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Seven Steps to EnGendering Evaluations of Public Health Programs

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Because international development increasingly focuses on gender, evaluators need a better understanding of how to measure and incorporate gender—including its economic, social, and health dimensions—in their evaluations. This interactive training, consisting of this presentation and a tool, will help participants learn to better evaluate programs with gender components. Access the tool at https://www.measureevaluation.org/resources/publications/tl-19-40

Published in: Health & Medicine
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Seven Steps to EnGendering Evaluations of Public Health Programs

  1. 1. Seven Steps to EnGendering Evaluations of Public Health Programs MEASURE Evaluation August 2019
  2. 2. Agenda 20 minutes Vote with Your Feet 30 minutes Gender 101 45 minutes Seven Steps to EnGendering Evaluation 1 hour Group Work: Case Studies 20 minutes Review from Group Work 5 minutes Wrap-Up
  3. 3. Activity: Vote with your feet! • This will help us explore gender concepts. • Our own beliefs about gender make a difference. • We need to keep this in mind when we integrate gender in evaluations. Source: United States Agency for International Development (USAID) Training of Trainers: Gender and Reproductive Health 101
  4. 4. Gender 101
  5. 5. Definitions SEX GENDER Biological difference between males and females: • Universal for all human beings • Usually unchanging • Determined at birth Beliefs about the appropriate roles, duties, rights, responsibilities, accepted behaviors, opportunities, and status of women, men, transgender people, and others in relation to one another: • Constructed by society • Differs between cultures and over time • Acquired • Includes identity, expression, and orientation *Source: World Health Organization (WHO), 2009: Integrating gender into HIV/AIDS programmes in the health sector
  6. 6. Roles, relations, and power among men, women, boys, girls, transgender people, and others • Focusing only on roles of women and girls ignores systems, institutions, and structures in place, and the role of men and boys within those systems. • You cannot fully empower women and girls without also engaging men and boys. • Gender equality is good for everyone. Families and communities benefit. • Sexual and gender minorities are exposed to the same social expectations and this can affect outcomes. Gender Beyond Women and Girls
  7. 7. Equality vs. equity Equal treatment Fairness; compensation
  8. 8. Questions? discussion?
  9. 9. The 7 steps
  10. 10. Why integrate gender in evaluation? • Gender is everywhere o Every development intervention has hierarchies, judgments, etc., related to masculinity and femininity. • Provide evidence to: o Improve programs o Address gender dimensions of health, education, agriculture, etc. (doesn’t have to be a “gender” program) o Raise awareness • Identify gender-related goals and priorities based on available information and consultation with stakeholders, to better tailor evaluation to needs and encourage data use.
  11. 11. • Ensure that all contribute to research management and process. • Ensure the research itself is gender-sensitive. Why integrate gender in evaluation? (2)
  12. 12. EnGendering evaluation “Not everything that counts can be counted, and not everything that can be counted counts.” ─Albert Einstein
  13. 13. 7 steps to engendering evaluations 1. Identify stakeholders and their roles 2. Develop gender-integrated theory of change 3. Define gender-related evaluation questions 4. Select appropriate study design 5. Select measures for gender-related outputs and outcomes 6. Collect and interpret sex-disaggregated and gender-sensitive data 7. Disseminate and use gender-integrated results
  14. 14. Step 1. Identify stakeholders and their roles
  15. 15. Step 1. Identify stakeholders and their roles • Determine who the stakeholders are o What is their role in the intervention? o What do they gain? o What might they lose? o How much of a priority is their participation? o At what stage should they be involved? o What are their ways and capacities for participation? • Engagement strengthens accountability, trust, credibility, data use, and equity
  16. 16. Step 2. Develop a gender- integrated theory of change
