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Health Care

The 2023 IGWG Plenary: Breaking Barriers: Addressing Gender Inequities Facing Global Health Workers

Posted on September 7, 2023

Background: The Interagency Gender Working Group (IGWG) hosted its 2023 Annual Plenary on Thursday, August 31 from 8:00-10:00 a.m. EDT, which explored how gender transformative programs can better address workplace inequities affecting health workers, and improve health and gender outcomes.

Gender inequities affect health workers in many ways. Gender inequities are common in health care system practices related to recruitment, retention, promotion pathways, leadership roles, earnings, and even access to full-time employment. Women represent about 70% of the health workforce but earn on average 28% less than men. Gender discrimination also affects health system leadership, governance, and occupational segregation. Women remain least represented in decision-making roles, including as physicians, administrators, and managers. Sexual and gender-based harassment, objectification, mistreatment, and violence are commonly reported by health workers around the world. Additionally, few policies and practices recognize and support the informal care that health workers, predominantly women, are expected to provide at home.

Despite evidence that gender discrimination and inequities in the health workplace are systemic, programmatic attention and funding to address these inequities are limited. However, evidence from other sectors indicates that addressing these inequities could lead to a more sustainable health system that can better address gender inequalities as a social determinant of health, and, ultimately, improve health outcomes for all.

Event overview: The 2023 Plenary highlighted research examining gender inequities faced by health workers and showcased promising practices and lessons learned from innovative programs working to address gender barriers in the health system workplace. The 2023 IGWG Plenary aimed to better equip IGWG members to examine gender inequity in their own organizations and to promote more equitable and inclusive workplaces—both within and outside the health system.

The virtual event began with a panel discussion led by experts and representatives of dynamic gender transformative programs addressing gender inequity in the health workforce.

Panelists included:

  • Dr. Amina Aminu Dorayi, Country Director, Pathfinder Nigeria
  • Seblewongel Fekadu, Gender Advisor, Jhpiego Ethiopia
  • Dr. Michelle McIsaac, Economist / Lead Gender Equity and Human Rights, Health Workforce Department, World Health Organization
  • Catherine Menganyi, Chapter Lead, Women in Global Health Kenya
  • Dr. Shabnum Sarfraz (moderator), Deputy Executive Director, Women in Global Health

Following the panel discussion, participants joined breakout rooms and shared their personal experiences addressing health workplace inequities, including challenges encountered in their work and advocacy efforts.

Event Slides

View slides from the event here.

Event Graphics

Positive Youth Development in Health Programming: How Does Engaging Boys and Young Men Fit In? A Technical Marketplace

Posted on September 29, 2022

On September 13, 2022, the Interagency Gender Working Group’s Male Engagement Task Force (METF) hosted the webinar “Positive Youth Development in Health Programming: How Does Engaging Boys and Young Men Fit In? A Technical Marketplace.” More than 100 participants from around the world—including Eswatini, Ethiopia, India, and Nigeria—participated in discussions on how gender transformative positive youth development (PYD) contributes to positive health behaviors related to family planning and reproductive health (FP/RH); HIV/AIDS; gender-based violence; maternal, newborn, and child health; and infectious disease prevention and treatment.

PYD is gaining traction as both a philosophy and a programmatic approach that can support healthy, productive, and engaged youth as they grow into adulthood. To empower youth to reach their full potential, PYD approaches support building skills, assets, and competencies; fostering healthy relationships; strengthening the environment; and transforming systems. By integrating gender transformative approaches, PYD can maximize its effects on youth empowerment, FP/RH outcomes, and gender equality, particularly when applied in early cognitive and relationship development stages for adolescent boys and young men (ABYM).

The webinar opened with two keynote addresses:

  • Michael Reichert, applied and research child psychologist and author of How to Raise a Boy: The Power of Connection to Build Good Mengave an opening keynote address, “The Promise of Human Development in Boys’ Lives”. His presentation emphasized that boys are naturally wired to connect with others, and that relationships are the medium through which successful teaching and learning is performed with boys. The prominent models for boyhood, however, do not nurture these connections.
  • Amy Uccello, senior youth and family planning technical adviser at the U.S. Agency for International Development (USAID), provided an overview of USAID’s recently launched Youth in Development Policy, including its PYD framework. The framework recognizes youth’s inherent rights and results in youth who have assets, the agency to leverage those assets, and the ability to contribute to positive change for themselves and their communities, supported by an enabling environment. In each of these domains, meaningfully engaging adolescent boys and young men is essential.

