Health

09 02 2016

Webinar: Community Health Workers – The Gender Agenda

On February 10th 2016 Health Systems Global will be hosting a webinar on community health workers and gender.

09 February 2016

Close-to-community (CTC) providers include community health workers, village midwives and community-based drug distributors, who deliver a wide range of services at the community level and are often female. Gender affects, and is affected by, close-to-community health programmes in a number of ways.

On February 10th, 2016 at 1pm GMT Health Systems Global invites you to the new webinar: ‘Community health workers – The gender agenda’ This webinar showcase a panel of researchers from around the world who have been exploring the issues.

To find out more about the webinar and to register click here.

10 12 2015

With challenges come opportunities: Sexual and Reproductive Rights in fragile states on Human Rights Day

Sally Theobald in conversation with Alexander Dimiti, Director General Reproductive Health in Ministry of Health, South Sudan, Lucy Bahr, Associate President of Liberia Midwife Association, and Jesse Rattan director of CARE’s global programme of Sexual and Reproductive Health in Emergencies.

Sally Theobald

10 December 2015

December 10th is human rights day and the culmination of 16 days of action of the UNiTE to End Violence against Women Campaign. The 2015 theme for action to end violence against women is prevention; whereas this year’s Human Rights Day is devoted to the launch of a year-long campaign for the 50th anniversary of the two International Covenants on Human Rights which were adopted by the United Nations General Assembly on 16 December 1966.

There are events happening all over the world today to mark action, for example in Democratic Republic of the Congo (DRC) the Palais de Justice will turn orange to highlight the importance of ending violence against women; there has also been the ‘oranging’ of bus stops in Timor-Leste and spontaneous orange flash mobs in Indonesi a. In Amsterdam, KIT, and partners are organizing a symposium on s exual and reproductive health and rights in fragile environments: Turning Challenges into opportunities. And it is here in Amsterdam in preparation for the panel that will be held in the symposium that we panelists had the opportunity to discuss the opportunities to realize sexual and reproductive rights and address violence in fragile settings.

We need to promote family planning as a right

There has been resistance to promoting family planning amongst some in contexts like South Sudan where an estimated 2.5 million people have been ‘lost’ to war; leaving some to feel discussion about contraception should not be entertained. Here exposing high profile policy players to debates and discussions at the 2013 International conference on family planning in Addis Ababa, helped transform senior delegates views on family planning as a right and as a strategy to save lives and build healthy communities.

Action on child marriage

Promoting sexual and reproductive rights requires action on child marriage. Lucy Bhar explained that in Liberia, after 40 years of conflict, forced early marriage is a reality for many girls. Similarly in many communities in South Sudan a girl is considered ready for marriage when she gets her first menstrual period; and child pregnancy is one of key reasons why girls drop out of school.

Exerting agency to reduce pregnancy

In South Sudan women and girls have very little autonomy, rights, or ability to negotiate sex in marriage or the use of family planning. However, even within very challenging circumstances and constrained room for manoeuvre some women manage to exert agency to reduce pregnancy. Dr. Dimiti narrated the stories of two women from his district, one had five children in eight years, she became adept at tracking her menstrual period and make the proactive decision to sleep in the bush – and hence avoid sex – during her fertile period. Another with eleven children, nearly died during child birth, but her husband still would not consider family planning. Here she offered her own cows as a form of dowry so that her husband could ‘access’ a second wife and continue procreating.

Spaces for reflective dialogue

We need to build spaces for reflection and dialogue and change at policy level and at community level to support women’s rights and make family planning a reality. Exposure to debates in Addis brought change to the views of policy players and opportunities for facilitated discussion can bring change at the community level: The SHARP programme in South Sudan has been hosting community dialogues – facilitated discussions between genders and generations – statements for change were negotiated and agreed. Here are some examples:

“If a man with more than one wife is not looking after one of his wives and their children, the wife has the possibility to refuse to produce any more children without having to pay back the cows/bride price and also has the right to not be beaten.”
“We don’t want daughters to marry or be pregnant before 18 years old and we in our family will do all we can – we want to pledge this to our family and community.”
“Married women should be allowed to use contraception and have three-year birth spacing.”

