"Policies and programmes to improve health outcomes and reduce health inequities are more effective when systems are in place to record, report, measure and monitor health data, analyse such evidence and apply it to design effective strategies."
Together, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) initiated development of this tool for strengthening gender-sensitive national HIV and sexual and reproductive health (SRH) monitoring and evaluation (M&E) systems as part of the implementation of the UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV. "Know your epidemic, know your response" has been the cornerstone of the HIV response. This tool supports this approach by helping identify inequities and underlying drivers and, hence, improve evidence-informed SRH and HIV programmes for all, but particularly for women and girls.
The impetus for this guide may be summarised as follows: "While gender inequality affects many health conditions and outcomes, nowhere is it more pronounced than in matters of sexuality and reproduction. Gender inequality influences the ability of women and girls to exercise control and autonomy when it comes to matters of their own sexuality (for example, choosing sexual partners, deciding when to have sex, refusing sex, engaging in safe sex) and reproduction (for example, deciding to or not to have children, using contraception and protecting themselves from sexually transmitted infections (STIs), including HIV). Hence, programmes and policies to address the health of women and girls, particularly their sexual and reproductive health (SRH) and HIV status, must be informed by evidence and address gender inequality."
The tool can be used for training M&E specialists and can also serve as a resource guide for SRH and HIV programmes to develop gender profiles of their SRH and HIV situation. It provides step-by-step guidance on how to:
- ask the right questions in order to uncover gender inequalities and their influence on health;
- identify and select gender-sensitive indicators;
- conduct gender-analysis of SRH and HIV data; and
- strengthen M&E systems to enable appropriate data collection and gender analysis.
The tool is structured into 4 modules, each of which offers practical and concrete aids, such as checklists, examples, and tables.
- Module 1 adapts the public health questions approach to M&E to provide users with a logical framework for monitoring and evaluating the impact of gender inequality on HIV and SRH outcomes and programme responses. It features 4 public health questions - several of which focus on communication (e.g., "Are programmes being delivered in ways that promote equality, rights and choices for beneficiaries?" - "Are programme staff aware of power dynamics in their own interpersonal communication with beneficiaries? Do they use communication (language and style) that fosters empowerment and agency among the beneficiaries to make informed choices?") and 8 steps for gender-sensitive M&E.
- Module 2 guides users in selecting indicators that help answer questions about gender inequality and HIV or SRH. Step 1 involves assessing whether existing indicators are gender-sensitive. Step 2 involves identifying gaps in gender-sensitive indicators. Step 3 entails formulating indicator sets.
- Module 3 helps users conduct gender analysis and interpret data gathered using gender-sensitive indicators. The following steps are to be undertaken: (i) Conduct descriptive analysis of gender inequality; (ii) analyse data over time, across subgroups, and in relation to other norms; and (iii) analyse gender inequality as a social determinant of health.
- Module 4 provides practical suggestions to assess and integrate gender sensitivity into the components of a national M&E system. In order to ask the right questions, select appropriate indicators, and analyse and interpret data, M&E systems themselves must be gender-sensitive.
- Annexes 1 to 9 provide examples and material illustrating how the core concepts of the tool can be applied to SRH data.
In a field-testing process carried out in collaboration with UN Women, the tool was used by nearly 30 country teams to analyse their own SRH and HIV data from a gender equality perspective. These teams comprised strategic information advisers from UNAIDS, national M&E officers of HIV and SRH programmes, and civil society organisations (for example, organisations of women living with HIV). Feedback from the field testing was used to revise and finalise the tool.
Posting from Ados May to the IBP Global Knowledge Gateway, December 13 2016. Image credit: UNAIDS - "The Namibia Planned Parenthood Association clinic in Windhoek [Namibia] is decorated with colourful murals, its walls brightly painted with red ribbons."