Bridging the Diagnostic Divide for Women and Girls in Humanitarian Settings

By guest contributor Dr Angela Muriuki

Amid increasing humanitarian crises worldwide, from conflicts to natural disasters and disease outbreaks, a critical yet often overlooked issue is the specific health needs of women and girls.¹ These populations face unique health challenges in crisis settings, including reproductive and sexual health concerns, such as inadequate antenatal, childbirth and postnatal care, and high prevalence of sexually transmitted infections and related complications.¹ In countries experiencing humanitarian crises, maternal mortality is almost double that of global estimates.² Furthermore, women and girls face barriers accessing quality healthcare in crisis settings. Coupled with poor living conditions, this increases the risk of infectious diseases and exacerbates chronic conditions, including diabetes and hypertension.

Diagnostic technologies are key to addressing these challenges, as they are essential for disease detection and health management. Gender-sensitive diagnostics could significantly improve the health outcomes of one of the most vulnerable groups in humanitarian crises, thereby fostering more equitable healthcare worldwide. However, innovative solutions are needed to develop and deploy diagnostics that can support the health needs of women and girls and are suitable for use in crisis settings.

The diagnostic value chain is a framework that outlines the essential steps in transforming a diagnostic tool from initial concept to clinical use, with the experiences of users feeding back into previous stages to create a ‘virtuous circle’. There is an opportunity for innovation and adaptation at each stage of the value chain, from initial research and development (R&D) and clinical evaluation through regulatory approval and manufacturing to end-user access and usability. By focusing on the needs of women and girls and the complexities of humanitarian crisis settings at each step, effective tools can be created to support improved health management and empowerment of these neglected populations (Figure 1).

R&D must focus on identifying biomarkers and developing tests for conditions that uniquely affect or are more prevalent in these populations. These include reproductive health issues and diseases that disproportionately impact women and girls due to displacement and stress. With the constraints of humanitarian settings in mind, tests must be robust, requiring minimal to no electricity, refrigeration, or sophisticated laboratory infrastructure. The ideal diagnostic tool for humanitarian crises is portable and durable. It can be used at the point of care by healthcare providers or even by the women and girls themselves through self-administration.

Clinical trials of diagnostic tools are required to ensure that they maintain high sensitivity (the ability to correctly identify those with the condition) and specificity (the ability to correctly identify those without the condition) in the intended setting. For humanitarian crises, this means contending with highly variable conditions and diverse populations, the added complexity of conducting trials in often unstable and resource-limited environments and the ethical issues of conducting research on vulnerable populations. Innovative approaches to trial design, such as mobile clinics or community-based participatory research, are needed to gather data representative of the target population under real-world conditions.

Navigating regulatory landscapes is particularly challenging in humanitarian contexts, where the urgency of health needs may conflict with the thoroughness of standard regulatory processes. Regulatory frameworks are needed that allow expedited review and emergency authorisation for diagnostics that address urgent health crises without compromising safety and efficacy standards. Efforts to harmonise regulatory requirements across different regulatory bodies could facilitate a more rapid introduction of diagnostics across different regions, which is especially important in multi-country humanitarian crises.

Once approved, diagnostics must be manufactured and distributed, a process fraught with challenges in crisis-affected areas. Manufacturing strategies will need to allow for rapid scaling to meet sudden spikes in demand and facilitate a steady supply of diagnostics to affected areas in times of need. Innovative logistical solutions will be required to overcome disrupted supply chains to ensure that the diagnostics can reach remote and conflict-affected areas reliably and quickly.

The final link in the diagnostic value chain is ensuring that diagnostics are accessible to and usable by the end-users. Strategies to support affordability and availability of diagnostics include partnerships with non-governmental organisations (NGOs) and governments for subsidy or distribution. Training for healthcare workers and informational materials for non-specialists is essential to ensure that tests are administered properly and results are interpreted correctly. Finally, in designing deployment strategies, the privacy and dignity of women and girls must be a primary consideration, especially for conditions that are associated with social stigma.

Women and girls’ health challenges in humanitarian crises demand a concerted effort to innovate and adapt diagnostics from concept to clinical use. Through a focused approach on the diagnostic value chain, essential tools can be developed and effectively deployed to those in dire need. From developers creating diagnostic solutions fit for purpose in crisis settings, to policymakers and donors who prioritize and fund humanitarian interventions, there is opportunity to significantly improve health outcomes in these vulnerable populations. We must continue to innovate, collaborate, and advocate to ensure that the health needs of women and girls are at the forefront of our humanitarian response efforts.

References

1. Asong Tazinya RM, El-Mowafi IM, Hajjar JM, Yaya S. Sexual and reproductive health and rights in humanitarian settings: a matter of life and death. Reprod Health. 2023;20(1):42. doi: 10.1186/s12978-023-01594-z.
2. United Nations Population Fund. Maternal mortality in humanitarian crises and in fragile settings. 2015. Available at: https://www.unfpa.org/resources/maternal-mortality-humanitarian-crises-and-fragile-settings [Accessed April 2024]

About the author:

Dr Angela Muriuki, the Director of Women’s Health at FIND, brings over 15 years of experience working with women and girls to her role. Her expertise spans programme, policy, research, system strengthening, and clinical positions in humanitarian and development settings. Under her leadership, FIND’s Women’s Health programme is committed to improving access to high-quality, affordable, gold-standard testing solutions for women and girls aged 10 to 64 in low- and middle-income countries. The program aims to bring these solutions as close to home as possible, leveraging both public and private sector channels.