Highlights of Results
Global Participation in Gender HSS eLearning Course
Since its June 2014 release, 1,474 learners from 57 countries have used the course and 637 (43%) have earned a certificate of course completion, of whom 54% are female. In 2014, the project also led 22 participants from 10 countries in a two-week study group to enhance learners’ understanding of the course content through moderated discussions.
Gender and HSS course learners from international nongovernmental organizations (INGOs) and government expressed how they planned to apply what they learned in their respective academic, programmatic, and clinical settings:
- “I will use the knowledge acquired [from the course] to empower women in rural communities to raise their voice toward demanding reproductive health right[s].” ~ Male INGO worker, Tanzania
- “I intend to advocate for gender equality in regards to health-related issues like signing consent for cesarean section, family planning, and even hospital-seeking services.” ~ Female INGO worker, Somalia
- “I will engage my colleagues in a conversation that addresses the issues of gender and reproductive health as they affect the victims of trafficking, so that [they] receive psychosocial supports from our shelter, and gender is streamlined in the policy.” ~ Female national government employee, Nigeria
- “[I will] undertake a retrospective analysis of reported data on activities based on sex disaggregation, and share the analysis with the project team.” ~ Male INGO worker, Burundi.
Fostering Action through Pilot Application of Advocacy Tools at the Country Level
CapacityPlus field-tested the gender equality advocacy tools through a capacity-building workshop with 51 health workforce, gender, and preservice education stakeholders in Cross River State, Nigeria in 2014. The workshop discussions enabled the stakeholders to identify and prioritize gender-related challenges—including learning and working environments that may promote sexual harassment and GBV, caregiver responsibilities discrimination affecting midwife deployment and retention, and occupational segregation and wage discrimination—while working on a draft advocacy action plan. Workshop participants then nominated representatives to form a state-level Gender Human Resources for Health (HRH) Working Group, which met in May 2015 to further refine and pursue advocacy goals to advance gender equality in the health workforce and at health professional education institutions, including promoting efforts alongside the state’s forthcoming gender policy.
In August 2015, a sex-disaggregated analysis of the CapacityPlus-supported Cross River State Ministry of Health workforce registry (customized from the project-supported iHRIS Manage software) was undertaken to develop a more robust evidence base on gender issues in the health workforce and better inform decision-making for how to promote and achieve gender equality. Preliminary results indicated that of the 3,626 health worker records that had a sex variable, 64% of health workers were female and 36% were male. Analyzing the age distribution of the Cross River State health workforce and disaggregating the results by sex revealed an important aspect of the female and male health worker life cycles. The proportion of females to males is 3.7 to 1 in the 26-35 age category, but 1.6:1 for health workers aged 36 to 45, and 1:1 for health workers aged 46 to 55. For those aged 56 to 65, this ratio is reversed, with almost twice as many male health workers (1.8) as females. This finding may imply that while many women start off their careers as health workers, there is attrition, with fewer women likely to remain in the profession until retirement. Alternatively, as these data represent only the current health workforce, this finding may imply that in recent decades there has been an influx of female health workers to the labor market, which would represent great potential in terms of achieving Nigeria’s health goals.
An analysis of data from the Community Health Practitioners Registration Board of Nigeria showed the sex distribution of Cross River State’s three types of community health practitioners. While all professions have a majority of female health workers, the community health officer position that requires the longest period of study and practica has the largest proportion of men, indicating that there may be challenges that women face to complete additional training within the community health practitioner profession.
Improving Training on and Management of Sexual and Gender-Based Violence
Kenya: With approximately 160,000 children and youth living with HIV in Kenya and an estimated adult prevalence of 5.3%, the government is seeking to reduce HIV risk factors, including those associated with SGBV. At the request of the USAID Office of HIV/AIDS Gender Technical Working Group and in collaboration with the USAID FUNZOKenya project, CapacityPlus integrated PEPFAR’s technical considerations for clinical management of children and adolescents who have experienced sexual violence into USAID’s APHIAplus service delivery project in Kamili zone. The projects worked with the Ministry of Health (MOH)’s Reproductive and Maternal Health Services Unit (RMHSU) to develop a new module focused on children and adolescents for the revised national curriculum on SGBV, including supplemental training and performance support materials. Sections in the module and wider curriculum address HIV counseling and testing (as well as pregnancy testing and counseling), plus post-exposure prophylaxis, referrals, and forensic examinations. The revised national SGBV curriculum (2015) seeks to advance the MOH’s mandate to train health workers on management of survivors of sexual violence.
Additionally, a training needs assessment conducted before testing of the new children and adolescents-focused module among trainers and providers identified shortages of key equipment (e.g., forensic kits), deficiencies in performance support mechanisms for staff, and the existence of inherent biases against adolescents by a number of providers. Findings from this assessment assisted the Ministry in incorporating health workers’ attitudinal aspects into the curriculum as well as taking corrective actions to ensure that appropriate equipment to address SGBV exists in health facilities.
Mali: The armed conflict in northern Mali has displaced about 180,000 people; the United Nations’ working group on violence found 2,383 cases of violence against women in 2012 and 3,330 in 2013 (UNFPA Mali 2015). In response to the crisis, in collaboration with USAID/Mali, CapacityPlus provided technical leadership to draft national health worker training materials in SGBV. National stakeholders from the Ministry of Health and Public Hygiene; Ministry for the Promotion of Women, Children, and the Family; Ministry of Solidarity, Humanitarian Affairs and Reconstruction in the North; health facilities; and NGOs validated and finalized training materials, including a reference manual, facilitator guide, and participant workbook and job aids. To further support victims of SGBV in Gao region, CapacityPlus supported local NGO Groupe de Recherche d’Etude de Formation Femme-Action (GREFFA) to conduct informational sessions on SGBV and identify victims of SGBV. In June 2015, the Ministry of Health and Public Hygiene, with technical and financial assistance from CapacityPlus, organized a national training of 18 trainers in case management of SGBV and targeted regional participants from the health directorates and hospitals. In collaboration with the Gao Nursing School, the project also organized an orientation session on SGBV case management for 30 teachers and trainers. This intervention constitutes the first step in the introduction of these national curricula into preservice education institutions in Mali.