Two panels with presenters from across the globe shared recent research or programming around PYD for adolescent boys and young men. Presentations explored how ABYM can benefit from the PYD approach through: access, including access to high-quality information, safe services, and livelihood opportunities to build the skills they need to lead healthy, productive, and engaged lives; participation, including full participation as key partners in decision-making to contribute to individual, household, community, and national well-being; and systems, including collective voice in local and national systems to achieve more coordinated and effective services, practices, and policies that embody the principles of positive youth development.    

Panel 1: Engaging Young Men for Positive Youth Development in Health Programming

  • “Leveraging Partnerships With Men and Boys for Optimum Health Outcomes for All,” Ajita Vidyarthi and Mohammed Ibrahim, Plan International Canada.
  • “Modalities for Change: How Youth Are Engaging Boys and Men in Youth-Led Social Accountability Work in Ghana,” Douri Bennin Hajei, Youth Advocacy on Rights and Opportunities (YARO).
  • “An Innovative Approach to HIV Prevention Through Engaging Boys and Young Men in Eswatini,” Mary Mhazo and Gift Dlamini, Kwakha Indvodza: Litfuba Ngelakho (The Chance is Yours).
  • “Promoting Adolescent Boys’ Engagement with Sexual and Reproductive Health, Agency, and Gender Synchronicity Through Gaming,” Kavita Ayyagari, Howard Delafield International LLP.

Panel 2: Engaging Boys for Positive Youth Development in Health Programming

  • “Boys’ Engagement in Menstrual Hygiene Management (MHM) in Rural Parts of Ethiopia,” Masresha Soressa, Pathfinder International.
  • “Sibling Support for Adolescent Girls in Emergencies (SSAGE): Findings From a Brother-Sister Centered, Family-Based Model to Address Violence Against Girls in Humanitarian Settings,” Monica Giuffrida, Women’s Refugee Commission.
  • “Engaging Adolescent Boys to Promote Reproductive Health and Prevent Gender-Based Violence in Nigeria: The SKILLZ Guyz Approach,” Usen Asanga, Youth Development and Empowerment Initiative.

Participants discussed key takeaways from the presentations, shared relevant examples from their own work, and identified critical next steps for research and programming. Key takeaways included:

  • The importance of a family-centered approach/multiple influencer involvement/multilevel programming (for example, bringing parents and ABYM together to meet ABYM needs and involving peers, parents, and institutions).
  • The importance of early intervention with ABYM (ages 10-14) to shift gender attitudes and norms.    
  • The importance of local adaptation/local-level planning to enhance program effectiveness.
  • The need for accountability to engage youth in program design as early as possible.
  • Youth-led programming is a priority with unique challenges and opportunities. For example, it may require one to two years to build youth agency and capacity and to advance an enabling environment.
  • of implemented interventions (for example, more restrictions on girls’ autonomy to prevent potential violence).   
  • The need to apply both quantitative and qualitative methods to measure gender transformative outcomes, including relations between girls and boys and men and women.

Event Recording:

EXPLORE ADDITIONAL RESOURCES

Click the links below to access slides from the webinar and other related resources.

Webinar Slides

Related Resources:

  • DO’s & DON’Ts for Engaging Men & Boys.
  • Does Your Program Reflect Gender Transformative or Positive Youth Development Practices? A Checklist
  • Youth in Development Policy | USAID.
  • Positive Youth Development (PYD) Framework | YouthPower2
  • Game of Choice, Not Chance.
  • Sibling Support to Adolescent Girls in Emergencies (SSAGE) Implementation Toolkit | Mercy Corps.
  • Champions of Change for Gender Equality and Girls’ Rights | Plan International.
  • Listening to Girls as They Grow Up–Our Longitudinal Study | Plan International.

Want to Know More about IGWG’s Male Engagement Task Force?

The Male Engagement Task Force (METF) is an information, advocacy, and knowledge exchange network that examines what it means to engage men and boys in health promotion and gender equality. The METF aims to explore why we should engage men and boys, what are the benefits, how to do it, what works and doesn’t work, and what modalities of health services can better reach and include men and boys while addressing gender dynamics that act as barriers to health. Health areas of focus include family planning; sexual and reproductive health; maternal, newborn, child, and adolescent health; nutrition; HIV/AIDS; and prevention and treatment of infectious diseases such as malaria and tuberculosis. The METF considers relevant social and behavior change, service delivery, research, and policy efforts to improve outcomes across these health areas. For more information, click here.

