Day 3 gender panel integrating suppy and demand tz 108023

1. Project Title: Improving Access to Health Services and Quality of
Care for Mothers and Children in Tanzania
Implementation Research Team
Dr. Stephen Maluka (PI), University of Dar es Salaam, Tanzania
Dr. Robert Salim (Co-PI), Regional Secretariat, Iringa, Tanzania
Dr. Khadija Begum (Co-PI), HealthBridge Foundation of Canada
Prof. Peter Kamuzora, University of Dar es Salaam, Tanzania
Prof. Esther Dungumaro, University of Dar es Salaam, Tanzania
Dr. Dereck Chitama, Muhimbili University of Health & Allied Sciences, Tanzania
Dr. May Alexander, Iringa Municipal Health Office, Tanzania

2. Focus on Gender and Equity in IMCHA Research Project
Outline
Social and Gendered Focus (SAGF) in Research Design/Objectives
Social and Gendered Dimensions (SAGD) of Research Methods,
Field Work and Questions in Research Tools
Current/Emerging Social and Gendered Research Findings
,

3. Social and Gendered Focus (SAGF) in Research Design/Objectives
Objective 1: Understand the processes and context at the community and health facility level that affect
acceptability, quality, equity and utilization of maternal, newborn and child health services.
• SAGF is to better understand how gender, equity, social and cultural values, norms and practices, beliefs
and perceptions are related to acceptability, quality, access and utilization of MNCH services
Objective 2: Understand the mechanisms by which the integrated demand and supply side interventions may
influence the acceptability, quality, equity and utilization of MNCH services.
• SAGF is to assess how gender, equity, social and cultural values, norms and practices, values, beliefs and
perceptions and other Social and Gendered learnings can be integrated into the demand and supply side
interventions of the project to ensure equitable aceess and utilization of quality MNCH services through
active engagement of men and women in the community and health facility
Objective 3: Assess the impact of community level and health facility level interventions on acceptability,
quality, equity and utilization of MNCH services
• SAGF is to conduct social and gender analyses at different stages of assessment and impact evaluation
of the research to assess variations/improvements in
a. access to health services and QoC for Mothers and Children by different social identity groups
b. roles and responsibilities of men and women in relation to MNCH services
c. decision making roles and responsibilities among men and women in relation to access and
utilization of MNCH services

4.  By nature the target beneficiaries are pro-poor marginalized group
 Social and gender focused baseline situation analyses through a mixed method approach
• Quantitative household survey of mothers/caregivers of children 0-23.9 mo
• Quantitative health facility assessment and exit interview of mothers/caregivers of children 0-23.9 mo and
pregnant and lactating women
• Qualitative assessment of social and gender relations in men and women regarding MNCH (FGDs & IDIs)
 Attention was given to recruit women from poor households as well as women living with HIV/AIDS in
order to ensure that the voices of the marginalized women are taken into account.
 FGDs were conducted separately for men and women to ensure that women expressed their views
freely without being dominated by men.
 Intervention design based on existing gender and social consideration to empower women, increase women’s
voice in the community and promote women’s leadership in MNCH services through
• Women’s participatory Learning and Action Groups (WPLAG) meetings
• Sharing WPLAG findings through community meetings to engage husbands, men and other community
members in MNCH
• Gender equity and social inclusion (GESI) training to all project staff, facility staff and members of Health
Facility Governing Committee (HFGCs)
• Ongoing monitoring of intervention processes to assess equity in project participation, access to and
utilization of MNCH services
 Impact evaluation to assess project impact on various social identity groups (disaggregated by age, education,
socioeconomic status, geographic location/facility catchment area, HIV status and so on)
Social and Gendered Dimensions of Research Methods

5. Social and Gendered Dimensions of Baseline Tools
 Household survey tools included social and gendered focused questions
• HH socio-economic status, women’s education and decision making on major
household purchases, health care including decision on place of delivery
• Health care provisions from a male or female care provider and women’s
preference including privacy during care seeking at health facility
• Social and perception factors related to delay, access and utilization of facilities
 Health facility assessment tools looked into
• Ratio of men and women member in the Health Facility Governing Committee
• User fee waiver for poor families, pregnant women, under-five children or over-
sixty clients
• Infrastructural, funding and resource status of the health facility
• Family planning and obstetric services provided at the facility

6. Social and Gendered Dimensions of Baseline Tools
 Health facility exit interview tools looked into
• Social, economic and perception factors related to delay, access and utilization of
facilities
• Barriers and facilitators of care seeking at the facility from women users’
perspective
 Social and gender assessment tools included
• Men and women participants including traditional birth attendants, faith leaders
and health workers
• Focused on gender, equity, social and cultural values, norms and practices, beliefs
and perceptions related to acceptability, quality, access and utilization of MNCH
services including barriers and enabling factors

7.  Completed baseline assessment including social and gender focused IDIs (80) and FGDs (#38) using tools
that included questions on social and gender relations of MNCH services (467 HHS, 19 HFA and 217 exit
interviews in both intervention and comparison sites)
 For example, FGDs with women addressed issues around men accompanying women during care
seeking at health facilities and decision making power of women and men as regard to MNCH
 20 WPLAG was formed in 20 intervention villages which included a total of 400 women (15-49 years, ≥2
pregnant women in each group, ≥2 Champion women in each group)—to conduct WPLAG meetings
 For example, these WPLAG meetings are conducted by women community members but findings
are shared periodically with other men and women in the communities to facilitate men’s
engagement and accountability
 40 Women Group Facilitators (WGFs) was recruited from 20 intervention villages (male: female=1:1)
 WPLAGs and WGFs were trained on participatory action research and social and gender equity issues
Social and Gendered Dimensions of Field Work

8. Baseline social and gender analyses of household survey (preliminary results)
 Male headed households: 72.9%
 Single, widowed, divorced or separated women: 26.5%
 Women alone made the final decision on start attending ANC clinic: 49.7%
 Women alone made the final decision on big family purchases (e.g., house, farm etc.): 8.4%
 Women alone made the final decision on daily family purchases (e.g., food, cloths etc.): 38.1%
 Women alone made the final decision on where to deliver her last child: 24.3%
 Women’s reported preference for a female provider: 56.6%
 Received ANC from a male provider: 14.5%
Current/Emerging Social and Gendered Research Findings

9. Current/Emerging Social and Gendered Research Findings
Baseline qualitative social and gender analyses
 Men are mainly responsible for household decision making although in some cases decisions are
made jointly
 Although women have limited decision making power, “permission” from the male partner is “not
a big problem” to access MNCH services
 Entrenched belief is that men are not responsible for pregnancy and childbirth related matters
 Walking is the main mode of attending health facility
 Distance to the health facility and economic factors are barriers to access in some wards
 Transportation and costs are major challenges for transferring referred critically ill patent and
pregnant women during delivery
 Despite these barriers, women still prefer to give birth in a health facility and believes that TBAs
are not adequately equipped to handle deliveries (Baseline HHS reported 97.4% health facility
delivery rate)
 Drug stock-out and staff-shortage were mentioned as barriers to access adequate care in some
facilities

10. THANK YOU!