Healthy Images of Manhood: A “Male Engagement” Approach for Workplace Health

1. Healthy Images of Manhood: A “Male Engagement” Approach for Workplace Health Pauline Muhuhu David Wofford Extending Service Delivery Project February 11, 2010

2. What is the Extending Service Delivery Project (ESD)? • Global project in reproductive health and family planning (RH/FP) funded by USAID • Addresses unmet need for RH/FP and increases access to services by the poor and underserved at the community level • Project Organizations: • Pathfinder International – Managing partner • IntraHealth – gender, religious leaders, BPs • Management Sciences for Health – Health systems • Meridian Group International Inc. – CSR

3. What are ESD’s main technical focuses for reproductive health/family planning? • Best Practices – identifying BPs in and promoting use of BPs • CSR and Corporate Partnerships • Family Planning-HIV Integration (of services) • Healthy Timing and Spacing of Pregnancy • Gender – launching HIM approach for companies and workplaces

4. What is ESD’s experience in Africa? • Country-level projects: Kenya (North East Province APHIA –HIV/AIDS); Burundi; Guinea; Angola; D.R. Congo; Ethiopia; Sudan • Tanzania • Unilever Tea: HIM + service delivery • Medical Women Association of Tanzania: healthy timing and spacing of pregnancy • Kenya • Dadaab/Kakuma – religious leaders training; youth training in gender-based violence prevention

5. Who are ESD’s Corporate, NGO Partners? • Unilever Tea Tanzania and KenyaLtd. – workplace peer education project using the Healthy Images of Manhood approach • Business for Social Responsibility – (Health Enables Returns) HERproject technical advisor • Levi Strauss & Co. – Workplace health program in 3 supplier companies in Egypt/2 suppliers in Pakistan • Bayer Schering Pharma – Healthy Timing and Spacing of Pregnancy education materials • The Calvert Group (social investment firm) – the Calvert Women’s Principles/Gender Equity Principles • Global Business Coalition on HIV/AIDS, TB, and Malaria – HIM in Kenya; CSR workshop on health

6. Where did HIM come from? HIM takes the best of: • Proven “community-based” gender programs – Project H, Raising Voices, and Men as Partners AND • Integrates ESD’s expertise in reproductive health/family planning and workplace programs • TO address the needs of companies & workplaces.

7. What is the HIM approach? • HIM is about men’s and women’s empowerment to improve health: • Helping men to reflect on negative social norms that lead to unhealthy behaviors • Providing peer educators “gender” knowledge and skills to influence their peers to adopt healthy behaviors • Linking health education to health services • Taking a holistic approach to health – integrating of HIV, family planning etc.

8. What is the meaning of Gender?

9. What is the meaning of Gender? Sex or Gender: • Breastfeeding? • Changing Nappies? • Driving a trailer truck? • Getting a vasectomy? • Giving birth? • Going to a bar? • Washing clothes?

10. Definition of Sex and Gender • Sex refers to the physiological characteristics that identify a person as male or female. • Gender refers to the widely shared, expectations and norms about BOTH men and women and their behaviors. Sex is a fact of biology (genitalia, hormones etc.) Page 24 – HIM Training Manual

11. Why is male engagement important in general and for companies? • Many good health education programs fail to address the effect of cultural beliefs on men’s behavior • Companies are not getting as much out their investments in worker health

12. Why is male engagement important in general and for companies? • Men’s unhealthy choices and behaviors harm more men– but also their families and entire communities • Peer health educators need specific knowledge and skills for addressing men’s cultural beliefs

13. What is unique about HIM as a gender program? It shares many elements BUT • Gender programs are not tailored to the workplace realities • They are focused on a narrow, specific area: Gender-Based Violence; HIV/AIDS and care-giving; • Family planning & reproductive health are not integral

14. How is HIM different from most peer education training? Many elements are the same BUT • Gender skills/knowledge are made integral to development of communication skills and health knowledge and outreach • Personal behavior change by PHEs themselves is essential • HIM takes a “whole person” approach to health

16. What are the main elements of HIM?

17. What are the main elements of HIM? • Core Curriculum blending: • Gender skills/knowledge • Health knowledge (RH/FP/HIV/Child health) • Participatory outreach skills • Modular curriculum adaptable to each workplace • Other valuable elements • Linkages/improvements to health services • Capacity building: • Strong supervision – focused on mentoring, • Ongoing skills development for PEs • Company management ability to maintain/expand program on its own