Unsafe abortions

Unsafe abortions are too often the last chance for some women and girls wishing to avoid pregnancy: many girls and women seek abortions but in South Sudan and Liberia this is only legal when the pregnancy poses a threat to women’s lives. Lucy Bahr said that women, and especially poorer women with limited options, resort to using stick to try to self-abort. Whereas Dr.Dimiti explained that two thirds of maternity wings in South Sudan are due to cases of bleeding and it is not known how many of these follow unsafe or partial abortions.

Change is possible

Jesse Rattan provided an inspiring example from Eastern DRC where stakeholders at different levels – including policy makers, the police, health providers and community leaders – took action to address the negative effects of unsafe abortion that was literally killing women and girls. They joined together to support girls and women to access safe abortion within the law, and where needed post-abortion care and doing so without fear of harassment, blame or stigma. This is an example of partnerships for change and embedded community action for change.

Stop the silence

Too often there is silence when girls and women suffer sexual and gender based violence. In some contexts, this silence is seen as protecting, as the stigma associated with being raped is immense, and hence not speaking about it will ‘protect’ a girl’s chances in life. There is also arguably an even bigger silence around cases of rape of boys and men which is also sadly a reality in context such as Eastern DRC. Action here requires service provision – post-rape care, emergency contraception, post exposure prophylaxis and counselling and ensuring that services to address sexual and gender based violence also link with and strengthen the broader health system. This is discussed in a set of resources on Building back better: gender, equity and health systems in post conflict contexts. And as per this year’s theme we also need to go beyond the sticking plaster treatment approach and simultaneously focus on prevention. This too requires action and changes on multiple levels and new partnerships within and beyond the community to promote change.

We have seen that change if possible – with challenges come opportunities – we need to work together to be part of the solution, and work in partnership at the community level to promote resilience and gender and societal norms that address violence and promote rights. Today’s symposium is focusing on experience sharing for action to meet sexual and reproductive rights in fragile contexts – learn more on Twitter with the hashtag #srhrsymposium or follow @100KIT

02 12 2015

Incorporating gender into ethics reflections when conducting health systems research…. Where to begin?

In this blog post, Sassy Molyneux reflects upon the intersection of gender and ethics analysis, and how each can be applied, within health systems research.

Sassy Molyneux

02 December 2015

The title of this blog includes many head-scratching elements: What is health systems research? What’s is gender analysis? What are ethics? And then how on earth can we bring all three of these complex elements together to reflect upon them in our studies? Of course each of these areas could be – and appropriately is – studied in great depth by experts from diverse disciplines across the world.

But there is so much information out there it can be quite overwhelming for a health systems researcher to know where to start for multi-method studies involving substantial qualitative elements.

So in this blog I want to provide a few suggestions of entry points that you can use. Bearing in mind that there is no ‘right way’ of doing it.

Gender and ethics analysis are intricately inter-related

Ethics can be defined as the norms and standards – whether written or spoken, conscious or unconscious – that guide personal and interpersonal conduct. They help us think about what ought to happen in different situations, and on what actions or behaviours are right or wrong. There are three widely agreed broad values or norms considered fundamental to conducting ethical research:

Beneficience and non-maleficence, i.e. that research on human subjects should produce some positive and identifiable benefit, however indirect and long-term, and that researchers should care for the well-being of and avoid harming participants;
Respect for persons and, increasingly, communities, i.e. that the values and decisions of research participants and the communities from which they come should be respected, and;
Justice, i.e. that people should be treated equally and there should be fairness in who participates in and gains from research.

Gender is the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men, women and other genders (WHO 2015). It shapes individual identities and values, interpersonal relationships, and how social systems are organised (in terms of social norms, institutions, structures, and resources). As such it is difficult to disentangle gender and ethics in conducting health systems research.

In our work we need to ask:

Have we considered the potential differences in interests and experiences between men, women and other genders?
How do these differences inter-relate with other social stratifiers (such as class race, education, ethnicity, age, geographic location, (dis)ability, and sexuality?

Biomedical ethics guidelines and regulations: Incorporating a gender lens

There are many research ethics recommendations and guidelines based on the three fundamental research ethics values and norms outlined above. Emanuel et al. identified eight principles and 31 corresponding benchmarks to consider in planning and reviewing clinical research in developing countries. Because this paper draws on guidelines that are so familiar to biomedical researchers, we found this to be an accessible and useful framework to think about ethical questions for multi-method health systems studies, including studies that involve a substantial amount of qualitative research. We didn’t use this framework as a checklist to tick off ‘doing ethics’ or ‘being ethical’ but as set of considerations to prompt discussion and weighing-up of issues.

