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  • The reason we must think about gender and M&E is because it has a powerful impact on health status outcomes. Studies for 25 years have documented that gender, measured in a variety of ways, influences a range health outcomes, including HIV/AIDS. This effect has shown to be independent of other factors. In other words, these health outcomes are influenced by gender equality regardless of economic and educational status, age, religion, urban or rural residence and a host of other factors. These factors mediate the effect of gender. For example, in the Indian state of Uttar Pradesh, it was observed that poor women with low autonomy are less likely to use antenatal and delivery care than are their wealthier counterparts with low autonomy, but poor women with higher autonomy were more likely to use maternal health services than richer women with low autonomy. This applies to almost any health outcome studied. We next focus on HIV/AIDS.
  • This slide gives practical examples of what has been used to indicate gender factors in quantitative analyses. At the most basic level, most health information systems collect information by sex on many areas related to HIV/AIDS programming, such as surveillance of prevalence in different populations, service utilization like VCT, PMTCT, and service delivery. Doing analyses by sex will reveal any gender differentials in these areas.Measuring other aspects of gender is more complicated. Unlike other risk factors for HIV, such as alcohol use, mobility, number of partners etc., gender is a complex construct that covers a range of areas in of itself. Many of these measures are composites of several variables, or scales with many items. The reason for this is that these areas cannot be captured with a single question or variable.The areas of measurement are important to define: what aspect of gender do we want to measure? The possibilities are listed here:Norms or roles: what people believe is defines acceptable behavior for women and menRelationship factors: how women and men relate to each other—sexual negotiation, communication about other thingsWomen’s autonomy: ability to do what she wants, make decisions, freedom of movement (going places), financial decision-making (spending money independently)Access to economic resources: land, income


  • 1. Getting the G into M&EGender and Monitoring and EvaluationShelah Bloom, ScD
  • 2. Overview Gender—what are we talking about? Why gender and health? New strategic developments Health programming models Getting the G into M&E
  • 3. Definitions1 Sex: Biological difference between males & females1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector
  • 4. Definitions1 Gender: Beliefs about the appropriate roles, duties, rights, responsibilities, accepted behaviors, opportunities and status of women and men, in relation to one another Vary between places & change over time in the same place1 WHO 2009: Integrating gender into HIV/AIDS programmes in thehealth sector
  • 5. Definitions1  Gender Equality  Equal treatment in laws and policies, equal access to health resources and services within families, communities and society at large  Gender Equity  Absence of unfair/avoidable or preventable differences in health between women and men.  Accounting for different barriers affecting women and men in benefiting from health-care programs1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector
  • 6. Gender inequality is the most pervasive form of social inequality Gender inequality cuts across all other forms such as class, caste, race and ethnicity11 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector
  • 7. Why Gender? Gender inequality influences  Higher child mortality, rates of stunting and wasting  Lower rates of health care utilization for maternal, child, and reproductive health services (including STI/HIV)  Higher maternal mortality  Higher GBV Gender Inequality recognized as driver of the AIDS pandemic
  • 8. Why Gender?  Gender inequality index (75 countries)  Low birth weight, higher fertility, infant & <5 mortality1  Lower women’s empowerment  Trafficked FSWs , increased HIV risk in India2  Decreased use of maternal health services in India3  Increased neonatal mortality in Bangladesh4  Increased family planning use in Ghana5  Increased wasting in 6 African countries61Varkey et al. 2010;2 Silverman et al., 32011;Bloom et. al, 2001,4Hossain et al., 2007 5 Norwood 2011; 6Singh et al. 2011
  • 9. New Strategic Developments
  • 10. Addressing gender is a global priority
  • 11. Addressing Gender in Health Programs
  • 12. Addressing Gender in health programs: Gender integration continuum11USAID Training of Trainers: Gender and Reproductive Health 101
  • 13. Accommodating or Transformative?
  • 14. Accommodating or Transformative?
  • 15. Addressing Gender in health programs: Gender-Based Analysis1  Analyze: gender differentials  Health status & determinants  Care utilization needs  Ability to pay  Participation of in health management  Gender-related influences, omissions & implications in health policy, programming & planning  Leads to addressing gender explicitly1PAHO (2009). Guidelines for gender-based analysis of health data fordecision making. PAHO.
  • 16. GBA Data requirements 1  Quantitative  Collecting, reporting & analyzing sex disaggregated  Socioeconomic determinants  Gender measures  Qualitative  Personal experiences and perspectives, motivations, attitudes, behaviors, choices etc.  Gets to the why of what quantitative data shows but often cannot explain1PAHO (2009). Guidelines for gender-based analysis of health data fordecision making. PAHO.
