CHEW _Gender Supplementary Materials-1

GENDER SUPPLEMENTARY MATERIALS
FOR ENRICHING TEACHING CONTENT
OF COMMUNITY HEALTH EXTENSION
WORKERS (CHEW) COURSES
Nigeria-Canada School of Health Technology and
Primary Health Care Development Project
March 2011

GENDER SUPPLEMENTARY MATERIALS FOR CHEW CURRICULUM
Nigeria-Canada Colleges of Health Technology ii
and Primary Health Care Development Project March 2011
TABLE OF CONTENTS
TABLE OF CONTENTS..............................................................................................................................ii
ACRONYMS AND ABBREVIATIONS ....................................................................................................iv
ACKNOWLEDGMENTS ............................................................................................................................v
1. INTRODUCTION ................................................................................................................................7
1.1 REASON THE MANUAL WAS DEVELOPED.............................................................................7
1.2 HOW THE MANUAL WAS DEVELOPED ...................................................................................7
1.3 WHAT YOU WILL FIND IN THE MANUAL ...............................................................................8
2. CHEW COURSES OFFERED.............................................................................................................9
2.1 FIRST YEAR, FIRST SEMESTER..................................................................................................9
2.2 FIRST YEAR, SECOND SEMESTER ............................................................................................9
2.3 SECOND YEAR, FIRST SEMESTER ..........................................................................................10
2.4 SECOND YEAR, SECOND SEMESTER .....................................................................................10
2.5 THIRD YEAR, FIRST SEMESTER ..............................................................................................10
2.6 THIRD YEAR, SECOND SEMESTER .........................................................................................11
3. GENDER SUPPLEMENTARY MATERIALS .................................................................................12
GNS 1O2 – COMMUNICATION IN ENGLISH.......................................................................................12
COM 111 – INTRODUCTION TO COMPUTER EDUCATION.............................................................12
CHE 211 - PROFESSIONAL ETHICS......................................................................................................13
CHE 211 – ANATOMY AND PHYSIOLOGY I.......................................................................................14
CHE 231 – ANATOMY AND PHYSIOLOGY II .....................................................................................14
GNS 411 – INTRODUCTION TO PSYCHOLOGY .................................................................................15
GNS 213 - INTRODUCTION TO MEDICAL SOCIOLOGY...................................................................16
CH 215 – INTRODUCTION TO PRIMARY HEALTH CARE...............................................................17
CHE 232 – ADVOCACY, SITUATION ANALYSIS AND COMMUNITY DIAGNOSIS.....................18
CHE 213 – INFORMATION, EDUCATION AND COMMUNICATION...............................................19
CHE 222 – SUPERVISED CLINICAL EXPERIENCE ............................................................................20
CHE 223 –CLINICAL SKILLS I...............................................................................................................20
CHE 241 – CLINICAL SKILLS II.............................................................................................................21
CHE 221 – USE OF STANDING ORDERS..............................................................................................22
STB 211 – INTRODUCTORY MICROBIOLOGY...................................................................................23
CHE 251 – COMMUNITY EAR, NOSE AND THROAT ........................................................................23
CHE 252 – COMMUNITY EYE CARE ....................................................................................................23

Nigeria-Canada Colleges of Health Technology iii
CHE 242 – COMMUNITY MENTAL HEALTH......................................................................................24
CHE 233 – ORAL HEALTH......................................................................................................................25
CHE 224 – REPRODUCTIVE HEALTH ..................................................................................................26
CHE 234 – CHILD HEALH/IMCI.............................................................................................................27
CHE 243 – SCHOOL HEALTH PROGRAMME......................................................................................28
CHE 235 – OCCUPATIONAL HEALTH AND SAFETY........................................................................29
CHE 253 – CARE OF THE AGED............................................................................................................30
CHE 254 – CARE OF THE HANDICAPPED...........................................................................................31
CHE 255 – HEALTH STATISTICS ..........................................................................................................32
CHE 244 – COMMUNICABLE AND NON-COMMUNICABLE DISEASES........................................33
CHE 245 – SUPERVISED CLINICAL EXPERIENCE (SCE) II..............................................................36
CHE 261 – PRIMARY HEALTH CARE MANAGEMENT.....................................................................36
CHE 262 – REFERRAL SYSTEM AND OUTREACH SERVICES ........................................................37
CHE 256 – MANAGEMENT OF ESSENTIAL DRUGS..........................................................................37
CHE 263 – ACCOUNTING SYSTEM IN PRIMARY HEALTH CARE..................................................38
CHE 264 – HEALTH MANAGEMENT INFORMATION SYSTEM ......................................................38
CHE 257 – HUMAN RESOURCE TRAINING ........................................................................................39
CHE 214 – HUMAN NUTRITION............................................................................................................40
EHT 111 – INTRODUCTION TO ENVIRONMENTAL HEALTH.........................................................41
CHE 225 – IMMUNITY AND IMMUNISATION....................................................................................42
CHE 246 – ACCIDENT AND EMERGENCY..........................................................................................42
CHE 258 – RESEARCH METHODS ........................................................................................................43
CHE 265 – RESEARCH PROJECT...........................................................................................................44
CHE 259 – SUPERVISED COMMUNITY BASED EXPERIENCE (SCBE) ..........................................44
GNP 123 – INTRODUCTORY PHARMACOLOGY ...............................................................................45
BCH 111 – GENERAL AND PHYSICAL CHEMISTRY.........................................................................46
FOT 111 – GEOGRAPHY .........................................................................................................................46
BUS 213 – SMALL BUSINESS MANAGEMENT...................................................................................47
GNS 111 – CITIZENSHIP EDUCATION .................................................................................................48
APPENDIX 1: LIST OF CURRICULUM DEVELOPMENT COMMITTEE MEMBERS, CHT
CALABAR .................................................................................................................................................50
APPENDIX 2: PARTICIPANTS OF THE WORKSHOP ON GENDER BASED ANALYSIS OF THE
CHEW CURRICULUM HELD IN CALABAR ........................................................................................51
APPENDIX 3: PROJECT STAFF AND MANAGEMENT ......................................................................53

ACRONYMS AND ABBREVIATIONS
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Care
BCH Basic Sciences
BUS Business Studies
CDC Curriculum Development Committee
CHE Code for Community Health Extension Workers Courses
CHEWs Community Health Extension Workers
CHT College of Health Technology [Calabar]
COM Computer Science
DRF Drug Revolving Fund
e.g. Example(s)
EHT Environmental Health Technicians Course
ENT Ear, Nose and Throat
FOT Forestry Technology
GNP General Nursing
GNS General Studies
HIV Human Immunodeficiency Virus
HPV Human Papillomavirus
ICT Information and Communication Technology
IT Information Technology
ITNs Insecticide Treated Bed-Nets
IEC Information, Education and Communication
IMCI Integrated Management of Childhood Illnesses
JCHEWs Junior Community Health Extension Workers
LCI Learner Centred Instruction
LGA Local Government Area
mmHg millimetres of Mercury
NGOs Non-Governmental Organisations
PHC Primary Health Care
PID Pelvic Inflammatory Disease
PLA Participatory Learning and Action
PMTCT Prevention of Mother to Child Transmission
STB Science Laboratory Technology
STIs Sexually Transmitted Infections
TB Tuberculosis
TBAs Traditional Birth Attendants
TV Television
USA United States of America
VVHWs Volunteer Village Health Workers

