Focusing Dignity

Executive Summary

Disrespect for dignity is common and harmful. Over half of women giving birth in facilities worldwide experience mistreatment, and more than a third of Africans seeking medical care report being treated with little or no respect. The evidence strongly suggests that this matters — patients will travel twice as far and wait five times longer to be treated with respect, and respectful maternity care halves maternal complications and postpartum depression. This amounts to a profound broken promise by governments and development actors who proclaim dignity as a core value.

We aim to reposition dignity from an aspirational value to a practical experience of citizens encountering public systems. Dignity should be measurably felt, as a consequence of interventions and cultures at scale.

This report presents the evidence and analysis behind four foundational strategic decisions for advancing dignity in public services towards this goal. We draw on published academic evidence, 48 practitioner interviews, and quantitative data from authoritative international sources.

We conclude that:

• Dignity applies in many sectors – but health is the most promising for dignity partnerships now. A structured comparison across five candidate sectors — health, employment, education, social protection, and humanitarian — concludes that while all health possesses a particularly strong foundation for dignity-focused work. It is the only sector with validated measurement tools, WHO-endorsed frameworks, systematic reviews spanning hundreds of studies, and an active advocacy ecosystem that has translated evidence into institutional standards. No other sector offers comparable prevalence data, causal evidence on the consequences of disrespect, or scalable delivery infrastructure.
• A scoring framework applied to 37 low- and middle-income countries identifies four high-ranking countries: Kenya, India, South Africa and Ghana. We select Kenya and India because, among the top-ranked countries, we have the strongest existing relationships and networks. In a further scoring exercise, we identify the most promising states and counties there for exploring such partnerships.
• We diagnose a series of well-documented interlocking failures of systems that together produce indignity. Dignity is widely recognised in law, policy and rhetoric. Yet this recognition has not been operationalised through measurement, feedback and accountability mechanisms. Health workers operate under severe time pressure, volume-based performance targets, and hierarchical cultures that reward compliance over compassion, creating “benevolent indignities”. Interventions to date have been fragmented and subscale. Many people work on dignity, but they do not know one another.
• Therefore, dignity champions need community. A comparative assessment of six intervention models — training, coalitions, advisory consulting, certification, demonstration projects, and fellowships — concludes that fellowships for public sector health leaders offer the strongest pathway to durable change, and the best match for our diagnosis. The theory of change proposes that transformed leaders, equipped with evidence and embedded in a supportive community, can shift institutional cultures from the inside — moving dignity from a rhetorical commitment to a lived reality in the daily interactions that matter most to patients.

This is a moment for dignity. For all the progress the world has made, tens of millions of patients are still preventably dying. The politics of contempt is rampant, public service is being slashed, and health expertise is met with fear and doubt. New tech creates opportunities and dilemmas. There are leaders championing dignity right now. They need community and evidenced solutions, to really make change in their systems. That is the path forward, if we are to repair services, respect citizens and keep the lofty promises proclaimed in our value statements.