By Alanna Savage and Andrew Gaydos
Alanna Savage is a Senior Communications Specialist for the FCI Program of Management Sciences for Health (MSH) and Andrew Gaydos is a Project Support Associate at MSH.
In our ambitious vision to reach all people, everywhere, it is ever more necessary to examine the varying life experiences–the actual realities–of the people whose health we work to improve. Part of this examination requires a critical look at how gender plays out in the power structures of society, the daily lives of people, and more concretely, in the “who, what, where, when, and how” of health-seeking behavior and access to essential reproductive and maternal health care.
Maternal mortality in Mali remains high–587 women die for every 100,000 live births–but only 28 percent of sexually active women of reproductive have satisfied their demand for family planning. Women and girls continue to confront widespread sexual and gender-based violence, including female genital mutilation/cutting (FGM/C); in 2015, about 126,000 women and girls received prevention services, protection, and care related to FGM/C. And thanks to the work of the FCI Program of MSH, traditional and faith leaders are advocating for family planning and coming together to provide support to survivors of gender-based violence and to identify early warning signs of imminent violence.
Gender inequality undoubtedly plays a role in high maternal mortality and unmet need for family planning and the continuance of sexual and gender-based violence. As long as women and girls must continue to fight for equal voice and an equal share of opportunity and power, their lives and health will remain under threat. Gender influences health outcomes, access to care, providers’ treatment of patients, relationships among health workers and supervisors, and health career barriers and opportunities.
During a four-day workshop in Mali, the Keneya Jemu Kan (KJK) project invited Fatimata Kané from the FCI Program of MSH to co-lead a discussion on incorporating gender into the Program for Organizational Growth, Resilience, and Sustainability (PROGRES) tool, which organizations use to examine their own strengths, weaknesses, and barriers to sustainability. The KJK project works with non-governmental organizations and public sector institutions in Mali to strengthen their capacity to monitor and evaluate health programs to ensure they are effectively reaching their target populations, especially the most vulnerable.
The KJK team organized the workshop to adapt the PROGRES tool–comprising several domains such as governance and leadership, human resources management, advocacy and alliance building, among several others–to the Malian context. But the team recognized that the tool was lacking a cross-cutting gender dimension, a necessary component for assessing an organization’s effectiveness in responding to the gender dynamics that affect health outcomes, access to care, and delivery.
“Today, the concept of gender must be consistently taken into account when designing programs and projects if we want to achieve equality and combat discrimination across all areas of development,” Fatimata said during her presentation to the KJK team.
Fatimata emphasized that gender transformative thinking and action were central to sustainable development and ending discrimination, an ongoing challenge in Mali due to a lack of awareness and training on the subject. Gender is not a subject that belongs in a separate silo, however. It has implications within and across all domains of the PROGRES tool. Workshop participants revised the PROGRES tool to include a gender-focused domain and to integrate gender analysis across all of the domains. This revised tool will help organizations, in and beyond Mali, assess how gender interacts with their health programs and activities.
Gender roles and norms influence how women and girls access health services and how health systems respond to their unique needs. Achieving equity in access to care among women, men, girls, and boys–as well as improving their health and well-being–requires that health planners recognize and transform entrenched gender norms.