Nigeria-Canada Colleges of Health Technology v
ACKNOWLEDGMENTS
This manual was completed and produced with support from the Canadian International
Development Agency (CIDA) and the Government of Nigeria through their support for the
Nigeria Colleges of Health Technology and Primary Health Care Development Project in
Bauchi and Cross River States.
Through technical support provided by Nancy Drost, the Canadian Gender Mainstreaming
Advisor, the project supported the Curriculum Development Committees in Bauchi State
College of Health Technology (Ningi) and the Cross River State College of Health
Technology (Calabar) to review the CHEW and JCHEW curricula from a gender perspective.
We acknowledge the important commitment and collaboration of every member of the
Curriculum Development Committees (CDC) and tutors in each state. The list of the
committee members and Tutors are attached (see Appendix 1).
As outlined in Section 1 of this manual, the process began in a workshop on Gender and the
Community Curriculum held on 9 June 2010 in Bauchi, focusing on JCHEW courses. The
Workshop was replicated in Calabar from 16-17 June 2010 but with a focus on gender review
of the CHEW Curriculum. The gender supplementary materials for enriching CHEW and
JCHEW teaching content is in two separate volumes as identified below:
 Volume 1: Gender Supplementary Materials for Enriching Teaching Content of
CHEW Courses and;
JCHEW Courses
This Volume presents results of the gender based analysis of the CHEW Curriculum carried
out in Calabar. For this reason, the acknowledgements focus on people who contributed to its
development. The Calabar workshop facilitated by Nancy Drost enabled participants (see
Appendix 2) to interrogate CHEW curriculum from a gender perspective. Workshop
participants comprised CDC members in the respective institutions, tutors, students,
preceptors, NGO partners, Cross River State Agency for the Control of AIDS (SACA) and
representatives of the Ministry of Health in Cross River State. We appreciate the hard work
and cooperation of participants in the two-day workshop that resulted in the framework for
this manual.
Following the two workshops, Nancy Drost provided online support and refined the results of
the workshops, filling gaps where necessary. Without her technical assistance and guidance,
it would not have been possible to complete and produce this manual. We appreciate her
assistance and dedication to work.
We also want to thank the employees of Agriteam Canada for their substantial logistical and
technical assistance throughout the process of developing the manual. Their names are
mentioned in Annex 3. We specially thank the Field Manager of the Project, Catherine
Hakim, and the Provost of the College of Health Technology, Dr Franklin Ani and the
Registrar, Mrs Philomena Obaji for their management support.

Nigeria-Canada Colleges of Health Technology vi
Finally we thank the staff of Cross River State Ministry of Health, College, the College
Governing Council, Management and Students for their support to this project.
We thank everyone for their great contributions!

1.INTRODUCTION
1.1 REASON THE MANUAL WAS DEVELOPED
This manual is one of the results of Nigeria Colleges of Health Technology and Primary
Health Care Development Project’s support to tutors and preceptors in addressing gender
issues implicated in curricula for pre-service training of CHEWs and JCHEWs. The project
produced gender supplementary materials for enriching teaching content of Community
Health courses in two separate volumes as identified below:
CHEW Courses and;
JCHEW Courses
This Volume presents results of the gender based analysis of the CHEW Curriculum carried
out in Calabar. Volume 1 (this volume) was designed bearing in mind the gender issues
implicated in the mandated CHEW courses in general, but addresses gender issues specific to
delivery of PHC services in Bauchi and Cross River States, being the location of the CIDA-
funded project.
At project outset when the mandated curriculum for pre-service training of CHEWS was
assessed by Jean Garsonin, the then project’s gender mainstreaming advisor, it was concluded
that there is no evidence of basic gender concepts in the core social modules, and there is
correspondingly no gender-based analysis in the health care/service delivery modules, which
would serve to identify potential gender differentials in health status and access to health care
at the community level where CHEWs will work upon graduation.
Therefore, the project with partners identified the need to review the entire CHEW
curriculum from a gender perspective. Partners also expressed the need for guidance in
selecting materials that can enrich the gender content of the various modules they are
responsible for delivering to students. This manual meets this need and offers an example of
how to enrich the gender content of curricula used in any educational institution.
1.2 HOW THE MANUAL WAS DEVELOPED
Through technical support provided by Nancy Drost, the Canadian Gender Mainstreaming
Advisor, the project supported the Curriculum Development Committees in Bauchi State
College of Health Technology (Ningi) and the Cross River State College of Health
Technology (Calabar) to review the CHEW and JCHEW curricula from a gender perspective.
Given the overlap in content between JCHEW and CHEW curricula coupled with the fact
that the two institutions use the same curricula for pre-service training of these cadres of
health workers, the project divided the task of gender based review of the two curricula

Nigeria-Canada Colleges of Health Technology 8
between the two institutions. While the JCHEW curriculum was reviewed in Bauchi by CHT
Ningi CDC members, tutors and preceptors, CHEW curriculum was reviewed by their
counterparts in Calabar, Cross River State..
The process of developing the CHEW manual began in a workshop on Gender and the
Community Curriculum held on 9 June 2010 in Bauchi, focusing on JCHEW courses. The
Workshop was replicated in Calabar from 16-17 June 2010 but with a focus on gender review
of the CHEW Curriculum. The workshop facilitated by Nancy Drost enabled participants to
interrogate the CHEW and JCHEW curricula from a gender perspective.
The following three questions guided the workshop participants’ review of the various
modules of the CHEW curriculum:
 What are the gender issues implicated in the different modules you are reviewing?
 What questions could you raise in class or during practicum training to orient students
to these gender issues?
 What measures of gender equity at the community level should be taken to address
the issues identified?
Discussions and draft responses to these questions formed the framework for developing the
gender supplement for enriching the CHEW curriculum.
1.3 WHAT YOU WILL FIND IN THE MANUAL
The manual provides answers to the three questions outlined in 1.2 above and covers all 46
modules in the CHEW Curriculum. Section 2 of this manual provides the list of the courses
as well as the Semesters when they are taken.

2.CHEW COURSES OFFERED
2.1 FIRST YEAR, FIRST SEMESTER
CODE COURSE DURATION UNITS
GNS 102 Communication in English 30hrs 2
CHE 211 Professional Ethics 15hrs 1
CHE 212 Anatomy and Physiology I 60hrs 4
GNS 213 Introduction to Medical Sociology 45hrs 3
CHE 213 Information Education and Communication (IEC) 60hrs 3
CHE 214 Human Nutrition 15hrs 1
EHT 111 Introduction to Environmental Health 30hrs 2
CHE 215 Introduction to Primary Health Care 30hrs 2
BCH 111 General and Physical Chemistry 15hrs 1
GNS 111 Citizenship Education 15hrs 1
TOTAL 315hrs 20
2.2 FIRST YEAR, SECOND SEMESTER
GNS 411 Introduction to Psychology 45hrs 3
CHE 221 Use of Standing Orders 75hrs 3
CHE 222 Supervised Clinical Experience (SCE) I 105hrs 4
CHE 223 Clinical Skills I 90hrs 4
CHE 224 Reproductive Health 90hrs 4
CHE 225 Immunity and Immunization 45hrs 2
FOT 111 Geography 15hrs 1
TOTAL 465hrs 21

