This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of […]
The objective of this research was to explore midwives’ experiences working on the frontlines of the COVID-19 pandemic in British Columbia, Canada. It is a qualitative study involving three semi-structured focus groups and four in-depth interviews with 13 midwives. The research took place during the COVID-19 pandemic in British Columbia, Canada from 2020-2021. Qualitative analysis surfaced […]
The COVID-19 pandemic has disproportionately impacted women and vulnerable groups, magnifying existing gender inequalities. To prevent inequalities from further widening, countries must urgently address and mitigate the gendered impacts of the pandemic. In this report, we outline the gendered impacts of the pandemic in Kenya, summarise measures taken by the Kenyan government to address these […]
Women and Global Health Leadership Introduction Women represent the majority of people working to improve health outcomes in communities, non-governmental and multilateral organizations, both as paid and unpaid health and social care workers. So why is it that when it comes to leadership positions, we have a governance system that privileges men and what can […]
Abstract Fragile and shock-prone settings (FASP) present a critical development challenge, eroding efforts to build healthy, sustainable and equitable societies. Power relations and inequities experienced by people because of social markers, e.g., gender, age, education, ethnicity, and race, intersect leading to poverty and associated health challenges. Concurrent to the growing body of literature exploring the […]
Abstract Throughout the COVID-19 pandemic, as measures have been taken to both prevent the spread of COVID-19 and provide care to those who fall ill, healthcare workers have faced added risks to their health and wellbeing. These risks are disproportionately felt by women healthcare workers, yet health policies do not always take a gendered approach. Background Objectives […]
Abstract Objective To explore how gender influences the way community health workers (CHWs) are managed and supported and the effects on their work experiences. Setting Two districts in three fragile countries. Sierra Leone—Kenema and Bonthe districts; Liberia—two districts in Grand Bassa county one with international support for CHW activities and one without: Democratic Republic of Congo (DRC)—Aru […]
This brief describes differences in the secondary economic, social, health, and security effects of pandemics across genders. It aims to help decision makers to address gender disparities in pandemic preparedness, response, and recovery plans. The document outlines the process of creating a gender-responsive pandemic plan and priority areas for action; it also provides recommendations on […]
Post-pandemic economic recovery plans have relied heavily upon benchmarks set by studies and frameworks that do not address the gendered impacts of crises or take proactive, feminist measures to reach women, girls, Indigenous peoples, immigrant communities, and other historically disadvantaged groups. The need for an inclusive, gender-equitable recovery from the COVID-19 pandemic is slowly gaining […]
This brief – which is also a sign-on letter that is open to all – outlines how the Biden-Harris Transition Plan in the US can be made more gender-responsive. The Biden-Harris Transition Plan is an important vision for change on COVID-19, economic recovery, racial equity, and climate change. It emphasizes the need for systemic change, instead of simply reconstructing and perpetuating […]
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working […]
Policy makers should consider gender at all levels of the health system, and in all activities. This would lead to a more equitable health system that serves everyone, and meets health goals. Many policy makers are interested in gender equity, but lack guidance on how to implement changes in the health system. Questions of gender […]
Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gendered analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four […]
Link to the full paper… Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, […]
Through a combination of a small grants programme, online and face-to-face capacity development interventions, the creation of practical tools to guide researchers, and academic publishing, Research in Gender and Ethics (RinGs): Building Stronger Health Systems has increased the ability of individuals to reflect on gender and intersectionality and to apply this learning. This brief explores how the concept and theory of intersectionality has impacted […]
This brief describes how RinGs worked with the ReBUILD Research Programme Consortium to stimulate and embed gendered research within the partnership. It includes detail on how the collaboration fostered new ways of knowing and framing problems in health systems research. How it provided channels of capacity development on gender and intersectionality analysis. How it influenced policy and […]
This brief explains how we developed our partnership to research and sharing learning on close-to-community providers of health care across contexts.
