Friday, September 22, 2017

Enhancing Gender Lens in Health Systems

The United Nations in 2012 together with all its member-states adopted the 17 Sustainable Development Goals (SDGs). Included in these goals is the stand-alone goal on gender equality (SDG 5), recognizing that gender equality and equity is an important foundation for a healthy and a more sustainable world.

And with the enactment of the comprehensive women's human rights law - the Magna Carta of Women in 2008 - the Philippine government committed to eliminate all forms of discrimination against women by establishing the Gender and Development initiatives and programs in every government agency.

But ever since I have been providing technical assistance and consultancy work on Gender and Development to many health-related government agencies, I would always receive almost similar verbalization of confusion or frustration of where they will allocate and attribute their mandated five percent GAD budget relevant to their health programs. 

Here are some tips to make your health programs more gender-responsive:

1. Conduct Gender Analysis
One of the reasons why government agencies fail in identifying gender issues is that they do not regularly conduct Gender Analysis. This is a process of identifying and analyzing gender issues using a more systematic approach. But Gender Analysis is a technical process that would require the members of the Gender Focal Point System (GFPS) to have a specific lens to be able to quickly identify emerging and recurring gender issues. 

The  GFPS may engage external consultants to aid them in facilitating their GAs. External consultants are trained professionals who have keen eye for gender issues. However issues on gender should be acknowledged by the agency after a rigorous process. 

There are two major types of Gender Analysis tools in my experience: One is the community-based GA tool where they are usually intended for the members of the community or towards the beneficiaries/partners of the agency. Community-based GA have been developed by different scholars and gender experts globally. The most notable of all is the Moser Gender Planning Framework. The Moser Framework is one of the most appropriate tool for the GFPS to adopt since it has both technical and adaptive components. One of the challenges though in using the Moser Framework is that it is highly suitable for planners and since not all members of the GFPS are planners, it would be best to establish a common working ground first. 

The next type of GA tool is the technical GA. These are tools developed by the Philippine Commission on Women (PCW) with their partner agencies. Technical GA tools are the Harmonized Gender and Development Guidelines (HGDG) used for individual projects and programs, and the Enhanced Gender Mainstreaming Evaluation Framework (GMEF) used to assess gender mainstreaming initiatives at the institutional level. 

Both HGDG and GMEF are tools that utilize a 20-point scoring system. Both tools are necessary in identifying gender issues using a more technical approach. The HGDG measures the gender sensitivity and responsiveness of individual projects and programs. A conditional pass is 4/20 but projects and programs that are categorized as gender sensitive and responsive are graded 8/20 and 15/20 respectively. 
Although agencies may adopt different GA tools in identifying their gender issues, it is only HGDG that can calculate the percentage of attributable funds of projects & programs to the five percent GAD budget. 
The GMEF is the tool used to assess the overall status of the agency's gender mainstreaming efforts and initiatives and are assessed through the four entry points: Policy, People, PPAs, and Enabling Mechanisms. The scoring in GMEF informs the agency's current level of their GAD efforts in those 4 areas. Most of the agencies, upon initial subjection to GMEF would yield an overall level of 1-2/5.

The conduct of GA should be regularly conducted as well. All projects and programs should be subjected to HGDG while it is being conceptualized. And be subjected again once it is done. For GMEF it is ideally done once after ever three years. But it can be done annually depending on how the agency would want to focus in improving their overall scores. 

2. Establish Sex-Disaggregated Database
One of the key building blocks in gender mainstreaming is the establishment of a functional Sex-Disaggregated Database (SDD also known as Gender-Disaggregated Database). Collecting data is needed to address health inequalities related to gender for this establishes the needed evidences to identify emerging gender issue, support an existing gender issue, and to quantify efforts in responding to a gender issue. 



But why do we need to disaggregate data based on sex? Because it will give us the necessary view of the difference of how men and women are treated in different programmatic levels and activities. You might think that men and women are treated equally in your agency, wait till you disaggregate data and subject them to Gender Analysis. 

An example of disaggregation of data by sex is the current workforce. You might be able to see a disparity in the number of men and women nurses hired in a government hospital. Then you ask why is that so? How about the number of men and women staff hired to do security services? The number of women and men in the management, and so on. Disaggregation of data by sex will provide you of an overview of why men and women are not equally represented in your workforce and in your management and Gender Analysis will help you unearth the issues and stories behind the numbers. 

Sex disaggregation in data can be done in different areas such as but not limited to human resources, training, programs/projects, and recipients of services. Sex disaggregation in data enables statistical awareness among users and providers of services. 

While SDD should be internally generated, it can be later used in comparison with the indicators and results from secondary data for example the National Demographic and Health Survey, the Family Health Survey, and the Field Health Service Information System among others. 

It is but important for the members of the GFPS in coordination with their Information System units to have the capability to generate SDDs, to be able to use and transform it into measurable indicators, and enhance their skills in collecting, collating, analyzing, and applying SDDs in policy and program management. 

3. Gender M&E System
Another skill that the GFPS should possess is the ability to develop measurable indicators and targets that they will need to monitor and evaluate in the GAD Plan and Budget. 

According to the World Health Organization, a good indicator is ethical where data collected and processed respects people’s rights to confidentiality, where there is the freedom of choice in supplying information, and consent is informed regarding the nature and implications of the data required. The indicator should be useful and that it acts as a marker of progress toward specified process goals. Indicators should also be scientifically-robust, valid, specific, and reliable. Indicators must adequately be representative of all the gender issues it is expected to cover. It should also be understandable and simple to define or interpret. And finally, indicators should be accessible and uses information that are already available or are relatively easy to acquire.

And according to the Canadian International Development Agency, data collected should be sex-disaggregated so an appropriate analysis can be done to males and females separatelty. 

Below are examples of indicators per aspects of Gender in gender-sensitive programming according to various literature:   

Gender-sensitive monitoring and evaluation is not just done by developing indicators but in ensuring that these are integrated to the agency's regular M&E system. The GFPS should pursue two things: to develop indicators that are solely meant to measure gender mainstreaming efforts of the agency, and to integrate a gender perspective in the current M&E indicators present in the system.

This level of capacity is advance and would require the members of the GFPS to be specially equipped. I suggest that they engage a certified GAD expert endorsed by the Philippine Commission on Women to help them do they foundation work. And once they have increased their capacity they may train internal GAD experts that would focus on gender M&E and SDD. 

In the next series of articles, I'll be breaking down different indicators that the GFPS may start looking in their agency programs and projects. 

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