2.3 SECOND YEAR, FIRST SEMESTER
COM111 Introduction to Basic Computer Education 30hrs 2
CHE 231 Anatomy and Physiology II 60hrs 4
CHE 232 Advocacy, Situation Analysis and Community
Diagnosis
90hrs 4
CHE 233 Oral Health 15hrs 1
CHE 234 Child Health / IMCI 90hrs 4
CHE 235 Occupational Health and Safety 30hrs 2
STB 211 Introductory Microbiology 75hrs 3
TOTAL 390hrs 20
2.4 SECOND YEAR, SECOND SEMESTER
CHE 241 Clinical Skills 90hrs 4
CHE 242 Community Mental Health 30hrs 2
CHE 243 School Health Programme 15hrs 1
CHE 244 Communicable and Non-Communicable Diseases 45hrs 3
CHE 245 Supervised Clinical Experience (SCE) II 60hrs 2
CHE 246 Accident and Emergencies 45hrs 2
GNP 123 Introductory Pharmacology 15hrs 1
BUS 213 Small Business Management 15hrs 1
TOTAL 315hrs 17
2.5 THIRD YEAR, FIRST SEMESTER
CHE 251 Community Ear, Nose and Throat Care 30hrs 2
CHE 252 Community Eye Care 15hrs 1

CHE 253 Care of the Aged 15hrs 1
CHE 254 Care of the Handicapped 15hrs 1
CHE 255 Health Statistics 30hrs 2
CHE 256 Management of Essential Drugs 15hrs 1
CHE 257 Human Resource Training 15hrs 1
CHE 258 Basic Research 30hrs 1
CHE 259 Supervised Community Based Experience (SCBE) 120hrs 4
TOTAL 285hrs 15
2.6 THIRD YEAR, SECOND SEMESTER
CHE 261 Primary Health Care Management 30hrs 2
CHE 262 Referral System and Outreach Services 30hrs 2
CHE 263 Accounting System in PHC 15hrs 1
CHE 264 Health Management Information System 15hrs 1
CHE 265 Research Project 6
TOTAL 90hrs 12

3.GENDER SUPPLEMENTARY MATERIALS
GNS 1O2 – COMMUNICATION IN ENGLISH
Some gender issues implicated in this module:
 Because of traditions and customs, girls and women are often disadvantaged in receiving the
same educational opportunities as boys and men. This extends to the use of the English
language, which is considered to be a language of the more educated in society.
 English is the official language for government and big business. These are field
predominantly occupied by men. Authorities – bosses, managers, supervisors -- are mostly
men. Again, the environment in which men are encouraged to interact is one in which English
is spoken.
 Traditionally, women are not involved in politics or government, and also mostly involved in
the informal or small business sector. They have less opportunity to speak English. Even if
women have opportunities to speak English, they are often shy to do so.
 Both women and men health professionals need to speak and write in English. They need to
communicate clearly, and write letters and reports. Traditionally, men would give the job of
writing to women, while they would dictate their letters and reports. This was because women
commonly occupied the role of secretary. Now with the use of computers, both women and
men can write their own reports quickly and easily.
Questions for classroom discussion:
 What are some of the traditional attitudes that have prevented girls from receiving the same
educational opportunities as boys? Do these attitudes still persist? Why?
 If the English language could be classified as male or female, what would it be? Why?
 How important is it for men and women to write good letters and reports? What counts as
more important: the spoken or written word? Are women or men more associated with
speaking or writing? Why?
 The professional world has always been a male world, where English is spoken and deals are
done. However, this is changing. More women are entering professional fields, and
occupying roles of authority just like men. Give examples of successful women in your
profession, in other fields, in government. What are the reasons for their success? Are any of
the reasons related to their proficiency in English?
Strategies for addressing the gender issues in the community:
 Start a campaign for girl child education and women’s literacy.
 Identify key English words and teach them to your antenatal class.
 When addressing the community, translate the local language in English, and vice versa. This
way people, especially women, will start to identify English words and phrases.
COM 111 – INTRODUCTION TO COMPUTER EDUCATION
 When it comes to technology or gadgets, boys and men seem to take hold of them faster than
women.
 Women are often intimidated by computers, like they are by math and science.
 Boys and men who have more freedom from the household can frequent Internet cafes more

than girls and women. Thus, they become more familiar with the technology and use it in
many ways.
 The Internet is an excellent tool for communication and research. However, the Internet is also
used to promote issues which are contrary to gender equality. Internet pornography is readily
available on the Internet if someone wants to access it. The Internet provides the most
immediate and plentiful source of pornography. Many men, and a lesser number of women,
have become addicted to Internet pornography. Pornography places women and men in
situations depicted by sex, which are often stereotypical and exploitative.
 Why are girls and women intimidated by computers?
 How can Internet cafés be more user-friendly to girls and women?
 How can social networking, i.e. Facebook, be used to promote positive and progressive gender
roles and responsibilities?
 Have a women-only evening for students at the Internet café.
 Have men students teach women students how to use the technology. Then have the women
teach the other women students how to use the Internet for research, e-mail, and social
networking.
CHE 211 - PROFESSIONAL ETHICS
 Women and men have significant moral responsibilities as health professionals. Ethics
pertains to how professionals relate to their patients or clients, as well as how they relate to
each other. Your code of conduct gives guidance about how to behave as professionals.
Gender issues are also implicated in this guidance.
 In communities, male health professionals are often thought of as “doctors” whereas women
are thought of as nurses. Even though each may have the same credentials and experience,
men are usually given more privileged status.
 Both men and women can take advantage of their privileges as health professionals in
communities. Some men health professionals may have sex with clients or clients’ relatives
because they are seeking favours for services. Some women health professionals use their
privilege to intimidate or be rude to clients. These behaviours have become gender
stereotypes.
 Two students – one woman and one man -- both with the same qualifications, enter a
community. The community gives special attention and gifts to the man because they think he
is a doctor. What should the male student do, according to the code of ethics? How can the
male student show support for his female colleague?
 What are the most common ethical misdemeanours related to how men and women show
power and control – over each other and over their clients?
 What happens to the health professional-patient/client relationship when sex enters into the
picture?
 Two married health practitioners have an extra-marital affair. Is this against the code of
ethics? If they are consenting adults, is it wrong? Yes or no? Why or why not?
 Inform clients of the health professionals’ code of conduct.

