To start this webinar on Gender and the LMG project, I want to first define what gender is and what gender equality means. This is to make sure that when we speak about gender we refer to both men and women and not women only. However even though we do speak about men and women in relation to gender, this presentation focuses primarily on women because we are speaking about health systems where the major beneficiaries and the major providers of care are women. In moving to the definition of gender equality, we again have to include men and women because when gender equality exists, both men and women benefit from it and not women alone. However again in this presentation we are going to speak about the roles and responsibilities of women in the health sector and their location within that framework to understand their challenges. Gender discrimination in the health workforce has serious implications for the long term strength of health systems.
An overview of the conditions of women in the health workforce will outline the challenges women have as the starting point for out discussion. This will be followed by strategic approaches that the LMG project is going to use over all its activities to ensure that gender is mainstreamed into all our activities. The presentation will also discuss how the LMG project is aligned with global mandates and talk about approaches it will take towards mainstreaming gender in particular focus areas. To conduct this webinar, an extensive literature search was conducted and a summary of the findings will be presented. Finally the LMG framework for gender in health systems will be presented based on the WHO framework for leadership and management. Governance is one of the most important aspects of this project therefore the intersection between governance and gender is also discussed. Finally two case studies will be presented to demonstrate the need to address gender issues and their impact on health systems and health outcomes.
Gender influences how work is recognized, valued, and supported.There are different consequences for men and womenProfessional level: career trajectories, pay, training, other technical resources, and access to professional networksPersonal level: personal safety, stress, autonomy, self-esteem, family and other social relationshipsWhere there is no equity health system outcomes are unproductive and they restrain the true capacity of individuals working in the health sector.Less likely to hold decision making and leadership positions. Earlier that women are the major providers and consumers of health care both in the formal and informal health systems either as voluntary health workers in the community, care providers in the home or front line workers. Data for developing countries shows that leadership and decision making roles are mostly occupied by males. They face discrimination either because they are married or because they are not married and areConform to male work models which does not take into account their reproductive and family roles. Oftentimes they are subject to harassment or sexual violence as health workers. This has been studied in many countries and is widely reported to be a problem for women health workers particularly at the lower level.
As a result of these concrete situations that women face as health provider the LMG project hopes to address gender through the following:What is the environment like for women working in health systemsHow do we raise awareness among men and women to break negative patterns of gender equityHow do you link gender equity to better health outcomes for all (including men and women)How do you build the capacity of women to lead manage and govern. This includes both working with women who are already working in the health system but also new ones through pre-service trainingIf gender is used as a tool for analysis then it can be a cross cutting issueBuilding evidence beyond anecdotes is also an important aspect of the LMG project. It used to surprise me in Ethiopia that when I went to a health center I would know before I spoke to anyone if the manager of the center was a man or a woman. This is not to stereotype one or the other but both men and women bring particular attributes and potential to the project that needs to be harnessed. In order to do that evidence must be collected beyond anectodes and my observation. Last but not least the issue of governance if of paramount interest. This will be discussed later but in the context of gender we need to go beyond formal institutions and look at governance in how communities are able to exercise choice, have a voice individually and collectively.
Three focus areas have been identified for the LMG projectTraining and Capacity Building…..men and women should have core competencies on gender to promote transformational change in organizations and systems. A critical mass of men and women is needed to achieve this objective. Research and Knowledge Exchange: A lot of the evidence is now in showing how important Leadership and Management is and is relationship to gender. It is now time to start looking at the HOW to do it. MSH’s experience on how will be an important foundation to address this question. Advocacy and Partnership: The need to address gender issues in the health workforce will require the collective efforts of government, donors and civil society groups and therefore this aspect of the LMG project will be critical to any success that will be attained.
This is an excellent opportunity for LMG to hold its head high and stand among that powerful global consensus regarding gender. This means that it is not an uphill battle rather a battle which requires strategic thinking as well as partners because in all three mandates Gender front and center. GHI talks about women and girls, so does PEPFAR and the MDG’s which have eight goals have one goal 8 which speaks to empowerment of women, and the others are linked either directly or indirectly to issues regarding women.
