Gendered health systems: evidence from low- and middle-income countries

INTRODUCTION

How to do gender in health systems

• Gender analysis is vital to ensure effective health systems research
• Synthesises findings from nine studies focusing on human resources, service delivery, governance and financing
• Provides examples of how to adopt an intersectional and gendered lens to research in low- and middle-income settings

Applying gender analysis to LMIC settings

Within health systems research, gender analysis – which is often neglected – seeks to understand how gender power relations influence access to resources, distribution of labour, social norms, and decision-making. This article provides examples of how it can be applied in low- and middle-income (LMIC) settings to uncover new ways of viewing and addressing issues across health systems.

The implications of the diverse examples of gender and health systems research highlighted indicate that policy-makers, health practitioners and others interested in enhancing health system research and delivery have solid grounds to advance their enquiry and that one-size-fits-all health interventions that ignore gender and intersectionality dimensions require caution.

KEY TAKEAWAYS

1. Be intersectional in your approach

   Intersectional gender analysis – i.e., analysing how gender intersects with other social stratifiers – enables researchers to go beyond binary categories of male and female, to offer new forms of disaggregation of data, and to emphasise a transformational change in improving women’s access to services. The examples included in the study highlighted the importance of the intersections of gender with age and education in the Indian Sundarbans in relation to eye health and with migration and ethnic identity in Uganda in relation to maternal health.

2. Address underpinning power relations and systems of power

   Examples from Cambodia, Tanzania and Nigeria illustrate the importance of addressing the power relations underlying men’s involvement in health programs directed towards women, including within human resources, access to healthcare, and service delivery. Intersectional gender analysis is needed to explore men’s positions and vulnerabilities, the potential benefits or harms caused by their involvement, and how institutional arrangements reinforce power relations in decision-making.

3. Gender analysis is needed to understand how gendered social norms influence health system structures and processes

   Studies in Zimbabwe and Uganda demonstrate how the gendered experiences of health workers reflect gender norms and power relations in society with regard to differential access to resources, division of labour, and career development.

4. Address unpaid care work across different contexts and settings

   Health systems intensely rely upon unpaid care, which is overwhelmingly performed by women. In Uganda, community health workers (CHWs), the majority of whom are women, are a critical force in expanding health service access but are underpaid – or not paid at all – and under-supported. In China, gender analysis reveals gender differences in who provides elder care in rural and urban areas. Additional research is needed to identify weaknesses and gaps in provision and improve social welfare systems.

5. Ensure policy development integrates gender

   Health systems policy development lacks adequate attention to gender. Policymakers often have limited knowledge about gender, which limits its recognition and inclusion. A study of Tanzania’s policies for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) services shows the need to go beyond the simple inclusion of gender in policy and promote gender-transformative approaches in order to effectively reduce child and maternal morbidity and mortality.

Read the full journal article here.