Applying a gender lens could also involve considering how groups of principles and benchmarks might apply differently to different genders as a result of gender differences in: 1) access to resources, 2) division of labour, 3) social norms and 4) rules and decision-making. For example:

Do community engagement and consent processes consider gendered decision-making processes in households?
Will the potential benefits and harms of the research during and after research accrue equally to men, women and other genders given gender differences in access to resources or divisions of labour?
Has the research considered gendered social norms and will it at least ensure there is no gendered harm, even if there is unlikely to be a transformation of damaging norms?

Recognising the limitations of (biomedical) guidelines and regulations

The application of all guidelines and regulations in practice is contested and limited:

“…the ethics of human subjects research may be universal but is at the same time deeply particularized, so that what autonomy or informed consent or even benefit and harm means depends on the circumstances” (King, cited in Quinn 2004)

“current guidelines and regulations are an inadequate response to the complex, often unpredictable and ever shifting ethical dilemmas facing researchers ‘in the field’” (Mitchell, Nakamanya, Kamali et al., 2002).

Understanding what ethical priorities and concerns are in different settings and communities, and how these unfold and change over time and over the course of studies, is essential. Ideally all analyses would be gendered.

Examples of how these analyses may be conducted include:

In-depth social science studies specifically designed to examine values and perspectives of diverse community members in different contexts, including on particular topics (see for example this study from Kenya).
Careful community engagement activities in advance of studies aimed at identifying communities’ priorities and concerns and responding to them in terms of study content, design, process and outcomes. Gender and other social stratifiers should be a key consideration in relation to who is engaged with, where engagement activities happen, how they are organised, and what topics are covered. Community engagement is increasingly recommended for all studies by funders and reviewers globally (and is built into community based participatory research), and there is growing funding for such activities. This paper provides an overview of key issues.
Regular reflection among team members conducting the research on the ground about ethical issues being raised as the study unfolds – i.e. issues where there is a moral dilemma; a worry and need for careful reflection about what ought to be done. This latter point is arguably good practice anyway for any research, but adding a gender/ethics lens helps to guide reflection and ensure that potential for gendered harm is minimised and benefits maximised. The kinds of issues raised and how they are handled is illustrated in this paper by Kamuya et al.

We have found that in practice it is often the social relationships – many of which involve complex imbalances of power – that are established in research teams, between researchers and health staff and managers, and between field-teams and community members, that are critical to fulfilling the moral (as opposed to the legal) aspects of ethics practice in health policy and systems research. These need gendered consideration prior to, throughout, and on completion of the study. This can be done in many ways, the points above are just some initial suggestions.

Sassy Molyneux is part of the steering committee for Research in Gender and Ethics (RinGs): Building Stronger Health Systems. She is employed by Oxford University and has been working as part of the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya, since 1994.

For more information about RinGs visit our website.

02 11 2015

How to do gender analysis in health systems research – Significance of data collectors’ gender (part 2)

This blog post is part of a series looking at key questions related to gender analysis within health systems research. In this post we explore the significance of data collectors’ gender in relation to whether the emphasis should be on training as opposed to the gender of data collectors.

RinGs Steering Committee

02 November 2015

On 8 September 2015 Research in Gender and Ethics (RinGs): Building Stronger Health Systems held a cross-RPC webinar on “How to do gender analysis within health systems research”. The webinar involved 26 members from Future Health Systems, ReBUILD, and RESYST.

Webinar participants asked some very interesting and relevant questions about how gender analysis can be incorporated into health systems research. In this blog series, we discuss some of the issues raised and we would be interested in your viewpoints as well. Please let us know in the comments section below!

Q: When thinking about gender in relation to the data collection process there is often a lot of focus on who is collecting data, i.e. the gender of the data collectors. Instead, should not the focus be on whether those collecting data have the relevant training and required skills to recognize gender issues and report on them? If not, isn’t there a danger that only women should be collecting data on issues relevant to gender? Male participant, Uganda

A: This is a very good question and shows the tendency of health systems researchers to equate gender work with women, or think that studies which examine gender often focus on topics related to women’s health needs, such as maternal and child health or sexual and reproductive health. A focus on gender, however, does not focus solely on women, but with the “socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women” and people of other genders (WHO 2015). Men may be excluded from women’s health studies despite their important role in influencing women’s health-seeking behavior.

