20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community

INTRODUCTION

Gender equity shapes poverty and the experience of diseases

Gender equity shapes poverty and the experience of disease in multiple ways; yet to date, there has been little attention paid to gender equity in neglected tropical diseases (NTD) control efforts. Drawing on literature, the knowledge and experience of the authors, and discussions at a meeting on women, girls and NTDs, this paper provides five key lessons from over 20 years of gender mainstreaming in health. It links this learning to Mass Drug Administration (MDA), which has been a core prevention and treatment strategy for NTDs for several decades.

KEY TAKEAWAYS

1. Tailored gender frameworks support gender analysis within research and programming

   The authors present a gender framework for different approaches to MDA, namely house to house, fixed point, child health/special events, school-based programs, and coverage improvement activities. It highlights the extent to which sex-disaggregated data are collected in each approach and poses questions to support critical reflection on how gender may shape access to, and experiences of, MDA.

2. Intersectional analysis is key

   Intersectional analysis is important for inclusive and responsive NTD programs, as it allows for a more thorough and nuanced approach. Examples demonstrate how gender interacts with other axes of inequality, including poverty, (dis)ability, occupation, power, and geography. Other developments in gender mainstreaming include a critique of the male/female binary and how this might limit analysis and action to address the needs of gender minorities.

3. Community participation strategies must not reinforce gender and social hierarchies

   Gender, power, and positionality shape who is chosen as community drug distributors (CDDs). Although community participation strategies may appear equitable, their implementation can have the unintended consequence of reinforcing gender and social hierarchies within communities. How CDDs interact with communities, who is chosen for these roles, and how they are valued needs to be better understood.

4. We need to unpack the household gender power dynamics that impact MDA coverage and interactions with CDDs

   CDDs influence who can make choices, access resources, and take medicines. CDDs are well placed to understand and potentially address the norms that can determine health outcomes by acting as agents for gender equity and social change in different contexts.

5. More sex-disaggregated data is needed

   Sex-disaggregated data needs to be collected and used at all levels of health systems to support the development of more equitable and sustainable NTD programs. Additionally, qualitative and participatory research can support with better understanding of how gender influences experiences, access to MDA, and strategies to document the tacit knowledge of CDDs.

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