Gender considerations are critical to improving … 27, 2017 · Gender considerations are critical...

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1 Gender considerations are critical to improving quality of care Dr. Taroub Harb Faramand Founder and President WI-HER, LLC ASSIST Project April 27, 2017
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Transcript of Gender considerations are critical to improving … 27, 2017 · Gender considerations are critical...

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    Gender considerations are critical to improving quality of

    careDr. Taroub Harb Faramand

    Founder and PresidentWI-HER, LLC

    ASSIST Project

    April 27, 2017

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    DEFINING GENDER AND RELATED CONCEPTS

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  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Gender & Sex

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    What is sex?

    What is gender?

    WI-HER LLC

  • USAID Applying Science to Strengthen and Improve Systems

    Sex

    A medical term used to refer to the chromosomal, hormonal, and anatomical characteristics that are used to classify an individual as female, male or intersex

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    Intersex: An umbrella term that refers to a variety of chromosomal, hormonal, and anatomical conditions in which a person does not seem to fit the typical definitions of female or male.

    Adapted from: Killerman, 2013

  • USAID Applying Science to Strengthen and Improve Systems

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    You Soup

    The Gender Person

    Additional Terminology

    Local Terminology

    Myths and Misconceptions

    Gender Expression

    The external display of ones gender, through a combination of appearance, disposition, social behavior, and other factors, generally measured on a scale of masculinity and femininity.

    Gender norms: A culturally-defined set of roles, responsibilities, rights, entitlements, and obligations, associated with being female and male, as well as the power relations between and among women and men, boys and girls.

    35Adapted from: Killerman, 2013

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    Why Gender?

    Taroub Faramand WI-HER, ASSIST

  • USAID Applying Science to Strengthen and Improve Systems

    Why consider gender in improvement work?

    Gender norms and inequalities, and Gender-Based Violence (GBV) affect health outcomes for all people

    Enjoying the highest attainable standard of health is a human rights issue

    Understanding the unique needs and vulnerabilities of all people helps us identify target populations, tailor responses and dedicate resources where they are most needed

    Make sure we are doing the right things at the right time for every person, every time

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  • USAID Applying Science to Strengthen and Improve Systems

    Improvement Results

    Tuberculosis Treatment Success in Swaziland

    Taroub Faramand WI-HER, ASSIST

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Example: Improvement Results, South Africa

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    No HIV kits in country

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Example: Improvement Results-Disaggregated by Sex, South Africa

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  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Our approach to gender integration

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    Analyze gender constraints, social and political issues affecting health

    outcomes

    Identify gender gaps and issues affecting health outcomes

    Develop activities to address issues and test changes

    WI-HER LLC

  • USAID Applying Science to Strengthen and Improve Systems

    Steps to integrate gender into improvement

    1. Conduct a gender analysis to inform program design and implementation

    2. Collect and analyze sex-disaggregated and gender-sensitive data, where appropriate

    3. Identify gender-related gaps and issues and develop changes to test

    4. Implement and monitor gender-related changes over time to determine whether desired results are achieved

    5. If effective, scale to other facilities

    6. Document and share learning

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  • USAID Applying Science to Strengthen and Improve Systems

    Do No Harm Approach

    Must ensure changes tested do not create/increase risk for women, men, girls or boys Ongoing monitoring of shifts in the local context

    Examples of negative unintended consequences: Pressuring women to disclose their status to their partners

    Women could be subjected to violence Prioritizing couples in PMTCT services

    Leaves single women disadvantaged Prioritizing couples for VMMC services

    Leaves single men disadvantaged

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  • USAID Applying Science to Strengthen and Improve Systems

    What is gender analysis?

    Gender analysis is a systematic way of examining relational differences between men women, girls and boys related to:

    Practices, roles, and participation Knowledge, beliefs, and perceptions Legal rights and status Access to assets and services Access to and exercise of power

    and the impact of these differences in their lives and health

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  • USAID Applying Science to Strengthen and Improve Systems

    Two fundamental questions to consider

    How will gender relations affect the achievement of sustainable results?