 Provide advice to clients about who to contact if they feel that the health professional is
behaving inappropriately.
 Discuss ways you can better serve your male and female clients in ways that show respect for
them. Take into account the gender issues involved in confidentiality and privacy.
CHE 211 – ANATOMY AND PHYSIOLOGY I
 Men and women have different anatomy and physiology. However, that doesn’t mean that
men and women do not have equal rights.
 Women have a different anatomy and physiology than men. Those differences cause most
societies to think of women as “weaker,” “softer,” and “more vulnerable” than men.
 Men have a different anatomy and physiology than women. Those differences causes most
societies to think of men as “stronger,” “braver” and “more able to be protectors” than women.
 When society imposes these characteristics and personalities on to women and men, we call
these “stereotypes.” To stereotype a person means that you give them traits before you get to
know them. Other words for “stereotype” include “bias,” “type cast” and “prejudice.”
 Even though there are differences in anatomy and physiology, men and women do not always
follow the types of characteristics and personalities that society expects of them. Men and
women have a lot more in common than they do differences!
 When we stereotype people, we do not make room for change and acceptance.
 Women are most often stereotyped as teachers, nurses and secretaries. What happens when a
man wants to take up these roles?
 If a man is a nurse, why does the community insist that he is a doctor?
 How does society respond to women who are more assertive? How does society respond to
men who like cooking? Why?
 Anatomy and physiology are important for men’s and women’s health, but they do not define
who we are – our likes and dislikes, our occupations or our hobbies.
 Encourage girls and women in the community to explore different options for generating
income, participating in community management functions and in politics.
 Encourage men to explore the side of them that wants to spend more time talking to their
wives, playing with their children, and helping out around the house.
 Encourage men and women in communities to help each other with household work and
parenting for the good of the family.
CHE 231 – ANATOMY AND PHYSIOLOGY II
 Because society has certain expectations of boys and men and girls and women, they have
health implications. These are called the gendered determinants of health. Many of these
implications will be explored in the individual modules related to different health issues and
diseases.
 For example, because of the ways that men are expected to behave in society, they smoke more

than women. This may have implications on the respiratory system.
 Because of the ways that girls are expected to behave at school, they may hold in their urine
until they get home. This may have implications on the urinary system.
 Because of the ways that women are expected to be passive and submissive in the presence of
men, she may have many more children than she wants. This may have implications for the
reproductive system.
 Have you ever thought that “gender” is a determinant of health? Think back to the experiences
of your parents and grandparents, or even yourself. Was there a health problem that could
have been prevented if society had not put so much pressure on someone to “act like a man” or
“act like a woman?”
 Think about alcoholism. Is this a men’s health issue or a women’s health issue, or both?
Why?
 Think about accidents. Is this a men’s health issue or a women’s health issue, or both? Why?
 Think about sexually transmitted diseases. Is this a men’s health issue or a women’s health
issue, or both? Why?
 Why is it important to think of gender as a determinant of health in all we do as health
practitioners?
 Offer to visit men’s and women’s groups to explain the differences in male and female
physiology and anatomy. It’s surprising how many people do not have this information.
 Lead a discussion on your observations of major health issues in the community. Try to bring
up the issue of gender roles, and discuss whether there are differences in men’s and women’s
experience of the illness. Discuss recommendations for new behaviours or bye-laws to prevent
the illness from becoming a bigger problem.
GNS 411 – INTRODUCTION TO PSYCHOLOGY
 Gender roles are factors in our psychological make-up.
 Personality development – our attitudes, behaviours and sense of self-esteem – are in great part
determined by society’s gendered expectations of boys and girls, men and women. During
puberty while they are developing physically, girls may lose a lot of the self-esteem they had
as children. Teenage boys may take a lot of risks because they feel invincible at this stage.
 The way we express emotions is tempered by the gendered expectations society has from us, as
men and women. Boys are not allowed to cry. Men are encouraged to hold their emotions in.
Girls are expected to cry. Women are encourage to get their emotions out. You can see the
differences between how emotions are expressed at funerals, for example.
 Illnesses that are characterized as psychological often have a gender determinant at their roots.
These illnesses may arise as a result of how personalities were formed and how emotions were
or were not expressed. For example, women can be depressed if they feel they are confined to
the household as a wife. At the same time, men can be depressed if they have too much
responsibility for the family and cannot live up to everybody’s expectations as a husband.
 A gender perspective of psychology can explain worker motivation. If certain tasks are not
consistent with your gender roles, you may not feel motivated to do them. On the other hand,
if you are prevented from doing certain tasks because society does not feel that they are
appropriate gender roles, you may feel frustrated because you are not able to try new things.

 A gendered perspective on psychology can also be applied to management models. Autocratic
models are mostly associated with me, whereas democratic models and building team harmony
and cohesion are associated with women. These associations do not always hold true because
they are gender stereotypes.
 In the community, men health practitioners are not always given the opportunity to attend
births. This is because it is seen as a women’s role, not a men’s role. However, this prevents
men health practitioners from experiencing a very important aspect of community health work.
This affects worker motivation. Is this true in your experience? How can we overcome the
notion that it is inappropriate for men to participate in birthing?
 What affects your motivation as a health practitioner? How is it related to your gender roles?
 What are some of the gender issues related to fatigue, frustration and lack of interest? Give
examples.
 In your profession, there are gendered stereotypes for personalities of both men and women
health practitioners. For example, women are often stereotyped as bossy. Men are often
stereotyped as arrogant. How can we overcome stereotypical personalities in our profession?
 Explain to the community some of the most common psychological illness, like depression,
severe fatigue and anxiety. Ask if they know anyone who has these problems, whether they
know the causes, and whether they causes are related to gender roles and responsibilities. Ask
how the community can provide support to those suffering from psychological illnesses.
 Inform people about the role of psychological illness and its relationship to hypertension and
coronary heart disease. Explain the gender determinants of hypertension and coronary heart
disease. Explain preventative measures and medications, and how both men and women can
learn and adapt to them.
GNS 213 - INTRODUCTION TO MEDICAL SOCIOLOGY
 The family is a social institution in which the most intimate relationships occur. The family is
the place where we learn about our gender roles and responsibilities and how they are valued.
 In many families, girls do the housework and boys work outside the house. These messages
from your parents about “who should do what” will influence what you do for the rest of your
life.
 Some families encourage girls to go to school and study, instead of doing housework. Some
families encourage boys to share in household chores, like sweeping, fetching water and taking
care of their little brother and sister. These families are challenging traditional gender roles.
 The gendered determinants of health have their roots in how our families encouraged us to take
on certain gender roles and responsibilities. Gender roles can influence illness – how and
when we get sick; how we respond to illness – whether we seek medical attention or not and
on time or late; and how we care for those who are sick – whether we take care of the person
ourselves or pay someone to do it for us.
 Just as the family has a significant influence on gender and health, so does our level of income.
If we were born into a poor family, there are implications for gender and health. If we were
born into a rich family, there are implication for gender and health.
 These factors – family, income level and societal class – have a great influence on gender
roles. They need to be taken into consideration when you examine clients and determine their

