Mainstreaming

gender, equity and human rights

into the work of WHO

Anjana Bhushan
Regional Advisor, Service Delivery Systems, Health Systems Development
 Session outline
• Why do gender, equity and human rights matter
in health?
• Clarifying concepts on equity, gender and
human rights
• How to integrate equity, gender and human
rights into the work of WHO?
 13GPW
 PB20-21

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 Why do
gender, equity and human rights
matter in health?

3|
 Powerwalk

4|
 Clarifying concepts

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 True or false?
Gender is about socially
Whycharacteristics
constructed do
gender,ofequity
women and human
and men, rights
suchmatter in health?
as norms, roles and
relationships.

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 Sex ≠ gender
 Sex: biological and physiological
characteristics of males and females, such
as reproductive organs, chromosomes or
hormones. It is usually difficult to change.

 Gender: norms, roles and relationships of

and between women and men. It varies
from society to society and can be
changed.

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 Gender is…
 Relational – women and men live together in society.

 Hierarchical – more importance or value often placed on

“masculine” characteristics

 Historical – beliefs and practices change over time

 Contextually specific – diversity among women and men

changes gender norms, roles and relations
– For example, ethnicity, culture, age, sexual orientation, religion and other
factors influence gender norms and vice versa.

 Institutionally structured – beliefs about women and men are

often upheld in values, legislation, religion, etc.

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 Language matters…!
 One small step for man, one giant step for mankind.
 All doctors and their wives are cordially invited to dinner.
 The project will improve the lives of fishermen and their
families.
 The government's manpower planning policy includes
adequate training opportunities for both men and women.
 The consultant shall submit his report within three months.
 We invite nominations for the position of Chairman of this
regional consultation.

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 Flash card facts

 Do you know the answer to this question?

 Did you know this fact?

 How can you explain this fact? Give one or two

suggested reasons.

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 So, does gender matter in health?
Due to their biological and social standing, men and
women experience differences in:
 health status,
 exposure to risk and vulnerability,
 access to and use of services,
 health-seeking behaviour,
 experiences in health care settings, and
 health and social outcomes.

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 True or false?

HealthWhy domeans
equity
gender, equity
equality andrespect
with humantorights
matter
health in health?
determinants.

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 Two people, one bowl of rice

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 Health equity …

… the absence of unfair, avoidable or preventable

differences in health among population groups.

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15 |
 True or false?

Why do
Health as a human right means
gender, equity and human rights
the right to be healthy.
matter in health?

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 Human rights are…
 Inherent in ALL human beings: Instruments that protect
the inherent dignity of persons
 Universal, interdependent, indivisible
 Primarily concern relationship between individual (and
groups) and the state
 Legal norms and principles generated by governments
through International , regional and national law

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Links between health & human rights
TORTURE SLAVERY

HARMFUL VIOLENCE
TRADITIONAL HUMAN RIGHTS AGAINST
PRACTICES VIOLATIONS CAN WOMEN
RESULT IN
ILL-HEALTH
x

RIGHT TO RIGHT TO
INFORMATION PARTICIPATION
HEALTH
HUMAN RIGHTS DEVELOPMENT

x
HEALTH FREEDOM FROM
RIGHT TO CAN REDUCE AND
CAN PROMOTE
DISCRIMINATION
EDUCATION x
VULNERABILITY HUMAN OR
TO ILL-HEALTH RIGHTS VIOLATE
RIGHTS
RIGHT TO
FOOD & FREEDOM OF
NUTRITION MOVEMENT

RIGHT TO
18 |RIGHT TO WATER PRIVACY
How do human rights link to health?

The right to health

AAAQ
availability,
Underlying accessibility, Health care
determinants acceptability,
quality of
services

19 |
 True or false?

GER mainstreaming
Why do
is about integrating GER
gender, equity and human rights
into programme design
matter in health?
for universal health coverage.

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 Mainstreaming …
… assesses the implications of actions in
political, economic and social spheres for Women, men, boys,
all population groups girls, person living in
poverty, ethnic
minorities, illiterate
… considers people’s concerns and
experiences in the design, person, refugee, older
implementation, monitoring and person, migrants,
evaluation of policies and programmes person with disabilities
……
… contributes to people's abilities to benefit
equitably from policies and programmes

… is a process to achieve gender equality,

the right to health and health equity

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 Both approaches are needed
Programmatic mainstreaming: Institutional mainstreaming:
enhancing programme ensuring that organizational
outcomes procedures and mechanisms
do not reinforce inequality
 Address how health problems
affect population groups  Establish appropriate policies
differently. on staff recruitment and
benefits
 Provide an evidence base to
 Reflect equity-enhancing,
enable appropriate, effective
and efficient health planning, gender-responsive and human
policy-making and service rights-based approaches in
delivery. strategic agendas, policy
statements and M&E of
organizational performance

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 How to integrate
gender, equity and human rights
into the work of WHO?

