Advancing Women's Health in Africa Via a Data Driven Roadmap

Op-ed co-authored with Nyawira Njeru, Hologic, Head of Market Access & Government Affairs-Africa and Kaushal Shah, Africa Health Business, Head of Health Strategy
Healthy women are the cornerstones of healthy economies and societies. But women’s health rarely gets the attention that it deserves. By focusing on women’s health and working together to address key issues, we can not only improve women’s lives, we can also realize social and economic progress globally. To accomplish this, we need robust data on women’s health, and the ability to benchmark and track it over time on a global level.
Women’s health and health equity are arguably in a better place today than they were more than a few decades ago. However, progress on fundamental health challenges, including cancer, reproductive health issues, sexually transmitted diseases and violence against them. To keep moving forward, and save more women’s lives, leaders and policymakers need to understand the realities of women’s healthcare experiences.

To do that, they need access to robust, quality data that disaggregates this information by gender and exposes the inequities and what’s driving them. Critical data for global, regional and national development policymaking is still lacking. Many governments still do not have access to adequate data on their entire populations. This is particularly true for the poorest and most marginalized. The challenge is that in most of the world, these data are at best lacking, or at worst, non-existent.

The Hologic Global Women’s Health Index — a multiyear, globally comparative survey of women’s health — strives to fill the critical gap in what the world knows about the health and well-being of the world’s women and girls. But more than that, it aims to identify the keys to help them live longer, safer and healthier lives.
The Hologic Global Women’s Health Index is a global indicator of a healthy future for women
What is the Hologic Global Women’s Health Index?
Harnessing the statistical power and global reach of Gallup’s World Poll, the Hologic Global Women’s Health Index is a multiyear, globally comparative survey that tracks multiple health issues essential to improving the health, quality of life and life expectancy of the world’s women and girls.
Based on women’s responses in the first year of this survey, Hologic and Gallup developed the Hologic Global Women’s Health Index, an indicator of women’s health that country leaders and policymakers can use to help build a healthy and safe future for women.
The Hologic Global Women’s Health Index calculates a score for each of the 116 countries based on the women’s answers summarizes a host of complex factors that contribute to women’s health. A higher score on the overall Index means more women are having positive experiences in five dimensions that explain more than 80% of women’s average life expectancy at birth: Preventive Care, Basic Needs, Emotional Health, Opinions of Health and Safety, and Individual Health.
Global, regional and country-level results on the overall Index, as well as the five individual dimensions, are presented and discussed in further detail throughout this report. More technical details about the construction and scoring of the Index and the dimensions are available in the Appendix.
About Gallup’s World Poll
Since 2005, Gallup has been interviewing nationally representative samples of women and men in more than 160 countries and territories annually on core topics that are important to women’s lives, and to the rest of the world. All of Gallup’s core question items are disaggregated by gender.
What does the Index measure?
Using a factor analysis of the responses to these questions from nearly 60,000 women aged 15 and older, the Gallup and Hologic research team identified questions that related to five dimensions of women’s health that together explain more than 80% of women’s average life expectancy at birth.
Gallup calculated individual Index scores, first creating a simple average of the responses to the questions included in each dimension and then a weighted average of all dimension scores. This provides the foundation for the calculation of country averages and allows for a granular understanding of how different groups of women score differently based on health determinants — such as age, education, income, urban or rural status and women’s age of first pregnancy.
Why is the Index important?
Hologic and Gallup discovered that the Hologic Global Women’s Health Index is strongly related to women’s average life expectancy at birth — one of the most frequently used health status indicators reported and measured over time. The current data suggest positive improvements on any one of the five dimensions could potentially help women live healthier, longer lives. As it stands, these dimensions provide insights with the power to change countries and territories.
What are the goals for the Index?
The Index aims to provide country leaders and policymakers with an indicator and the data to understand what changes are needed that will help them improve the lives of women now and increase their longevity and quality of life in the future. By using a global ranking, and the data which resulted in these rankings, of countries and territories thus pinpointing what contributes to the greatest differences in women’s health scores, leaders can see where they stand relative to the rest of the world, identify their areas of strength and opportunities for improvement, and use those insights to direct their priorities and policies more effectively.
How does Africa compare to the world?
The findings in this report offer a glimpse into what Hologic learned about women’s health from the first year of this survey, which is based on interviews Gallup conducted throughout 2020 with just over 120,000 women and men aged 15 and older in 116 countries and territories. The Index was developed using the responses from 60,000 women and girls.
In analysing the results from 116 countries and territories in the Hologic Global Women’s Health Index, the study uses the following regional groupings: Australia/New Zealand, East Asia, Europe, South America, Central America, Caribbean, Western Asia, Northern America Central Asia, Sub-Saharan Africa and Northern Africa.
The relatively low coverage of African countries included in this first year of the Index, was largely due to inability to survey in areas requiring face to face interviewing in 2020. In 2021, the number of African countries has increased and we hope this will continue to increase over time.
Sub-Saharan Africa:
Benin, Burkina Faso, Cameroon, Congo, Ivory Coast, Ethiopia, Gabon, Ghana, Guinea, Kenya, Mali, Mauritius, Namibia, Nigeria, Senegal, South Africa, Tanzania, Uganda, Zambia, Zimbabwe
Northern Africa:
Algeria, Egypt, Morocco, Tunisia
Every country or territory has work to do
• Higher scores on the Hologic Global Women’s Health Index mean potentially healthier, safer and longer lives for women, but with a global score of just 54 out of 100, world leaders need to do better on women’s health. Index scores range between 0 to 100.