September Gender Knowledge Exchange Event: Exploring Evaluation and Learning Methods in Community-Led Gender Transformative Programming

Posted on September 9, 2022

Background: The 2022 Interagency Gender Working Group (IGWG) Plenary explored the elements and impacts of community-led, gender transformative programming, a topic that resonated with our members and attendees. The event, which convened more than 200 attendees representing 46 countries, highlighted promising practices and lessons learned for how to ensure meaningful community leadership in gender transformative global health programming.

The discussions that arose during the plenary highlighted the importance of gender champions cultivating effective and equitable learning and evaluation partnerships with community leaders and groups—both formal and informal—to help address common challenges such as limited resources, competing agendas, and ingrained power differences.

Event Recording:

The opinions expressed in this video are those of the presenters and do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States government.

Event Materials:

View slides from the event here.

Event Overview: Building on the momentum of the 2022 Plenary, the IGWG hosted a gender knowledge exchange event on September 7 from 9:00-11:00 a.m. EDT, exploring in more depth one of the plenary’s many thematic areas of interest: participatory and inclusive evaluation and learning methods in community-led, gender transformative programming, particularly family planning, reproductive health, and gender-based violence prevention.

Despite the wide acceptance of the importance of community leadership in theory and practice, many implementation challenges remain, particularly in strengthening programming’s participatory learning and evaluation components. Recent published literature reveals questions about the relationship between degree of participation and impact, how impact should be defined, and the role of wider social forces on the evaluation process for health programs. Additionally, practical process and content questions remain about how to get started implementing participatory learning and evaluation in programs, what steps are necessary to form these processes, how decisions are made, and what outcomes should be monitored.

This gender knowledge exchange provided members with the opportunity for deeper and more informal exchange as participants heard lessons learned from gender champions and experts on these topics in a small-group setting. It began with a panel discussion led by a group of experts, community leaders, and researchers focusing on strategies for and approaches to participatory and inclusive evaluation and learning methods and exploring promising practices for measuring community leadership in gender transformative programming. Following the panel discussion, attendees had the opportunity to participate in a Q&A session with speakers. Panelists included:

  • Nancy Glass, Professor and Independence Foundation Chair, Johns Hopkins University School of Nursing
  • Tamil Kendall, Director, Partnership for Women’s Health Research Canada
  • Renu Khanna, Co-Founder and Mentor, Society for Health Alternatives (SAHAJ)
  • Rachel Litoroh, Monitoring, Evaluation, Accountability, and Learning Manager, Comitato Internazionale per lo Sviluppo dei Popoli/International Committee for the Development of Peoples (CISP)

Key Takeaways:

How can program implementers engage with community leaders to improve monitoring and learning activities and influence the effectiveness and relevance of gender transformative programs?

  • Program implementers should consult regularly with community members to hear their concerns and feedback and build trust, understanding that the primary role of implementers in these meetings should be to keep a pulse on what is happening in the community and listen to constituents. For example, the SAHAJ program implemented periodic federation meetings where community leaders of each group came together to share issues, lessons learned, and challenges. This feedback was then incorporated into program interventions.
  • In meetings with community leaders, implementers should be open to hearing alternative solutions to challenges and not go into meetings with decisions already made.

How can the role or insights of community leaders in monitoring or evaluation contribute to and affect gender transformative programming’s attention toethical dilemmas and efforts to do no harm?