  17. 17. Step 2. Theory of change If we do these activities Then we think get this result in the short term Then we think we’ll get this result in the long term Project goal, based on solution creation, derived from problem analysis Short-term outcome derived from thinking about the short-term steps that would lead to the long-term impact Activities derived from thinking about what concrete actions will lead to the short-term outcome
  18. 18. Step 2. Example theories of change If we train teachers on curriculum delivery Then students will receive quality instruction on reading Then students ages 7 to 10 will have improved literacy Example: Simple Education Project Theory of Change Example: Simple Gender-integrated Education Project Theory of Change If we train teachers on curriculum delivery, with attention to gender- related differences in learning Then students of all genders will receive quality instruction in reading Then students of all genders, ages 7 to 10, will have improved literacy
  19. 19. Step 2. Example gender- integrated theory of change PROCESS OUTPUT OUTCOME IMPACT Curriculum for discussions with men on basics of importance of family planning (FP) Discussion series with males about importance of FP Number of workshops with men on importance of FP Short-term: Increased awareness of importance of FP Intermediate: Increased proportion of men attending FP clinics with wives Increased proportion of couples using FP INPUT
  20. 20. Step 3. Define gender-related evaluation questions
  21. 21. Step 3. Define questions Consider: • What is the evaluation mandate? • How strongly gender-integrated is the program? • What barriers to changes in gender norms is the program trying to address? • How does gender play a role in the theory of change and what relationship(s) might you want to examine?
  22. 22. Step 3. Define questions Outcome/impact: • Has the program had the same impact on health outcomes for men and women? • Has the program reduced power differences in relations between men and women? • Have stigma and discrimination against people who do not follow traditional gender norms and behaviors been reduced? • Has the removal of gender-based constraints contributed to improved health outcomes? Examples
  23. 23. Step 3. Define questions Process/implementation: • Were gender-integrated program components implemented as planned? • What positive or negative unintended effects on gender equality were identified during implementation, if any? How were they addressed? • Were there any constraints (e.g., political, practical, bureaucratic) to addressing gender efficiently during implementation? If yes, what efforts were made to overcome these challenges? Examples
  24. 24. Step 4. Select an appropriate study design
  25. 25. Step 4. Study design Consider: • What are your gender-related questions? • Measure unintended consequences? • Measure complex norms, relationships? • How sensitive is the topic/population? • What types of evidence, funding, time, and other common considerations do stakeholders need? • Can your methods be empowering? (participatory methods) Methods
  26. 26. Step 4. Study design • Quantitative o Answers what and gives aggregate picture o Misses the quality of participation/performance  Qualitative o Address the why and how o Very important in gender  Complex relationships hard to measure quantitatively  Inequality, inequity are lived experiences  Mixed methods ideal Methods
  27. 27. Step 4. Study design To make determinations about the effects of a program on men vs. women, boys vs. girls, etc., you need a sample size of groups of interest that is large enough Need to consider sample size calculations, whether quantitative or qualitative Sampling
  28. 28. Step 4. Study design • Consider ethical concerns affecting sampling. For example: o Gender-based violence (GBV): only interview one woman per household o May need to use method like “snowball sampling” for some stigmatized populations  E.g., countries where homosexuality is illegal and you are working with men who have sex with men (MSM) Sampling (2)
  29. 29. Step 5. Select measures for gender-related outputs and outcomes Indicator types: • Sex-* and age- disaggregated o At a minimum • Gender-sensitive * Ideally gender-disaggregated
  30. 30. Gender-sensitive indicators • No single “gold standard” for measuring gender norms, attitudes, women’s empowerment • Use multiple measures o Gender is a complex construct and operates in multiple spheres o A scale combining several items is more valid than a single item used alone
  31. 31. Gender-sensitive indicators • Household decision-making power • Experience of GBV • Women’s autonomy and empowerment • Economic empowerment • Service delivery: gender equity, stigma, and discrimination • Couples counseling and male involvement Examples (1)
