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.

Dando respuesta a los asuntos de género para mejorar los resultados en la atención en salud relacionada con el Zika

Este documento proporciona información sobre los problemas relacionados con el género en relación con la atención médica relacionada con el Zika.

Resalta los principales problemas:

• Roles y valores relacionados con el género
• Acceso limitado y / o control sobre educación sexual, anticonceptivos y otros servicios de salud reproductiva
• La falta de poder de las mujeres para negociar el uso de anticonceptivos (incluidos los condones)
• Estigma que lleva al abandono de la madre y el niño

Version en español

USAID ASSIST Project Semi-Annual Performance Monitoring Report FY18

University Research Co., LLC (URC) and its partners have completed 5.5 years of implementation of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. This report is the eleventh Semi-Annual Performance Monitoring Report for ASSIST, summarizing the project’s accomplishments and results during the first two quarters (Q1-2) of Fiscal Year 2018 (FY18).  In late September 2017, the project was awarded a two-year costed extension with additional funding for Zika-related activities.  No further funding was provided for non-Zika work.  The project’s FY18 work plan thus focuses mainly on Zika-related support in eight countries and completion of previously funded work in other countries.

Overall goals
The USAID ASSIST Project fosters improvements in a range of health care processes through the application of modern improvement methods by host country providers and managers in USAID-assisted countries. The project’s central purpose is to build the capacity of host country health and social service systems to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the services they provide. In addition to supporting the implementation of improvement strategies, the project seeks to generate new knowledge to increase the effectiveness and efficiency of applying improvement methods in low- and middle-income countries.
USAID ASSIST country programs align with the goals of United States Government’s global initiatives and policies, including preventing child and maternal deaths, achieving HIV epidemic control, combating other public health threats, protecting life, and addressing gender inequalities.

Where we work
During the first half of FY18, USAID ASSIST provided technical support in 23 countries through field and core funding. USAID Mission funds supported work in nine countries: Cambodia, Côte d’Ivoire, India, Indonesia, Lesotho, Mali, Swaziland, Tanzania, and Uganda. USAID core funds from the Office of HIV/AIDS supported activities in seven countries: Kenya, Lesotho, Malawi, Mozambique, Namibia, Tanzania, and Zimbabwe.  Funds for Neglected Tropical Diseases supported improvement work to combat the Zika virus in the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, Paraguay, and Peru.  USAID cross-bureau-funded activities, through the Office of Health Systems, supported malaria prevention activities in Malawi and global and regional initiatives that contribute to local and global learning in improvement.

FY18 Q1-2 accomplishments and results:

  • Improvement in key indicators: As discussed in this report, ASSIST-supported programs demonstrated improved care and outcomes for a range of services, including antenatal and postnatal care, essential obstetric and newborn care, screening of pregnant women and newborns for Zika-related signs and symptoms, Zika care and support, PMTCT, and HIV prevention.
  • Research and evaluation studies: At of the end of the reporting period, the project had 29 research studies in planning, underway or completed in 14 countries. Three are multi-country studies.
  • Promoting the use of improvement methods: During the reporting period, project staff published nine peer-reviewed articles; seven case studies; four technical and research reports; and 10 guides, tools, and job aids. ASSIST staff led six sessions and made eight oral presentations at six regional and international conferences. ASSIST’s work continued to be promoted through the project’s website and social media engagement, with some 27,867 visitors viewing 61,572 pages within the ASSIST Knowledge Portal during the past two quarters.

Quality improvement as a framework for behavior change interventions in HIV-predisposed communities: a case of adolescent girls and young women in northern Uganda

Conventional approaches to HIV prevention remain the foundation for reducing HIV infections in Uganda, but innovations that demonstrate reduction in risk to infection in vulnerable populations also should be urgently embraced. Over the past two years, ASSIST tested a quality improvement for behavior change model to address barriers to behavioral change among adolescent girls and young women (AGYW) at high risk of HIV infection. The model comprised skills building to improve ability of AGYW to stop risky behavior; setting up and empowering community quality improvement (QI) teams to mobilize community resources to support AGYW to stop risky behavior; and service delivery camps to provide HIV prevention services and commodities to AGYW and other community members.

We recruited and followed a cohort of 409 AGYW at high risk of HIV infection over a two-year period to examine the effect of the QBC model on risky behaviors. High-risk behavior was defined to include transactional sex, having multiple sexual partners, and not using condoms in high-risk sex.

The rollout of the quality improvement for behavior change model resulted in a statistically significant (p <0.05) decline in high-risk behavior among adolescent girls and young women involved in the study. The percentage of AGYW reporting multiple sexual partners reduced from 16.6% at baseline to 3.2% at follow up and the percentage engaged in transactional sex reduced from 13.2 to 3.6%. The proportion of AGYW experiencing sexual and other forms of gender-based violence reduced from 49% at baseline to 19.5% at follow up due to the complementary targeting of parents and partners by QI teams.

Read the full article in AIDS Research and Therapy.

Our “Best 9” stories in 2017

Vicky Ramirez

Consultant, USAID ASSIST Project/URC

Looking back, 2017 was a great year for us at ASSIST. In 2017, we were featured in USAID’s Exposure; we collaborated with a number of partners to publish ICHC Blog Series, which was cross-posted on The Huffington Post; and we ran a blog series in honor of Health Worker Week. After our resources page, our blog was the most visited page on our website. In case you missed some of these highlights, we’ve put together our “Best 9” stories. These posts illustrate the stories behind the great work employed by our country teams, partners, and individuals. Let us know which story you loved the most!

