Lessons from Women RISE: Evidence for more resilient, gender-responsive health systems

COVID-19 exposed the fragility of health systems worldwide. IDRC-supported research from the Global South adds to the evidence that women paid the pandemic’s highest price. When health systems collapsed, women's vulnerabilities were magnified, stalling progress in, for example, immunization, maternal health and HIV-related services.

Women faced systemic inequities that hindered their access to social protection, economic security and gender-responsive health systems that recognize and address how gender roles and inequities affect access, outcomes and resilience. According to UNFPA estimates,  nearly 12 million women in 115 countries lost access to family planning services, resulting in 1.4 million unintended pregnancies in 2020 alone. A WHO pulse survey that same year found that 90% of countries globally reported service disruptions, with low- and middle-income countries experiencing the most severe impacts. 

The Women RISE initiative was launched in 2022 to address these pandemic-related impacts. Funded by IDRC, the Canadian Institutes of Health Research  and the Social Sciences and Humanities Research Council, the four-year program supported research to generate action-oriented, evidence-based solutions for building resilient health systems. The initiative’s framework centres the intersection of women’s work and health during crises, creating locally driven interventions that can inform long-term systemic change.

Women RISE research findings: How the pandemic affected women globally

Women RISE research projects documented women’s intersecting realities across multiple continents during the pandemic. The evidence revealed a consistent pattern: when health systems are fragile, women suffer disproportionately, especially during emergencies. During the pandemic, health-care workers, mainly women, were overwhelmed, with many experiencing equipment shortages and mental health crises and considering leaving their jobs. Meanwhile, women's unpaid caregiving responsibilities increased as formal support systems collapsed, creating a cascade of health, economic and social challenges evidenced in Asia, Africa and Latin America.

Women RISE research revealed the extent of the impact. In Kenya, health facilities closed to consolidate resources for frontline workers, creating critical access gaps in underserved areas. In Nigeria, rural communities faced severe health worker shortages due to geographic isolation, dilapidated infrastructure and COVID-19’s additional strain. In Lebanon, restrictive gender norms, low retention at work and conflict exacerbated pandemic-related stressors on women in the health-care sector. In Argentina, female sex workers faced a devastating convergence of income loss, limited health-care access and violence.

At the same time, these overlapping findings reveal how crises can turn into opportunities to strengthen health systems and make them more resilient. With this goal in mind, Women RISE research identified several approaches — or evidence-based pathways — that can be used to transform health systems in the face of the challenges. 

Supporting health systems through evidence-backed research

The following Women RISE research projects illustrate how different evidence-based pathways can support health systems transformation.

• Kenya’s WHEELER project shows that fairly compensating community health workers builds resilience. The project transformed community health volunteers from excluded actors to essential frontline workers while providing targeted support for female health workers. The research proved that properly compensating community health workers — most of whom are women doing unpaid or underpaid work — strengthens system resilience and crisis preparedness.
• In Peru, the ANITA project demonstrates that extending formal social protection schemes to cover domestic workers can improve health financing gaps. Research revealed that 89% of domestic workers had verbal-only employment agreements, 95% received no severance pay and only 17% were enrolled in social security. This exclusion meant that domestic workers were mostly uninsured and relied on already overstretched public facilities without contributing to pooled health financing. Such gaps undermine health system sustainability. Through deliberative dialogues with the Ministry of Labour’s Multisectoral Working Group, the project co-designed regulatory frameworks to strengthen written contracts and employer contributions, creating integrated financing mechanisms linking labour formalization to health system sustainability.
• Argentina’s one-stop-shop model reduced stigma and expanded care for female sex workers. The project streamlined and created new referral pathways and trained health-care service providers in trauma-responsive care to reduce stigma and ensure sex workers received respectful, comprehensive services ranging from testing for HIV and sexually transmitted infections to cancer screening, and contraceptive access aligned with the Ministry of Health’s “progressive care” roadmap. The intervention improved female sex workers’ ability and willingness to access and utilize critical health services during the pandemic. This demonstrates how re-engineering service models strengthens systems while expanding access.
• Nigeria’s community-led, participatory governance initiatives strengthened trust in and access to critical health systems. This Women RISE project worked with policymakers to study how to be inclusive of rural women’s health, mobilizing community project implementation committees and volunteer health workers (70% women) to address these existing gaps. These community-led committees renovated six dilapidated health facilities, installed clean water systems in four communities and conducted door-to-door maternal and child health immunization outreach, rebuilding trust in primary health care. This participatory governance approach improved service uptake while informing the rural health strategy of Nigeria’s Primary Health Care Development Agency.
• In Lebanon, research demonstrated how addressing employment conditions that affect worker retention can significantly strengthen health systems. The study found that chronic diseases significantly increased unemployment risk and that workplace violence affected 32% of workers (with higher rates among health-care employees). The project generated evidence-based recommendations for decision-makers on how to address both workforce sustainability and gender-responsive service delivery, positioning health worker retention as fundamental and supportive working conditions as essential for crisis-resilient health systems. 

Looking ahead: Women RISE as a framework for action 

Women RISE research has proven that resilient and gender-responsive health systems are achievable when research, policy and communities align strategically. The initiative provides a practical roadmap for governments and global health actors committed to achieving priority 3.5 of the UN Research Roadmap for COVID-19 Recovery. 

Strengthening health systems requires the dismantling of structural inequalities that determine who can access, afford and benefit from health care. Now is the time to centre gender equity in health systems design. As evidenced by the research carried out under the Women RISE initiative, creating resilient pathways to respond to pandemics benefits entire communities and lays the foundation for sustainable development and crisis preparedness.