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Jhpiego

Gender

Harmful gender norms inhibit women, girls, men and boys from accessing and using health information and services. Gender inequality contributes to preventable deaths and illness in women and men throughout the life course. It also hinders the use of contraceptive methods and women’s ability to decide if, when and how often to become pregnant; the ability to deliver safely in a facility or with a skilled birth attendant; and the ability to take a child to health services. Additionally, health services often exclude men, unmarried clients, adolescents and lesbian, gay, bisexual, transgender and intersex clients due to discriminatory gender attitudes among providers. Survivors of gender-based violence (GBV) lack access to timely, appropriate care, particularly HIV and pregnancy prevention, as well as empathetic counseling and referrals.

When women are empowered to make decisions about their bodies and their futures, studies show they and their families are healthier, happier and more prosperous. MCSP worked to mitigate gender inequalities that act as barriers to optimal health outcomes for women and girls: lack of women’s knowledge, choice and decision-making power; GBV and other discriminatory treatment; limited male engagement in reproductive, maternal, newborn, child and adolescent health (RMNCAH); mistreatment during services; and negative gender attitudes faced by health workers themselves that impact service quality.

MCSP worked with health providers and facilities to ensure that all people can avail of health care services that guarantee equal access to respectful care for clients of any gender and age, ensuring accessibility, privacy and confidentiality, respectful and informative provider-client interaction, and appropriate infrastructure and commodities. Gender-sensitive services ensure that clients receive the highest quality of care, where they can access services equally; be empowered to make full, free, and informed choices about their health care; participate fully in decision-making about their own health; and be given the opportunity to include their partners and families if they choose to do so.

MCSP addressed gender through four technical approaches:

  1. Addressing GBV:
    MCSP worked to prevent GBV, identify survivors and link them to care, and strengthen post-GBV services.
  2. Male Engagement and Couples’ Decision-Making:
    MCSP actively engaged men and promoted healthy decision-making among couples in RMNCAH services.
  3. Ensuring Gender-Sensitive, Respectful Services:
    The Program worked to ensure equal access to high-quality services for clients of any gender.
  4. Promoting Gender-Equity in the Health Workforce:
    MCSP empowered female health students and workers to overcome gender discrimination in the workplace and educational settings.

Key Results

GBV

  • In Guinea, MCSP established a network of 7 health facilities comprised of 42 healthcare providers, 125 community educators, 10 paralegals and university committees to support GBV survivors. In addition, 180 educational sessions on GBV have reached 13,000 people in Guinea, including security forces and local government officials.
  • In Rwanda between October 2016 and March 2018, MCSP reached more than 13,000 survivors with post-GBV care and built the capacity of 173 trainers and 1,500 health providers on GBV, including identification of survivors, empathetic counseling and clinical care, safety planning and referrals. MCSP conducted quality assurance for GBV service delivery through the use of evidence-based standards, improving performance by over 20% in 12 Isange One Stop Centers in the areas of empathetic counseling, special care for child and adolescent survivors, and ensuring privacy.
  • In Nigeria in March 2018, MCSP built the capacity of 41 facilitators (pre-service and in-service providers) in GBV first line support and basic clinical care, who went on to train their peers. MCSP also mapped the availability of GBV services in Kogi and Ebonyi States, as well as provider knowledge, attitudes and practices, producing a GBV Rapid Assessment Report and GBV Referral Maps.
  • In Ghana, MCSP worked with the Ministry of Health (MOH) to develop an e-learning module for health providers and students on the basics of post-GBV care, which was then adapted and translated into French by MCSP in Madagascar. The module was administered to community midwives and nurses.