Incorporating gender analysis into a study, goes beyond focusing on men or women in isolation. It entails examining the social context of gendered power relations and how these affect such things as access to resources, division of labour, social norms, and rules and decision-making.

When collecting data it is not a pre-requisite that female data collectors must be used with female respondents and male data collectors must be used with male respondents. Data collectors from either gender can be trained to understand and recognize gender issues. However, it is important to recognize that in some contexts it will not be acceptable for male data collectors to collect data from females, or female data collectors to collect data from males.

Some respondents may be uncomfortable sharing information with a person from the opposite sex. This is particularly relevant for sensitive issues, such as sexual and reproductive health. It is therefore up to the researchers to understand the context in which they are collecting data and to make an informed judgement on who is to collect data from whom. Our goal as researchers is to collect accurate and high quality data, and the identity of our data collectors may be an important component in doing so.

To view a recording of the webinar or the webinar presentation slides, click here.

For more information about RinGs visit our website.

27 10 2015

How to do gender analysis in health systems research – Significance of data collectors’ gender

RinGs Steering Committee

27 October 2015

Q: How important is it to consider the gender of data collectors while developing a data collection team for quantitative data? Female participant, India

A: It is important to consider the gender of data collectors for both quantitative and qualitative research as it has the potential to negatively bias the data collected. While it is true that qualitative data methods often involve a much more personal relationship with respondents compared to quantitative data methods due to the nature of one-on-one or group interviews, rapport and trust are a core part of both quantitative and qualitative data collection processes.

Quantitative methods that involve direct contact with participants, such as home-based or community surveys where data collectors ask specific and direct questions to respondents. In such instances, the gender of data collectors may impact upon participants’ willingness to disclose personal or sensitive information.

In cases where a survey is left with a respondent to fill out on their own, while data collectors may feel that respondents are able to provide anonymized answers, respondents themselves may not feel this if data collectors personally return to collect the completed survey. It is therefore important for researchers to understand the context in which they are collecting data and whether male or female data collectors would be the most appropriate to ensure that the data collected is accurate and unbiased.

Ensuring same sex data collectors does not preclude gender bias. In qualitative research, the principle of reflexivity, where the positionality of researchers is examined and where data collection processes and analysis is discussed by research teams is critical to further understanding potential bias or different interpretations of the research context.

To view a recording of the webinar or the webinar presentation slides, click here.

For more information about RinGs visit our website.

26 10 2015

Moving forward an ethical agenda in health systems research: Areas for discussion and routes for the future

Recently I attended a meeting convened by the World Health Organization that aimed to start the process of developing guidance for research ethics committee’s review of health systems research (HSR). This blog incorporates some reflections of the key points discussed during the meeting.

Bridget Pratt

26 October 2015

Justice

Despite the growth of HSR being conducted worldwide, we lack guidance and consensus statements regarding the ethical considerations that are specific to the field. One area that I think is particularly necessary to think about is justice. This is because HSR has been identified as an essential means to reduce health disparities through helping identify how governance, service delivery, financing, and human resource components of health systems can best be organized to improve access and financial protection for disadvantaged groups in low- and middle-income countries.

Ethical considerations relating to equity arise during all phases of HSR, from the selection of research questions and participants to research design to implementation and monitoring and evaluation:

“Where HSR contributes to the planning of services and policymaking, the voice of the socially excluded may be muffled, and that of the better educated and materially secure, artiﬁcially ampliﬁed”

Where participants in HSR are representative of a relatively limited and privileged subset of the population, HSR will not be set up to determine how disadvantaged groups will be affected by, for example, changes to models of service delivery or insurance schemes.

Gender and power

Ethical concerns relating to justice in HSR can also be linked to considerations of gender and power. Take community entry and consent processes as an example:

“The Ekjut intervention in Jharkhand, India tries to help women in underserved communities to take charge of their health needs…. How ethical is it to take consent from (mostly male) guardians who embody the social structure within which the [female] participants will be maneuvering?”

