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Making Gender Count

Making Gender Count. Shelah Bloom, ScD Gender Specialist, MEASURE Evaluation. Overview. Definitions GHI, Gender and Health Strategies Addressing gender in health programming Gender and Health M&E Health systems Measures Gender M&E Resources and Tools. Definitions 1.

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Making Gender Count

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  1. Making Gender Count Shelah Bloom, ScD Gender Specialist, MEASURE Evaluation

  2. Overview • Definitions • GHI, Gender and Health Strategies • Addressing gender in health programming • Gender and Health M&E • Health systems • Measures • Gender M&E Resources and Tools

  3. Definitions1 Sex: Biological difference between males & females 1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

  4. Definitions1 Gender:Beliefs about the appropriate roles, duties, rights, responsibilities, accepted behaviors, opportunities and status of women and men, in relation to one another These vary between places & change over time in the same place 1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

  5. Definitions1 • Gender Equality • Equal treatment of women and men in laws and policies, and equal access to health resources and services within families, communities and society at large • Gender Equity • Absence of unfair/avoidable or preventable differences in health between women and men. • Accounting for different barriers affecting women and men in benefiting from health-care programs 1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

  6. Gender inequality is the most pervasive form of social inequality Gender inequality cuts across all other forms such as class, caste, race and ethnicity1 1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

  7. GHI, Gender and Health Strategies

  8. GHI, Gender and Health Strategies • Why think about gender and health? • Gender inequality is associated with poor outcomes • Child mortality, stunting &wasting, care utilization, maternal mortality, GBV • Gender Inequality is recognized as a driver of the AIDS epidemic world-wide

  9. GHI, Gender and Health Strategies:Women, girls and gender equality1 • Work with partner countries to redress gender imbalances related to health • Equitable access • Building capacity of women & girls in program design & M&E • Response to GBV • Address social, economic and cultural determinants of health • Country strategies should include gender assessments & gender equality narrative 1The United States Government Global Health Initiative, strategy document

  10. GHI, Gender and Health Strategies:PEPFAR Gender Strategy1 • Gender integration in all program areas (prevention, care & treatment) • Programming along 5 strategic, cross cutting areas: • Increase gender equity in activities/services • Reduce violence and coercion • Address male norms & behaviors • Increase women’s legal protection • Increase women’s access to income/productive resources 1http://www.pepfar.gov/press/2011/157860.htm

  11. GHI, Gender and Health Strategies:MEASURE Evaluation • Integrate gender into activities by adding a gender lens or gender component • Implement activities illuminating gender effects on health risks, access to and use of health services • Provide M&E technical support to global networks and initiatives • Capacity building and training in gender M&E

  12. Addressing Gender in Health Programs

  13. Addressing Gender in health programs:Gender integration continuum1 1USAID Training of Trainers: Gender and Reproductive Health 101

  14. Gender norms: accommodating or transformative?

  15. Gender norms: accommodating or transformative?

  16. Addressing Gender in health programs:Gender-Based Analysis1 • Understand gender differentials based on roles, responsibilities, norms, power • Health status & determinants • Care utilization re: needs • Ability to pay for services • Participation of in health management • GBA reveals influences, omissions & implications in health policy, programming & planning • Leads to addressing gender explicitly 1PAHO (2009). Guidelines for gender-based analysis of health data for decision making. PAHO.

  17. Addressing Gender in health programs:GBA Data requirements 1 • Quantitative • Collecting, reporting & analyzing sex disaggregated • Explore socioeconomic determinants of health outcomes and service utilization, further disaggregation by location, age, income, ethnicity & education • Qualitative • Personal experiences and perspectives, motivations, attitudes, behaviors, choices etc. • Gets to the why of what quantitative data shows but often cannot explain 1PAHO (2009). Guidelines for gender-based analysis of health data for decision making. PAHO.

  18. Gender and Health M&E

  19. Gender & Health M&E:1Basics • Monitoring • Indicators on gender-specific programmatic outputs • Data collection in areas such as attitudes and behavior that reflect gender norms, and items that will fit into standard measures • Evaluation • Measuring program impact on gender-related outcomes • Demonstrate progress and impact on health status, generate demand for richer data 11 USAID IGWG 2009, A manual for integrating gender into reproductive health and HIV programs

  20. Gender and Health M&E:Basics • How can health information systems address gender inequality? 1 • Involvement of stakeholders at all levels • Sex-disaggregated data • Ongoing gender training for M&E system staff • Gender-integrated M&E plans 1Payne, Sarah (2009). How can gender equity be addressed through health systems? WHO, policy brief #12

  21. Gender and Health M&E:Using existing health systems data • Know your HIV/AIDS epidemic from a gender perspective: Kenya • Objectives • Illuminate gender effects on programmatic response • Generate demand for richer gender-related data • Assess existing national level data for potential • Analyses using gender indicators & show gender effects • Implement tool to create graphs & help interpretation to drive programmatic decision-making

  22. Gender & Health M&E: Measuring gender • Complex construct • Quantitative measures for gender equality • Norms for women and men, including attitudes about gender-based violence (GBV) • Beliefs about roles • Relationship factors • Women’s decision making power in various areas • Independent access to economic resources • Experience of GBV • Complex analytical methods to demonstrate impact

  23. Gender & Health M&E: Measuring gender • GEM Scale: measure attitudes towards gender norms in intimate relationships among men • Use: predict multiple partners, family planning use, IPV & more in varied contexts (Brazil, India, China, Uganda etc.) • Content: 24 items, 2 sub scales • Requirements: asking 24 (can be more or less, depending on context) items, then performing a statistical analysis

  24. Gender & Health M&E: Measuring gender as a global commitment • Collaborative effort to add gender & HIV indicator for post-UNGASS core set • TAG included USG, UN, GFATM, WB, other experts • Prevalence of Recent Intimate Partner Violence (IPV) • Women 15-49, have/had intimate partner, reporting physical or sexual violence in past 12 months • Total women surveyed aged 15-49 who currently have or had an intimate partner

  25. Gender & Health M&E: Capacity building • Adding gender session M&E workshop curricula • Define gender & related terms • Importance of gender to health programming & outcomes • Addressing gender in programs • Donor gender M&E requirements • Measuring gender • Integrate gender into M&E plans • Piloted in India, Senegal and Nigeria

  26. Gender M&E Resources and Tools

  27. Gender M&E Resources and Tools • VAW/G compendium • https://www.cpc.unc.edu/measure/publications/ms-08-30 • HIV indicator Registry (UNAIDS) • http://www.indicatorregistry.org/ • Go to: browse indicators—need to identify the gender indicators here • Gender scales • http://www.c-changeprogram.org/content/gender-scales-compendium/index.html • K4 Health IGWG Gender and Health Toolkit • http://www.k4health.org/toolkits/igwg-gender • MEASURE Evaluation gender website: http://www.cpc.unc.edu/measure/our-work/gender

  28. Gender M&E Resources and Tools:Coming soon • Gender and HIV indicator menu of options • Set of harmonized, agreed-on indicators • TAG includes USG (PEPFAR USAID), UN (UNWomen UNAIDS, WHO, UNFPA), World Bank, GFATM & other experts • Resource guide for gender data and statistics (WHO, IGWG/USAID & MEASURE Evaluation)

  29. Where are we in gender M&E? • Gaps • Data: sex disaggregated: collection, analysis, reporting • Data: items for complex measures • Capacity building in gender M&E • Gender-based analyses • Tool development

  30. MEASURE Evaluation is a MEASURE project funded by the U.S. Agency for International Development and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health and nutrition worldwide.

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