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 Organizational mandates
• Growing WHO commitment, global and regional
- WHO mandate: Constitution & WHA resolutions
- WHO transformation: increasing the impact of WHO’s work

• UN developments: UN System-wide action plan on GEEW, UN human rights-

based approach, SDGs

• Donor interest in integrating GER lens

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 13 GPW

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 New approach to measuring WHO performance:
outputs based scorecard
o Measure 6 aspects of output delivery
based on GPW13 strategic and
6 output assessment dimensions
organizational shifts
Effective delivery: Leadership function o Use multi-method measurements
4

3
(qualitative and quantitative
Effective delivery: Global Goods Delivering value for money
2
methods)
1

0
o Use the same 6 dimensions across
outputs

ective delivery: Technical support at the country level o Uses

same scale to measure different
Achievement of results in ways leading to impacts
dimensions
Impactful integration of GER
o Allows Secretariat to present
measurement for each output in a
similar way

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 How will we track and report progress?
o Present results by output (using
spider-gram)

1. Effective delivery of technical support at country level

2. Effective delivery of leadership functions
3. Effective delivery of global goods
4. Impactful integration of Gender, equity and human rights
o Establish baseline and realistic
4 target for each dimension, output
3 6. Evidence of delivery of value for money
2
1
o Possible to use the same approach
0 for country by country
achievement measurement; use
5. Achievement of leading indicators country measurements to
aggregate for global reporting
o Aggregate data by ‘Billion’,
outcome

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 Output measurement framework
D Effective mainstreaming of gender, equity and human rights
Evidence and analysis of GER
D1.1 Disaggregate health-related data by sex.
D1.2 Disaggregate health-related data by at least two other variables
D1.3 Analyse existing evidence on barriers to health services and disadvantages faced by specific populations
D1.4 Where necessary collect evidence to fill gaps on barriers
Reduce inequities
D2.1 Include in programmes adequate integration of equity, gender and rights to reduce inequities, discriminatory
practices and differentials in health outcomes, and improve programme quality.
D2.2 ‘Nothing about us, without us': Promote and support meaningful participation of individuals and communities in
WHO work
D2.3 Progress achieved on reducing key targeted inequities according to WHO's role, mandate and agreed contribution.
Accountability for GER mainstreaming
D3.1 Facilitate the public availability of GER data and evidence
D3.2 Accountability for GER mainstreaming in the programme area is clear and enforced
Management - Capacity and resources for GER mainstreaming
D4.1 Undertake systematic and effective capacity building for GER mainstreaming
D4.2 Programme area allocated adequate level of resources to implement the above, at each of the 3 levels of the
organisation
D4.3 Effective and visible leadership specifically on GER is provided within the programme area
D4.4 Awareness and understanding of GER issues is at the required level to support the above

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 Integrating
gender, equity &
human rights
into health
planning and
programming

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 Entry points for integration
Situation
analysis

Policy and
(Re) plan programme
design

Monitoring
Implemen
and
t activities
evaluation

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 WHO Gender analysis matrix
Factors that influence health outcomes:
Factors that influence Gender-related considerations
health outcomes:
Biological Socio-cultural factors Access to, and
Health-related factors control over
considerations resources

Risk factors and

vulnerability

Access and use of

health services
Health seeking
behaviour
Treatment options

Experiences in health
care settings
Health and social
outcomes and
consequences
|
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WHO Gender Assessment Tool (GAT)
 Some policy examples
• Service providers require a man’s consent before a woman
can be sterilized.
• A community-based AIDS care programme says that the
health care system cannot take responsibility for caring for
people with AIDS, so home-based care must be instituted.
• A water supply project provides taps close to villages so that
women will not have to walk as far to fetch water.
• A reproductive health programme advocates to women and
men about mutual respect and equal rights in sexual
decision-making as a means of promoting safer sex
practices.

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Gender Responsive Assessment Scale (GRAS):
a tool to assess policies and programmes

• Gender-unequal
• Gender-blind
• Gender-sensitive
• Gender-specific
• Gender-transformative

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WHO Gender Responsive Log Frame
Priority Rationale Activity Type and Indicator(s) Stakeholders Specific or
gender and timeline of success or partners Trans-
health formative
issue
WHO Gender and
health planning
and programming
checklist
 How to reduce health inequities?
 Put equity on the health agenda
 Put health on the poverty/development agenda

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 How to reduce health inequities?

Tackle
access
barriers.

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In monitoring and evaluation…

 Collect, analyse and use in policy-making

information that is disaggregated by income, sex,
ethnicity, rural-urban residence, employment
status, etc.
 Conduct operational research

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 WHO Equity analysis tools

WHO HEAT Plus WHO Innov8

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 WHO Innov8’s 8 steps

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 WHO Urban HEART:
Urban Health Equity Matrix
POLICY DOMAIN INDICATORS NEIGHBOURHOODS
#1 #2 #3 #4 #5 #6

PHYSICAL Access to safe water

ENVIRONMENT &
INFRASTRUCTURE Access to improved sanitation

SOCIAL & HUMAN Prevalence of tobacco smoking

DEVELOPMENT
Completion of primary
education

Skilled birth attendance

ECONOMICS Poverty

Unemployment

GOVERNANCE Government spending on

health

Voter participation
 Reaching the poor series

Tuberculosis Child health

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 True or false?