What does the literature say?Review of the literature and what has been done in this field shoes the following:1.It is only now that data is routinely being disaggregated by gender. Without this there is no way to find out women’s location in the workforce. For example what percentage of women are in the role of decision making, what percentage are working as frontline workers and what percentage as specialists and doctors. 2. Increase access to pre-service and in-service education and training This will be an important aspect for LMG to incorporate training into the curriculum before they enter into the workforce and afterReview recruitment policies and practicesFocus on Gender equity in managerial and decision making roles Compensation equity Gender differentials in constructing incentive structures to promote retentions and productivity Protect the workplace climate, including combatting sexual harassment and gender-based violenceMaking sure you also see this:http://www.globalhealthmagazine.com/images/uploads/spring_2011/gender_principles.gifhttp://www.globalhealthmagazine.com/cover_stories/gender_equitable_health_organizations/
The column on the left is the WHO recommendations for Strengthening leadership and Management in the health sector. While this is a standard recommendation, integrating gender into this model will help LMG attain the goals outlined by WHO but move further into a more equitable health system where gender is central.
The project name Leadership Management with governance added provides tremendous opportunities to address issues such inclusiveness, participation, accountability, transparency ….the pillars of governance. When these intersect with gender it becomes a more compelling argument to make this a critical component of the LMG project. UNIFEM has this to say about the relationship between gender and governance……
So simply put governance cannot be effective or GOOD unless it is gender sensitive
Employment and compensation:Policies and practices to eliminate gender discrimination in recruitment, hiring, pay, and promotionWork-life balance and career development:Policies and practices in favor of work-life balance, educational and career developmentHealth, safety, and freedom from violence:Policies to secure, health, safety, and freedom from violence:Management and governance:Policies to ensure equitable participation in management and governanceBusiness, supply chain, and marketing practicesImplementing non-discriminatory business, supply chain, contracting, and marketing practicesCivil and community engagement:Policies to promote equitable participation in civic lifeTransparency and accountabilityGender equality policies that are publicly disclosed (e.g., benchmarks for progress, commitment to these principles and policies by the executive director of the organization, etc.)
The study demonstrated that changing times required changes in the way the sick were taken care of Male and female traits and gender status reinforced the inequitable division of HIV/AIDs caregiving in LesothoRealization that males were as fully capable in providing care as women Public ridicule was given as one of the reasons for men giving care to familiesGeneral conclusionsCare giving is not gender neutral and tradition kept men out of it stereotypesFeasible to involve men in caregiving Training might mitigate negative stereotypes of men and assuage women’s fears about potentaailtendacy towards sexual exploitationMOH decision to provide compensation for men’s participation Result is that there was a gender desegregated workforce in HIV/AIDs case. Gender redistribution and reversing stereotypes improves health outcomes. Occupational segregation is detrimental to women, leads to income inequality, poverty. Women generally occupy lower level cadres, usually in the informal care economy. Assisted the MOH to strengthen its capacity to respond to the HIV/AIDS pandemic by understanding the gendered division of labor and to identify gender redistributive approaches to recruit, train, support, and retain men in jobs traditionally considered the province of women. Explain why this pertains to LMG approaches.
