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Welcome to the SPHS Webinar Series
"Human Rights and Gender Equality in Health Supply
Chains"
www.savinglivesustainably.org
October 17, 2017
Agenda
1. Welcome remarks by the moderator
2. Introduction to speakers
3. Presentations
• UNDP: Introduction to the SPHS initiative
• UNDP: Gender Equality in the Global Health
Supply Chains
• Ethical Trading Initiative: Human Rights and
Gender Equality in Health Supply Chains
• British Medical Association: The Human Cost of
Healthcare
4. Q&A
Speakers
Ms. Bharati SadasivamGender Practice Team LeaderUNDP
Ms. Arthy HartwellHead of International & Immigration, Professionalism, and Guidance, Policy DirectorateBritish Medical Association
Ms. Cindy BermanHead of Modern Slavery Strategy Ethical Trading Initiative
Sustainable Procurement in the Health Sector
(SPHS)
Dr. Rosemary Kumwenda
SPHS Coordinator and Team Leader for Regional
HIV, Health and Development, UNDP Europe and
CIS
SPHS Webinar Series : Human Rights and Gender
Equality in Health Supply Chains, October 17,
2017
INTRODUCTION
Global perspectives on health and environment
SPHS Task Team is, through a transparent and inclusive engagement process, leveraging its normative and market power, lowering the
environmental impact of its procurement, with a final aim of improving human health and well-being.
Procurement Statistics 2015
Procurement Statistics 2013 - 2015
Procurement Statistics 2013 - 2015
Linking our work to the Sustainable
Development Goals and Key Focus Areas
More global than ever
Online Knowledge-Hub on Good Practices in
Sustainable Health Procurement and
Manufacturing:
www.savinglivesustainably.org
The SPHS global network of collaborators
Communication Statistics 2016
Looking Forward –
More Sustainable Health Policies, Strategies and
Practices
GET IN TOUCH @ www.savinglivesustainably.orgTwitter: @UN_SPHS
We look forward to working with you on a more sustainable global health sector.
Gender Equality in the Global Health Supply
Chains
Ms. Bharati Sadasivam
Gender Practice Team Leader
UNDP Europe and CIS
SPHS Webinar Series : Human Rights and Gender
Equality in Health Supply Chains, October 17,
2017
PRESENTATION #1
Global template for complex world
Universal in scope
Reflects concerns of rich advanced economies and developing world
Poverty, deprivation, inequality (including gender inequality), and unsustainable patterns of production and consumption are common concerns
The 2030 Agenda for Sustainable Development
Scope: economic, social, environmental, and political dimensions of inequality and injustice.
Reflects concern with structural issues at a time of rising inequality through the goals of:
Reducing inequality (Goal 10)
Strengthening full employment and decent work (Goal 8)
Supporting quality investments in infrastructure (Goal 9), health (Goal 3), education (Goal 4)
Ensuring sustainable consumption and production patterns (Goal 12)Broad and
ambitious agenda
Broad scope of targets:
Discriminatory laws, harmful practices, violence against women and girls
Sexual and reproductive health and reproductive rights
Distribution of unpaid care work
Access to productive resources
Participation in decision-making Goal 5: Achieve gender equality and empower all women and girls
Besides Goal 5, UN Country Teams identified Goal 1 (“End poverty in all its forms”) as the SDG where gender most needs to be mainstreamed in ECA countries.
ECA Country Teams identified the following targets as priorities:
5.1: End all forms of discrimination against all women and girls everywhere (75.8%)
5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation (72.7%)
5.c: Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all (75.8%)
UN Country Team priority
targets
Need to tackle a broad set of core issues and challenges, such as:
Unpaid care/domestic work - gendered division of labour in non-market based productive activities
Labour regulation, social security
Access to/control over assets and resources
Gender-based violence
Access to justice, legal protection
This can only be done through addressing structural causes/drivers, not symptoms:
Inequality in power relations between women and men
Social norms, stereotypes and practices that discriminateagainst women and girls in all development spheres (economic,social, political, environmental)
SDGs and global health supply
chains
The UNCTAD report Trade and Gender (2004: 16) summarisesthe ways in which trade can affect gender equality:
A positive or negative impact on growth and employment opportunities;
Competitive pressures, which may reduce or encourage gender discrimination, in particular wage differentials;
Facilitating or raising barriers to access by women to resources and services; and
Multilateral trading rules, which may facilitate or constrain governments in applying policies or regulations that address gender inequality
SDGs and global health supply
chains
Drivers of gender inequality in supply chains:
Working hours, particularly involuntary overtime
Freedom of association and collective bargaining
Informal labour and forced labour: Women and girls represent the greatest share of the 21 million people in forced labourglobally
Horizontal and vertical job segregation, gendered divisions of labourSDGs and global
health supply chains
SDGs and global health supply
chains
Integrating gender equality principles into global heath supply chains will increase:
Safety
Sustainability
Efficiency
Equity
Women’s Empowerment
Principles
Principle 5: Implement enterprise development, supply chain and marketing practices that empower women
Expand business relationships with women-owned enterprises, including small businesses, and women entrepreneurs
Support gender-sensitive solutions to credit and lending barriers Ask business partners and peers to respect the company’s commitment to advancing equality and inclusion
Respect the dignity of women in all marketing and other company materials
Ensure that company products, services and facilities are not used for human trafficking and/or labour or sexual exploitation
Promoting gender equality
through procurement
The following measures should be considered while designing procurement strategy and guidelines:
Consider women led businesses or businesses that employ more women for procurement contracts; consider companies that employ 50% women or have clear gender equality policies in place.
