Feminist, rights-based partnerships: a key to sustainable gender-transformative health outcomes

Recently, we’ve all borne witness to unprecedented attacks on human rights and a shrinking civic space. Among the most alarming outcomes is the severe endangerment of the sexual and reproductive health and rights (SRHR) of those who are already most at risk, leading to reduced access to comprehensive sexuality education, contraceptives, safe abortion, sexually transmitted infection (STI) prevention and management, and gender affirming care. 

Despite severe under-resourcing, feminist activists, local women’s and 2SLGBTQIA+ rights organizations and other rights-based groups remain key actors for change. Their efforts towards gender equality range from social norm and behavioral change to being the first point of contact for those in need of emergency services. Partnering with local, feminist, rights-based organizations is a core strategy of any gender responsive or transformative program, particularly in the areas of strengthening healthcare access and advancing SRHR in contextually-relevant and locally-led ways. 

This blog documents select evidence-based approaches, and provides a roadmap to donors and health rights focused partner organizations in the Global North to engage local rights-based organizations.

Placing local Women’s Rights Organizations (WROs) and Youth-Led Organizations (YLOs) at the center of gender transformative health programming

Many health programs that are designed as gender-transformative adopt a socioecological approach, with interventions at the individual, community, institutional and policy levels. They also target a diverse range of stakeholders to collectively address root causes of social and gender inequalities that impede the health and rights of marginalized groups. This typically includes increasing agency of rights holders, particularly girls and young women, on health and related issues. It also includes sensitizing gatekeepers such as caregivers, male partners, women power holders and religious and traditional leaders as change agents, and training health and protection service providers and policy makers for improved design and strengthened delivery of gender and adolescent responsive and inclusive services. 

While health interventions are often implemented with local partners, rarely are these partners feminist collectives, WROs or YLOs. Reasons for this may include limited resources within WROs for compliance controls mandated by international donors, weak alliances with power holders such as local governments, limited ability to implement large grants or a lack of capacity to secure international funding. Furthermore, rarely are the terms of partnership with local actors aligned with feminist principles of valuing locally-led development, equitable decision-making, capacity and resource sharing. 

Protecting and promoting WROs andYLOs-led development and action

At the core of feminist partnerships is strengthening the agency and decision making power of local actors, such that they not only participate in design processes, but lead them. Barriers to gender equality differ across and within communities; therefore, leveraging the invaluable insights of WROs, YLOs and other Civil Society Organizations (CSOs) is crucial for effective, accountable and sustainable change. 

Aga Khan Foundation (AKF) and Global Affairs Canada’s Foundations for Health and Empowerment (F4HE) and Foundations for Education and Empowerment (F4EE) projects both include an Advancing Gender Equality through Civil Society sub-component, which supports local organizations to lead, design and implement gender-transformative initiatives in ways that are relevant and contextually-informed. Advancing Gender Equality through Civil Society (AGECS), an F4EE sub-project, works alongside community organizations to enhance gender equality and transformative change through a locally-led approach.

Another example is the Kigali Declaration on NTDs, a global advocacy tool to support the ambitious goals of the World Health Organization (WHO) NTD Roadmap 2030 which recognizes the power of youth as change agents in health promotion and policy leadership locally, internationally and regionally. 

Plan International’s new position paper on locally-led, globally-connected sums up this approach by pledging to use and challenge its existing privilege and power to shift decision-making and resources closer to the point of impact, inclusive of building equitable partnerships with youth and women-led organizations.

Another example that recognizes the unique and critical role of youth as change agents is  the Aga Khan Foundation’s Strengthening Partnerships to Advance Sexual and Reproductive Health and Rights of Women and Adolescents in Cabo Delgado, Mozambique (SPARC). The project works with in-school adolescent peer educator groups and adolescent out of school girl mentor groups to enhance SRHR, with specific focus on community-based family planning (FP) and early pregnancy reduction. 

Prioritizing WROs andYLOs institutional strengthening

Despite the many gains in local development being led by local actors, studies by UNFPA have highlighted that many WROs and YLOs lack the technical, financial, and managerial capacity to effectively address health challenges. To bridge this capacity gap, large health projects can leverage tools designed to strengthen WRO and YLO organizational systems. This  empowers them to advance SRHR at the local level, promotes health and rights awareness and increases access to sexual health services and psychosocial support, particularly for women and girls. 

Plan International’s ASPIRE project in Nigeria follows a three-fold approach of strengthening health systems, building agency of rights-holders and offering flexible funding and mentorship support to local WROs and YLOs to advance the SRHR of adolescents and youth. WROs and YLOs first identified organizational needs through a participatory self-assessment tool. Results from the assessment then informed a comprehensive capacity sharing initiative, resulting in skills building in topics ranging from technical knowledge of gender specific SRHR strategies to resource mobilization, monitoring tools and compliance controls. This culminated in the joint design of over 120 local evidence-based actions towards advancing SRHR of adolescent girls and young women. 

Completed in 2022, a project focused on maternal and child health implemented in Ethiopia, Kenya, Malawi and Tanzania is another example. Through the project, country offices worked directly with WROs and YLOs. Their first step was to assess the organizations’ systemic needs and provide that support through training. Topics ranged from leadership strategies, technical issues, systems strengthening and governance. Other health projects focused on strengthening youth advocacy for SRHR in Kenya. This enabled them to participate more actively on youth-identified policies related to gender equality and SRHR. YLOs were also provided with advocacy training to enhance their ability to champion these issues as well as hold policy makers and community leaders accountable. 