health problems.
 Overall, when you are planning a health care intervention, it is important to consider the
setting – what type of families are in the community, how traditional they are, how poor or
affluent they are, and how all these factors affect the gendered determinants of health in that
community.
 Think about your childhood. What messages did you mother give you about how to be a
“good girl” or a “good boy.” Did you receive the same messages from your father, or were
they different? Have you had to go against their advice and find your own way, challenging
society’s expectations of your gender roles and responsibilities? Yes? No? Why?
 Consider obesity as an illness. Who is most prone to being obese: girls, women, boys, men?
What are the gender determinants of obesity – how does society encourage or discourage men
or women to become obese? How are these gender determinants accentuated or underplayed if
you come from a poor family or a wealthy family?
 You are working in a small village. The family structure is polygamous, and the people are
very poor. Many of the men have gone off to work in the city, leaving mostly women,
children and old people. What types of illnesses are most common? What are the gender
determinants of health?
 Help people to understand the gender determinants of health. For example, “fattening” a
woman in readiness for marriage may lead to obesity and other health complications.
Kwashiorkor is a result of giving birth to children too close in succession. Both men and
women need to negotiate family planning, so that children do not suffer from under-nutrition.
 Emphasize to the community prevention of illnesses that can be caused by adhering to
traditional gender roles. For example, tell both women and men how important it is for women
to eat foods rich in iron, especially red meats, in order to avoid anaemia. In many societies,
women are not allowed to eat a lot of meat, but its consumption is essential for their health
 When meeting a client for the first time, sensitively ask questions to assess if there are specific
determinants of health related to gender roles, family and income.
CH 215 – INTRODUCTION TO PRIMARY HEALTH CARE
 Primary Health Care places a large responsibility for health care on the community.
Community participation is key to how communities address their own health problems.
Communities can involve both women and men in committees to plan for better health care
and services. When women leaders are left out of these official committees, women’s voices,
concerns and health issues are not heard.
 Good food, nutrition, water and sanitation are all important for Primary Health Care. These
fall primarily within women’s responsibilities. However, men are the decision-makers in the
family, and if they do not agree, women may not be able to fulfill their responsibilities to the
extent that the benefit the health of the family. Men and women need to work together to
make primary health care work.
 Prevention is key to Primary Health Care. All members of the family should seek medical
attention when they are ill. Men are less likely to seek medical attention than women because
culturally, they do not want to appear weak. Women can seek medical attention only if they
have permission from men, and if men provide them with the transportation and money to go

to the health centre or hospital. Women are more likely to seek medical attention, if they can,
because they need to care for all family members and cannot do this if they are sick.
 Mothers and fathers need to watch their children to determine when they become ill. Mothers
have this responsibility more than fathers because they are with their children most often.
However, again, mothers cannot take their children to the clinic, unless they have their fathers’
permission and the required assistance. This situation puts women under a lot of pressure
because they cannot make important decisions about their health and the health of their
children on their own. Men may be absent, uncooperative or unwilling to provide the required
assistance for families’ primary health care.
 At the same time, men may have more knowledge and awareness about Primary Health Care
because they hear about it on the radio or TV. They may encourage their wives and children to
attend clinics. However, some women, particularly mothers-in-law, may be less willing to
allow family members to go to the health centre. They may only patronize those who practice
traditional medicine. Because women have less education and less awareness about modern
medicine, they may be more resistant to primary health care than some men.
 What are some of the constraints that mothers have in seeking PHC services for themselves,
their husbands and their children?
 What are some the constraints that fathers have in seeking PHC services for themselves, their
wives and their children?
 In listing the components of Primary Health Care, identify the issues that have an effect on
men, on women? Are they the same? Different? Why?
 Review the composition of the community health committee with community leaders. Are
there equals numbers of men and women on the committee? If not, why not? Suggest to the
leaders that more women should be involved because women’s and children’s health issues are
important to the community.
 Talk to men in the community about Primary Health Care. Find out what their major health
issues and illnesses are. Answer their questions and concerns. Find out what their challenges
and barriers are to assisting their wives and children to access Primary Health Care facilities.
 Have a meeting with the community. Discuss what the major barriers are to receiving good
primary health care. There may be issues of distance, access, quality services, or lack of
knowledge about what is available. Have a series of meetings to come up with bye-laws so
that more people will benefit from Primary Health Care.
CHE 232 – ADVOCACY, SITUATION ANALYSIS AND COMMUNITY
DIAGNOSIS
 In mobilising the community for health action, men participate in community mobilisation, are
members of village health committees and take key decisions affecting health of community
members. These are seen as the exclusive roles of men in the community. When women are
part of the health committees, their views or opinions are not taken into consideration because
they are considered inferior and they cannot take decisions.
 In diagnosing community health problems, women may not participate because they have to
have permission from their husbands. They also might not participate because they are not
used to attending public meetings or joining community activities. However, it is important

that women’s issues and concerns are represented during community diagnosis. Otherwise, the
findings will only represent men’s points of view.
 In sketching community maps, men may dominate the discussion and do the sketching because
they believe they know the community boundaries and resources more than the women. They
also have freedom to move around in the community and they interact more with their peers.
Women have to take permission before going out of their home and so their movement is
restricted.
 When presenting the situation analysis of community primary health care, women’s views and
concerns may not come out strongly because men dominate the community diagnosis
exercises. When women are involved in interviews and group discussions, their ideas can be
better represented in the situation analysis.
 Women are responsible for safekeeping on the home-based records for themselves, their
husbands and their children. Therefore, they also need to understand the reasons for their
importance. Men may dominate community diagnosis, but women are the ones who need to
manage and maintain family primary health care.
 If you were to do a community mapping exercise, first with men and secondly with women,
would there be any differences in the maps? If yes, why? If no, why not? There should be
differences because women and men are involved in different activities and may have different
boundaries. How can we encourage women’s full participation in community diagnosis (e.g.
mapping)?
 Use gender-sensitive Participatory Learning and Action tools to encourage women’s
participation in community diagnosis
 Involve boys and girls in community diagnosis, and take note of their observations. You will
find their views useful for planning.
CHE 213 – INFORMATION, EDUCATION AND COMMUNICATION
 Communicating health messages within the context of Health Education involves
understanding your audience. You, the “sender,” is communicating a message to the
“receiver” through a “medium” in order to get positive “feedback.” Gender issues should be
considered for different receivers: boys, girls, men or women.
 Because of men’s greater access to news, radio and TV, they may have more health
information than women. Therefore, you may be able to build on what men know more easily
than women. Although men may understand health education messages more easily than
women, they may not share them with their families because they do not see it as their role or
responsibility.
 There are a lot of harmful traditions surrounding women’s sexual and reproductive practices,
such a “dry sex” and avoidance of meat and eggs during pregnancy. They traditions have a
strong influence on women, and may influence women’s ability to take up positive health
behaviours. Women may feel ashamed or afraid to go against traditional practices, even if
they are harmful to them.
 Women and men may enjoy different methods of communication. Women often enjoy
singing, dancing and joking. Men often enjoy lecture and discussion. Understanding all the
barriers involving effective communication means taking into account how men and women

learn, especially those in poorer areas lacking in educational opportunities.
 Some messages can be shared with everyone in the community at the same time. But
sometimes, when there are sensitive messages about sex and reproductive health, it is
important to separate men and women, so that they can talk about the issues amongst
themselves. Women are often shy to talk about sensitive issues in front of men. They can
always be brought together later to discuss what they have to share with each other. Family
planning is a good example of such an issue.
 Women enjoy coming together for health education, but often they cannot find the time
because they are busy with household chores, farm and garden activities, and community
volunteer work. Health education sessions need to be organized when most women have free
time.
 Men generally have more free time than women, but may not want to attend a health education
meeting unless they understand how it is relevant for them, in ways that appeal to their
leadership and decision-making roles.
 If people in your community are convinced that they cannot break a harmful traditional
practice, such as early marriage, how could you convince them otherwise? What are the health
implications for early marriage? What are the gender issues for girls, boys, men, and women?
What messages will you use as part of your health education campaign? What methods will
you use to communicate the messages?
 Men are the leaders, the heads of households – they have the money and make the decisions.
Why are women the main focus for health education, rather than men?
 What types of health education messages are most powerful for you? What methods are most
effective to catch your interest? Make sure to get responses from both women and men in the
classroom. Are there any differences in their responses? Why do these differences exist?
Identify the gendered issues to effective learning.
 Find out what the traditions are for having women’s meetings and men’s meetings. What
aspects can you adopt for your health education sessions?
 Try involving both men and women in a health education session about caring for infants or
toddlers. Emphasize the need for both parents to be involved in bonding with and parenting
their children. See the reactions of both men and women.
 Ensure that posters or leaflets show the roles and responsibilities of women, men, boys and
girls in community mobilization for health action.
CHE 222 – SUPERVISED CLINICAL EXPERIENCE
 Refer to CHE 223 Clinical Skills I and CHE 241 Clinical Skills II
CHE 223 –CLINICAL SKILLS I
 Women health workers may win the confidence of a woman client more easily because both
are women. In situations where the woman health worker is not friendly, the woman client

