Jessica Fehringer, PhD, MHSBrittany Schriver, MPHMEASURE Evaluation

July 14-22, 2015Routine Health Information Network (RHINO) Online Forum

Collecting, Analyzing, and Using Sex-disaggregated and Gender-sensitive Data in RHIS

Overview

• Definitions• Gender and Health• Gender and RHIS• Q&A

• Definitions

Definitions: Sex

• Determined at birth based on biological characteristics

• Universal for all human beings

• Hard to change

Source: USAID March 2012 Gender Equality and Female Empowerment Policy

Biological classification of males and females

Definitions: Gender

Culturally defined set of roles, duties, rights, responsibilities, and accepted behaviors associated with being male and female

Source: IGWG training resources; USAID Gender Equality and Female Empowerment Policy

• Power relations between and among women & men, boys & girls.

• Vary across cultures and over time.

Definitions: Gender EqualityThe state that affords women, men, transgender persons equal enjoyment of human rights, socially valued goods, opportunities, and resources.

Source: WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

Gender inequality is the most pervasive form of social inequality; it cuts across all other forms such as class, caste, race and ethnicity

• Expanded freedoms and improved quality of life for all people.

• Comes from written and unwritten norms, rules, laws and shared understandings.

Definitions: Gender EquityThe process of being fair to women & men, boys & girls, transgender persons.

Source: IGWG training resources

• Stress is on fairness as the end goal• Different/unequal needs & barriers affecting women,

men, and transgender persons in accessing/benefiting from health-care facilities/programs must be considered in resource allocation & design

• Should be inherent to policy/program M&E

Overview

• Definitions• Gender and

Health• Gender and RHIS• Q&A

Gender and Health

Adherence to rigid gender roles can create a gender gap

Women Men

Legal rights

Social and political spaces

Income

Education

Informal labor market

Education

Credit and savings groups

Source: WHO, Why Gender and Health?

• unequal options, opportunities and realities that women and men experience

Source: World Health Organization http://www.who.int/gender/genderandhealth/en/index.html

A teenage boy dies in accident because he tried to meet peers’ expectations that young men should take risks

A woman cannot access needed maternal health care because she does not have control of the household money.

A women contracts HIV because societal norms prevent wives from insisting on condom use with husbands, and yet tolerate husbands’ extra-marital sex

Gender and Health

Gender inequality is associated with poor outcomes such as

• Higher child mortality, stunting & wasting

• Lower maternal health care utilization, higher maternal mortality

• Higher fertility, lower family planning use

• GBV

Gender inequality is a major driver of the AIDS epidemic and leads to lower awareness, knowledge

• Higher risky sex & PMTCT, lower VCT & ARV

• Higher prevalence & incidence

Gender and Health

Addressing gender in health systems

An integrative approach considers the impact of gender on the people, the health services, and the results

Health problem

Gender-specific needs and

barriers

Desired health

outcomes

Gender and Health

Overview

• Definitions• Gender and Health• Gender RHIS• Q&A

Gender and RHISRHIS provides evidence to:

Raise awareness

Advocate for change

Address gender

dimensions

Demonstrate Progress

Demand richer data

• National M&E strategic plans address gender inequalities in their objectives, frameworks, indicators and results

• Data are sex- and age disaggregated at all stages of monitoring and evaluation (i.e., data collection, analysis and reporting)

• HIS data are used for gender-related analyses and evaluations

• There is coordination, information sharing and use of gender-related data across sectors

What does a gender-integrated RHIS look like?

Gender and RHIS

Sex DisaggregationRoutine data: what do we need?Sex disaggregated data

Allows for basic analysis:Are there gender differences in use of/access to services/treatment? For example:

• Use of ART? Adherence?• Detection of TB? Referral for treatment?• Malaria testing and treatment?

Gender sensitive dataFocus on gender equality:

For example:• Gender Based Violence (GBV) service

encounters• Male attendance at antenatal care (ANC)

visits

August 2010 August 2011 August 20120

50

100

150

200

250

Number of clients (age 15-24) tested HIV positive through PIT, by month

Total

August 2010 August 2011 August 20120

50

100

150

200

250

Number of clients (age 15-24) tested HIV positive through PIT, by month

FemaleMale

Why do we want to analyze and report data by sex?

Sex Disaggregation

Sex DisaggregationIndicators

HIV referral completionProportion of referred clients that completes referral at receiving service • Numerator: Number of referred men and

women seen at receiving service. • Denominator: Number of men and women

referred from initiating service. Data source: HIS

Sex DisaggregationIndicators

• Numerator: Number of new smear-positive pulmonary TB cases registered in a specified period that were cured by sex

• Denominator: Total number of new smear-positive pulmonary TB cases registered in the same period by sex

Tuberculosis: cure rate

Disaggregation by sex will illustrate if men or women disproportionately higher rates of treatment leading to cure

Data source: HIS

Male EngagementHas there been an increase in male involvement in reproductive health programs?• Data: Percent male clients

receiving RH services (data collected at multiple time points)

Data source: HIS

Gender SensitiveIndicators

Gender Based Violence (GBV)Number of GBV service-encounters at a health facility (P12.6.D PEPFAR Output)

Disaggregated by the age group and sex of the client receiving the service.

Gender SensitiveIndicators

• Numerator: Number of GBV-related service-encounters.• Denominator: N/A

Gender Based Violence (GBV)Percentage of health facilities with Gender-Based Violence and Coercion (GBV) services available (P12.7.D PEPFAR Output)

Disaggregated by type of service and type of facility

Gender SensitiveIndicators

• Numerator: Number of health facilities reporting that they offer (1) GBV screening and/or (2) assessment and provision or referral to the relevant service components for the management of GBV-related health needs as defined below.

• Denominator: Total number of health facilities in the region or country being measured.

Gender and RHIS

• Ensure data are collected, analyzed and reported on by sex

• Train all M&E personnel on gender-focused monitoring, evaluation and research

• Carry out and disseminate gender-based analysis of health data

• Use gender-based analysis results in program and policy decision-making

• Create feedback mechanisms to share results of gender-based analyses and evaluations

How do we ensure RHIS addresses gender?

Overview

• Definitions• Gender and Health• Gender and M&E• Q&A

MEASURE Evaluation gender websitewww.measureevaluation.org/gender

Gender and Health Systems Strengthening e-learning coursehttps://www.globalhealthlearning.org/course/gender-and-health-systems-strengthening

Compendium of Gender Equality and HIV Indicatorshttp://www.cpc.unc.edu/measure/publications/ms-13-82

VAW/G compendiumhttps://www.cpc.unc.edu/measure/publications/ms-08-30

Gender M&E Online course:http://www.globalhealthlearning.org/course/gender-m-e

Gender scaleshttp://www.c-changeprogram.org/content/gender-scales-compendium/index.html

K4 Health IGWG Gender and Health Toolkithttp://www.k4health.org/toolkits/igwg-gender

Resource guide for gender data and statisticshttps://www.cpc.unc.edu/measure/publications/ms-12-52

EMAIL US! GenderM&E@unc.edu

Resources and Tools

MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) under terms of Cooperative Agreement AID-OAA-L-14-00004 and implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.

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