In all countries with community health programmes, close-to-community providers collect data about the people that they serve and the services that they provide. Depending on the country, these services include a mixture of health promotion, disease prevention, referral, and curative and disease management services. These data are essential to monitor the performance of community health […]
This commentary accompanies a paper by Tamblyn and colleagues that presents evidence from a cross-sectional study that shows the presence of gender bias in the grant peer review process in Canadian health research funding. Notably, female applicants with past grant success rates equivalent to male applicants were given lower application scores by reviewers, and male […]
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper […]
Part of REACHOUT’s communication strategy was to attend and present at national, regional and international conferences – both to target other academic and research audiences to share learning on areas of mutual interest and also to network and engage with policy makers and practitioners. Over time our approach to conferences has adapted based on learning of what has the most impact and encourages engagement with stakeholders, evidence, and current debates. Our relationship with organisations like Health Systems Global (who organise the major two-yearly global conference) has deepened and we decided to invest time and resources in helping to found and…
This Reader brings together case studies from the small grants programme. These studies explore some of the core spheres of health systems research: care-seeking; financing and contracting; governance; human resources; and service delivery with a gender lens. Each case study in this Reader demonstrates the importance of using a gender analysis in health systems research. This analysis enabled the researchers to explore new ways of looking at the world around them, it built new skills, and it led to some unexpected findings. It also demonstrates how such an approach can be applied in practice. We hope that this Reader will…
This editorial discusses a collection of papers examining gender across a range of health policy and systems contexts, from access to services, governance, health financing, and human resources for health. The papers interrogate differing health issues and core health systems functions using a gender lens. Together they produce new knowledge on the multiple impacts of gender on health experiences and demonstrate the importance of gender analyses and gender sensitive interventions for promoting well-being and health systems strengthening. The findings from these papers collectively show how gender intersects with other axes of inequity within specific contexts to shape experiences of health…
Neglected tropical diseases (NTDs) affect the poorest of the poor. NTD programmes can and should rise to the challenge of playing a part in promoting more gender equitable societies. Gender equity shapes poverty and the experience of disease in multiple ways; yet to date, there has been little attention paid to gender equity in NTD control efforts. Drawing on a synthesis of relevant literature, the tacit knowledge and experience of the authors, and discussions at a meeting on women, girls and NTDs, this analysis paper distills five key lessons from over 20 years of gender mainstreaming in health. The paper…
As the drive for Universal Health Coverage and the Sustainable Development Goals (SDGs) has led to a push for greater health service access, the issue of sustaining and embedding quality in the ways in which these services are delivered has gained prominence. Measurement of quality and attribution of its effects in health is challenging at any level. But little is known about how quality is assessed within community health programmes, who are on the frontline of health service delivery in many low- and middle-income settings. The degree to which new initiatives like the Lancet Commission on Quality in Health Systems…
Equity is at the core of the Sustainable Development Goals (SDGs), including SDG 3: ‘ensure healthy lives and promote well-being for all at all ages’. Improving health requires accelerated efforts to address inequity, in particular, among marginalised populations who are most affected by the burden of disease. Increasingly, the importance of gender equity within global health leadership is being recognised, and SDG 5: ‘achieve gender equality and empower all women and girls’ is supported by a target on ensuring women’s equal opportunities for leadership. In many countries, more than 75% of people engaged and working in global health are women,…
Gender equity is imperative to the attainment of healthy lives and wellbeing of all, and promoting gender equity in leadership in the health sector is an important part of this endeavour. This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels.…
In Cambodia, civil war and conflict lasted almost 30 years, from 1970 to 1998. Health workers were among the 3.3 million professionals who were executed during the Khmer Rouge regime (1975- 1979). After the fall of the Khmer Rouge, it is believed that only 40 doctors were left in the country. Now, after a 20-year period of strengthening the health system and developing human resources for health (HRH), over 19,000 people are employed in the health sector in Cambodia. Women make up most of the health workforce, and yet rarely hold senior roles, and have fewer opportunities than men to…
This chapter explores how gender analysis can be incorporated into health systems implementation research. This is the process of analysing how gendered power relations influence the implementation of an intervention, as well as the extent to which the research process itself progressively transforms gendered power relations, or at least does not exacerbate them.
Despite the importance of incorporating gender analysis into existing research programmes, it is not without its challenges. This brief outlines some of these challenges, along with ways in which Research in Gender and Ethics (RinGs): Building Stronger Health Systems has responded to them. RinGs is a cross research programme consortium (RPC) bringing together three health systems RPCs – Future Health Systems, ReBUILD, and RESYST – to better understand gendered dynamics in health systems and to galvanise gender analysis in health systems research.
