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“I noticed that every time he went to appointments or emergency services, he was often met with suspicion or treated as if he was exaggerating his symptoms,” shared a community support worker from Canada, describing how an Indigenous teenager waited three months for mental health services while non-Indigenous youth were seen within weeks.
This testimony was just one of hundreds shared during an unusual global gathering where frontline health workers confronted an uncomfortable truth: healthcare systems worldwide are riddled with biases that determine who lives and who dies.
“Equity Matters: A Practical Approach to Identify and Eliminate Biases,” a special event hosted by the Geneva Learning Foundation (TGLF) on 10-11 April 2025, drew nearly 5,000 health professionals from 72 countries. What made the event distinctive wasn’t just its scope, but its approach: creating a forum where community health workers from rural Nigeria could share insights alongside WHO officials from Switzerland, where district nurses from South Sudan could analyze cases with medical college professors from India.
When healthcare isn’t equal: Global patterns emerge
Despite working in vastly different contexts, participants described remarkably similar patterns of bias.
“A pregnant woman was about to deliver in the hospital, but the doctor said they need to deposit 500,000 naira before she can touch the woman,” recounted Onosi Chikaodiri Peter, a community health worker with Light Bringer’s Outreach in Nigeria. “The husband was begging, pleading, with 100,000 naira, telling the doctor that he could sell all his livestock to make sure that the wife was okay. But the doctor wouldn’t attend to the woman. Along the line, the woman gave up. The child died.”
Dr. Tusiime Ramadhan, who works with Humanitarian Volunteers International in Uganda, observed the same pattern: “People with money are referred to private clinics and hospitals for better health services often owned by the same government workers who sent them there.”
Some biases manifest in subtler ways. Hussainah Abba Ali, who works with Impact Santé Afrique in Cameroon, described seeking treatment for malaria during her university years: “Because I was a young woman, the nurse assumed I was just exaggerating. She barely examined me, gave me paracetamol and told me to rest. I later found out that several men who came in after me with similar symptoms were tested immediately for malaria.”
The stories came from everywhere—a physiotherapist in Nigeria whose expertise was ignored in favor of a male colleague; a nutritionist in DR Congo whose albino neighbor avoided vaccination clinics because of stigma; a public health specialist in Ethiopia’s Somali Region who explained how healthcare systems are designed for settled communities, leaving pastoralist populations behind.
Alina Onica, a psychologist with Romania’s Icar Foundation working with domestic violence survivors, noted: “Victims are often judged for ‘not leaving’ the abuser, as if staying means it’s not serious. This bias ignores the complex trauma and fear they live with every day.”
A framework for sense-making beyond single-issue analysis
What united these diverse testimonies was the application of the BIAS FREE Framework, a practical tool that helps identify and eliminate discriminatory patterns in health systems.
“Margaret Eichler and I started this work back in 1995 after developing some gender-based analysis tools,” explained Mary Anne Burke, the framework’s co-author. “We realized we had created something that could be applied to all social hierarchies. We’ve workshopped it on every continent but Antarctica and found it applicable everywhere.”
Unlike approaches that focus exclusively on gender, ethnicity, or disability, the BIAS FREE Framework examines how these factors intersect. Brigid Burke, a researcher who’s used and taught the framework for 15 years, explained how to identify three distinct problem types:
- H problems: Where existing hierarchies are maintained
- F problems: Where relevant differences between groups are ignored
- D problems: Where different standards are applied to different groups
“It is easier to understand a hierarchy when you’re experiencing the oppression,” Burke told participants. “You can feel that you’re being treated in a way that takes away your dignity. It’s harder when you might be the one who is either consciously or unconsciously oppressing other people.”
During the event, participants first shared their own experiences, then began to analyze them using the framework. Abdoulie Bah, a regional Red Cross officer from The Gambia, offered his analysis: “Oppressive hierarchies suggest that certain groups experience more oppression than others, often leading to a competitive dynamic among marginalized groups.”
Solutions from the ground up
What distinguished this event from typical global health conferences was its emphasis on solutions developed by frontline workers themselves.
Dr. Orimbato Raharijaona, a medical doctor from Madagascar, described his team’s efforts to reach children in remote areas: “We prioritized areas with low vaccination coverage and strengthened birth follow-up to target zero-doses. Community dialogue helped raise awareness of the need for vaccination.”
In Mali, Bouréma Mounkoro, a public health medical assistant, discovered that simply rescheduling vaccination days to align with community availability dramatically improved coverage rates and reduced dropouts.
Dayambo Yendoukoua from Niger’s Red Cross developed an integrated approach addressing rural women’s exclusion from maternal care: “Women from villages and farming hamlets have three times less access to obstetric care than urban women. We grouped women into Mothers’ Clubs, provided literacy training, set up income-generating activities, and established traditional ambulances managed by women.”
This emphasis on community-based solutions resonated with Esther Y. Yakubu, a health worker with the Health and Development Support Programme in Nigeria: “This program will surely be of great value in the health sector. If put in place, it will make a huge difference and patients will receive quality treatment without any segregations.”
Practical action – not academic debates – to decolonize global health
The event itself embodied the principles it aimed to teach. Rather than positioning Western experts as authorities, TGLF structured the event to value diverse forms of expertise.
“Community health workers can see barriers that researchers miss. Global researchers spot patterns invisible at the local level. Policy makers understand system constraints that affect implementation,” explained Reda Sadki, TGLF’s Executive Director. “It’s when these perspectives connect that we find better solutions.”
On 24-25 April 2025, this community will reconvene to determine if there is enough interest and momentum to launch the Foundation’s Certificate peer learning programme for equity in research and practice. An inaugural course could be launched as early as June 2025.
“Your participation helps determine if we develop a full program on identifying and removing bias in health systems,” TGLF explained in its materials. “When more than 1,000 people participate, it shows enough interest to create a more comprehensive learning opportunity.”
The certificate program will bring together participants from across professional hierarchies—community health workers, district managers, national planners, and global researchers—creating a rare space where knowledge flows in all directions.
Across time zones and contexts, the conversation highlighted a shared understanding: addressing bias in healthcare isn’t just about fairness—it’s about survival. As Haske Akiti Joseph, a radiographer from Nigeria’s National Orthopaedic Hospital, reflected: “These issues are happening everywhere because governments will not provide free medical services to the people, and medical considerations come due to who you are, not based on priority.”
In a world where your chances of receiving timely, appropriate healthcare often depend on your gender, ethnicity, wealth, or location, the BIAS FREE Framework offers a practical way forward—one that begins with recognizing patterns of oppression that transcend borders and cultures.
Image: The Geneva Learning Foundation Collection © 2025
