Introducing Tumaini Mwita Nyamhanga: Examining Gender Mainstreaming in Governance of Health Service Delivery in Tanzania: The Case of Reproductive and Child Health Services in Public Hospitals in Mwanza City

Background information about the author and interest in gender studies

My interest in the gender dimensions of health arose when I was completing my Master’s degree – MA (Development Studies) from the University of Dar es Salaam.  I did my basic training in Nursing, so when I went for further studies I sought to major in something that would broaden my understanding of health,  yet not to lose touch with  my background. In nursing there is a course called community reproductive health which enables learners to understand causes of health problems facing women and children from a social perspective.

At the Master’s level, I found Gender Studies to be an entry point for furthering my interests in reproductive health through the seemingly different world of social sciences. Hence, I majored in Gender and Health and my Master’s dissertation was about economic and socio-cultural factors influencing maternal mortality in Mbeya, Tanzania. This marked the beginning of my interest in the gender dimensions of sexual and reproductive health challenges.

Apart from gender studies, I have recently been working on health systems research and got to understand that clinical service delivery is sub-optimal partly because the role of governance in health service delivery has not been given adequate attention.  In this context, governance refers to the capacity of the health facility to effectively manage its resources, implement sound policies or guidelines, and demonstrate respect of its clients. Deficiency in this capacity has resulted into a number of problems, including: corruption, limited accountability, and weak supervision.

So when I saw a call on gender and health systems research, I saw it as an opportunity to gain a better understanding of gaps in the governance of reproductive health services using a gender perspective.

About the project

This project seeks to assess how well clinical governance elements (leadership, guidelines, ethical practice [patient provider communication]) take gender concerns, alongside other social determinants, into account in the delivery of reproductive and child health (RCH) services. It will take place in public hospitals in Mwanza Region.

Why I chose to do this project, and why it is important

Given the powerful impact that gender has on reproductive health, it is imperative that health service governance be gender mainstreamed.  Short of that, health programmes will fall short, and goals of health equity will remain out of reach. For instance, gender norms of masculinity may hinder men from attending antenatal clinics for prevention of mother-to-child transmission of HIV (PMTCT). This failure of men to attend PMTCT clinics makes it difficult for the HIV+ woman to disclose her status and diminishes support for adoption of safe infant feeding options.

Although gender mainstreaming has been long recognized to be an international strategy for addressing gender inequalities and negative health outcomes, its implementation has remained a challenge. There is very little information on how well governance of clinical practice has been gender mainstreamed to address health inequities.  It is this gap in knowledge that this study intends to fill. The information that will be generated from this study will guide integration of gender in governance of reproductive health services, and thereby contribute toward strengthening health systems. Health systems whose governance structures are gender mainstreamed will increase accountability towards meeting health needs of parents and children.

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