20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community

The authors present a gender framework for different approaches to MDA, namely house to house, fixed point, child health/special events, school-based programs, and coverage improvement activities. It highlights the extent to which sex-disaggregated data are collected in each approach and poses questions to support critical reflection on how gender may shape access to, and experiences of, MDA.

Intersectional analysis is important for inclusive and responsive NTD programs, as it allows for a more thorough and nuanced approach. Examples demonstrate how gender interacts with other axes of inequality, including poverty, (dis)ability, occupation, power, and geography. Other developments in gender mainstreaming include a critique of the male/female binary and how this might limit analysis and action to address the needs of gender minorities.

Gender, power, and positionality shape who is chosen as community drug distributors (CDDs). Although community participation strategies may appear equitable, their implementation can have the unintended consequence of reinforcing gender and social hierarchies within communities. How CDDs interact with communities, who is chosen for these roles, and how they are valued needs to be better understood.

CDDs influence who can make choices, access resources, and take medicines. CDDs are well placed to understand and potentially address the norms that can determine health outcomes by acting as agents for gender equity and social change in different contexts.

Sex-disaggregated data needs to be collected and used at all levels of health systems to support the development of more equitable and sustainable NTD programs. Additionally, qualitative and participatory research can support with better understanding of how gender influences experiences, access to MDA, and strategies to document the tacit knowledge of CDDs.