Male Engagement and Couples Decision-Making

  • MCSP co-chaired the Male Engagement Taskforce of the USAID Interagency Gender Working Group, which has grown to 177 members in one year. In this role, MCSP facilitated dialogue and exchange of lessons on male engagement in RMNCAH. In February 2018, MCSP hosted a workshop, “State of the Art and Advancements in Male Engagement Programming,” highlighting successful and promising approaches, as well as lessons in engaging men as clients, partners, and champions for change in programming for HIV, RMNCAH, violence prevention, child marriage, and economic empowerment.
  • In Mozambique by December 2017, MCSP reached 31,424 community members through community dialogues conducted by 758 community health committees in Sofala and Nampula Provinces. The dialogues encouraged couples to practice positive gender norms such as sharing household labor and caregiving, ensuring pregnant women have rest, nutritious food and access to health services, and preventing GBV. MCSP trained 1,358 health providers and facility managers from 86 health facilities on gender-sensitive service delivery and male engagement. These providers helped 5,185 couples develop joint birth preparedness plans, deciding where to deliver, arranging transport and saving money. Between October 2016 and December 2017, over 190,000 men accompanied their partners to RMNCAH visits, leading to increased rates of facility delivery.
  • In Rwanda, MCSP built the capacity of 173 trainers and 1,500 health providers on gender, GBV and male engagement, improving gender-sensitive RMNCAH service delivery and GBV identification, care and referral. MCSP reached 4,267 individuals through community dialogues on transforming harmful gender norms, engaging men, and preventing GBV. MCSP also engaged individuals in Rwanda through community dialogues on transforming harmful gender norms, engaging men, and preventing GBV through an adaptation of the successful Bandebereho Curriculum developed by Promundo. In 2018, Promundo conducted a randomized controlled trial of the full intervention and found that participants had significant increases in contraceptive use, sharing of housework, involvement of women in household financial decision-making, and reductions in physical and sexual violence.
  • In Nigeria, MCSP promoted the engagement of men and couples in RMNCAH by ensuring that health providers and facilities were “male-friendly,” and educating clients. MCSP developed awareness-raising posters, a pamphlet and job aid to help providers counsel clients on how men can contribute to their family’s health. MCSP built the capacity of 41 pre-and in-service providers as training facilitators on male engagement in March 2018. The Program also provided privacy screens in key facilities to improve respectful care for pregnant women, and to ensure men could support their partners during labor and delivery. These interventions resulted in 6,529 males accompanying their partners at their request between October and December 2017, representing a four-fold increase compared to the previous quarter.

Ensuring Gender-Sensitive, Respectful Services

  • The journal BMC Reproductive Health published an MCSP review examining how gender inequalities contribute to mistreatment during childbirth, entitled: “Expanding the Agenda for Addressing Mistreatment in Maternity Care: A Mapping Review and Gender Analysis.”
  • The Mozambique MOH asked MCSP to develop a gender strategy for the health sector. The strategy was launched in June 2018 at a stakeholders’ workshop, and MCSP provided technical assistance to the MOH to integrate gender into its health interventions, budgets, planning processes, and data collection.
  • In India, MCSP partnered with an Indian organization, Centre for Catalyzing Change (C3), to train 20,489 community health workers, nurses, and community health committee members; 2,157 facility-level providers; 136 district- and state-level officials; and 1,253 Rogi Kalyan Samiti (Patient Welfare Committee) members by September 2018 on gender- sensitive FP services that respect women’s autonomy, dignity and privacy. Other MCSP/India results include:
    – Improved privacy during counseling by supporting the establishment of counseling corners at 85% of focus facilities; and
    – Increased facility score by 43% with regards to inclusion of spouse or other family members during counseling, and 47% with regards to ensuring privacy during pre-operation assessment and examination.
  • In Tanzania, MCSP incorporated gender into community social and behavior change communication efforts led by community health workers (CHWs). More than 10,000 community members — including more than 4,000 men — participated in community-gender dialogue sessions led by CHWs. In Mara, 91% of men who participated indicated that they were willing to educate others at community and church meetings.
  • Jhpiego developed the Gender Service Delivery Standards, a tool to assess and improve the quality of gender-sensitive, respectful care. The tool helps identify challenges for facilities in providing gender-sensitive care and the improvements that can be made, including enhanced client privacy, male engagement, and improved policies regarding a woman’s ability to select family planning methods without requiring a husband’s consent. These standards were implemented and adapted across health facilities where MCSP worked:
    • MCSP/Tanzania adapted and integrated the Gender Service Delivery Standards in assessments and continuous quality improvement processes.
    • MCSP/Mozambique applied the standards in 56 health facilities in Nampula Province and 30 in Sofala Province.
    • MCSP/Nigeria built the capacity of 41 providers to implement the Gender Service Delivery Standards.

Promoting Gender-Equity in the Health Workforce

In Nigeria, MCSP trained more than 30 core facilitators and 1,000 health providers on the Health Workers for Change (HWFC) approach, which uses a participatory approach to help providers address the gender inequities, attitudes and barriers to delivering high-quality care. Participants created action plans to address gaps and challenges, and reported the following outcomes from HWFC:

  • Improved interpersonal communication, empathy with clients
  • Improved provider punctuality and commitment to work
  • Improved privacy during medical examinations and labor
  • Hired additional cleaning and security staff, adjusted duty rosters and provided accommodation to midwives to offer after-hour services
  • Infrastructure improvements: clear signage, fans for ventilation, handwashing stations, reconstructed and built new labor wards to allow for supportive companions to have space to attend their partner’s birth, etc.

In Liberia, MCSP trained clinical mentors on gender-responsive methods to improve the gender-sensitivity of teaching practices. This was done using a Gender Sensitive Teaching Methods Curricula adapted from a curricula developed by USAID’s Ethiopia Health Systems Strengthening Program.

Our Focus

Sources:
Maternal and Child Survival Program