Health systems research often relies on gatekeepers to obtain consent or permission for studies to proceed in particular villages or districts. For studies involving female participants, what should be done if gatekeepers are primarily male? Can they really represent the interests and concerns of women in their locations? There are also likely to be many other differences between potential research participants and gate-keepers in terms of age, religion, experience, interest and ability to raise and respond to concerns about research. Given these complexities, how can appropriate representatives of individuals and communities be identified and consulted with, at what stage of studies, and to what end?

These are common dilemmas for all types of research, but are amplified for health systems research, where consent is sought primarily at a group/cluster level. When study interventions aim to change the status quo – which is common in health systems research using participatory action methods – working with individuals who represent traditional power structures and authorities raises particular dilemmas regarding their ability to prioritise the interests of the most marginalised men and women in society.

Taking health systems research ethics to the next level

It is essential to identify how considerations of justice should be built into the different stages of the health systems research process. For example, considerations might include:

How we define disadvantage and marginalisation. In local terms, national terms, global terms, or according to what criteria, e.g. those proposed by Wolff and deShalit?
Whether the research population adequately includes disadvantaged groups from the host country?
Whether the research question(s) create new knowledge that can improve health systems for marginalised groups?
If disadvantaged groups are included as part of community engagement during research design and implementation. How are they given an equal opportunity to participate?
Whether monitoring and evaluation include measuring study interventions’ impact on inequalities in health and access to services between groups?

But this also raises the question: if HSR is intended to work to reduce health inequities during all stages of the research process, whose role is it to ensure that these considerations are addressed by proposed projects? Research ethics committees are the main body of oversight for ethics matters in research. Does it all fall on their under-resourced shoulders? I think that research ethics committees certainly have a part to play in ensuring equity considerations are dealt with by proposed projects. They can at least help ensure that proposed research does not exacerbate existing inequities and vulnerabilities and ideally support the development of research questions and/or designs that give voice to those who often do not have one.

Yet making these committees solely responsible for addressing the above considerations may not be the most effective approach. Other players have the power to play a significant role. For example, funders, research institutes and national governments set policies about the type of research questions they’re interested in and investing in. They can also set policies for how the research they support is conducted. Ultimately, these actors have clear responsibilities for ensuring that HSR addresses equity considerations. But their responsibilities need to be better defined.

How to do gender analysis in health systems research – Significance of gender as a variable

This blog post is part of a series looking at key questions related to gender analysis within health systems research. In this post we explore the significance of gender as a variable.

RinGs Steering Committee

20 October 2015

Q: Within health systems research, should gender be mentioned when it is not significant significant as a variable? Should it still be reported? Female participant, China.

A: Gender and gendered power relations is relevant for all health systems research, including efforts to examine and change vulnerability to ill- health; household decision-making and health-seeking behaviour; access to and utilization of health services; the design and use of medical products and technology; the nature of the health labour force; what health programs or issues get financed; what health issues get prioritized and how they are framed.

Within quantitative research there are many things which may impact whether or not a variable is statistically significant, including: the overall sample size, the sex disaggregated sample sizes, the questions asked, and the type of analysis used. Therefore just because a variable was found to be statistically not significant, does not mean it doesn’t play a role, or indeed it is not important. As researchers we need to understand more about the context and explore why certain variables are not found statistically significant. It gives us an opportunity to revisit our conceptual frameworks or program theories and explore whether the variable is not relevant in the context we are examining, or did we not fully understand other dynamics going on that are masking social inequalities? For example, in India, parents tend to favor male over female children in terms of health care seeking. A finding of equal access to public sector doctors for male and female children may not indicate that gender bias does not exist, if the gender bias is predominately manifested in the private sector which makes up the bulk of care seeking for sick children.

It is important to show not just what variables were statistically significant, but also to revisit our conceptual frameworks and theories to enquire further about the variables that were found to be statistically not significant and examine why this is the case. Such insights can lead us to better understand nuances and unexplored research avenues.

Next week this blog series will explore the significance data collectors’ gender

To view a recording of the webinar or the webinar presentation slides, click here.

For more information about RinGs visit our website.