    How will these proposed results affect the relative status of men and women? Will it exacerbate inequalities, accommodate inequalities,

    or transform gender relations?

    Remember the principle of Do No Harm!

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  • USAID Applying Science to Strengthen and Improve Systems

    Sources of data

    Experiences of those most affected and their advocates

    Primary Interviewsindividual and group Participatory research Surveys

    Secondary Gender assessmentscountry or topic Local organizations and partners International grey literature Published articles

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    IDENTIFYING GENDER ISSUES AND GAPS

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    Tools to use

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    Problem tree Driver diagram Fishbone diagram Root cause analysis Cause and effect analysis

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    ADDRESSING ISSUES AND GAPS

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  • USAID Applying Science to Strengthen and Improve Systems

    Designing a change to address gender inequity

    Consider the barriers youve identified and think through direct changes that alleviate those barriers

    Where do we get ideas for changes? Literature Guidelines Normative documents Team problem solving Benchmarking Knowledge management

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  • USAID Applying Science to Strengthen and Improve Systems

    Before you start

    Understand culture and gender issues very well If you still have doubts, ask more questions

    Be sensitive to local issues and personal issues Be true to yourself

    Be respectful Be open to ideas and points of view Do not make assumptions or judgments Remember every group you talk to is different Tailor the discussion to local needs

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    Gender equality and equity

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  • USAID Applying Science to Strengthen and Improve Systems

    Examining data:

    Collect sex- and age-disaggregated data E.g., access services, retention in care, health outcomes

    Analyze results among males and females Identify notable issues and patterns

    Does it reflect national- and community-level data? Consider:

    Epidemiology The principal practices that are producing the issues The gender relations that shape those practices

    Monitor to identify gaps and trends and how they change over time

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    Examples of indicators that should always be disaggregated by sex

    People living with HIV identified in the community Females and males living with HIV identified in the community

    Clients on antiretroviral therapy (ART) Females and males on ART

    Orphans and vulnerable children accessing childrens centers for psychosocial wellbeing Vulnerable girls and vulnerable boys accessing childrens

    centers HIV-positive people assessed for nutritional status

    HIV-positive women and HIV-positive men assessed for nutritional status

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  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC 25

    0%

    10%

    20%

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    40%

    50%

    60%

    70%

    80%

    90%

    100%

    Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14

    TB/HIV Co-Infected Clients on ART in 42 sites, Dec13 - Nov '14

    0

    50

    100

    150

    200

    Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14

    Denominator: Number of TB/HIV Co-Infected Patients by Sex

    Changes implemented:-Sensitized staff about gender -Synchronized appointment dates for TB and HIV clinics

    Results: Gender integration and improved outcomes, Uganda (TB/HIV, 1 of 2)

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    Results: Gender integration and improved outcomes, Uganda (TB/HIV, 2 of 2)

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    Females

    Males

    Average

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    90%

    100%

    Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14

    TB/HIV Co-Infected Clients on ART in 42 sites, Dec13 - Nov '14

    020406080

    100120

    Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14

    Denominator: Number of TB/HIV Co-Infected Patients by Sex

    Changes implemented:-Sensitized staff about gender -Synchronized appointment dates for TB and HIV clinics

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Results: Retention of mother-baby pairs in treatment in PHFS program in Uganda

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    100%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    90%

    100%

    Feb13 May13 Aug13 Nov13 Feb14 May14

    Mother-Baby Pairs retained in care at Ivukula HC IIIFeb13 Jun14

    July '13: Pairing mother & baby cards and synchronizing appts

    Feb-Mar '14: Synchronized family support meetings & clinic appts, mother-baby pairs' & male partners' apptdates, and began gender

    Mar '14: Health talks focus on male partners

    June '13: One service point for mother-baby pairs; began awareness raising about male involvement

