Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Taroub Harb Faramand_5.6.14
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  • Incorporate discussions on gender in workshops, learning sessions, and coaching and site visits with QI teamsTest changes to address identified gender-related barriers as you would other changes using the PDSA cycleScale up and spread successful changes…but keep in mind that gender constructs are unique to each community, so what works at one site may not work in another

Transcript

  • 1. 1 Gender Integration in Quality Improvement Taroub Harb Faramand, MD, MPH President WI-HER, LLC USAID Applying Science to Strengthen and Improve Systems Project
  • 2. USAID Applying Science to Strengthen and Improve Systems ASSIST Gender Integration Strategy  Build local capacity and foster local partnerships  Integrate gender in improvement activities  Document and share learning through knowledge management strategies and research  Scale up and institutionalize
  • 3. USAID Applying Science to Strengthen and Improve Systems Tuberculosis Treatment Success in Swazil The Power of Data
  • 4. USAID Applying Science to Strengthen and Improve Systems The Power of Data
  • 5. USAID Applying Science to Strengthen and Improve Systems Results-Disaggregated by Sex
  • 6. USAID Applying Science to Strengthen and Improve Systems Science of Improvement • The Science underlying improvement draws on psychology, adult learning, organizational behavior and statistical analysis of variation and is grounded in a systems understanding of work. • The fundamental concept of improvement is that improvement requires change • Not every change leads to improvement, we therefore study and act 6
  • 7. USAID Applying Science to Strengthen and Improve Systems Testing Changes Identify gender gaps and issues affecting health outcomes Analyze gender constraints, social political affecting health outcomes Develop activities to address issues and test changes
  • 8. USAID Applying Science to Strengthen and Improve Systems Example: Male Participation in Prevention of Mother-to-child transmission (PMTCT) of HIV Improve PMTCT Services Tradition and culture Aim Primary Driver Knowledge about PMTCT One education sessions during work hours Lack of Male participation Reproductive health issues are “women’s responsibilities” Secondary Drivers Illustrative Activities • Education on how men’s health affects wives and children • Community/ religious leaders’ announcements • Facilities sent invitations to men • Education sessions held 3 times • Women accompanied by a partner are seen first Taroub Harb Faramand MD, MPH WI-HER LLC Staff unfriendly towards men
  • 9. USAID Applying Science to Strengthen and Improve Systems9 Ivukula Health Facility-Eastern Uganda Gender Integration
  • 10. USAID Applying Science to Strengthen and Improve Systems Ivukula Health Facility-Eastern Uganda Gender Integration Changes tested: • Involve male community leaders/volunteer health workers • Utilize family support groups • Combine education sessions • Involve fathers in child health • Offer priority to couples and male-focused services
  • 11. USAID Applying Science to Strengthen and Improve Systems Proud Team: 100% Retention in Care Ivukula Health Facility-Eastern Uganda Joyce Draru, QI Advisor, ASSIST & QI team Maria Nakato and Teopista Bamuleese. Twelve-month results showing 100% retention of mother-baby pairs in care. Enable—Engage—Exemplify—Encourage
  • 12. USAID Applying Science to Strengthen and Improve Systems Uganda results: Retention of mother-baby pairs in treatment Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb No. MB pairs who came in the month 11 12 12 15 19 18 25 15 22 24 29 31 28 No. of MB who should be accessing care 27 28 28 29 29 29 31 30 32 35 34 35 31 Percentage retained 41 43 43 52 66 62 81 50 69 69 85 89 90 Started improvement work One service point, pairing mother and baby cards, same appointment date, involve men Synchronized appointments for family support group meetings and clinic appointments. Tagged MB pair appointment dates to male partners' appointment dates for clinic visits Repackaged the health care talks to focus on roles of male partners in PMTCT 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of mother-baby pairs retained in care at Ivukula HCIII, February 2013- February 2014
  • 13. USAID Applying Science to Strengthen and Improve Systems Uganda: changes tested to integrate gender in VMMC • Train on importance of gender in SMC • Talking points to mobilize partners • Document partner participation • Friendly clinics for women and men • Collaborate with other organizations • Technical brief to give more information to staff • Services provided for women • Male champions in communities Since the SMC gender component was introduced, improved outcomes have been documented Client register showing services offered to partners
  • 14. USAID Applying Science to Strengthen and Improve Systems Uganda results: Gender integration in VMMC 14 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 # attend with partners at HCIV 0 0 0 0 0 0 36 61 54 29 59 23 38 72 %age attend with partners at HCIV 0 0 0 0 0 0 7 16 14 28 26 30 30 32 %age attend with partners at 18 sites 0 0 0 0 15 13 15 15 13 17 19 8 8 25 # with partners at HCIV 0 0 0 0 0 0 509 392 377 102 227 76 127 228 # attend with partners at 18 sites 0 0 0 0 110 60 110 175 166 278 135 72 110 501 # with partners at 18 sites 81 41 30 77 749 452 731 1170 1311 1664 712 945 1362 2042 Percentage of SMC clients that attend with their partners at 18 sites and at Buyinja HCIV Collaboration with Marie Stopes to provide cancer screening Start of gender integration
  • 15. USAID Applying Science to Strengthen and Improve Systems Uganda results: Gender integration in VMMC 15 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% O-12 N-12 D-12 J-13 F-13 M-13 A-13 M-13 J-13 J-13 A-13 S-13 O-13 N-13 D-13 J-14 F-14 M-14 Oct-12Nov-12Dec-12Jan-13Feb-13Mar-13Apr-13May-13Jun-13Jul-13Aug-13Sep-13Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14 Percentage that return within 48 hrs post operation 58 59 38 18 60 34 33 36 58 69 67 68 78 82 89 86 84 98 Percentage that return after 1 week follow up 54 56 31 59 45 47 25 13 29 43 33 33 52 56 64 62 63 94 Percentage that return after 6 weeks 0 0 0 0 0 30 4 2 5 13 6 6 13 25 31 16 5 Percentage of male circumcision clients who attend follow up visits at 48 hours, 1 week, and 6 weeks after surgery Female partner involvement
  • 16. USAID Applying Science to Strengthen and Improve Systems Changing Behavior
  • 17. USAID Applying Science to Strengthen and Improve Systems Gender Integration and QI • Focus on Outcomes • Systematic & Efficient • Regular monitoring • Systems and Processes • Test, adjust and scale • Change from within • Research operationalized • Less resistance to gender • Simple, clear & practical • Learning & Sharing • Team work • Country ownership • Leadership
  • 18. USAID Applying Science to Strengthen and Improve Systems For more information about gender integration in quality improvement please contact: Taroub Harb Faramand: tfaramand@wi-her.org or Elizabeth Romanoff Silva: esilva@wi-her.org Learn more about our gender work through the USAID ASSIST project on our new knowledge portal at: www.usaidassist.org/topics/gender