Research shows that CHWs are effective in delivering health services in low- and middle-income countries. They can also improve equitable health care and extend access for populations who are difficult to reach. But data are often too patchy or project specific. Several assumptions are commonly made about CHWs including that they are less expensive than formal health care workers as a way of delivering key services. What is striking, however, is the lack of robust evidence on the cost-effectiveness of CHWs. In order to enhance understanding and inform policy dialogue on the role of CHWs in the health system, the…
The concept of a technological quick fix or ‘magic-bullet’ for control and elimination of Neglected Tropical Diseases (NTDs) is flawed. NTDs are embedded within complex biological and social systems that are shaped by ecological and political contexts. This commentary emphasises the need for implementation research to address implementation gaps in the control of NTDs. With a specific focus on sub-Saharan Africa and helminth diseases amenable to preventive chemotherapy through mass drug administration, we explore the important role of context, programme partnerships and community in achieving equitable and effective NTD control.
The recent thematic series on close-to-community providers published in this journal brings together 14 papers from a variety of contexts and that use a range of research methods. The series clearly illustrates the renewed emphasis and excitement about the potential of close-to-community (CTC) providers in realising universal health coverage and supporting the sustainable development goals. This editorial discusses key themes that have emerged from this rich and varied set of papers and reflect on the implications for evidence-based programming. We are at a critical stage in the development of CTC programming and policy which requires the creation and communication of…
Gender—the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders—affects how people live, work and relate to each other at all levels, including in relation to the health system. Health systems research (HSR) aims to inform more strategic, effective and equitable health systems interventions, programs and policies; and the inclusion of gender analysis into HSR is a core part of that endeavour. We outline what gender analysis is and how gender analysis can be incorporated into HSR content, process and outcomes . Starting with HSR content, i.e. the substantive focus of HSR,…
In the health sector we are facing a double challenge; there is a shortage of formal health workers and a concurrent push to scale up programmes to meet targets such as Universal Health Coverage and the Millennium Development Goals. Working with Community Health Workers (CHWs) is thought to be a potential solution. Ensuring that CHWs are properly supported is vital if they are to fulfill the critical role they can play in improving the health of communities. There are management challenges associated with CHW programmes, including attracting recruits, turnover and performance. A range of different health actors are involved in…
A new way to prevent HIV, known as pre-exposure prophylaxis (PrEP), can provide protection where condoms are not used. Integrating it into HIV and sexual health programming for various communities has become a focus of researchers and health and development agencies. However, PrEP raises important challenges in the context of female sex work. To protect sexual and reproductive health and avoid pregnancy, PrEP must be used with condoms but that may be difficult where clients perceive PrEP as an alternative. Frequent HIV testing and medicalisation of HIV prevention in low-income settings presents challenges for those who lack the rights and…
Kembatti Mentti Gezzimma (KMG) is an Ethiopian organisation working to encourage communities to abandon the practice of FGM-C. There has been a phenomenal reduction in FGM-C prevalence levels in Kembatta Zone where KMG has worked for the last two decades. Between 1999 and 2008, the number of people practising FGM-C in Kembatta zone reduced by approximately 92% (OHCHR 2008). KMG has expanded its work to other zones, including most recently the Sidama zone, and nearly the entire southern region of Ethiopia has been reached by its FGM-C prevention efforts.
The Living Peace four year project is being implemented in Democratic Republic of Congo (DRC), a country where conflict has led to millions of deaths, mass displacement, and many victims and perpetrators of violence. In addition, DRC exhibits a prevalence of highly inequitable, violent partner relationships driven by childhood experiences of violence, gender inequitable beliefs, power inequalities, economic stress and insufficient coping mechanisms around post-conflict trauma. Living Peace provides psychosocial support through group therapy for men (and their partners) to reduce sexual and gender based violence, promote healing, restore relationships and rebuild communities in postconflict settings. The aim of the…
This policy brief looks at the context of gender and health, and how they are affected by conflict. It also assesses whether humanitarian assistance in the immediate post- conflict period addresses the impact of conflict on health from a gender perspective. A second sister brief examines long-term reform of the health system through a gender lens, using the World Health Organization’s health system building blocks as a framework.