Target companies that implement preferential gender responsive procurement policy for award of contracts.
Recruit, train and promote women in public procurement
Simplify tendering processes
Include gender-responsive evaluation criteria
Encourage signing of voluntary agreement
Disaggregate procurement data
Procurement in health sector value chains has great potential for equal opportunities in employment.
It is important to train and equip responsible officials and agencies with information that will help them understand how to advance women’s employment and address gender dimensions in procurement processes. This is not, and should not be a “gender-neutral” sector.
All sectors including international organizations: it is important to invest in the health manufacturing and supply chain sector with a gender lens because of the multiple ways in which such investment can advance Agenda 2030 and the SDGs at national levels.
Conclusions
Human Rights and Gender Equality in Health Supply
Chains
Ms. Cindy BermanHead of Modern Slavery Strategy
Ethical Trading Initiative
PRESENTATION #2
Presentation Outline
⚫What is ETI and how do we work?
⚫ Labour rights risks in health supply chains (Pakistan example)
⚫Gender dimensions of health supply chains
⚫How to tackle this⚫ UN Guiding Principles on Business & Human Rights
⚫ Human Rights Due Diligence
⚫ Critical elements of a response
⚫ Opportunities
⚫ Further resources
Members of
What is Ethical Trading Initiative?
ETI
Employment is freely chosen
Freedom of association & the right to collective bargaining
Safe and hygienic working conditions
No child labour
Living wages are paid
Working hours are not excessive
No discrimination
Regular employment
No inhumane treatment
THE ETI BASE CODE
ETI
Influencing policy & practice
Building capacity
Supply chain programmes
Sharing knowledge &
learning
Accountability & reporting
Enabling collaboration – locally &
globally
Modern Slavery Act, Cambodia, Bangladesh Accord
TNMS, Turkey, Spain, Rajasthan, South Africa, Kenya, Morocco, Peru
Training on Modern Slavery and Due Diligence;Coaching
India, Bangladesh, China Pakistan, Turkey etc.
Guidance, toolkits, research, events, sharing lessons &
resources
Company annual reporting and review
ETHICAL TRADING INITIATIVE
Health Supply Chains
⚫ Increasing global demand for health supplies (ageing etc.)
⚫ Complex and fragmented supply chains – multiple countries, manufacturing processes
⚫ Increasingly globalised & deregulated labour markets
⚫ Procurement rules and regulations – cost drivers, speed, volume, security of supply & product quality
⚫ Labour / human rights risks – race to the bottom
⚫ Lack of coherence – modern slavery legislation, increasing human rights due diligence regulation vs government systems
⚫ Limited expertise, resource & capacity
⚫ Sourcing from countries with poor governance, limited space for civil society, media, trade unions, transparency
Key Issues
Labour Rights Risks in Health Supply Chains
⚫ Long supply chains - rights violation risks at every stage
⚫ Lack of visibility, oversight, problems with audits
⚫ Multi-staged manufacturing processes⚫ Authorised & unauthorised sub-contracting
⚫Unregistered, unregulated small units & businesses
⚫ Informal sector & home working (gender dimensions)
⚫No formal contracts – workers paid piece rate no fixed wages
⚫ Poor / no oversight of health & safety, wages, hours
⚫ Lack of record-keeping, HR systems
⚫ Use of labour contractors (no employer/employee relationship)
⚫ Unscrupulous recruitment practices, debt bondage risks
⚫ Piece rates, rather than a fixed regular income.
An example: NHS Supply Labour Management Assurance System
⚫ Based on ETI Base Code
⚫ Four step assurance system – suppliers must be at Level 2 to bid for contracts, must reach level 3 within 18 months
⚫
Gender issues in global value chains
⚫ Increasingly feminized wage labour
⚫Discrimination (added to other labour rights risks ) ⚫ low / unskilled work
⚫ precarious work
⚫ low status jobs, limited advancement opportunities
⚫ poorly paid
⚫ long hours, no flexible working
⚫ poor health & safety at work & to work
⚫ childcare, domestic responsibilities not recognised
⚫ subject to sexual harassment, threat & abuse
⚫ limited representation, voice, choice & negotiation power
⚫Home working (piece rates, rights as workers not recognised, no oversight, isolated, lack of collective organising power)
⚫ Very poor data (lack of sex-disaggregated data & monitoring)
Some of the challenges…
Gender dimensions to consider
⚫ Agency (trade union; other organization; individual / collective voice & decision-making)
⚫ Aspiration (meeting goals, opportunities for advancement)
⚫ Dignity (treatment, behavior, attitudes)
⚫ Reward (wages, other benefits – including maternity, childcare etc.)
