23 June 2015).
3. Global Health Observatory Data Repository. Geneva: World Health Organization (http://apps.who.int/gho/data/?theme=main,
accessed 23 June 2015).
4. Maternal mortality Fact sheet N348. Geneva: World Health Organization; 2014 (http://www.who.int/mediacentre/factsheets/
fs348/en/, accessed 23 June 2015).
5. Constitution of the World Health Organization. Geneva: World Trade Organization; 1946 (http://apps.who.int/gb/bd/PDF/bd48/
basic-documents-48th-edition-en.pdf#page=7, accessed 23 June 2015).
6. Twelfth General Programme of Work. Geneva: World Health Organization; 2014 http://apps.who.int/iris/bit-
stream/10665/112792/1/GPW_2014-2019_eng.pdf?ua=1, accessed 23 June 2015).
7. Handbook for the induction of Heads of WHO Offices in countries, territories and areas. Geneva: World Health Organization; 2014
(http://apps.who.int/iris/bitstream/10665/136490/1/HandbookforInductionofHeadsofWHO offices_en.pdf, accessed 28 June
2015).
8. Review and reorientation of the Programme for active health protection of mothers and children for greater health equity in the
former Yugoslav Republic of Macedonia. Roma Health Case Study Series No. 2. Copenhagen: WHO Regional Office for Europe;
2015 (http://www.euro.who.int/__data/assets/pdf_file/0008/276479/Review-Programme-active-health-protection-mothers-
children-greater-health-equity-en.pdf, accessed 23 June 2015).

16
 Integrating
equity,
gender,
human rights
and social
determinants into
the work of WHO

Roadmap
for
Action
(20142019)
WHO/FWC/GER/15.2

World Health Organization 2015

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.
int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27,
Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).
Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial
distribution should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/
copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the expres-
sion of any opinion whatsoever on the part of the World Health Organization concerning the legal status of
any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundar-
ies. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full
agreement.
The mention of specific companies or of certain manufacturers products does not imply that they are endorsed
or recommended by the World Health Organization in preference to others of a similar nature that are not men-
tioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital
letters.
All reasonable precautions have been taken by the World Health Organization to verify the information con-
tained in this publication. However, the published material is being distributed without warranty of any kind,
either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader.
In no event shall the World Health Organization be liable for damages arising from its use.
Cover design and layout by Jean-Claude Fattier
Printed by the WHO Document Production Services, Geneva, Switzerland