Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men’s health in sub-Saharan Africa

Abstract

Background Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women’s health, which is a long-standing global health priority. We examine literature focused on the ‘missing men’ in global health research, in particular empirical studies that document interventions, programmes, and services targeting men’s health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men’s health and how these have influenced the design of men’s health interventions and services. Methods This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis. Results From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as ‘gatekeepers’; ‘masculine’ men, ‘marginal’ men and as ‘clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, −partnering, −sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features – focused mainly on achieving women’s access to, and uptake of services – may contribute to the latter gap leading to poor access and engagement of men with health services. Conclusion This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men’s health issues and health-seeking patterns.

Integration of a menstrual health intervention in a community-based sexual and reproductive health service for young people in Zimbabwe: a qualitative acceptability study

“…This subsequently negatively affected male engagement and exacerbated a perception by both potential and current male clients of CHIEDZA as a female-only service. These findings build on existing evidence highlighting poor male engagement with SRH services and the need for health systems to consider men’s perceptions of health services and how this informs health-seeking behaviours [ 33 ].…”

“…Overall, the study results showed that the MHH intervention itself and its integration within an SRH community-based service were acceptable among both intervention implementors and young women in communities across Zimbabwe. In an environment where there is a global push for the integration of MHH and SRH and uptake of SRH services is especially low amongst men [ 33 ], our findings add to the increasing evidence base for integrated services and provide crucial insight into some of the contextual factors policy-makers and implementors should consider and pre-emptively prepare for when designing and implementing acceptable integrated SRH services in community-based settings. Acceptable MHH interventions need to be comprehensive and need to consider the contextual factors that inform access to and informed choice of menstrual products [ 18 , 28 , 38 , 39 ].…”

COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda

“…However, men compared to women were less likely to have vaccinated (63% vs.73%) or willing to vaccinate (30% vs.25%). Men are known to less likely seek medical services than women in SSA) [34,35]. According to the World Health organization, vaccine acceptance is influenced by a constellation of factors including confidence, complacency, and convenience [14,26].…”

Towards gender-transformative SRHR: a statement in reply to EUPHA and offer of a working definition

“…Gender-transformative interventions and research in the Global South, however, are showing that unjust systems can be changed. 9 Furthermore, successful gender-transformative interventions do not just require action from government bodies, as the EUPHA statement 1 remarks. Instead, it takes sustained action and strategic co-operation between governments, activists, health providers, civic society associations and research institutions that hold themselves and each other accountable in mobilizing their forces within and across their respective levels.…”

“…Instead, it takes sustained action and strategic co-operation between governments, activists, health providers, civic society associations and research institutions that hold themselves and each other accountable in mobilizing their forces within and across their respective levels. 9 …”