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

Thank youahartwell@bma.org.uk

bma.org.uk/fairmedtrade@fairmedtrade

Q & A

GET IN TOUCH @ www.savinglivesustainably.orgTwitter: @UN_SPHS

We look forward to working with you on a more sustainable global health sector.