Advancements in gender statistics and health: experiences from the Western Pacific Region

1. Advancements in gender statistics and health: experiences from the Western Pacific Region Anjana Bhushan, Technical Officer (Health in Development) WHO/WPRO 3rd Global Forum on Gender Statistics Manila, 11-13 October 2010 ESA/STAT/AC.219/34

2. Keys to accelerating the development and better use of gender statistics • Strengthening vital events monitoringwith causes of death, through existing civil registration systems, demographic surveillance sites, or hospital statistics • Harmonizing health surveysthrough a country-led national plan with increased focus on gender, equity, and social determinants for health • Improving the timeliness, completeness and qualityof facility- and survey-generated disaggregated data • Developing a multi-sector culture ofdisaggregated data collection for deriving gender statisticsand use aligned with national M&E and HIS frameworks • Ensuring skills and capacity availablefor presentation, interpretation, dissemination, and use of gender statistics with different target audiences

3. Example 1: Proposed maternal and U5 death surveillance system, Lao PDR Background • Based on Cambodia experience • 2005 Lao PDR census: about 2 maternal deaths; 36 under-five child deaths, including 26 infant deaths (71% of U5MR), every day • Vital registration not functioning • Routine reporting/surveillance system unreliable • Provincial/district hospitals report deaths, but only about 13% births in health facilities (2005) • Mobile phone network used by 60% of rural families Objectives (May 2010-March 2011) • Provide timely information on maternal and child deaths, followed by death review • Monitor MNCH trends and strengthen achievement of MDGs 4, 5 • Inform MNCH programme planning, policy development and interventions' targeting

4. Proposed approaches • Case reports • By villagers, village health volunteers, health workers, witnesses • Report all maternal and child (under-5) deaths anywhere • Set up toll-free landline at central level for case reporting • Encourage reporting through: • government circular to all districts, health centers and village committees • mass media campaign • incentives to reporters (2) Case records • Call related health center to verify report, collect more information and enter into computer Epi-Info program • Health centers to keep copy of death confirmation sheet for regular reporting and death audit (3) Information utilization • Update summary of records weekly on national map, by written report, on MOH website • Set up maternal and child death information room in Ministry of Health • Analyze data and report monthly to MOH, provinces, districts • Conduct maternal and neonatal death review and report annually • Incorporate the surveillance system into HMIS

5. Case report by community or health facility to toll-free line MOH Info Room MCHC Team Regular reports Case confirmation with HC or health facility MOH – HMIS website

6. Example 2: Understanding gender-based violence in the Pacific Background WHO Multi-country Study on Women's Health and Domestic Violence Against Women 2005 • gathered comparable data from over 24 000 women interviewed in 15 sites in 10 countries (including Japan, New Zealand, Samoa [Polynesia]) • found that VAW is widespread, with far-reaching health consequences, and demands a public health response • called on governments to take concerted action, recommended actions for health, education, criminal justice sectors Objectives • estimate the prevalence of violence against women, with particular emphasis on physical, sexual and emotional violence by male intimate partners; • assess the extent to which intimate partner violence is associated with a range of health outcomes; • identify factors that may either protect or put women at risk of partner violence • document and compare the strategies and services that women use to deal with violence by an intimate partner

7. Using the methodology in the Pacific Socio-Cultural Research on Gender-Based Violence and Child Abuse in Melanesia (Kiribati, 2008) and Micronesia (Solomon Islands, 2008-09) project (funded by UNFPA, AusAID; implemented by SPC) Kiribati:National representative study on intimate partner violence (Kiribati Family Health and Support Study), 2008 • Findings: • 68% of ever-partnered women reported experiencing at least one act of physical or sexual violence, or both, by an intimate partner; 73% of all women aged 15-49 have experienced some form of physical or sexual violence, either by a partner or a non-partner • VAW has a devastating impact on women, their families and communities • Unequal power relations between men and women are the root cause • Legal framework:no specific domestic violence/VAW and VAW not addressed appropriately in existing laws • Services: Social Welfare Unit: day-to-day services, counseling; limited capacity; few NGOs active; limited reach and capacity; Catholic Women’s Crisis Centre: shelter and care; underutilized due to social and cultural barriers faced by victims

8. Using the methodology in the Pacific Kiribati • Government response: • Family Affairs and Sexual Offences Unit established in 2004 to manage cases of domestic violence, rape, abuse and other sexual offences • Study endorsed by government, launched by President • National Action Plan for elimination of VAW developed, policy being drafted Partners’ response: • Support to multi-sectoral VAW action : • AusAID/WHO Gender Health and Development Programme, 2010-11 (Solomon Islands) • Planned Multi-year UN Joint Programme to EVAW, 2011 (Kiribati) • Pacific UNiTE Campaign to End Violence Against Women • Additional studies using WHO methodology: Vanuatu (nearing completion); Fiji: (commencing)

9. Example 3: Gender in the national TB programme review, Viet Nam Findings: • M/F ratio in TB cases increased from 1.6 to 2.1 • Why? • Partly: biological/ epidemiological factors • Partly: gender-related barriers to access Trends in SM+ Viet Nam: 1990-1999)

10. Viet Nam NTP findings • Women have longer delay before diagnosis, because: • they may consult less-qualified health care providers or self-medicate • they may face barriers to access: distance and mobility • they are less likely to present with ‘typical’ symptoms • Women may produce sputum of poorer quality and quantity, decreasing their chances of diagnosis

11. Example 4: Other promising developments in Viet Nam • General Statistics Office and line ministries, with UNDP’s support, are developing a M&E framework for the implementation of: • the Law on Gender Equality • the Law on Domestic Violence Control • General Statistics Office, with WHO’s support, is finalizing the first national study on violence against women • National Strategy on Gender Equality (2011-2020) and National Targeted Programme for Gender Equality (2011-15) are under development • Joint Annual Health Review includes key indicators to assess health sector, including some on gender and health issues (e.g., sex ratio at birth, gender-based violence)

12. Example 5: Women’s health in the Western Pacific Region • Women's Health: Western Pacific Region, 2001. • Contains country profiles • Reviews progress and lessons learned in implementing Beijing Declaration and Platform for Action (1995) • Identifies constraints, priority areas, and areas of collaboration among partners • Women and Health: Today’s Evidence, Tomorrow’s Agenda, 2009. • provides evidence on women's health needs and challenges over the life-course • includes latest figures on health and leading causes of death in women. • Agenda item on “Women’s health”, Western Pacific Regional Committee Meeting, Oct 2010. Key messages: • Women face distinct health needs through the lifecycle • There are multiple determinants of women’s health • Health systems are failing women • The unfinished agenda can—and should—be addressed, through multisectoral action, health systems strengthening, and partnerships • Women and Health in the Western Pacific Region, planned 2011: new regional report on women and health

13. Priorities for improving national HIS in the Western Pacific Region • Advancing countries along HIS continuum • Improving data collection, analysis, quality, and use • Providing better training, tools, and techniques • Improving interoperability of databases and systems

14. Thank you