may not feel free to talk at all.
 Male health workers are generally not allowed to assess the heath conditions of female clients
because of cultural and religious beliefs. However, in many cases, when a male health worker
talks with a woman client, the interaction can be positive and the assessment can proceed
successfully. The sex of the health worker does not necessarily determine whether a client will
have a satisfactory experience during the interview, history taking or physical exam.
 Men and women clients may both have difficulty providing you, the health worker, with
accurate information, during History Taking. They may not remember dates of illnesses or
even be able to name the illness with the correct medical term. Women, in particular, may not
be willing to provide information about birth history and exclude information about abortions
or miscarriages. They may also not disclose information about domestic violence. Men
influence and control the information their wives can provide to health workers. For example,
if a man beats his wife and she is taken to hospital, the man will advise the wife to say that she
fell down rather than say she was beaten.
 Women and men may be sensitive about the Physical Examination. Both may be shy or even
afraid to have the private parts of their bodies examined. Men may be less modest than
women. Women may be embarrassed because they are not used to exposing their bodies. The
feelings that women and men have during Physical Examination may affect their vital signs,
such as blood pressure.
 The use of Salt Sugar Solution is generally taught to women, because usually mothers, not
fathers, will give it to children. When women are taught how to made and administer the Salt
Sugar Solution, they may need several lessons and practice sessions, so that they can do it
themselves at home. Some women cannot read words or even pictures, so they need hands-on
education to do it correctly.
 When you try to develop rapport with a woman client, what do you do to make her
comfortable? When you try to development rapport with a male client, what do you do to
make him comfortable? Are the experiences the same? Why or why not? Why do the
differences exist?
 What types of health issues do you expect from history taking with a woman? With a man?
Are there differences? Why or why not?
 What are the main challenges you face during the physical exam? For women patients? For
men patients? Why?
 What are the most difficult aspects of carrying out the physical exam for you as a woman
health worker? As a male health worker? Why?
 Have several meetings with the community to sensitize them to the advantages of having both
men and women health workers examine men and women clients.
 Have sessions for men on how to make and administer Salt Sugar Solution. Explain to them
that one of the highest causes of child death is diarrhoea, so they, as caring fathers, should
know to prevent death from dehydration.
CHE 241 – CLINICAL SKILLS II
 Because of the different activities that men and women are involved in, they may come to the
health centre with different types of wounds. Men may have wounds related to work in

clearing land, from axes or machetes. Women may have wounds related to kitchen accidents,
from accidental cuts or burns. Men are much more prone to work-related incidents, car
accidents and fights.
 Generally women are seen by society as family care givers, so the role of wound dressing is
ascribed to them.
 Women are also generally responsible for ensuring that children receive their immunizations
on time. Most men do not take the same responsibilities for caring for babies and young
children. At the same time, the government policy on Primary Health Care favours women
and children, encouraging their utilization of facilities, such as growth monitoring,
immunisation and treatment of minor ailments.
 Women may more readily present their urine specimen for testing than men. Men often
suspect that the specimen will expose urinary infections due to the fact that most men have
multiple partners.
 Breast self-examinations have been assigned to women in order that they identify lumps for
early detection of cancer. Many women do not practice breast self-examination because of
lack of knowledge, less time for self care, and modesty.
 Men have better access to quality oral toilet products because of their economic advantage,
along with better oral health information. Women are more vulnerable to dental caries and
infections because of poor oral care. For example, often men will have a tooth brush and
paste, while women share chewing sticks and charcoal with their children.
 If Primary Health Care favours women and children, how should men get involved?
 Why are there gendered inequities in basic health care, such as oral hygiene?
 Encourage men in the community to attend immunization clinics along with their wives, or just
with their children.
 Remind women at every meeting to do their monthly breast self-examination. Tell them the
right time to do it during their monthly cycle.
CHE 221 – USE OF STANDING ORDERS
 Women health workers (students) are more likely to consistently consult their standing orders
for the care and treatment than men students. This is because the men students believe that
they can remember the standing order and know what to do. On the other hand, women are
more cautious and want to check, just to make sure they get the standing order right.
 If women are referred to another health service, what are some of the barriers which might
prevent them from following up on the referral?
 Identify conditions in boys, girls, men and women which put them in grave danger. Which are
related to gender issues?
 Work in teams (men and women) when treating cases, so that men and women can learn from
each other how they respond to clients’ complaints.
 Test each other on knowledge of standing orders in spare time during practicum assignments,
to improve on men’s knowledge and women’s confidence.

STB 211 – INTRODUCTORY MICROBIOLOGY
 Men are not allowed to take lab specimen from women (e.g. vaginal swabs) because of culture
or religious beliefs.
 Men have more access to mechanical labs because women believe that it men’s work.
 More men are more exposed to communicable diseases because they do more work in the
laboratory
 Women are more prone to catching micro-organisms that cause ill health because women are
generally assigned responsibility for maintaining laboratory hygiene and safety.
 Why are male health workers usually not allowed to take specimens from women clients?
 Why does the perception persist that that only men should work in the medical microbiology
lab?
 Communities should be given an orientation on importance of recognizing the value of both
men and women community health workers for women’s health.
 Women students should be encouraged to study neurobiology.
CHE 251 – COMMUNITY EAR, NOSE AND THROAT
 Men are more exposed to ENT diseases as a result of their exposure to occupational hazards,
i.e. dust, fumes, industrial smoke, because they are more likely to work in factories.
 In the community, women are more exposed to ENT diseases because they are more exposed
to smoke from firewood during cooking.
 Men smoke cigarettes more than women, and thus are more prone to health issues involving
the throat and nose.
 Women and children can be affected by the second-hand cigarette smoke of those smoking
nearby.
 What are the unsafe practices in the community associated with disorders of the ear, nose and
throat? Which ones are associated with women? Why? With men? Why?
 Discuss with the community the dangers of cigarette smoke for men, women and children.
 Find out which designs for smokeless stoves are being used in the area, and promote them in
your community.
CHE 252 – COMMUNITY EYE CARE
 Onchocerciasis also known as river blindness and Robles' Disease is a parasitic disease caused
by infection through the bite of a blackfly and subsequent infestation of larvae throughout the

