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