USAID ASSIST Project Annual Performance Monitoring Report FY17

University Research Co., LLC (URC) and its partners have completed the fifth year of implementation of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. This report is the tenth Semi-Annual Performance Monitoring Report for the project and aims to summarize the accomplishments and results toward the program objectives of USAID ASSIST activities during quarter (Q) 1 through 4 of Fiscal Year 2017 (FY17).

Scale of USAID ASSIST work, FY17

FY17 Accomplishments and Results

  • Improvement in key indicators: As discussed in this report, ASSIST-supported programs demonstrated improved care and outcomes for a range of services, including antenatal and postnatal care, essential obstetric and newborn care, family planning, PMTCT, HIV care and treatment, HIV prevention, NACS, TB diagnosis and treatment, malaria diagnosis and case management, and services for vulnerable children and families.
  • Gender integration: Onsite gender training and technical support was provided to country teams in Burundi, Cote d’Ivoire, DRC, Lesotho, Mali, South Africa, and Uganda to integrate gender considerations into their improvement work. Ongoing gender support was provided to all field offices with improvement activities to collect and analyze sex-disaggregated indicators, identify gender-related gaps affecting outcomes, and respond to those gaps.
  • Research and evaluation studies: At of the end of the reporting period, the project had 37 studies underway or completed in 15 countries. Four are multi-country studies.
  • Promoting the use of improvement methods: In FY17, project staff published 14 peer-reviewed articles; 23 case studies; 11 technical and research reports; 42 guides and tools, six short reports; 29 annual reports, and seven multimedia products describing project-supported work and results as well as gender integration learning videos. ASSIST had an active presence at 16 international and national conferences. In all, project staff led 18 sessions and workshops and delivered 14 oral and 14 poster presentations. ASSIST’s work continued to be promoted through strategic engagement in Twitter chats, reaching close to 2,374 followers (26% increase from FY16) and an average of 26,500 unique Twitter users per month (impressions). We continued sharing resources via the ASSIST Facebook page (over 6,200 likes) as well as publishing engaging blog content (28 blogs in FY17).

What We’ve Learned About Integrating Gender in Improvement

Julia Holtemeyer

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

Guidance for Improving Family Planning/HIV Integration Service Delivery for Adolescent Girls and Young Women

PEPFAR-funded programs for vulnerable children and adolescents are assessed using the Site Improvement Monitoring System (SIMS) to ensure that programs are meeting minimum standards and providing quality services to vulnerable children and families. In the orphans and vulnerable children (OVC) domain, SIMS covers many core essential elements (CEE), including Family Planning/HIV Integration Service Delivery in Community Settings. This CEE standard requires that “each service delivery point supporting services for this population provides access to high quality family planning (FP) education and services, directly or through referrals.”

Accessing quality FP/HIV services improves health outcomes among adolescent girls and young women (AGYW) as it leads to preventing unwanted pregnancies especially among sexually active girls younger than 18 years. It also is a critical step in managing cases of sexual abuse within the first 72 hours to prevent unwanted pregnancy and exposure to new HIV infections. The USAID ASSIST Project is developing resources to help service delivery partners not only meet the requirements of the CEE but to better understand the key steps and best practices involved in implementing FP/HIV Integration programs for OVC.

This presentation by Dr. Diana Chamrad of URC and Dr. Taroub Faramand of WI-HER, LLC, developed for the 2017 Africa Psychosocial Support Forum in Arusha, Tanzania, describes:

  • Why family planning/HIV integration is critical for adolescent girls and young women (AGYW)
  • How the quality improvement (QI) process can help implementers effectively integrate quality FP/HIV services
  • A case example of FP/HIV integration in the DREAMS Initiative in Northern Uganda
  • Tools developed to support delivery of high-quality FP/HIV services for adolescent girls and young women in community settings


Dominican Republic Gender Analysis: A study of the impact of the Zika virus on women, girls, boys and men

The USAID ASSIST Project works in the Dominican Republic and other countries in Latin America and the Caribbean to add quality Zika services to existing antenatal care, postpartum, and family planning services. The current outbreak of Zika virus in the Dominican Republic is having severe consequences on the lives and health of thousands of people.

In order to assess the gender, practical and strategic needs of women, girls, boys and men, Oxfam and Doctors of the World conducted a gender analysis in May–October 2016. The analysis seeks to understand the impact of Zika on different population groups, their specific vulnerabilities and needs, and their coping mechanisms. The study aims to provide findings and recommendations to support humanitarian agencies to intervene in this health emergency in a gender-responsive way and also to mainstream Zika with a gender perspective into emergency responses caused by natural disasters.

Download the report from the Oxfam website.

A Guide to Integrating Gender in Improvement

This guide incorporates the USAID ASSIST Project's learning and experience with gender integration in improvement over the last five years. It explains gender and gender integration, details how to integrate gender in improvement activities, encourages additional areas for consideration, provides resources that improvement teams can use to integrate gender, and lists many resources from which you can learn more.

The guide is designed for quality improvement teams, but is also relevant for all staff supporting those teams, including management, technical staff, monitoring and evaluation (M&E) specialists, and research professionals. It may also be useful to anyone who aims to address gender considerations to achieve better outcomes among women and men, girls and boys, or other professionals more broadly who are seeking to address gender in their own studies or activities.

The guide is divided into three main sections to support gender integration in quality improvement activities:

  1. understanding gender and gender integration,
  2. understanding the step-by-step process of integrating gender in improvement, and
  3. understanding additional factors to consider when integrating gender into improvement activities.

Though it focuses on the process for activities that have not yet begun, the guide will also be helpful to integrate gender in activities that are already underway. Review the entire guide and determine which components are useful for you.

The Appendices provide tools and resources to support this work.