Six-step Approach to Identify and Close Gender-related Gaps

A six-step approach was developed by ASSIST partner WI-HER, LLC to help teams integrate gender into improvement activities and identify and close gender-related gaps. This approach has been tested in various ASSIST programs and countries, achieving improved service utilization and retention in care, as well as a decline in adverse events. The six-step approach begins with conducting a gender analysis to inform program design and implementation. This involves identifying gender issues that could have or have impeded project goals, analyzing the impact of planned and current activities on women, men, girls, and boys, and looking for differences among them. A gender analysis is a systematic way of identifying and describing the social, economic, education, health, and political factors that affect the lives of women, men, girls, and boys, and how differences in these can lead to gender inequalities and affect development outcomes. In Mali, ASSIST's gender analysis identified gender-related issues affecting the achievement of maternal and child health-related project objectives, as well as opportunities to leverage. The improvement team found that husbands and mothers-in-law often decided whether or not a woman needed to go to the health facility, rather than the woman herself. Therefore, the team realized the importance of targeting family members in addition to mothers themselves with health education to improve maternal and child health outcomes. The second step in the six-step approach is to collect and analyze sex-disaggregated and gender-sensitive data. Improvement teams use sex-disaggregated and gender-sensitive data to identify gender-related gaps in access, utilization, care, treatment, outcomes, and other factors between women and men and between girls and boys. Sex-disaggregated data are data collected and presented separately for both males and females, which allow teams to identify quantifiable differences by sex. For example, teams could analyze the use of health services, nutrition status, education outcomes, or retention in care for males and females separately. In Uganda, a TB/HIV co-infection case management improvement effort began disaggregating data by sex in December 2013. ASSIST found a huge gap between females and males retained in care, with aggregated data showing that 48% of all clients were retained in care, hiding the gap between females (79%) and males (34%). With appropriate training and support, health providers identified reasons for the gap and designed activities to target them. Improvement changes included sensitizing staff in both TB and ART clinics on gender disparities and synchronizing appointments between the clinics so patients only needed to make one visit to the facility. The six-step approach continues with analyzing data to determine whether a gap in outcomes between females and males exists in chosen indicators. If a gap is found, the team proceeds to Step 3. If not, the team returns to Step 2 and selects 2-3 different indicators to analyze. It is essential to note that even if an improvement team does not identify a gender-related gap in its facility, such a gap could be found at a later point in time or at another facility. Therefore, the decision to continue analyzing sex-disaggregated data is dependent on context, local setting, and in-depth knowledge of the situation, which is informed by the gender analysis conducted in Step 1. The six-step approach has been effective in identifying and closing gender-related gaps in various ASSIST programs and countries. By conducting a gender analysis, collecting and analyzing sex-disaggregated and gender-sensitive data, and analyzing data to determine whether a gap in outcomes between females and males exists, improvement teams can identify and address gender-related issues and improve healthcare quality and outcomes.