What We’ve Learned About Integrating Gender in Improvement

Julia Holtemeyer

Improvement Specialist for Gender and Knowledge Management, USAID ASSIST Project/WI-HER, LLC

(WI-HER, LLC President Dr. Taroub Faramand supports the ASSIST team in Tanzania to implement and monitor gender-related change ideas in their quality improvement work. Photo credit: WI-HER, LLC)

Gender is an important social determinant of health that should be explicitly considered when improving health systems. (Social determinants are the social circumstances in which people live that affect their health.) There are many other social determinants of health that should also be considered in different communities and cultures—age, race, poverty status, tribal affiliation, urban/rural location, socioeconomic status, and more—but gender is a universal social determinant of health. It is closely tied to sex (the biological, physiological, and genetic characteristics we use to separate people along the spectrum of female to intersex to male), but gender encompasses the social rules, norms, and constructs that communities and cultures associate with having certain biological, physiological, and genetic characteristics.

Integrating gender improves our work because it helps us make sure we reach all people equitably and improve health care for all.

At the USAID ASSIST Project, we have always taken a gender-sensitive approach to improvement, believing that to truly improve the quality of care for all people—women, men, girls, boys, and people of other gender identities—gender must be explicitly considered by health systems, facilities, providers, and improvement professionals. Integrating gender improves our work because it helps us make sure we reach all people equitably and improve health care for all.

We recently published A Guide to Integrating Gender in Improvement, incorporating our learning and experience with gender integration in improvement over the last five years. We have not only learned that gender integration makes improvement interventions stronger, we have also applied the process of improvement to how we integrate gender, making gender integration itself stronger. This is the foundation of the Guide, built from our work in nearly 30 countries across Africa, the Middle East, Asia, and Latin America in health facilities and communities. The Guide provides:

  • Definitions of gender, gender integration, and other key terms
  • Details and examples of how to integrate gender in improvement activities
  • Tools for improvement teams to use to integrate gender
  • Additional areas beyond gender to consider in improvement
  • A long list of resources that provide additional information about a variety of topics

Gender integration is everyone’s responsibility. The process of integrating gender into program implementation includes “quick wins,” like collecting and analyzing sex-disaggregated data (i.e., separate data for females and males) to identify gaps between sexes, and more intensive work, like conducting a gender analysis across all five USAID-recommended domains of analysis and determining how they may affect and be affected by your program. Though we designed the Guide to be a useful and accessible resource for quality improvement teams, it is also relevant for staff supporting those teams, including management, technical staff, monitoring and evaluation specialists, and research professionals. It focuses on the gender integration process when planning improvement activities, but will also be helpful to integrate gender in activities that are already underway.

In addition to the Guide, we have case studies, change packages, blogs, technical briefs, and videos that explain how to integrate gender and detail experiences with gender integration in different countries and health areas. I have had the opportunity to work with wonderful ASSIST colleagues across all our country teams and travel to Botswana, Côte d’Ivoire, Democratic Republic of Congo, Lesotho, Malawi, and Uganda, and without their dedication to and enthusiasm for gender integration we would never have been able to publish A Guide to Integrating Gender in Improvement. So review, share, and use the Guide—and let us know what you find most useful, and what you think is missing.

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