The examples outlined above demonstrate that by engaging local WROs and YLOs in the assessment process, local expertise can be identified and amplified. Which, as identified by UNICEF, is a core approach in advancing locally-led advocacy and action for equitable SRH policies, legal frameworks, and services. 

Creating flexible funding opportunities for WROs and YLOs

WROs, YLOs and CSOs possess critical relationships and knowledge that enable them to respond to participants’ needs and experiences more effectively. They are, therefore, fundamental to enhancing health services and rights. However, these organizations often lack more accessible, flexible and long-term funding to help them achieve impact at scale. 

Identifying opportunities to address systemic barriers that preclude local organizations from resources is critical. Feminist partnerships recognize that WROs and YLOs do not function in a vacuum. Many WROs and YLOs face challenges with complicated funding processes that have stringent financial and compliance controls which make funding inaccessible to many.  

However, models do exist that are supportive of feminist organizations and women’s rights organizations. For instance, AmplifyChange and Global Affairs Canada’s Women’s Voice and Leadership Program provide direct grants to CSOs who are working to advance human rights, including SRHR. Through AKF’s AGECS and its accessible granting model, AKF has supported 26 subprojects, which are led and implemented by CSOs across Africa and Asia. The project shares capacity in areas of gender mainstreaming, resource mobilization, sustainability planning and more. Co-creation is essential to share capacity, resources and linkages so that local partners can access opportunities for continuous funding autonomously and beyond the life of the project. It is not only essential for the design and implementation of project activities, but also for creating a sustainability framework within the project design. 

Convening international and local platforms for strengthened collaboration

CSOs are crucial actors in knowledge-sharing, service delivery and awareness-raising in communities, especially for issues of gender equality and health care. However, opportunities to convene and share challenges and learnings are limited. In addition to its focus on enhancing the ability of community structures, institutions and leaders to respond to gender and social barriers, AGECS also provides a unique opportunity for gender equality and women’s rights champions to collaborate at a regional and global level. In February 2024, the project convened over 140 women’s rights activists, gender equality advocates and civil society leaders representing 13 countries to share experiences, challenges and learnings. Creating shared platforms is equally a necessity at the local level, to increase momentum towards rights-based advocacy and action.

Plan International’s LEAP project in Cox’s Bazar, Bangladesh, supported local WROs and YLOs to co-create health advocacy action plans, resourcing multiple platforms that first forged alliances between WROs/YLOs and then helped gain an audience with local government representatives to collectively demand improved gender responsiveness of service delivery. As a result, local needs ranging from activating school-based sexuality health sessions to integrated referral systems for GBV survivors and new adolescent friendly corners in health facilities were raised, reflecting a context where local WROs/YLOs could directly demand change and advocate for improved health and protection rights.

In medicine and health, mentorship is an effective strategy for capacity-sharing and countering the ever-present threat of anti-feminist health care delivery. The regional platform of the  Mwele Malecela Mentorship program for Women in Neglected Tropical Diseases supports women living and working in Africa to become leaders in their NTD work and benefits from longer-term funding to 2030. The platform is helping to build a diverse, skilled health care workforce that embraces the leadership of women through their education and career journeys in health care, ensuring women and girls are represented in the health systems in which they seek care. 

In celebrating and strengthening the work of local civil society on advancing gender equality and health rights, organizations can demonstrate commitment to driving forward the collective effort towards an inclusive future where everyone can thrive together. As we do so, we must remember that ultimately in the absence of equitable partnerships with local civil society, including WROs and YLOs especially, the results we strive for will neither be relevant, optimal or sustainable.

Calls to action 

1. Disrupt and transform unequal power norms within projects and partnerships by mainstreaming feminist principles. International development and global health practitioners have a responsibility to take the measured risks to ensure work is gender-transformative in a world where the rights of women and girls are increasingly fragile. Prioritizing participatory, rights-based approaches that address the diverse needs and experiences of women and girls, and amplifying the voices of equity-deserving groups to support shifts in power is critical to our work.

2. Create a funding and partnerships environment more favorable for the integration of global and public health advocacy. Advocacy is essential for making sustainable gains in healthcare for women and youth. Yet, restrictions on advocacy limit the critical work that connects women and youth with their governments as duty-bearers and international platforms to support more equitable health policies and programs. Advocacy approaches must be informed by context and aligned with local action to reduce health inequity. Health advocacy strategies also require sufficient funding and technical support to provide safety and legal protection for rights advocates in what is often a hostile environment. Canada’s 10 year commitment to global health and rights recognizes and reports on the critical role played by advocacy in healthcare delivery. However, more effort can be made to work more directly with WROs and YLOs on advocacy as foundational to sustainable change in global health.

3.  Accessible, flexible, long-term funding is crucial for enabling organizations to adapt to rapidly shifting local contexts, capitalize on emerging opportunities and tackle unexpected challenges. Flexible and core funding offers organizations the freedom to direct resources toward the areas of greatest need, while allowing opportunities to foster innovation and growth, adjust their priorities as conditions evolve and sustain long-term impact. Additionally, streamlined application processes reduce administrative burdens for smaller, grassroots organizations with limited staff and resources. By simplifying requirements, donors can encourage greater inclusivity, allowing more diverse organizations to apply. This not only broadens the range of solutions addressing local challenges but  expands reach and empowers underrepresented groups. It also ensures more opportunities for women’s rights and youth-led organizations to sustainably contribute to their communities’ right to health.