While gender and ethics are taken into account as cross-cutting issues in many international development programmes, to date there has been very limited attention to gender in health systems. Often there is no disaggregation of data by sex and many terms such as community health workers and village health committees are gender neutral, when the reality is that their composition is heavily skewed, masking vast inequities. Even where gender is considered, it often does not go beyond sex disaggregation and focuses on women only. It often misses the social context and power relations that drive the inequalities. There is particularly limited work on gender in health financing.
Research in gender and ethics: Building stronger health systems (RinGs) recently conducted a seminar at DFID with the goal of answering the question, “What is the role of gender and ethics in building stronger health systems?” RinGs is a collaboration across three Research Programme Consortia (RPCs) – Resyst, ReBuild and Future Health Systems – which aims to advance gender and ethics analysis; strengthen RPC thematic areas; and galvanise action on gender and ethics.
Gender analysis is an invaluable tool to better understand and positively influence health systems. It involves questioning whether the potential differences in interests and experiences between men women and people of other genders have been considered; and how these differences inter-relate with other social stratifiers such as class, race, education etc. Sex-disaggregated data is useful to develop an initial skeleton around which further understanding can be built through the use of gender frameworks as analytical guides and gender analysis questions as entry points for further understanding.
Gender frameworks involve assessing what constitutes gendered power relations in terms of access to resources, division of labour, socials norms and decision-making; and how power is negotiated and changed on both an individual and structural level. Researchers can gather information on these key areas through asking tailored gender analysis questions. In terms of health systems, these questions might include who bears the burden of routine data collection; to what extent information systems recognise and record gender based violence against women and men; and who decides which data is collected and how health system performance is measured.
Positive benefits of RinGs
RPC members have found RinGs membership to have been highly beneficial to their work, resulting in: increased understanding of gender and ethics; increased usage of gender analysis; and improved networks and collaboration with others. The development and sharing of resources, including through the creation of an online knowledge platform, were particularly valued by RPC members. RinGs is working to disseminate information and resources to a wide audience through their website and Twitter along with numerous outreach activities including events organised for International Women’s Day with Health Systems Global.
Some key questions
DFID brought up several key questions during the seminar. They asked what evidence there is on the benefits of taking a gender approach to health systems, and the resilience of gender-sensitive health systems programming. They were interested in methods to engage those who have already been won over by the need for gender analysis and gender-sensitive programming on the importance of health systems approaches, as opposed to engaging those interested in health systems in gender equity. Collaboration is enormously beneficial to the advancement of both agendas and RinGs is already working to bridge the gap between these two camps. They were interested in receiving more information on the indicators RinGs uses to track how knowledge and research is put into policy and practice. Crucially, DFID agreed that it is vitally important that gender is incorporated in the next health systems framework, and we look forward to future collaboration to achieve this.
By Tessa Hewitt, Liverpool School of Tropical Medicine