body. The infection causes the severe inflammatory response that causes intense itching and
can destroy nearby tissues, such as the eye. Onchocerciasis is the world's second-leading
infectious cause of blindness. Women in riverine areas are more predisposed to river blindness
because of their responsibility of fetching water.
 Oncho generally affects more men than women, although sex-related differences may not be
apparent until the patient reaches a certain age. Sex-related differences are more pronounced
in high-transmission areas, particularly the savannah. There are increased exposures in men,
which are related to the occupational risk in farming and fishing.
 Women are prone to eye problems like cataracts, due to their exposure to smoky cooking
environments and use of fire wood.
 Men are prone to eye problems due to exposure to occupational hazards, i.e. flame from
welding or dust from lumber activities.
 Access to Vitamin A-rich foods and supplements may prevent eye problems. Men have more
access to nutritional varieties and supplements because of their economic advantage in the
family.
 How can men and women protect themselves from hazards affecting their eyes in their daily
activities?
 Advocate for provision of safe water in the community to reduce the incidence of river
blindness.
 Encourage the construction of well-ventilated kitchen and use of smokeless cooking stoves for
women
 Encourage the use of protective measures for men e.g. wearing of goggles to protect eyes
during working hours.
CHE 242 – COMMUNITY MENTAL HEALTH
 Women are the major care givers of people with mental illness. Some women have to leave
their small businesses in order to provide full-time care for people with mental illness because
they need to be watched constantly. This puts women at a disadvantage economically.
 Men and women suffer different types of stress, according to their roles and responsibilities.
Men may experience more stress from not being able to carry out their roles as provider for the
family because of unemployment. This may cause men to drink alcohol excessively, which
may lead to addiction. In extreme situations, men may commit suicide if they cannot resolve
their roles. Women may suffer stress because of their family situations. Stress may manifest
itself in depression. Some women also turn to alcohol.
 Men are more prone to major mental disorders like psychosis and schizophrenia because they
engage in risky behaviour such as taking hard drugs. Men with severe mental illness often
resist treatment. They are often seen on main streets, unclean and almost naked. They inspire
fear in people and are often left uncared for.
 Mental illnesses are often associated with other conditions, such as epilepsy and Down’s
syndrome. These are not mental illnesses, but conditions caused by neurological and
chromosomal anomalies. Grouped together, these problems present different challenges for
women and men. Women who are considered “mad” are often preyed on by men who seek to
have sex with them, believing that the act of sex with a “mad woman” will provide them with

special powers.
 Mentally ill men may receive more medical attention and care than mentally ill women,
because they are able to access health care, have more access to information and are
considered as the breadwinner and more valuable to the society.
 Most mental illnesses in women are not adequately diagnosed or managed because the society
believes that some of these conditions are caused by the woman’s adultery, or breaking of
societal norms and values. The condition is seen as punishment for her sins. Therefore, family
members may not take the woman’s condition seriously, leading to further neglect.
 If there has been any case of mental illness in the family, some women may be denied the right
to marriage, because the society believes that such women will eventually have mental
problems and pass them on to their children.
 Positive mental health habits are adequate sleep, nutrition and leisure time. Are both men and
women able to practice positive mental health habits in the same ways? Why or why not?
 What are the major stigma and misconceptions related to mental illness in women? In men?
Are they different? Why?
 Discuss with the community the possibility of starting “support groups” for people with mental
illness and their care givers. This way women carers may be able to find ways to continue
their income generating activities.
 Create awareness to correct myths and misconception to reduce stigma associated with mental
illness in the community, particularly those related to gender.
CHE 233 – ORAL HEALTH
 One of the biggest causes of dental caries is poor dental hygiene in childhood. In some areas,
children are offered lots of sweets, especially hard candies at home. Boys may have access to
more sweets than girls because they are able to move more freely outside of the house, and
often given money to purchase sweets. Moreover, boys may be more careless about cleaning
their teeth than girls. Girls are expected to maintain good hygiene, and this may include being
more careful about brushing teeth.
 This behaviour may extend to adulthood. Men who are careless about cleaning their teeth may
develop gingivitis and more serious conditions, such as abscesses. Eventually, the condition in
the mouth will affect the blood and even the heart. In addition, men may engage in practices
which compromise their oral health, such as smoking, which minimally causes yellowing of
the teeth and bad breath. Men are also prone to physical fighting which may result in damage
to the teeth and jaw, include loss of teeth.
 On the other hand, men may able to manage their oral health conditions because they have
more access to information on radio and television on oral hygiene. Men have better access to
quality oral toilet products because of their economic advantage. Women may be more
vulnerable to dental caries and infections because of poor oral care. For example, often men
will have a tooth brush and paste, while women share chewing sticks and charcoal with their
children. Men may be able to afford to go to a dentist, but may not understand the importance
of sending other family members.
 What are some of the challenges to good oral health? For men? For women? Boys? Girls?

Are there differences? Why?
 In mobilizing the community in promoting positive oral health behaviour, focus messages for
women, for men, and for children. Each have their own challenges to oral health which need
to be addressed.
CHE 224 – REPRODUCTIVE HEALTH
 Women are not always as knowledgeable about sexuality and reproductive health issues as
men, because they do not have equal access to relevant quality information, either from school
or from the media. Men have more access to information, even when they are not educated,
due to socialisation and mobility.
 Society expects men to express their sexuality. Men are expected to be “macho” and to have
multiple partners.
 Women are expected to be modest about their sexuality – if they are not modest; they are
labelled “loose” or “prostitute.”
 Female Genital Mutilation or Cutting is a traditional practice. Cutting is carried out to varying
degrees on the labia and clitoris. One of the intentions is to reduce sexual arousal and pleasure
in the woman. Moreover, the effect of the cutting is to tighten the area for penile penetration,
thus providing men with great sexual pleasure. Depending on how the cutting and sewing of
the wound is done, there may be resulting infections and consequences which are harmful to
health and child bearing. Older women in the community tend to promote this practice even
more than men.
 Early marriage for girls is also a traditional practice. One intention is to commit the girl to a
man before she is able to assert her own sexuality. When younger girls get pregnant, they face
higher risks, including complications such as heavy bleeding, fistula, infection, anaemia, and
eclampsia which contribute to higher mortality rates of both mother and child. At a young age
a girl has not developed fully and her body may strain under the effort of child birth, which can
result in obstructed labour and obstetric fistula. Obstetric fistula can also be caused by the early
sexual relations associated with child marriage, which take place sometimes even before first
menstruation.
 Many women lack awareness about their reproductive rights. They cannot take decisions
about their reproductive health and the number of children they will have, because men take
these decisions for them. Women often find it difficult to negotiate safe sex, because many
men are reluctant to use condoms. Female condoms are less accessible than male condoms.
 Women usually do not have independent access to family planning because they do not have
access to resources, and they have to get their husband’s consent or permission before
accessing reproductive or health care services.
 During their monthly menstruation, most girls absent themselves from school because there are
no sanitation facilities in the school (toilets, water for hand washing, incinerators for disposing
menstrual pads or cotton wool). Most of the sanitation facilities in the school do not take into
consideration the special needs of female students. This affects their academic performance.
 When a teenage girl or a woman has an unwanted pregnancy, abortion and post-abortion care
may be difficult for her to access. Unwanted pregnancies are usually blamed on women, and
the men who impregnate them are not often made to be responsible.
 Women are usually blamed for the problem of infertility and miscarriage of early pregnancy