• Every country or territory has room to improve. Not one country or territory scores higher than a 69 on the Index.

• The countries and territories with the lowest scores on the Index all share high income inequality and weak or destabilized infrastructure for healthcare.

• The wide range in overall Index scores at the regional level, from a high of 64 in Australia/New Zealand to a low of 44 in South America illustrates the health inequity that exists for women across the planet. Sub- Saharan Africa (48) and Northern Africa (47) indicate women having negative health and healthcare experiences in this region.

• Mali (42), Tunisia (42), Republic of Congo (38) and Gabon (38) all placed within the bottom ten countries of the of the Index.
The world is weak on preventive care
• Sixty-one percent — or more than 1.5 billion women — did not get tested for any of the most damaging diseases for women in the past 12 months.

• On average, one in three women worldwide had their blood pressure tested in the previous 12 months — despite heart disease being the leading cause of death globally for women and men.

• Worldwide, just 12% of women said in 2020 that they have been tested for any type of cancer in the past 12 months.

• Worldwide, about one in five (19%) women reported being tested in the previous 12 months for diabetes, the sixth leading cause of death for women globally.

• Fewer than one in nine women had been tested for sexually transmitted diseases or infections — all of which are risk factors for HIV, cancer and infertility — in the previous 12 months.

• Country-level scores on the Preventive Care dimension in Africa range from a low of 8 in Ivory Coast, 10 in Mali, 11 in Nigeria and Ghana, 12 in Benin and Guinea to a high of 40 in Zambia and 43 in South Africa.

• Both Zambia and South Africa’s scores were boosted by relatively high levels of testing for high blood pressure and STDs/STIs.

• However, in contrast, in Ivory Coast, just 14% of women were tested for high blood pressure in the past year; less than 10% were tested for any of the other conditions.

• In Tanzania, for example, although 100% of women polled say regular check-ups improve women’s health, 70% say they had spoken with a healthcare professional in the past 12 months. The availability of healthcare and other social barriers may be a factor into the disconnect. In Tanzania, there is less than one doctor for every 1,000 people in the country.
Women’s emotional health suffered
• Women in 2020 were more worried and stressed, sad and angry, along with the rest of the world.

• About four in 10 women in 2020 say they experienced worry (40%) and stress (38%) during a lot of the day before the survey, while about one in four say they experienced sadness (26%) and anger (23%).