18. What other elements are in the HIM approach? • Data collection & analysis – by and for PHEs • M&E: “feedback loops” among PEs, Health Providers and the community

19. HIM Modules 1 & 2

20. HIM Modules 3 & 4

21. HIM Module 5 & 6 (& Appendices)

22. What materials supplement the HIM approach? • A PE Workbook • A HIM Coordinator Guidebook • Pop Council Balanced Counseling Strategy • Video, Brochures, Posters on Healthy Timing and Spacing of Pregnancy

23. A Small Taste of HIMExercise 1: Values Clarification

25. Experiences with HIM

26. How did we arrive with Unilever at Healthy Images of Manhood • Responding to specific needs of the company • High HIV rate; good health services/ systems • Low use services, particularly by men • Creating a “male engagement” program adapted to a workplace

27. What were the main goals of HIM at UTTL? • Primary Goal: to increase men’s use of UTTL’s health services (HIV, family planning etc.) • Secondary Goals: • Improve the quality of PHEs’ outreach • Promote behavior change in PHEs themselves • Create linkages between peer education activities and service providers

28. How was the HIM program implemented at UTTL? • HIM Program Start-Up: • Training program for 29 male peer health educators – begun January 2008 (six days) • ESD trained an external Tanzanian trainer in HIM for initial training and capacity building for coordinator • Full-time coordinator assigned: mentoring, support • Monthly follow-up meetings

29. How was HIM implemented at UTTL? • HIM Development over 18 months: • September 2008: 3-day refresher training • Full-time coordinator assuming full management • Data collection system improvements • Changes and Scale-Up of program • 52 new PHEs trained in HIM in September • Half of new HIM PHEs are women • HIM elements now in basic PHE training

30. What has been the impact of HIM to date? • Referrals: • Increase in male enrollment at CTC • In 2009, for first time, men coming STI clinic at same rate as women (and lower STI rate overall) • Family Planning services: • Gradual uptake in FP by HIV clients (not previously offered in CTC): 17 new FP clients and 70 repeat visits Jan-June 2009 • Gradual increase overall of new FP clients: 16/month Jan-June 2009 compared to an average of 11/month for Jan-June 2007 • PHE Productivity: • 122,492 male and 5,321 female condoms distributed by HIM-trained PHEs over 17 months

31. What has been the impact of HIM to date? • Qualitative: • HIM-trained peer educators highly positive about training and personal changes • Positive reaction from women: “HIM is our salvation” • PHEs have been asked to mediate marital dispute • Peer educators are seen as a resource • On mobile clinic days (Maternal & Child Health/FP), PHEs provide health education and assistance

32. “I always thought I was right. I treated her as a worker rather than a spouse. I have changed my behaviors towards my wife. I have began consulting her in family matters, sharing domestic responsibilities. • “People now come to me for referrals” • “Company leadership has received HIM very well. Unfavorable behaviors of masculinity have gone down at that level.”

33. Changes in the belief that HIV+ person committed a sin and that condoms are for prostitutes. Less suspicion in the home now when a woman finds a packet of condom in the husbands pockets. • One cited an incident where a woman came to him to thank him for whatever he did to her husband because the beatings have stopped

34. HIM Exercise 2: Proverbs • Each group will receive a proverb or saying for around • Discuss what you think is the meaning of the proverb • Explain what it tells you about what is that society’s view of men or women • Each group will identify 1-2 similar proverbs/sayings from their communities

35. The Business Case for HIM • ESD has major focus on Return on Investment analysis: • Workplaces in Bangladesh and Guatemala (studies) • Interest in health outcomes and business outcomes • HIM also is designed with the business case in mind

36. The Business Case for HIM • Business is investing in health program on HIV/AIDS, TB, Malaria: • HIM is designed to complement these efforts in order to: • Get more return from these investments • Be easily adapted cost-effectively into existing PE and health programs • Provide easy tools for implementation

37. Business Case for HIM • Each company has its own business interests: • Fulfillment of CSR commitments and obligations • Legal obligations: eg. The Sexual Offenses Act in Kenya • Better use of resources • More impact from existing investments