  • Recruiting peers to lead evaluation interviews may help interviewees feel more comfortable about discussing sensitive or taboo topics. To document SRH violations that women living with HIV were experiencing, the ICW (International Community of Women Living With HIV)-Latina/Balance program recruited peers to document evidence and trained all peer researchers in confidentiality protocol and informed consent.
  • Program implementers should ensure community leaders have decision-making power over program evaluation goals and what data and information are documented. For example, community leaders can co-create questionnaires, helping to decide the language and framing of the questions. Implementers should ensure evaluation tools are communicated in a way that community leaders can understand (in other words, with less jargon), and support community leaders in feeling a sense of ownership over the program data, encouraging them to use the data in their work. Additionally, collaborating with community leaders to develop messaging around program data can foster a sense of joint ownership, which may support leaders’ use of the data in their work and advocacy efforts.
  • Community leaders can help program staff navigate discussions on sensitive topics with community members. For example, before discussing issues related to sexual and reproductive health and rights (SRHR) with youth in India—topics that are considered very sensitive and require consent to be discussed with young people—the SAHAJ program created community advisory groups of adults or supporters, progressive parents, teachers, and community leaders to guide the discussions and the ensure they were culturally appropriate and acceptable.
  • Implementers should support the inclusion of marginalized and excluded groups in evaluation and learning processes, recognizing that in some contexts, deep-seeded and intergenerational structures (for example, caste systems) are more difficult to penetrate.

How can community leaders play a role in the evaluations of gender transformative programs?

  • Before developing the program evaluation, implementers should meet with community leaders to discuss expectations for outcomes, what success looks like, and outcome indicators. Similarly, community leaders should be included in discussions for external evaluations. External evaluators should build in spaces to engage with community leaders and provide them with the opportunity to reflect on their work and why it has or has not worked, as well as to encourage leaders to share their stories.
  • Recognizing that community leaders have an important stake in the program evaluation process, implementers should engage leaders (including government officials) early to ensure programs are context-specific and achieve support for program results. For example, after receiving feedback from community leaders and authorities about the exclusion of female genital mutilation in their programming, the Community Care Programme (CCP) incorporated this topic into its interventions and evaluation.
  • Community leaders should help decide how evaluation findings are communicated back to the community, including how the results are shared and with whom. Their participation is especially important for findings on sensitive issues, which may face serious backlash from the community. Involving community and peer leaders can help program implementers frame their findings in a way that provides transparency and avoids setting back the work of gender transformative social norms or creating further risk to impacted groups.
  • Recognizing possible tensions that may arise between supporting organizations and the ability of community leaders to be frank and critical, program implementers should work to build the trust of community leaders to engage in evaluation and learning method processes effectively. Implementers should recognize that criticism from community leaders may be an indicator that they are starting to trust program processes.

What are some practices and methods that programs can apply and use to measure changes in community leadership?

  • To assess changes in growth in community leadership at individual and organizational levels, implementers can build questions into evaluations related to changes in community leaders (and their organizations’) capacity to lead during regular check-ins and progress meetings, as well as capture these changes through formal interviews and participant observations. The ICW/Balance program asked participants about how their views and personal priorities and practices related to SRH, and their organization’s priorities and collective action efforts with other organizations, changed throughout the process and documented these changes. In one example of growth, program participants—women living with HIV—acted as subject matter experts and used program-generated evidence to influence policy and care guidelines at the national level.
  • Stories shared during discussions with community leaders can be a rich way of learning about various forms of leadership, how capacities have changed and evolved, and how subject knowledge of issues has grown. Stories can also provide insight into the experiences of community leaders and marginalized groups, as well as the intersectional experiences of program participants.
  • In addition to using formal tools, program implementers can monitor the behavior of community leaders who are successfully and effectively facilitating discussions on sensitive topics. The CCP monitored how community leaders led discussions on sensitive topics, which helped indicate leaders who were likely to continue these discussions after the end of the program and identified those who could mentor other leaders. The CCP also mapped out reference groups, recognizing that leaders who are most vocal and well-known may not be the only the ones driving change.

Exploring the Impact of Reproductive Coercion on Sexual and Reproductive Health Outcomes

Posted on September 6, 2022

Background: Reproductive coercion is a form of gender-based violence (GBV) and refers to a range of behaviors that interfere with autonomous decision-making related to contraception and pregnancy. It negatively impacts an individual’s reproductive health and autonomy. Several studies have linked reproductive coercion to intimate partner violence (IPV), unintended pregnancies, adverse pregnancy outcomes, and poor mental health.

Event Recording:

Event Materials:

Read the meeting report here.

Complete event slidedeck.

“Introduction to Reproductive Coercion” presentation slides.

Event Overview: The Interagency Gender Working Group’s (IGWG) GBV Task Force hosted an event on Wednesday, August 31 from 8:00-10:00 a.m. EDT focused on exploring the connections between reproductive coercion in the context of intimate and household relationships, IPV, and domestic violence, as well as highlighting reproductive coercion’s impacts on sexual and reproductive health (SRH), particularly family planning and GBV outcomes.

