20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community

Abstract

Neglected tropical diseases (NTDs) affect the poorest of the poor. NTD programmes can and should rise to the challenge of playing a part in promoting more gender equitable societies. Gender equity shapes poverty and the experience of disease in multiple ways; yet to date, there has been little attention paid to gender equity in NTD control efforts. Drawing on a synthesis of relevant literature, the tacit knowledge and experience of the authors, and discussions at a meeting on women, girls and NTDs, this analysis paper distills five key lessons from over 20 years of gender mainstreaming in health. The paper links this learning to NTDs and Mass Drug Administration (MDA). Our first lesson is that tailored gender frameworks support gender analysis within research and programming. We present a gender review framework focusing on different MDA strategies. Second, gender interplays with other axes of inequality, such as disability and geographical location; hence, intersectionality is important for inclusive and responsive NTD programmes. Third, gender, power and positionality shape who is chosen as community drug distributors (CDDs). How CDDs interact with communities and how this interface role is valued and practised needs to be better understood. Fourth, we need to unpack the gender and power dynamics at household level to assess how this impacts MDA coverage and interactions with CDDs. Finally, we need to collect and use sex disaggregated data to support the development of more equitable and sustainable NTD programmes.

Gender mainstreaming as a pathway for sustainable arbovirus control in Latin America

“…This may in part relate to local division of labor but also points to societal power changes that may result from placing women at the helm. As authors from a study of 20 years of gender mainstreaming in health have acknowledged, gender intersects with other axes of inequity such as ethnicity, socioeconomic status, occupation status, age, sexuality, (dis)ability, and religion [43]. These intersections offer a wealth of possibilities for mainstreaming gender in arbovirus control in a sophisticated way.…”

A call to action for universal health coverage: Why we need to address gender inequities in the neglected tropical diseases community

“…Gender disaggregated data collection that also reflects the gender of the distributer will help shed light on potential gendered biases in MDA delivery. The gender of CDDs matters and programs should be supported with a set of probing questions to help districtand local-level implementers consider who is recruited as a CDD and where they will be best placed (Box 1) [5]. Providing training and supportive supervision structures would also help CDDs reflect on how they promote gender equity in their work and to consider which coverage improvement strategies will be most appropriate in different contexts [5].…”

“…Gender analysis and mainstreaming in policy development, advocacy, legislation, resource allocation, planning, implementation, and monitoring of NTD programs can help the NTD community move beyond dialogue to action [5]. It is also important to consider how rapidly changing environmental and political contexts due to conflict, climate change, urbanization, and migration, intersect with individual characteristics to affect levels of infection for people of different genders and how it impacts their vulnerability to infection, healthcare seeking behavior, and delivery of prevention and treatment programs.…”

Quantifying the socio-economic impact of leg lymphoedema on patient caregivers in a lymphatic filariasis and podoconiosis co-endemic district of Ethiopia

“…Understanding the gender roles and it's contributions to the hidden work caregiving embodies is important [32] as it is likely to pose a significant socio-economic burden on families and communities [33]. It is also fundamental to ensuring gender equity, which has been explored in relation to NTD mass drug administration (MDA) programmes [34]. Further, it may help achieve the Sustainable Development Goal (SDG) in relation to NTDs [35], as well as address SDG 5, target 5.4, which seeks to recognise and value unpaid care and domestic work [36].…”