  32. 32. Gender-sensitive indicators • Women’s Empowerment in Agriculture Index (WEAI): 5 domains • Perspectives on gender norms o Gender-Equitable Men (GEM) Scale; example items:  “If someone insults a man, he should defend his reputation with force if he has to.”  “A man needs other women even if things with his wife are fine.” Examples (2)
  33. 33. Gender-sensitive indicators Demonstrate removal of gender-related barriers • Barrier: perception that masculinity=many sexual partners • Measure success through: o % of men/women who agree that men who have one sexual partner are “real men” o % of men who report that they have only one partner Capture quality, not just quantity • Not just training attendance but true participation and decision-making roles o % of trainees who have mastered relevant knowledge • Not just numbers employed but also quality of jobs held o % of management positions held by women Selection tips
  34. 34. Step 6. Collect and interpret sex-disaggregated and gender-sensitive data This Photo by Unknown Author is licensed under CC BY-NC-ND
  35. 35. Step 6. Collect Consider: • Logistics: Timing? Who is the interviewer? Location? • Questionnaire administration o Gender biases that may affect data  E.g., male overreporting of the number of sexual partners; underreporting of GBV • Ethical issues, particularly for GBV and other sensitive topics and marginalized populations o Review relevant international guidelines
  36. 36. Step 6. Interpret • Go back to evaluation question(s) before starting the analysis • Interpret within the context of literature • Analyze data by sex and age, at a minimum; include gender-sensitive indicators (as applicable) o If no differences, at least report that you looked at subgroups and did not find differences
  37. 37. Step 6. Interpret (2) • Identify patterns and potential issues related to gender in program implementation and outcomes • Ask: o If health outcomes are not occurring but gender outcomes are, what might be going on? And vice versa? o Are gender elements of programs actually in place? • Don’t be seduced by personal beliefs and expectations; conclude only what results indicate
  38. 38. Step 7. Disseminate and use gender-integrated results MEASURE Evaluation. (2017) Gender Matters Video. Chapel Hill, NC, USA: University of North Carolina at Chapel Hill. See https://vimeo.com/219126971 0% 5% 10% 15% 20% 25% Male Female
  39. 39. Step 7. Disseminate and use gender-integrated results (2) Ensure that the information is available, accessible, relevant, and useful Also consider: • Implications of sharing results o E.g., sharing location-based results related to illegal behavior • How recommendations affect different stakeholders positively or negatively
  40. 40. Questions? discussion?
  41. 41. Gender evaluation resources and tools • Compendium of Gender Equality and HIV Indicators (MEASURE Evaluation) • Violence Against Women and Girls Compendium of M&E Indicators (MEASURE Evaluation) • Trafficking in Persons and Health: A Compendium of M&E Indicators (MEASURE Evaluation)
  42. 42. Gender evaluation resources and tools (2) • Family Planning and Reproductive Health Indicators Database (MEASURE Evaluation, PRH) • HIV Indicator Registry (Joint United Nations Programme on HIV/AIDS) • Resource guide for gender data and statistics (WHO, IGWG/USAID, and MEASURE Evaluation) • Guidelines for Gender-Based Analysis of Health Decision Making (PAHO) • K4 Health IGWG Gender and Health Toolkit
  43. 43. Gender evaluation resources and tools (3) • Positive Youth Development Measurement Toolkit (YouthPower) • Girl-Centered Program Design: A Toolkit to Develop, Strengthen, and Expand Adolescent Girls Programs (Population Council) • Integrating Gender in the Monitoring and Evaluation of Health Programs: A Toolkit (MEASURE Evaluation)
  44. 44. Gender evaluation resources and tools (4) • Integrating Human Rights and Gender Equality in Evaluations (United Nations Evaluation Group) • Gender Matters (video) (MEASURE Evaluation) • Addressing Gender in Impact Evaluation: What should be considered? (ODI)
  45. 45. Group exercise 1. Two case studies: one on HIV and one on healthy timing and spacing of pregnancies 2. Divide into groups and choose a case study 3. Review the case study 4. Answer questions 5. Report back in 45 minutes
  46. 46. This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government. www.measureevaluation.org

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