⚫ Safety (including sexual violence & harassment, safety to & from work & at work)
⚫ Security (job & income security, permanent / temporary contracts, formal/informal work)
The way forward:
Tackling human rights & gender equality in health supply chains
3 Pillars of the UN Guiding Principles for Business and Human Rights
UN Guiding Principles on Business & Human Rights
ETI human rights due diligence framework
Human rights due diligence is the action taken by a company to both identify and act upon actual and potential risks for workers in its operations, supply chains and the services it uses
Includes:
⚫Assessment of actual and potential human rights risks
⚫Mitigation of risk and remediation for workers impacted by human rights violations
⚫Identification of corporate leverage and responsibility, decision-making and actions needed
⚫Monitoring, review, reporting and continuous improvement
Driving leadership and improvements in corporate operations and global supply chains
CRITICAL ELEMENTS
⚫ Recognise complexity – no quick fixes
⚫ Recognise roles and responsibilities
⚫Diagnose the problems and design appropriate solutions
⚫Use leverage – government’s own procurement power is huge!
⚫ Build partnerships and foster collaboration
⚫ Carrot and Stick works ⚫ incentivise change but
⚫ hold those responsible to account
⚫ Rights, dignity and agency of workers respected & advanced
⚫ Better information to drive decision-making
⚫ Transparency & public accountability is key
⚫Review, learn, monitor, evaluate, share lessons
OPPORTUNITIES
⚫ SDGs provide key opportunity for entry points
⚫ New legislation (UK MSA, EU Directives, French, Dutch law)
⚫OSCE initiative to drive public procurement, transparency, labour monitoring and enforcement - engage with member states, use guidance
⚫Engage with government departments & local authorities providing health services & supplies. Insist on ethical procurement
⚫ Identify leaders & good practice (e.g. NHS Supply – Labour Monitoring and Assurance System)
⚫ Work with experts, engage with trade unions, civil society organisations, representatives of vulnerable workers
THANK YOU!
Guidance & more info: www.ethicaltrade.org• Human Rights Due Diligence Framework
• ETI Base Code Guidance series
• Blogs & briefings
• Research reports
• Training – through our website
The Human Cost of Healthcare
Ms. Arthy HartwellHead of International
British Medical Association
PRESENTATION #3
Many suppliers to the NHS outsource the manufacture of their products to factories around the world
The Human Cost of Healthcare
“Ethical procurement is about the overall practices of purchasing organisations and the steps they take to ensure that employment conditions and workers’ rights, in the supply chains of the products and services they procure, are maintained in line with internationally recognised conventions and local laws, as a minimum”
“The provision of healthcare goods and services is big business”
Department of Health
NHS EnglandNHS Wales NHS Scotland
Commissioning
Groups
NHS providers
NHS
Supply
Chain
ServicesGoods
Scottish
Health
Supplies
Welsh
Health
Supplies
Procurement
Hubs
Healthcare Industry
Department of Health
NHS EnglandNHS Wales NHS Scotland
Commissioning
Groups
NHS providers
NHS
Supply
Chain
Service
s
Goods
Scottish
Health
Supplie
s
Welsh
Health
Supplie
s
Procuremen
t Hubs
Healthcare Industry
Assured labour standards
in contracts for surgical
instruments & some
textiles
20
13
Gloves, procedure packs,
disposable curtains,
suction consumables20
14
Polymer products, theatre
clothing, continence
products20
15
Wound care, office
furniture, podiatry20
16
£18m
£110m
£142m
£80m
Labour Standards Assurance System
⚫Pioneering approach to include ethical procurement considerations into the tender for Surgical Instruments (2012)
⚫Covers a range of policies, procedures and practices to; identify labour standards issues, mitigate risks, and drive continuous improvement.
⚫Responsibility is on the supplier to demonstrate they have effective systems in place.
Level 4 – Progressive
demonstrates leadership level management of labour standards.
Level 3 – Established Implementation
robust system for managing labour standards in place. A more action-orientated level of
compliance.
Level 2 – Initiating Implementation
Demonstrates progression from level 1 and started to implement processes and procedures
to manage labour standards.
Level 1 – Foundation
Sets the building blocks for labour standards management in practice. Begun to consider how labour standards relate to its business.
Ethical procurement for health workbook Provide practical guidance for organisations in the health and social care sector to embed labour standards considerations into procurement and supplier management activities.
Promote awareness of labour standards risk in supply chains serving the health and care sector.
Demonstrate that ethical trade is compatible with public contracting policy and regulation.
Address the misperception that ethical trade is incompatible with public procurement law and/or value for money requirements.
EPH Flexible Framework
Legislative environment
UK Modern Slavery Act 2016
EU Non-Financial Reporting Directive 2014/95/EU
EU Public Procurement Directive 2014/36/EU
UK Public Contract Regulations 2015
UK
Sweden
Norway
Germany
Italy
Netherlands Standardise criteria and methods
Synchronised approach to effect
market forces
Engagement with European
Commission
Q & A
GET IN TOUCH @ www.savinglivesustainably.orgTwitter: @UN_SPHS
We look forward to working with you on a more sustainable global health sector.