14 10 2015

How to do gender analysis in health systems research – Moving beyond sex disaggregation

This blog post is part of a series looking at key questions related to gender analysis within health systems research. In this post we explore how health systems researchers can include more meaningful gender analysis within their research by moving beyond sex disaggregation.

RinGs Steering Committee

14 October 2015

Q: Most health systems research disaggregates by sex, however, this is often related to demographics and overall descriptive results. How do we move beyond sex disaggregation to ensure that health systems research includes more meaningful gender analysis? Male participant, Uganda

A: While it is true that a lot of research includes a demographic question about sex, this is not necessarily the case. Research on community participation many times fails to disaggregate by sex or any other socio-demographic identifiers. It therefore may unintentionally leave out the most vulnerable.

Sex disaggregation is critical within health systems research as aggregated datasets can mask differences between men and women, a bias which negatively affects the validity and reliability of research evidence. However, sex disaggregation is only a starting point to gender analysis. A study that only disaggregates by sex may be able to tell you that differences exist between men and women, however, it will not be able to tell you why those differences exist and what can be done about them. Or that sex is not statistically significant, contrary to our assumptions, but we don’t understand why or why not.

As suggested by this webinar, by applying gender analysis frameworks to frame further questions in data collection and analysis, research can move beyond sex disaggregation to understand more about how gender power relations operate in health systems. For example, factors underpinning sex differences in accessing health services can be examined by asking who controls resources at the household level and whether or not those resources are used for health care. It may also ask who does what activities within the home and how this impacts a person’s ability to travel to a health center. It may also explore how health care services are organized and whether men feel comfortable seeking care from them.

In addition, analysis should extend beyond sex disaggregation and incorporate intersectional analysis to explore the interactive influence of other social stratifiers, such as age, class, ethnicity, education, or location, for example, and how these intersect with gender. In particular, such analyses will be able to show us how power relations structure the lived experiences of different socially marginalized and vulnerable groups.

Research on health workers, for example, will often ask what type of health worker the respondent is but leave out information related to sex, age, ethnic or caste background, level of training, type of contract, etc. We may therefore assume that having a predominantly female frontline health work force is a positive sign, signaling greater opportunities for women. However, in more marginalized regions of South Asia, for example, many of these women come from the rural elite. On a broader level, it is also problematic if women are primarily employed in levels of the health workforce that have limited career pathways and are poorly paid.

While sex disaggregation is an important component of gender analysis, in order to ensure that health systems research includes more meaningful gender analysis, health systems researchers must move beyond sex disaggregation. The use of gender analysis frameworks to frame futher gender sensitive questions in data collection and analysis, as well as the use of intersectional analysis, can help health systems researchers ensure their research effectively incorporates gender analysis.

Next week this blog series will explore the significance of gender as a variable.

To view a recording of the webinar or the webinar presentation slides, click here.

For more information about RinGs visit our website.

12 10 2015

Ten gender-related points to keep in mind when you are doing health systems research

This post explores 10 gender-related points to consider in health systems research.

12 October 2015

Following RinGs webinar on how to do gender analysis in health systems research, Benjamin Uzochukwu and Kate Hawkins published a blog on Health Systems Global titled Ten gender-related points to keep in mind when you are doing health systems research.

For information visit Health Systems Global or read the 10 points below!

Recently we both attended a RinGs webinar on how to do gender analysis. This is part of the capacity strengthening activities of the project. It is really nice to take some time to hear from colleagues working on health systems around the world and get some space to think through how we can work together to strengthen a gender analysis. RinGs is developing a great deal of detailed material on this topic so we thought we would keep this short and give you our ten things to bear in mind about gender and health systems research.

1. Gender is a key social stratifier: As a power relation it affects vulnerability to ill health and the decision making space and economic power that people have to tackle illness. Access to health services can be effected by gender, for example, women may have less money to pay for health care and find it difficult to travel to a health care centre. On the other hand, sometimes health care centres can be too tailored to women, which puts men off attending.

2. To strengthen health systems we need to pay attention to gender: It is important to understand how health systems components interact with each other, how gender plays a role in each of these, and how to address these gender issues in health systems strengthening activities in order to improve health and social outcomes. Including gender analysis in health systems research help maximise the effectiveness of programmes, lead to better research recommendations, more strategic interventions and programmes and more effective policies.

