Journal Article
06 Jul 2018
16 views

Gendered health systems: evidence from low- and middle-income countries

Health Research Policy and Systems Rosemary Morgan, Richard Mangwi Ayia...+18 more
Health Research Policy and Systems
Rosemary Morgan, Richard Mangwi Ayiasi, Debjani Barman, Stephen Buzuzi, Charles Ssemugabo, Nkoli Ezumah, Asha S. George, Kate Hawkins, Xiaoning Hao, Rebecca King, Tianyang Liu, Sassy Molyneux, Kelly W. Muraya, David Musoke, Tumaini Nyamhanga, Bandeth Ros, Kassimu Tani, Sally Theobald, Sreytouch Vong & Linda Waldman
African Region
15 mins
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What you'll learn
How to do gender in health systems
  • Gender analysis is vital to ensure effective health systems research
  • Synthesises findings from nine studies focusing on human resources, service delivery, governance and financing
  • Provides examples of how to adopt an intersectional and gendered lens to research in low- and middle-income settings
Applying gender analysis to LMIC settings
Addressing gender in health
Within health systems research, gender analysis – which is often neglected – seeks to understand how gender power relations influence access to resources, distribution of labour, social norms, and decision-making. This article provides examples of how it can be applied in low- and middle-income (LMIC) settings to uncover new ways of viewing and addressing issues across health systems.

The implications of the diverse examples of gender and health systems research highlighted indicate that policy-makers, health practitioners and others interested in enhancing health system research and delivery have solid grounds to advance their enquiry and that one-size-fits-all health interventions that ignore gender and intersectionality dimensions require caution.

Key Takeaways
1
Be intersectional in your approach
Be intersectional in your approach
Intersectional gender analysis – i.e., analysing how gender intersects with other social stratifiers – enables researchers to go beyond binary categories of male and female, to offer new forms of disaggregation of data, and to emphasise a transformational change in improving women’s access to services. The examples included in the study highlighted the importance of the intersections of gender with age and education in the Indian Sundarbans in relation to eye health and with migration and ethnic identity in Uganda in relation to maternal health.
2
Address underpinning power relations and systems of power
Address underpinning power relations and systems of power
Examples from Cambodia, Tanzania and Nigeria illustrate the importance of addressing the power relations underlying men’s involvement in health programs directed towards women, including within human resources, access to healthcare, and service delivery. Intersectional gender analysis is needed to explore men’s positions and vulnerabilities, the potential benefits or harms caused by their involvement, and how institutional arrangements reinforce power relations in decision-making.
3
Gender analysis is needed to understand how gendered social norms influence health system structures and processes
Gender analysis is needed to understand how gendered social norms influence health system structures and processes
Studies in Zimbabwe and Uganda demonstrate how the gendered experiences of health workers reflect gender norms and power relations in society with regard to differential access to resources, division of labour, and career development.
4
Address unpaid care work across different contexts and settings
Address unpaid care work across different contexts and settings
Health systems intensely rely upon unpaid care, which is overwhelmingly performed by women. In Uganda, community health workers (CHWs), the majority of whom are women, are a critical force in expanding health service access but are underpaid – or not paid at all – and under-supported. In China, gender analysis reveals gender differences in who provides elder care in rural and urban areas. Additional research is needed to identify weaknesses and gaps in provision and improve social welfare systems.
5
Ensure policy development integrates gender
Ensure policy development integrates gender
Health systems policy development lacks adequate attention to gender. Policymakers often have limited knowledge about gender, which limits its recognition and inclusion. A study of Tanzania’s policies for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) services shows the need to go beyond the simple inclusion of gender in policy and promote gender-transformative approaches in order to effectively reduce child and maternal morbidity and mortality.
A group of young boys stand together in a Ugandan village.

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    Affiliations
    1. Rosemary Morgan, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America
    2. Richard Mangwi Ayiasi, Makerere University, School of Public Health, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
    3. Debjani Barman, IIHMR University, 1 Prabhu Dayal Marg, Near Sanganer Airport, Jaipur, 302029, India
    4. Stephen Buzuzi, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
    5. Charles Ssemugabo, Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Science, P.O. Box 7072, Kampala, Uganda
    6. Nkoli Ezumah, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria; Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria
    7. Asha S. George, School of Public Health, University of Western Cape, Private Bag x17, Bellville, Cape Town, 7535, South Africa
    8. Kate Hawkins, Pamoja Communications Ltd., 81 Ewhurst Road, Brighton, BN2 4AL, United Kingdom
    9. Xiaoning Hao, China National Health Development Research Center, NO.38 Xueyuan Road, Haidian District, Beijing, China
    10. Rebecca King, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, United Kingdom
    11. Tianyang Liu, China National Health Development Research Center, NO.38 Xueyuan Road, Haidian District, Beijing, China
    12. Sassy Molyneux, Kenya Medical Research Institute (KEMRI) – Wellcome Trust Research Programme, PO Box 43640-00100, Nairobi, Kenya; Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
    13. Kelly W. Muraya, Kenya Medical Research Institute (KEMRI) – Wellcome Trust Research Programme, PO Box 43640-00100, Nairobi, Kenya
    14. David Musoke, Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Science, P.O. Box 7072, Kampala, Uganda
    15. Tumaini Nyamhanga, Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65454, Dar es Salaam, Tanzania
    16. Bandeth Ros, ReBUILD and RinGs Consortia, Phnom Penh, Cambodia
    17. Kassimu Tani, Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
    18. Sally Theobald, Social Science and International Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, United Kingdom
    19. Sreytouch Vong, ReBUILD and RinGs Consortia, Phnom Penh, Cambodia
    20. Linda Waldman, Institute of Development Studies, Library Road, Brighton, BN1 9RE, United Kingdom
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