The event served as a forum for stakeholder dialogue and highlighted examples of program and advocacy approaches addressing reproductive coercion that have been successfully integrated into SRH programs, particularly family planning and GBV. It also shared considerations for funders, particularly around the roles they can play to strengthen commitments to prioritize and address reproductive coercion.

This GBV Task Force event began with a presentation providing an overview on the key elements and examples of reproductive coercion, as well as new findings and trends. A panel of expert implementers and researchers then shared key findings and promising practices from and challenges encountered in their programs. The panel discussion was followed by a Q&A session where attendees had the opportunity to pose questions to speakers. Panelists included:

  • Hannatu Abdullahi, Reproductive, Maternal, Newborn, and Child Health Technical Director, Jhpiego, Nigeria
  • Jhumka Gupta (moderator), ScD, MPH, Associate Professor, Department of Global and Community Health, College of Health and Human Services, George Mason University
  • Elizabeth Miller, MD, PhD, FSAHM, Distinguished Professor of Pediatrics, University of Pittsburgh School of Medicine
  • Jane Harriet Namwebya, Senior Implementation Coordinator, Population Council, Kenya
  • Fura Gelzen Sherpa, Board Member, Youth Peer (Y-PEER) Educational Network, Nepal
  • Jay Silverman, PhD, Professor of Medicine and Global Public Health and Associate Director, Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine

Lessons Learned in Gender Transformative Health Programming: A Rapid Literature Review

Posted on August 3, 2022

In the past two decades, use of the term gender transformative by policymakers, donors, implementing agencies, and civil society actors has increased dramatically. Many health donors, bilateral and global institutions, and implementing agencies have endorsed their commitment to realizing gender transformative programs, although the definitions used by global health institutions vary.

At the same time, research on the effectiveness of gender transformative health programs as it relates to health and gender equality outcomes has increased in the past two decades. As implementers and researchers use the term gender transformative as evaluative criteria for gender equality programs, with expanding evaluation data and evidence, the need for a clear understanding of what meets the definition becomes increasingly important.

At the 20-year anniversary of the Gender Integration Continuum, the Interagency Gender Working Group has developed a research brief addressing the following questions:

  • How effective is gender transformative programming?
  • What program elements are key to successful programs?
  • What questions or limitations have emerged about the implementation of gender transformative programs?
  • What lessons and conclusions can we take away from programming that aims to change gender and social norms, advance gender equality, and sustain improvements in health?

This research brief summarizes the methods, findings, and conclusions of a rapid literature review of systematic reviews of evaluated gender transformative health programs. It sheds light on how best to achieve gender equality and health outcomes through gender transformative programming. The brief also provides recommendations for program implementers, policy advocates, and funders for improving the effectiveness and sustainability of gender transformative health programs.

Read the Research Brief Here

Addressing GBV in Health Care Settings: Involving the Public Sector

Posted on May 29, 2017

The October 27th event examined the role of the public sector responses to gender-based violence. Panelists from Jhpiego and from Population Council shared lessons from projects in Mozambique and Zambia.

Population Council is working with the police in Zambia to better respond to GBV survivors. Their presentation, “Police as Part of the Public Health Response to SGBV: An Exploration of Task-Sharing in Zambia” included commentary by Dr. Jonathan Kaunda Mwansa, Pediatrician and Epidemiologist at Arthur Davidson Children’s Hospital, in Ndola, Zambia, Dr. George Msipu Phiri, Director of Medical Services, Zambia Police Service and Chi-Chi Undie, Associate in the Reproductive Health Program of the Population Council.

Meanwhile, Jhpiego’s work grew out of their experiences with One-Stop Centers and with maternity centers in Mozambique. Their presentation “Establishing Gender-Based Violence Clinical and Multi-Sectoral Services in Mozambique” was led by Myra Betron, Director for Gender at Jhpiego in Washington D.C. and Dr. Ana Baptista, coordinator of GBV activities for Jhpiego in Mozambique.

Additional Resources:

  • Presentation: Police as Part of the Public Health Response to SGBV: An Exploration of Task-Sharing in Zambia(Population Council)
  • Presentation: Establishing GBV Clinical and Multi-Sectoral Services in Mozambique (Jhpiego)
  • Speaker Bios
  • Event Notes
  • Video Recording of Event

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