3. As health systems researchers we need to recognise gender: Expressions of gender inequity -whether in the relations between women and men or within organisations -need to be recognised and addressed in order to redress discrimination and ensure interventions in health involve and benefit the disadvantaged.

4. Sometimes gender issues are rendered invisible: For example, terms like Community Health Worker, village health committees, insurance policies appear gender neutral and yet they are gendered. When we disaggregate data and analyse context and relationships these gendered aspects can come to the fore.

5. There are still issues and confusion about separating gender and sex, especially in analysis: ‘Being’ female and ‘being’ a woman are two very different sort of being. Yet in data analysis, for example, gender disaggregation means separation into male and female. It is not uncommon to see such variables as ‘Sex/Gender’.

6. We need to look beyond the individual: It is important to think about gender relations between couples, families and households. But gender analysis is also about how society is structured, the norms and institutions that guide things and access to resources that flow from this.

7. We need to take account of gender-fluidity: Gender isn’t fixed, it changes across time and across contexts. Looking at gender in combination with race, class and other forms of inequality enhances the analysis.

8. Gender frameworks can help: RinGs has collated what they consider the top ten gender frameworks on their website. They can help us think through what constitutes power gendered relations and how power is negotiated and changed.

9. We should also think creatively about the methods that we use: For example, we could employ social networking analysis of gender issues in healthsystems research in addition to other available tools.

10. Building capacity goes beyond the individual: Ensuring that gender infuses questions about research design, data collection and analysis is important. Researchers need to think carefully about their own positionality. However, we also need to look to those political, social and economic structural barriers that prevent a focus on gender in the first place. What can we – as health systems researchers – do to overcome these?

We call upon our colleagues in RinGs to use the comments function below to add to the list of gender-related points to keep in mind when you are doing health systems research and to keep the conversation live!

*Prof BSC Uzochukwu is the deputy coordinator of the Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-campus. He is a member of the Resilient and Responsive Health System Consortium (RESYST) and Board member of Health Systems Global (HSG).

Kate Hawkins is Director of Pamoja Communications.

22 09 2015

Come to our meeting on gender and health systems in post-conflict settings

ReBUILD and RinGs are delighted to invite you to our event, Building Better Back.

Kate Hawkins

22 September 2015

At the event we will discuss gender and health systems in post-conflict and post-crisis countries. The meeting will launch our new online resource and be an opportunity to find out more about post-conflict health systems reconstruction in Mozambique, Northern Uganda, Timor Leste and Sierra Leone and discuss the implications of reconstruction in these countries for other settings.

Where?

The Gallery, The Foresight Centre
The University of Liverpool
1 Brownlow St
L69 3GL Liverpool
United Kingdom

When?

Tuesday, October 20, 2015 from 12:00 PM to 1:30 PM (BST)

Who are the speakers?

Welcome – Sally Theobald, Liverpool School of Tropical Medicine, UK
Introduction to ReBUILD and the broader programme of work – Tim Martineau, Liverpool School of Tropical Medicine, UK
Overview of Building Back Better, including the publications, briefs and website – Val Percival, Carleton University, Canada
Perspective from Sierra Leone – Haja Wurie, College of Medicine and Applied Health Sciences, Freetown, Sierra Leone
Perspectives from Northern Uganda – Sarah Ssali, Department of Women & Gender Studies, Makerere University, Uganda and Justine Namakula, Department of Public Health, Makerere University, Uganda
Response from panel: Tulip Mazunda, BBC Foreign Correspondentand Alvaro Alonso-Garbayo, Liverpool School of Tropical Medicine, UK

Photo courtesy of Steve Evans

Health

Gender and ethics analysis are intricately inter-related

Biomedical ethics guidelines and regulations: Incorporating a gender lens

Recognising the limitations of (biomedical) guidelines and regulations

Q: How important is it to consider the gender of data collectors while developing a data collection team for quantitative data? Female participant, India

Justice

Gender and power

Taking health systems research ethics to the next level

Further reading

Q: Within health systems research, should gender be mentioned when it is not significant significant as a variable? Should it still be reported? Female participant, China.

Q: Most health systems research disaggregates by sex, however, this is often related to demographics and overall descriptive results. How do we move beyond sex disaggregation to ensure that health systems research includes more meaningful gender analysis? Male participant, Uganda