    0

    20

    40

    Feb-13 May-13 Aug-13 Nov-13 Feb-14 May-14

    Denominator: Number of mother-baby pairs who should be accessing care

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Results: VMMC, Uganda

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    94%

    80%77%

    56%

    48HR FOLLOW-UP 7 DAY FOLLW-UP

    Graph showing post-operative follow-up rates and partner involment in SMC

    % for those who had come with Partners % for those who did not come with their Partners

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    Results: Changes in risky sexual behavior among adolescent girls and young women

    Sexual behavior Baselinen=409

    Septn=409

    Sig

    Had multiple sexual partners

    16.6%(n=66)

    8.1%(n-=33)

    0.002

    In transactional sex 13.2%(n=54)

    5.1%(n=21)

    0.000

    Used condoms consistently with multiple sexual partners

    23.5%(n=16)

    60.6%(n=20)

    0.015

    Used condoms consistently in transactional sex

    29.6%(n=16)

    71.4%(n=15)

    0.007

    Septn=409

    Decn=409

    Sig

    8.1%(N-=33)

    4.2(n=17)

    0.000

    5.1%(n=21)

    2.5%(n=10)

    0.000

    60.6%(n=20)

    69.2%(n=12)

    0.054

    71.4%(n=15)

    70%(n=7)

    0.013

    Decn=409

    March n = 394

    Sig

    4.2%(n=17)

    3.2%(12)

    0.364

    2.5%(n=10)

    3.6%(14)

    0.364

    69.2%(n=12)

    75%(9)

    0.225

    70%(n=7)

    57.1%(8)

    0.330

    Round 2: Oct-December 2016 Round 1 interventions plus Savings groups Gender trainings

    Round 3: Jan-March 2017 Round 2 interventions plus Parent engagement Partner engagement

    Round 1: May-Sept 2016 Stepping Stones Service delivery camps Community QI teams

  • USAID Applying Science to Strengthen and Improve SystemsWI-HER LLC

    83%

    61%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    90%

    100%

    Term 1 Term 2 Term 3 Term 4 Term 5 Term 6 Term 7 Term 8 Term 9 Term 10

    Percent of boys and girls who pass termly exams at Chilore Primary School terms 1-10, compared with the average of 16 primary schools in

    Mangochi, Malawi (Sept 2013-Dec 2016)Boys- Chilore Girls-Chilore All schools

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    Improved education outcomes: Malawi OVC

    Improved education performance

    Changes tested included weekly assessments and early classes for standard 6 and 7

    Performance gap between boys and girls

    To close the gap, teachers paid more attention to the girls performance and encouraged them to improve their grades

  • USAID Applying Science to Strengthen and Improve Systems

    Percentage of pregnant women tested for HIV from ANC whose male partners are also tested for HIV, 15 scale-up sites, Kabezi Health District, Burundi (Jan 2015-Aug 2016)

    Improved male partner involvement: Burundi PMTCT

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  • USAID Applying Science to Strengthen and Improve Systems

    Institutionalizing gender integration

    Cote dIvoire Worked with MOH and others to develop a

    National QI Policy QI strategy document (training) and operational

    plan will include disaggregating data by sex, collecting gender-sensitive indicators, and considering gender issues in improving quality of care

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    Uganda Gender integration in National Standards of Care for OVC Gender in assessment tools QI training and coaching materials, and learning sessions

    address gender, including at the national level, which contributes to institutionalization

    Built staff capacity

  • USAID Applying Science to Strengthen and Improve Systems

    Institutionalizing community improvement

    Malawi National Plan of Action for vulnerable children from 2015-2018

    Malawi OVC standards for quality improvement for Vulnerable Children programs in Malawi

  • USAID Applying Science to Strengthen and Improve Systems

    Dr. Taroub Faramand [email protected] Visit www.usaidassist.org/topics/gender

    Technical briefs and additional resources (English, French, Spanish) Sex-disaggregated data collection tools Videos (English, French, Spanish)

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    For more information about gender integration in quality improvement

    WI-HER LLC