Women, men, boys, and girls should have equal opportunities to be healthy and to reach their full potential. Yet differing health-related needs and different social, economic, and cultural barriers to accessing care thwart the ability of certain groups to access and benefit from health care services. Gender is a social determinant of health across all countries and cultures. Gender gaps and issues affect access to, utilization of, and quality of care for women, men, boys, and girls. To truly improve the quality of all care for all, these gender gaps and issues must be explicitly recognized and addressed by providers, facilities, and health systems, and this is especially true in quality improvement activities. In this video, watch Dr. Taroub Harb Faramand of WI-HER, LLC explain how addressing gender considerations in improvement work leads to better outcomes.

Community Quality Improvement Team in Buikwe, Uganda

We take an improvement approach to integrate gender through the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project. By collecting and analyzing sex-disaggregated data and systematically identifying and analyzing gaps in outcomes among women, men, boys and girls, we evaluate what is causing poorer outcomes among one group, and design activities to respond to the needs of males or females to close the gap. We do this in improvement activities across health areas and beyond, including non-communicable diseases (NCDs) programming, HIV and ART services, OVC services, and more. We promote partner involvement in programs targeting either males or females, such as engaging male partners and fathers in ANC visits and PMTCT programs to improve outcomes for mothers and babies, and engaging female partners of males who undergo the VMMC procedure to improve follow-up and decrease adverse events. 

Our innovative and effective six-step approach to identify and close gender-related gaps improves health outcomes for all, and we utilize locally-owned, culturally-sensitive, and innovative models. We recognize that myriad factors at multiple levels of society affect gender norms that influence risk factors, access to care, utilization of care, and equality of treatment and we work to respond to these norms in concert to generate shifts in thinking and behavior. We address gender gaps and issues at the individual, household, and community levels, when necessary, though staff and community sensitization trainings, and we consider the varied contextual factors that drive outcomes for women, men, boys, and girls in the design, implementation, and evaluation of our programs.

To learn more about gender and how to integrate gender in improvement work, download A Guide to Integrating Gender in Improvement.

International Day to End Obstetric Fistula

Elizabeth Romanoff Silva


May 23rd marked the International Day to End Obstetric Fistula. This year’s theme “End fistula, restore women’s dignity,” emphasizes that high rates of fistula continue to debilitate women and girls and deny them equal opportunities around the world.

Empowering health workers to improve health and nutrition services for males and females in Zambia

Elizabeth Romanoff Silva


Last month I had the opportunity to travel to Zambia to provide gender technical assistance to the USAID ASSIST-supported nutrition assessment, counseling and support (NACS) services. Gender inequality is a major factor affecting vulnerability to malnutrition, especially for people living with HIV, so I was especially interested in working with health workers to identify the different issues preventing males and females from accessing services, issues affecting their nutrition status, and to identify the root causes preventing improved nutrition among women, men, girls and boys, and developing changes to test to find solutions.

Celebrating International Women's Day

Taroub Faramand

Founder and President, WI-HER, LLC

March 8th is International Women’s Day. This commemoration serves as an important opportunity to think critically about the changes that have come about during the past year to improve the lives of girls and women. It also serves as an opportunity to recognize where gaps and inequalities are still pervasive and prevent women and girls from realizing their full potential and to advocate for further changes to increase equal opportunities for women and girls.

Addressing gender-based violence prevention and treatment in a training curriculum to improve the quality of health instruction in Nicaragua

Ivonne Gómez Pasquier

Chief of Party, Nicaragua, USAID ASSIST/URC

Danilo Núñez Aguirre

Quality Improvement Advisor, Nicaragua, USAID ASSIST/URC

Through the USAID ASSIST Project, our team in Nicaragua is supporting the institutionalization of improvement methods and pre-service training in HIV services in medical and nursing schools at eight universities to develop the skills of nursing and medical professors to apply a teaching package for quality care.

Supporting communities to develop sustainable solutions to improve the welfare of girls and boys in Kenya

Stanley Masamo

Quality Improvement Advisor, OVC, Kenya, USAID ASSIST/URC

In Kenya, our OVC team is working to strengthen systems at national and local levels to support the institutionalization of quality improvement in the OVC program to improve the welfare of girls and boys. This includes providing TA to our service delivery partners -including APHIA plus, AMPATH plus, and the Ministry of Labour Social Security and Services - to apply improvement techniques to strengthen care for vulnerable girls, vulnerable boys, and their households. 

A gender-responsive approach to achieve an AIDS-free generation

Elizabeth Romanoff Silva


Women account for an estimated 58% of the total number of people living with HIV globally and according to the UNAIDS GAP Report, close to 60% of all new HIV infections among young people ages 15-24 were among girls and young women, with 80% of these HIV positive girls and young women living in Sub-Saharan Africa. Other at-risk groups which have disproportionately higher rates of HIV include sex workers, drug users, men who have sex with men and other LGBTI persons, among others. It is critical that HIV/AIDS programs and services employ a gender-responsive approach that identifies and responds to the specific needs, barriers, and issues affecting each at-risk group, based on the socially constructed roles, behaviors, attributes, and activities that a community considers appropriate for each group, in order to provide the best quality of care.

Improving reproductive health services by addressing gender issues in Ukraine

Megan Ivankovich

Senior Program Officer, WI-HER, LLC
Gender Training in Poltava, Ukraine

Participants in Poltava present Problem Trees and describe the causes and consequences of relevant public health issues

In October, I had the opportunity to travel to Ukraine to support the USAID ASSIST Project to integrate gender into the work currently underway. ASSIST is working with the Ministry of Health in Ukraine to improve reproductive health services at the primary health care level by working specifically to decrease alcohol and tobacco use by pregnant women, to improve health outcomes for mothers and babies.

Males and females face different levels of susceptibility to health concerns based on their genetic makeup as well as on prevailing gender norms that influence behaviors and quality of health services. For example, 46% of women in Ukraine reported alcohol use in the most recent months of pregnancy, yet counseling on the reduction of alcohol use during pregnancy is insufficient since health providers often don’t consider women at risk because these behaviors have been historically associated with men and boys. In addition, exposure to environmental pollutants such as second-hand smoke can negatively impact the health of pregnant women and their babies.

HIV and key populations: providing care where it is most needed

Anisa Ismail

Improvement Specialist, USAID ASSIST Project/URC

As a virus, HIV does not discriminate. But when combined with social and economic factors affecting health such as gender, sexual orientation, and poverty, HIV becomes a virus that manifests much more strongly in some groups over others. In public health language, these are our key populations- the groups of people who experience a heightened risk of being infected with HIV due to one of more of those factors.

Key populations include sex workers, men who have sex with men (MSM), people who inject drugs (PWID), and transgender persons.

Gender knowledge cafes: A technique to improve gender integration practices

Elizabeth Romanoff Silva

Gender knowledge cafe hosted at Creative Associates on November 6, 2014

Through the USAID ASSIST Project, we utilize knowledge cafes as a technique for stimulating the synthesis of knowledge among our improvement teams. I recently had the pleasure of applying the knowledge café model we use through the USAID ASSIST Project to gender integration by facilitating a Gender Knowledge Café at an event hosted by Creative Associates in collaboration with the Washington DC Gender and Development Networking Group. The event brought together DC's most experienced gender and development professionals, together with those just entering a career in gender, to discuss their career paths and exciting developments in the field.