Many countries, and particularly those including fragile contexts, have a shortage of formal health workers and are increasingly looking to close-to-community (CTC) providers to fill the gap. The experiences of CTC providers are shaped by context-embedded gender roles and relations. This qualitative research study in Lebanon, Nepal, Myanmar and Sierra Leone explored the gendered experiences of CTC providers during the COVID-19 pandemic in fragile settings. We used document review, in-depth interviews or focus group discussions with CTC providers, and key informant interviews with local stakeholders to generate in-depth and contextual information. The COVID-19-associated lockdowns and school closures brought additional stresses, with a gendered division of labour acutely felt by women CTC providers. Their work is poorly or not remunerated and is seen as risky. CTC providers are embedded within their communities with a strong willingness to serve. However, they experienced fractures in community trust and were sometimes viewed as a COVID-19 risk. During COVID-19, CTC providers experienced additional responsibilities on top of their routine work and family commitments, shaped by gender, and were not always receiving the support required. Understanding their experience through a gender lens is critical to developing equitable and inclusive approaches to support the COVID-19 response and future crises.

Background: Lymphatic Filariasis (LF), is a debilitating and painful neglected tropical disease and is one of the leading causes of permanent disability. Division of work within and outside the household and everyday practices influenced by sex and gender intersect with other demographics and social stratifiers that influence exposure to LF, which ultimately impact on disease burden. Hence, this study aimed to explore the influence of gender and its intersection with other social stratifiers for the prevention and care seeking behavior of LF in Nepal. Methods: This qualitative study was conducted using in-depth interviews (IDIs) and focus group discussions (FGDs) as methods for data collection in Bardiya district. Total 22 IDIs and 2 FGDs were conducted with purposively selected adult male and female aged ≥18 years, residing in the selected area for over a year. The data collection was conducted between January and March 2020. The study received ethical approval from Nepal Health Research Council (Reg. no. 656/2019) and Ethics Review Committee of WHO, Geneva. Results: Men spend more time outside their household compared to women while fulfilling their roles and responsibilities which was largely determined by what is socially acceptable. Thus, limited men’s access to preventive health services as they often missed mass drug administration (MDA) programme held every year in their community and had limited resources to adopt preventive measures to protect themselves from mosquito bites while travelling. The ability to prevent exposure varied when some did not have adequate bed nets for all family members. Although, women in most cases made decision on the selection, purchase and use of protective methods, it was influenced by the patriarchal and gender norms as they felt their responsibility to take care of the family members and thus prioritized male, children and elderly members of the household in case of limited availability. Gender, marital status, ethnicity and geographical areas intersected and influenced individual’s ability to access source of information. There existed sex and religion wise differences on preference of health facilities. Conclusion: Access to resources, division of work, norms and values and decision-making power alone and its interaction with various social stratifiers shaped peoples’ vulnerability to disease, ability to prevent exposure and response to illness. Trial registration: Not Applicable