Gender Integration Strategy for the Eradicate Tuberculosis Project in Zambia

The project's objectives rely on addressing gaps in health-seeking behaviors and gender-related barriers that lead to late presentation and poor treatment outcomes. To achieve this, the project takes a gender-aware approach, emphasizing the need for gender-sensitive activities and monitoring and evaluation. The project's gender integration strategy is based on the United States President's Emergency Plan for AIDS Relief (PEPFAR) definition of gender, which encompasses economic, social, and political roles, responsibilities, rights, entitlements, obligations, and power relations between and among women and men. The strategy also draws on guidance from USAID's operational policy Automated Directives System (ADS) Chapter 205, which emphasizes the importance of gender analysis in identifying and addressing gaps between males and females. A gender analysis was conducted to identify key findings, impact on TB risk and transmission, and impact on health-service demand and adherence. The analysis revealed that TB stigma related to HIV disproportionately affects women, who face social costs such as loss of income and social isolation. Male gender norms and behaviors also play a significant role in TB stigma, with men often being the primary breadwinners and facing pressure to maintain their masculinity. The analysis also highlighted the importance of gender roles, responsibilities, and time-use in TB health-seeking behaviors. Women often take on caregiving roles and have limited access to information and services, while men are more likely to be employed and have greater access to resources. The project aims to address these gaps through gender-sensitive activities and monitoring and evaluation. The project's implementation plan includes four tasks: pursuing high-quality DOTS expansion and enhancement, addressing TB/HIV and MDR-TB and the needs of poor and vulnerable populations, engaging all categories of care providers, and enabling and promoting operational research. The project also aims to develop gender-sensitive monitoring and evaluation (M&E) and performance indicators to track progress and identify areas for improvement. In terms of project management, the project will prioritize stakeholder coordination, staffing and budgeting for gender integration, and adaptive management. The project will also establish a system for tracking and reporting on gender-related data and outcomes. By taking a gender-aware approach and addressing the complex social and cultural factors that influence TB health-seeking behaviors, the Eradicate Tuberculosis project aims to achieve its objectives and contribute to a global reduction in TB mortality.