UniversalWhy do coverage
health
gender, equity
is not and human
concerned withrights
matter in health?
intersectoral approaches

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 Social
determinants of
45 | health
 Health in All Policies
An approach to public policies across
sectors that:
 systematically takes into account the
health implications of decisions

 seeks synergies across sectors

 avoids harmful health impacts to

improve population health and health
equity

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 The right to health
• Right to highest attainable standard of physical and mental health
• Governments must generate the conditions in which everyone can
be as healthy as possible
• 4 elements (AAAQ):
• Availability: Sufficient quantity of functioning public health and health care
facilities, goods & services, and programmes
• Accessibility: non-discrimination, physical accessibility, economic
accessibility (affordability), information accessibility
• Acceptability: respectful of medical ethics, culturally appropriate, sensitive
to gender & life-cycle requirements
• Quality: scientifically and medically appropriate and of good quality

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 Human rights-based approach to health

Apply the principles of

 non-discrimination
 participation
 accountability
to all interventions and processes towards the progressive
realization of the right to the highest attainable standard
of health for all.

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 Types of human rights obligations

Obligation to

Respect Protect Fulfill

Duty-bearer to Duty-bearer to Duty-bearer to adopt

refrain from prevent others appropriate
interfering with interfering with measures towards
enjoying the right the enjoyment of full realization of the
the right right

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 WHO Health & human rights tools

Human rights & gender equality in

WHO 25 Q & A on health & human rights health sector strategies

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 Example, HRBA: 4-country assessment of compulsory
treatment of people who use drugs -- an application of
selected human rights principles

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A typology for the work of health programmes

WHO technical programmes

Evidence-
building,
monitoring

Policy advocacy
& dialogue

Implementation
support

Capacity-
building

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 Typology and examples of GER mainstreaming
Communicable NCDs & health through Health security &
Health systems
diseases the lifecourse emergencies
Gender assessment of Integrating GER into monitoring Gender and diabetes country Taking sex and gender into
Evidence- women’s vulnerabilities in and evaluation for UHC (WPRO) exchange between Mexico account in emerging
building, accessing HIV services and Trinidad and Tobago infectious disease
monitoring (EMRO) (PAHO) programmes (WPRO)
Gender and malaria Integrating gender into national Addressing gender and rights Policy advocacy on the right
Action area for technical programmes

collaboration with Global health planning: policy support to prevent NCDs among to food, including food
Fund (WPRO) to Afghanistan Ministry of Public adolescents in the child and adequacy and food safety
Health (EMRO) adolescent health strategy (HQ)
(EURO)
Policy
advocacy, Preventing adolescent
dialogue pregnancy: resolutions in
Central America (gender and
human rights central to
process and outcome) (PAHO)

Integrating GER into a Addressing coverage gaps Review and redesign of  

national TB programme among minority population “programme for active health
Implemen- review (WPRO) groups (EURO) protection of mothers and
children” (EURO)
tation
support Smoke-free homes through
  women's empowerment
(WPRO)

Gender and HIV M&E Building GER into subnational Gender, ethnicity and rights Community empowerment
workshop health system strengthening capacity building on reducing and rights up front in
Capacity (WPRO) maternal mortality (PAHO) disasters and emergencies
building (EURO)

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Integrating poverty and gender into health programmes:
a sourcebook for health professionals

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Thank you
Taking sex and gender into account in emerging infectious
disease programmes in the Western Pacific Region

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 Example, gender mainstreaming: Making
gender a core component of APSED

• Technical advice
• Capacity building: brown bag; session during annual national
programme managers meeting; country, regional staff training
• Tools: Framework on gender analysis in emerging infectious
diseases; experience documented as a good practice example;
gender mainstreaming tools adapted to programme needs
• Policy: Gender integrated into second 5-year APSED work plan
• Operational work: ongoing analysis of sex- and age-disaggregated
data on surveillance, outbreaks and IBS; findings shared with
Member States through in-house online journal WPSAR and used
to inform response activities.

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 Example, HRBA: 4-country assessment of compulsory
treatment of people who use drugs -- an application of selected
human rights principles

 Like others, PWUD are especially vulnerable to HIV/AIDS and entitled to right to
health, like others. Governments should take measures to protect them.
 The assessment found a violation of the right to health in the centres, including:
– poor access to basic health services
– poor access to drug treatment
– almost no access to prevention, care, support and treatment of HIV

 Countries should improve treatment provided in the centres. At the same time,
they should initiate / expand harm reduction programmes, whose benefits are
well documented, eventually entirely replacing the centres.
 Report cited by DG (May 2010) as evidence that WHO does not support
compulsory treatment centres.

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 Example, gender mainstreaming: Smoke-
free living for women in Tianjin, China

 Raise awareness on harmful effects of smoking,

secondhand smoke
 Encourage women to raise a strong voice against smoking,
and thus:
- Promote smoke-free homes
- Help smokers to change smoking behavior
- Promote no smoking as socially acceptable norm

 Promote awareness and implementation of smoke-free law

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