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

Definitions1

Sex: Biological difference between males & females

1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

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

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

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

GHI, Gender and Health Strategies

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

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

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

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

Addressing Gender in Health Programs

Addressing Gender in health programs:Gender integration continuum1

1USAID Training of Trainers: Gender and Reproductive Health 101

Gender norms: accommodating or transformative?

Gender norms: accommodating or transformative?

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 explicitly1PAHO (2009). Guidelines for gender-based analysis of health data for decision making. PAHO.

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.

Gender and Health M&E

Gender & Health M&E:1

Basics 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

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

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

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

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

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

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

Gender M&E Resources and Tools

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.h

tml

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

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)

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

MEASURE Evaluation is a MEASURE project funded by theU.S. Agency for International Development and implemented bythe Carolina Population Center at the University of North Carolinaat 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 notnecessarily reflect the views of USAID or the U.S. Government.MEASURE Evaluation is the USAID Global Health Bureau'sprimary vehicle for supporting improvements in monitoring andevaluation in population, health and nutrition worldwide.