Abstract
BackgroundGlobally, gender as a barrier or facilitator in achieving health outcomes is increasingly being documented. However, the role of gender in health programming and organization is frequently ignored. The Global Polio Eradication Initiative, one of the largest globally coordinated public health programs in history, has faced and worked to address gender-based challenges as they emerge. This paper seeks to describe the role of gender power relations in the polio program across global, national, subnational, and front-line levels to offer lessons learned for global programs.MethodsWe conducted qualitative key-informant interviews with individuals purposively selected from the polio universe globally and within seven country partners: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, and Nigeria. The interview tool was designed to explore nuances of implementation challenges, strategies, and consequences within polio eradication. All interviews were conducted in the local or official language, audio-recorded, and transcribed. We employed a deductive coding approach and used four gender analysis domains to explore data at the household, community, workplace, and organizational levels.ResultsWe completed 196 interviews globally and within each partner country; 74.5% of respondents were male and 25.5% were female. Male polio workers were not allowed to enter many households in conservative communities which created demand for female vaccinators. This changed the dynamics of front-line program teams and workplaces and empowered many women to enter the workplace for the first time. However, some faced challenges with safety and balancing obligations at home. Women were less likely to receive promotions to managerial or supervisory roles; this was also reflected at the global level. Some described how this lack of diverse management and leadership negatively affected the quality of program planning, delivery and limited accountability.ConclusionsGender power relations play an important role in determining the success of global health programs from global to local levels. Without consideration of gender, large-scale programs may fail to meet targets and/or reinforce gender inequities. Global disease programs should incorporate a gender lens in planning and implementation by engaging men and boys, supporting women in the workplace, and increasing diversity and representation among leadership.
Highlights
Gender as a barrier or facilitator in achieving health outcomes is increasingly being documented
Using four gender analysis domains, we explored the data at the household, community, workplace, and Country distribution Global Afghanistan Bangladesh Democratic Republic of Congo Ethiopia India Indonesia Nigeria
Key findings are presented below: Gender at home and in the community Gender dynamics played an important role in household decision making for determining who, if anyone, was to receive the polio vaccine
Summary
Gender as a barrier or facilitator in achieving health outcomes is increasingly being documented. This paper seeks to describe the role of gender power relations in the polio program across global, national, subnational, and front-line levels to offer lessons learned for global programs. Defined as ‘socially constructed roles, behaviors, activities, attributes, and opportunities that a society considers appropriate for men, women, and people with diverse gender identities, and underpinned by power relations’ [3, 4], gender remains a complex notion [5]. Gender as a barrier or facilitator in achieving health outcomes has increasingly been documented, wherein it interacts with social and economic stratifiers such as age, education, ethnicity, religion, disability, etc., influencing individuals’ access to health services, control of resources, and needs and vulnerabilities [6, 7]. Gender influences not just the risks we take with our health, the risks we face, and whether or not we seek health care, it impacts how the health system responds to our needs when we are sick or need care [15]
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