This brief examines the reform of health systems in post-conflict settings through a gender lens, using the World Health Organization’s health system building blocks as a framework. Research into the importance of reconstructing health systems after a crisis or war is relatively new, therefore literature discussing challenges and best practices related to gender equity is weak and the evidence base limited. Further study is clearly needed into the impact of strengthening the health system on gender equity.
In this commentary, we discuss a photography competition, launched during the summer of 2014, to explore the everyday stories of how gender plays out within health systems around the world. While no submission fees were charged nor financial awards involved, the winning entries were exhibited at the Global Symposium on Health Systems Research in Cape Town, South Africa, in October 2014, with credits to the photographers involved. Anyone who had an experience of, or interest in, gender and health systems was invited to participate. Underlying the aims of the photo competition was a recognition of the importance of participation of…
Many countries in Sub-Saharan Africa have undergone a process of decentralising health system planning and management, shifting authority to varying degrees from central government to local districts. There are gaps in research on health worker performance at the district level. To strengthen the evidence base, PERFORM - a research consortium of three European and three African universities - has applied action research using a holistic “systems approach” to explore how improving management skills can enhance workforce performance at district level. The project aimed to boost the capacity of health managers in three districts in Ghana, Tanzania and Uganda to identify…
Streams of Influence tells the story of how the Gender, Power and Sexuality programme that sought to bring about positive changes on gender equality imagined and then experienced the process of influencing. Along the way there were the positives in terms of actions and outcomes going to plan, there were also some unintended but nonetheless welcome effects, but there were also a few activities that didn’t work as well as hoped. Programme partners also experienced periods of doubt, struggle and confusion.
From the 30 June – 2 July 2015 a group of researchers, policy analysis and civil society representatives met in Singapore to debate and discuss how gender roles and expectations influence the factors leading to migration, male and female migrants’ different experiences of migration and its impact on migrants, their families and communities. Our analysis does not equate gender with women and girls but aims to unpack how changes to occupational niches and flows of female migrants shape relationships with employers, families and friends, how they shape society and change our notions of gender and age appropriate behaviour. This conference…
After years of passionate advocacy informed by solid policy work on the ground, the global response to HIV/AIDS is better resourced. Poor countries can absorb considerably higher levels of aid than they currently receive, but recent increases in funding have generated a number of concerns. This paper analyses the capacity of NGOs, community-based organisations and governments to ensure that the influx of funds has a significant effect on the HIV epidemic and people's lives. Limited absorptive capacity may be an obstacle to the uptake of funding. To avoid community-based organisations being over-stretched by AIDS and to ensure capacity is maintained,…
On the 29-30 May 2014 a group of feminist scholars, activists, and media and communications professionals met at the Institute of Development Studies at the University of Sussex to celebrate and interrogate learning from the Pathways of Women’s Empowerment Consortium (Pathways). This was an opportunity to look at the trajectory that the consortium had taken since its early days in 2005, consider how Pathways research could shape the Post-2015 development agenda, and strategise about future directions in work on women’s empowerment.
This report synthesises learning from these audits and is part of a larger project that focuses on understanding the links between sexuality, gender plurality and poverty with the aim of improving socioeconomic policy and programming to support people marginalised because of their sexuality. The project was instigated as a result of earlier research by the Institute of Development Studies (IDS) Sexuality and Development Programme and partners. This research indicated that sexuality is directly related to physical, social and economic wellbeing, political participation and socioeconomic inclusion and the realisation of human rights, particularly for the poor and most marginalised (Jolly 2006;…
The global economic crisis is showing the cracks in the surface of how patriarchy is lived in everyday lives; is now not the right time to refocus the discussion? Can we reclaim ‘patriarchy’ from the analysis of all men as patriarchs? How do we understand masculinities in a more political way? How do we address the ways that patriarchy is bad for men, whilst still recognising the battles for women’s rights? What are the implications of rights language for an understanding of patriarchy? If marriage as an institution is the foundation of patriarchy, why are gay and lesbian movements so…
This is an annotated bibliography that has been put together by the IDS Sexuality and Development Programme. The IDS Sexuality and Development Programme is a reaction to the inadequate manner in which sexuality is approached by the development sector. Sexuality is not taken seriously: it is considered a frivolous, trivial issue that doesn’t relate to the more important aspects of development such as poverty. This is something that needs to change. This eclectic bibliography reflects global thinking on sexuality, bringing together texts on poverty, pleasure, gender, heteronormativity, rights, and a lot more! The ideas it contains will inspire you to think…
