Gender and Governance in Leadership, Management, and Governance

The project supports health systems strengthening by addressing the gaps in the leadership, management, and governance capacities of policy makers, health care providers, program managers, and those who govern. Ultimately, the goal is to increase the ability of health systems to deliver quality services at all levels. Gender equality is a critical component of the project, as it contributes to and is an outcome of efforts to strengthen the capacity of the state to deliver good governance to its citizens. In developing countries, deep-seated gender inequality is often a characteristic of poor governance and a barrier for women's success in becoming their own agents of change. The project aims to bring about a gender balance in the leadership and management of health systems, which is expected to improve the responsiveness of the public health system to gender inequities in service delivery and access. Gender roles and responsibilities privilege men at the expense of women, depriving them of their rights to make decisions, including decisions on healthcare. Traditional gender roles and responsibilities result in lower economic status, low literacy and education, poorer health outcomes, and greater exposure to gender-based violence. The Millennium Development Goal 3 is "To promote gender equality and empower women," and one of the guiding principles of the Global Initiative of USAID is also the empowerment of women and girls. Gender equity promotes fairness and justice in the distribution of opportunities, responsibilities, and benefits available to men and women. Gender equality is equal treatment of women and men in laws and policies, and equal access to resources and services within families, communities, and society at large. The 2012 World Development Report of the World Bank focuses on women and addresses gender gaps, such as excess deaths of girls and women, disparities in girls' schooling, unequal access to economic opportunity, and differences in voice in households and society. Interventions to address these disparities have been shown to improve lives in communities and countries. For example, in India, giving more power to women at the local level led to increases in the provision of public goods such as water and sanitation, which mattered more for women. In Rwanda, women representatives consider themselves to have a greater concern with grassroots politics, and in terms of agenda, women's issues are now raised more easily and more often than before. The intersection between gender leadership management and governance is critical in achieving better health outcomes. A gender analysis of the health system poses two broad questions: How will gender relations affect the achievement of sustainable health outcomes? How will the gender interventions of a project affect gender relations and the relative status of women? Gender mainstreaming is a strategy for making the concerns and experiences of women (as well as of men) an integral part of the design, implementation, monitoring, and evaluation of policies and programs in all political, economic, and societal spheres. The ultimate goal of mainstreaming is to achieve gender equality. In 2001, the Interagency Working Group on Gender (IGWG) established a task force on gender to answer the following questions: "What difference does it make to integrate gender concerns into reproductive health programs?" The review focused on four components of reproductive health interventions: reduction of unintended pregnancy and abortion, reduction of maternal morbidity and mortality, control of sexually transmitted infections/HIV/AIDS, and improvement in the quality of care. Out of 400 interventions, 25 were selected as examples and a criterion was established. The review concluded that integration of gender into reproductive health appears to have a positive impact on achieving reproductive health outcomes. The 25 interventions reviewed showed a direct link between integrating gender and positive health outcomes in the categories listed above, while 20 interventions that measured gender impact and outcomes were positive. The review clearly indicates that integrating a gender component into reproductive health programs makes a difference in both stronger health results and gender equity.