  • 17. Getting the G into M&E
  • 18. Monitoring Indicators that measure gender-specific outputs Indicators that track progress and effectiveness of gender-specific elements of programming Disaggregated data collection and analyses Data collection in areas such as attitudes and behavior that reflect gender norms USAID IGWG 2009, A manual for integrating gender into reproductive health and HIV programs
  • 19. Evaluation  Measuring impact on outcomes that relate to gender- specific programming  Elements that address gender equality  Data used to demonstrate progress and impact, influences demand for richer data USAID IGWG 2009, A manual for integrating gender intoreproductive health and HIV programs
  • 20. Measuring Gender Sex disaggregated data: differentials in disease incidence/prevalence and service utilization/delivery Complex construct unlike many risk factors Gender equality measures that have been used for quantitative analyses in HIV/AIDS studies  Norms for women and men, including attitudes about gender- based violence (GBV)  Beliefs about roles  Relationship factors  Women’s autonomy—decision making power in various areas  Independent access to economic resources  Experience of GBV
  • 21. Example of complex gender equalitymeasure: GEM Scale Objective is to measure attitudes towards gender norms in intimate relationships among men Used to predict multiple partners & IPV in varied contexts (Brazil, India, China, Uganda etc.) 24 items, 2 sub scales: Inequitable gender norms, Equitable gender norms Requires asking 24 (can be more or less, depending on context) items, then performing a statistical analysis
  • 22. Sample Indicators Gender Equality Measures Proportion of people who say that wife beating is an acceptable way for husbands to discipline their wives Numerator: Number of respondents in an area (region, community, country) who respond "yes" to any of the following questions: Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife if  she is unfaithful to him  disobeys her husband  argues with him  refuses to have sex with him  does not do the housework adequately Denominator: Total number of people surveyed
  • 23. Gender and Health M&E: Basics  How can health information systems address gender inequality? 1  Involvement of stakeholders at all levels  Sex-disaggregated data  Ongoing gender training for M&E system staff  Gender-integrated M&E plans1Payne, Sarah (2009). How can genderequity be addressed through healthsystems? WHO, policy brief #12
  • 24. MEASURE Evaluation Provide M&E CBT to improve gender data use Improve existing data use, new data collection to capture gender-related effects of programs and policies Research to improve evidence demonstrating effects of gender on health programming and policy Global collaboration to promote knowledge base of gender M&E
  • 25. Capacity building & training Regional M&E trainings: Gender module Tailored to region, context (PHN/HIV)  Understanding gender basics  Applied gender concepts  Integrating gender into M&E plans Used in India, Senegal (French), Nigeria, South Africa Online module
  • 26. Existing Data Use Know your HIV/AIDS epidemic from a gender perspective: Rwanda  Objectives  Illuminate gender effects on programmatic response  Generate demand for richer gender-related data  Assess existing national level data for potential  Analyses using gender indicators (menu of options) & show gender effects  Enhance data use with tool
  • 27. Research to improve evidence WJEI: Benin, Kenya, South Africa, Zambia GBV initiative Qualitative evaluation  Influences on design, implementation  Effects
  • 28. Global Collaboration Global AIDS Response Reporting “Gender Indicator” wanted Prevalence of Recent Intimate Partner Violence (IPV) Numerator: Women 15-49, have/had intimate partner, reporting physical or sexual violence in past 12 months Denominator Total women surveyed aged 15-49 who currently have or had an intimate partner
  • 29. Gender M&E Resources and Tools
  • 30. Gender M&E Resources and Tools VAW/G compendium Gender scales  http://www.c-changeprogram.org/content/gender-scales- compendium/index.html K4 Health IGWG Gender and Health Toolkit  http://www.k4health.org/toolkits/igwg-gender MEASURE Evaluation gender website: http://www.cpc.unc.edu/measure/our-work/gender
  • 31. Gender M&E Resources and Tools:Coming soon Gender and HIV indicator menu of options  Set of harmonized, agreed-on indicators  TAG includes USG (PEPFAR USAID), UN (UNWomen UNAIDS, WHO, UNFPA), World Bank, GFATM & other experts Resource guide for gender data and statistics (WHO, IGWG/USAID & MEASURE Evaluation)
  • 32. MEASURE Evaluation is a MEASURE project funded by theU.S. Agency for International Development and implemented bythe Carolina Population Center at the University of North Carolinaat Chapel Hill in partnership with Futures Group International,ICF Macro, John Snow, Inc., Management Sciences for Health,and Tulane University. Views expressed in this presentation do notnecessarily reflect the views of USAID or the U.S. Government.MEASURE Evaluation is the USAID Global Health Bureausprimary vehicle for supporting improvements in monitoring andevaluation in population, health and nutrition worldwide.