USAID Health Financing Improvement Program Gender Analysis and Strategy

The Program builds on previous investments in health care financing reform by USAID and the government of Ethiopia. The consortium implementing the Program is led by Abt Associates, and includes core partners Breakthrough International Consultancy, Dimagi, Institute for Healthcare Improvement, and Results for Development, and resource partner Harvard T.H. Chan School of Public Health. The Program aims to achieve four objectives: increase domestic resource mobilization for enhanced provision of quality primary health care services, streamline pooling of risk-sharing/insurance mechanisms for wider access to primary health care services with reduced financial barriers, facilitate strategic purchasing of health services from public and private health providers, and improve governance, management, and evidence-generation for health financing reforms and health facilities. Promoting gender equality and advancing the status of women and girls is vital to achieving USAID development objectives. The Program recognizes that gender is a key determinant of health and that understanding and addressing the gender-related opportunities and barriers to health care financing reform and the provision of primary health care services is important for the achievement of the Program's objectives. The Program is committed to gender integration, recognizing that gender equality and female empowerment are inherently worthwhile, as well as being key determinants of positive health outcomes. The Program's gender integration efforts are grounded in an interconnected, mutually reinforcing, gender-transformative, evidence-based approach that contributes to improved health care financing and quality primary health care services. In developing the gender strategy, the Program reviewed published and unpublished literature on themes related to gender equality and its influence on health and health-seeking behavior of women and girls in the Ethiopian setting. The Program also conducted a participatory workshop with program staff to brainstorm possible approaches and interventions to integrating gender equality and female empowerment across the Program's objectives. The Program's gender analysis and strategy aims to provide guidance for evidenced-based, gender-transformative interventions that address the existing gender gaps and opportunities identified by the analysis across the Program's four objectives. The primary objectives of this gender analysis and strategy are to strengthen and guide gender integration efforts across all Program result areas, prioritize gender gaps and opportunities identified in the gender analysis findings that can be addressed through advocacy and program activities, guide implementation, monitoring, and evaluation of gender-transformative activities in alignment with the program's annual theory of change and work planning process, and generate learning from gender-transformative program interventions to contribute to a body of evidence of the contributions of gender integration to improved health outcomes. The Program's gender strategy includes four intermediate results: increased domestic resource mobilization for enhanced provision of quality primary health care services, streamlined risk-pooling mechanisms for wider access to primary health care services with reduced financial barriers, improved arrangements for strategic purchasing of health services from public and private providers, and strengthened governance, management, and evidence generation for the health financing reforms and health facilities. The Program will revisit the strategy on an annual basis, prior to the annual work planning, along with the theory of change revision, to update the strategy as needed.