This thematic review focuses on a range of health challenges faced in particular by women and girls living in low-income urban settlements in expanding cities in Kenya and South Africa. The review has been compiled as part of a larger body of work being conducted by the Institute of Development Studies (IDS) and its partners on gender and international development and financed by the UK Department for International Development (DFID). The review was preceded by a literature search (using keywords to reflect the thematic focus) of key databases of published literature, as well as a search for grey literature and…
This pioneering collection explores the ways in which positive, pleasure-focused approaches to sexuality can empower women. Gender and development has tended to engage with sexuality only in relation to violence and ill-health. Although this has been hugely important in challenging violence against women, over-emphasizing these negative aspects has dovetailed with conservative ideologies that associate women’s sexualities with danger and fear. On the other hand, the media, the pharmaceutical industry, and pornography more broadly celebrate the pleasures of sex in ways that can be just as oppressive, often implying that only certain types of people - young, heterosexual, able-bodied, HIV-negative -…
The idea for this supplement arose from discussions among a set of research partners associated with the Realising Rights Research Programme Consortium (RR RPC), an international partnership funded by the UK Department for International Development from 2005-10 that focused on neglected areas of sexual and reproductive health and rights (SRHR). In the Consortium, work on rights has been concerned with ways of bridging the gap between international legal human rights frameworks as applied to SRHR, and how these play out for actual people ‘on the ground’. We noted that there was a well-developed international language of human rights in relation to sexual…
There is growing interest in the ways in which legal and human rights issues related to sex work affect sex workers’ vulnerability to HIV and abuses including human trafficking and sexual exploitation. International agencies, such as UNAIDS, have called for decriminalisation of sex work because the delivery of sexual and reproductive health services is affected by criminalisation and social exclusion as experienced by sex workers. The paper reflects on the connections in various actors’ framings between sex workers sexual and reproductive health and rights (SRHR) and the ways that international law is interpreted in policing and regulatory practices.
This commentary introduces the HARPS supplement on getting research into policy and practice in sexual and reproductive health (SRH). The papers in this supplement have been produced by the Sexual Health and HIV Evidence into Practice (SHHEP) collaboration of international research, practitioner and advocacy organizations based in research programmes funded by the UK Department for International Development.
The commentary describes the increasing interest from research and communication practitioners, policy makers and funders in expanding the impact of research on policy and practice. It notes the need for contextually embedded understanding of ways to engage multiple stakeholders in the politicized, sensitive and often contested arenas of sexual and reproductive health. The commentary then introduces the papers under their respective themes: (1) The theory and practice of research engagement (two global papers); (2) Applying policy analysis to explore the role of research evidence in SRH and HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia); (3)…
Depictions of sexuality are beamed into our homes through satellite TV, pored over in internet cafes, catapulted around social and technological networks, stitched into the material of women's attire, whispered in children's bedtime tales, captured and disseminated in epidemiological data and crooned over the airwaves. But despite its ubiquity, international development has failed to afford sexuality the prominence that it should.
What does sexuality have to do with women's empowerment? Research from the Pathways of Women's Empowerment RPC shows that sexuality affects women's political and economic empowerment in a number of important ways. For example, in the ways that women experience seeking election to political office, how women are treated and respected (or disrespected) in the workplace and in public, and how families and communities place expectations on how women should behave. Being exposed to sexual harassment and sexual violence and not being able to exercise choice in their sexual relationships affects women's wellbeing and ultimately undermines political, social and economic…
From the 21–23 June 2006, the International HIV/AIDS Alliance (the Alliance) and Reproductive Health Matters (RHM) hosted an international meeting in London to bring together a range of experts from academia, civil society, multilateral organisations and government. The purpose of this meeting was to facilitate dialogue between participants from different disciplines and geographical areas to explore successful methods of promoting condom use and barriers to condom promotion.
China is managing major health system reforms against a background of rapid economic and institutional change. In doing so it is developing a learning approach to transition management and institution-building. This approach includes testing innovations at local level, encouraging learning from success, and then gradually building institutions that support new ways of doing things. Chinese policymakers and analysts are also developing strategies for drawing on international experience. Analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.