• Women — along with the world in 2020 — were feeling the worst they had in 15 years. Global experiences of worry, stress, sadness and anger continued to rise in 2020 and set new records.

• Country-level scores on the Emotional Health dimension in Africa range from a low of 48 in Tunisia and Ivory Coast to a high of 84 in Mauritius, where women are least likely to experience negative feelings on a daily basis.
Well over half a billion women do not feel safe walking alone at night
• More than 800 million women do not feel safe walking alone. Women are also less likely than men to feel safe.

• Higher scores on the Opinions of Health and Safety dimension mean more women feel safe and are satisfied with the quality and availability of healthcare where they live. Overall, women worldwide score a 70 on the Opinions of Health and Safety dimension.

• Majorities of women in sub-Saharan African countries say they do not feel safe walking alone at night where they live. Many of these countries have high intentional homicide rates.

• At the country level, women’s scores on the Opinions of Health and Safety dimension in Africa fall below the average – such as Gabon scoring the lowest (below 35).
Millions struggling with basic needs
• Hundreds of millions of women worldwide cannot afford the food and shelter that they or their families need.

• In 2020, 34% of women — or nearly 900 million women — struggled to afford food in the past year.

• Nearly three in 10 (29%) women — or nearly 700 million — say there had been times in the past year when they were unable to afford adequate shelter.

• Countries with the lowest scores on the Basic Needs dimension are almost all sub-Saharan African and Latin American countries — the two regions where women are struggling most to meet their basic needs.

• In Namibia, for example, which scores the worst in the world on Basic Needs, the percentage of women who could not afford food for their families has been holding above 70% since 2019. Drought and food shortages in the past few years have stressed low-wage earners in this upper-middle-income country.

• Zimbabwe (33), Kenya (33), Gabon (33), Zambia (34), Cameroon (34), Nigeria (38) and Benin (38) also score in the bottom set of countries for Women’s Basic Needs.
Individual Health: The World Needs to Help Women Manage Pain
• More than half a billion women worldwide spent a lot of the previous day in pain.

• More than half a billion women have health problems that keep them from normal activities.

• Countries with the lowest scores for women’s Individual Health are largely a mix of low to lower middle-income countries. In nearly all these countries, at least half of women report experiencing pain the previous day.

• In places such as Congo and Senegal, the percentage of women reporting health problems is about twice the global average. In a number of these countries, the picture in 2020 looked more dire than the previous year.

• In Egypt, which has the lowest score on this dimension, the percentage of women reporting that they experienced pain rose from 46% to a world-high 67%, and the percentage with health problems rose from 27% to 35%.
Data is Key
In Africa, achieving Universal Health Coverage (UHC) is a primary goal. UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

Yet, progress in translating these commitments into expanded domestic resources for health, effective development assistance, and ultimately, equitable and quality health services, and increased financial protection, has been slow. Countries that achieve their UHC targets by 2030 will eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and strengthen the foundations for long-term economic growth. Sadly, there’s little data to measure the continent’s progress.

The challenge of government is to improve the quality of life of citizens. To meet this challenge, a government has to come up with a clear and coherent set of ideas—a vision—and use available resources and instruments as efficiently as possible to produce the results that citizens expect. Achieving that vision as effectively as possible requires effective risk management—in other words, good governance and accurate data measurements to guide and track. What is not measured, cannot be managed. The best way to improve government is to improve government’s ability to manage risk and produce results. This could be achieved by a shift toward data-based policy making.
About Hologic
Hologic is a global, innovative medical technology company whose purpose is to enable healthier lives everywhere, every day. The company is a champion of women’s health and has clear industry-leading products in each of the categories that it operates in medical diagnostics, medical imaging systems and surgical devices.

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About Africa Health Business
Africa Health Business (AHB) is a pan African boutique consulting firm, headquartered in Nairobi, Kenya, that aims to improve access to equitable healthcare in Africa. Our expert team provides clients with effective, evidence-based solutions for today’s complex healthcare challenges. Clients in government, the development space and the private sector rely on our research and advisory to inform and transform interactions with and use of healthcare systems.

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