Stronger health systems. Greater health impact.Management Sciences for Health 1
Definition of Gender Gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women. – WHO Gender equality in health means that women and men have equal conditions for realizing their full rights and potential to be healthy, contribute to health development, and benefit from the results. – Pan American Health Organization, Gender Equality PolicyManagement Sciences for Health 2
A Strategic Framework for Gender in the Leadership, Management, and Governance Project o Today’s Webinar o Overview of the conditions of women working within health systems o Strategic approaches for mainstreaming gender into LMG projects o Exploring new approaches to gender mainstreaming o Highlighting the intersection between gender and governanceManagement Sciences for Health 3
Gender-related Challenges for Women as Health Care Providers o Women are less likely to: o Hold decision-making and leadership positions o Women are more likely to: o Face discrimination based on marital status o Be expected to conform to male work models o Be subjected to violence and harassment while working o Be employed in low- and entry-level positionsManagement Sciences for Health 4
Strategic Approaches for Mainstreaming Gender into LMG Projects o Examine the health sector work environment o Raise awareness among both men and women to break negative patterns of gender inequity o Link gender equity to better health outcomes for all o Build women’s capacity to lead, manage, and govern o Utilize gender as a cross-cutting theme o Build the evidence base to support gender mainstreaming o Analyze governance structure to identify opportunities and challengesManagement Sciences for Health 5
Objectives of the LMG ProjectTraining & Capacity Of men and women to have core competencies in gender in order toBuilding decrease biases and stereotypes and promote gender interventions that can change institutional and organizational behaviorResearch and Knowledge Research on evidence demonstrating the benefits ofExchange promoting leadership and management for women (both to increase the numbers and empower women) for better health outcomesAdvocacy and Create partnerships with existing regional and global networks thatPartnerships promote women’s leadership and management and adapt it to theManagement Sciences for Health health systems 6
Alignment of LMG Project with Global Mandates “Investing in the health of women, adolescents, and girls is not only the right think to do; it is also the smart thing to do. That is why we are integrating women‟s issues as elements of our foreign policy agendas and in, especially, the Global Health Initiative…” --Secretary of State, Hillary Rodham Clinton, Remarks on the 15th Anniversary of the International Conference on Population and Development, January 8, 2010 o GHI: Focus on Women and Girls o MDGs: Goal 3, 4, 5, and 8 o PEPFAR: Focus on violenceManagement Sciences for Health 7
LMG Literature Review: Recommendations o Disaggregate data by gender o Increase access to pre-service and in-service education and training o Review recruitment policies and practices o Focus on o Gender equity in managerial and decision making roles o Compensation equity o Gender differentials in constructing incentive structures to promote retentions and productivity o Protect the workplace climate, including combatting sexual harassment and gender-based violenceManagement Sciences for Health 8
LMG Framework for Mainstreaming GenderWHO Recommendations forLMG Strategy to Promote and Mainstream LMG Strategy toto Promote and LMG Strategy Promote and Strengthening L&M Gender Mainstream Gender Mainstream Gender• Ensure adequate numbers of Ensure a gender balance in management managers and leadership positions Include gender awareness and• Ensure managers who have appropriate competencies understanding as core competency of managers and leaders• Create better critical Create management support systems management support systems that are gender sensitive Create an enabling environment that• Create an enabling environment is safe for women and provides support for leadership Management Sciences for Health 9
Governance cannot be effective unless it has gender equality at its center Governance must lead to a more equitable world, where women also have choices and their rights are realized. It cannot be effective if there is no understanding of the differing needs of women and men in public spending, policies and legislation. Nor can it be effective if women cannot exercise their right to participate equally in the decisions that affect their lives. In short governance cannot be effective or “good” unless it is gender sensitive. (UNIFEM 2003Management Sciences for Health 10
Relationship Between Good Governance and Gender Equity “Governance cannot be effective or „good‟ unless it is gender sensitive.” -- UNIFEM, 2003Management Sciences for Health 11
Gender and LMG Principles Employment and Compensation Work-Life Balance and Career Development Health, Safety, and Freedom from Violence Management and Governance Business, Supply chain, and Marketing practices Civil and Community Engagement Transparency and AccountabilityManagement Sciences for Health 12
Gender and LMG Case studies o Health Extension Program, Ethiopia o Capacity Project, South AfricaManagement Sciences for Health 13
Case Study: Health Extension Program, Ethiopia o Innovative leadership and management initiative focusing on training health extension workers (HEW) to reach underserved populations o Trained to: o Manage operations of health posts o Conduct home visits and outreach o Refer patients to health centers o Train volunteers o Survey communities and villages using standardized tools o Draft health plans o Focus on: o Community ownership o HEW work translated into positive health outcomesManagement Sciences for Health 14
Case Study: Men as Care Providers in Lesotho o The USAID-funded Capacity Project: o Focused on planning, developing and supporting the health workforce o Assisted the MOH in strengthening its capacity to respond to the HIV/AIDS pandemic by o Understanding the gendered division of labor o Identifying gender redistributive approaches to recruit, train, support, and retain men in jobs traditionally considered the province of women o Women generally occupy lower level cadres, usually in the informal care economy o Training can mitigate negative stereotypes “Gender redistribution” results in improved health outcomes.Management Sciences for Health 15
Thank you! Questions?Management Sciences for Health 16
Stronger health systems. Greater health impact. Saving lives and improving the health of the world‟s poorest and most vulnerable people by closing the gap between knowledge and action in public health.Management Sciences for Health 17