because society believes that such women have been promiscuous in the past and cannot be
fertile.
 In the community when couples are tested for HIV and the test result is positive, the woman is
usually blamed for infecting the man. This situation ignores the fact that social customs permit
men to have multiple sex partners and engage in risky sexual practices, while women are
expected to be faithful and submissive.
 If a woman gives birth to several baby girls, the society blames her for inability to have male
children and she may be denied certain benefits in the home. In some instances her girl
children will not be educated, and she will forfeit certain rights and benefits.
 In most societies, care of the new born is entirely seen as women’s role. Societal norms expect
men to be involved more in productive roles and community politics.
 In countries wherever Female Genital Mutilation or Cutting is practiced, there is an argument
over whether the practice should be stopped, continued in the traditional way, or continued
within the safety of a health facility. What do you think? What about male circumcision? Is it
the same?
 People continue to deny the threat of HIV in their community. How would you talk to a
women’s group about HIV? How would you talk to a men’s group about HIV? Are there
differences in the approaches you use and the messages that you give to each group? Why or
why not?
 Safe sex to prevent sexually transmitted infections and unwanted pregnancy is not easy to
negotiate, either for men or for women. What are the issues around condom use for women?
For men? What advice would you give a woman whose husband is unfaithful to her, but
refuses to wear a condom? What advice would you give a man whose wife insists that she
wants more children, but he cannot afford to have more. He wants all of his children to have a
good education and good prospects for the future – to ensure this, he wants to stop at two
children.
 Educate women on their basic reproductive health rights.
 Talk with the community about harmful traditional practices related to sex and sexuality. By
bringing the issues into the open, explore the introduction of bye-laws to prevent practices,
such as early marriage.
 Take every opportunity to do HIV education, during both formal and informal teaching and
learning times.
 Talk to the community and the school about providing private and adequate sanitary
conveniences for girls in schools.
 Educate the family and community about causes and effects of infertility which can affect men
and women.
CHE 234 – CHILD HEALH/IMCI
 Due to poverty and high dependence on men in the communities for decision making, most
women deliver in TBA homes in order to reduce cost of delivery and to be accepted as
“powerful women” in the community.
 The care of the new born is seen as entirely the job of women, especially elderly women.
Sometimes, these women are not educated and may engage in traditional practices which are

harmful to the new born.
 More attention and care is given to male children because of societal preference for the male
child. Male children are given more nutritious food because of societal beliefs that they
require more energy for growth and development.
 Girl children are often denied the right to education because preference is given to male child.
Most parents encourage boy child education because they believe girls may get pregnant at
school.
 Women have comparatively more information on IMCI because they attend health talks at
ante-natal clinics. Women also take children to growth monitoring and immunization clinics.
Women’s engagement in these activities often prevents men from getting involved in child
care.
 Women are responsible for home-based interventions to improve nutrition, such as home
gardening, small-scale fishing, piggery, etc. Men usually do not get involved in these activities
unless they are able to sell the produce for cash.
 The use of insecticide-treated nets (ITNs) is sometimes misunderstood within the family. Men
sometimes sleep under the net because the family sees them as privileged breadwinners who
need special attention. Sometimes, women and children are left sleeping outside the net.
 Examine the major articles in the Convention on the Rights of the Child. Which rights does
society privilege boys more than girls? Girls more than boys?
 Encourage parents and communities to accept newborn babies equally regardless of sex.
 Promote involvement of both mothers and fathers in growth monitoring and immunization
clinics.
 Educate parents on importance of balanced diet for both male and female children.
 Advocate for girl child education.
CHE 243 – SCHOOL HEALTH PROGRAMME
 The government and Ministry of Health often use the school system to promote health.
Sometimes, vaccinations and de-worming medications are given at schools. Moreover, health
education is provided at school. This can include conventional health messages on hygiene, in
addition to education on sexual health. These interventions have different implications for
boys and girls. Both boys and girls enter puberty and become more sexual aware when they
are at school. Girls start to menstruate, and stay away from school during their periods if the
school does not have a girls’ toilet, hand washing stand or incinerator for burning sanitary
waste. When girls absent themselves because they have their periods, boys often tease the
girls when they return. Girls’ frequent absences from school may cause lack of confidence.
Educational inequities are more prominent between boys and girls during the adolescent phase.
 As girls develop physically, they become more vulnerable to sexual attention from community
members, teachers and other students. Girls may experience sexual touching or forced sexual
intercourse within the school context. This may result in lack of confidence, unwillingness to
continue school, psychological trauma, sexually transmitted infections, including HIV, and
pregnancy. The boys or men responsible for this sexual abuse often go unpunished or are able
to buy their way out of punishment. Some sexual abusers argue that girls want to have sex
with them. The issue of girls’ consent is not an issue when the girl is a child or a minor. In

addition, it is the responsibility of the school to protect boys and girls from sexual abuse on its
premises and even on the way from home to school.
 Boys at school are more prone to accidents at school because they play more games and play
more roughly than girls.
 Both boys and girls are put to work at school, maintaining the classrooms and school grounds,
and also school farms. Depending on the type of work and implements and agents involved,
accidents may occur. Because boys are given the heavier work, they may have more accidents
at school.
 The Child-to-Child Care programme involves both boys and girls, and can have a positive
impact on modelling positive and progressive gender relations. Both boys and girls are shown
how to care for each other and their brothers and sisters.
 Food vendors at schools are usually women. Selling food at school is an important source of
income for women, and provides an opportunity for them to share in household finances and
decision-making with their husbands. When standards and regulations for food vendors are in
place, women are better equipped to ensure food safety and secure their livelihood.
 What are some of the health issues that teachers observe in boys? In girls? Are there any
differences? Why?
 Work with the School Management Committee and teachers to ensure that both boys and girls
can provide Child-to-Child care.
 Work with the School Management Committee and teachers to ensure that a Code of Conduct
is in place that ensures safety for all students, and puts in place strong sanctions for teachers,
vendors and students who sexually abuse girls or boys.
CHE 235 – OCCUPATIONAL HEALTH AND SAFETY
 Both women and men are exposed to chemicals (i.e. pesticides, fertilizers) during farming
activities. If they do not use proper precautions (protective masks, gloves, clothing), they may
expose their skin and respiratory systems to harmful liquids, gases and fumes. Most of the
farming equipment is made for men. Thus, a backpack sprayer for spraying pesticides may not
fit a woman properly. This may cause her to be more exposed to harmful chemicals than a
man, whose physical frame is more suited to using the equipment properly.
 Certain agricultural activities are traditional assigned to women, such as weeding crops. These
types of activities are sometimes more tedious in that they require continuous and repetitive
actions which may cause muscle strain and back pain. Moreover, the implements that women
use for these activities (small hoes) are not designed to reduce the effects of repetitive strain.
Men have more access to modern technology and equipment to do their agricultural work, i.e.
animal traction, motorized tractors. This equipment allows men to reduce their level of
physical labour.
 Men are more susceptible to contract STIs and HIV because of work that requires frequent
travelling, such as truck driving.
 Men more often work in factories and places where heavy equipment is used. They are more
prone to industrial accidents involving burns, cuts, broken or severed limbs.
 Some women who work for companies or institutions are sexually harassed by men and
sometimes coerced into unwanted sexual contact or intercourse because their jobs are

threatened. This causes stress and trauma.
 Company policies for maternity leave and for sick leave may be unfair to women because of
their multiple roles and responsibilities at home and at work. Generally, maternity leaves are
three months, and sick leave does not always take into consideration when children and other
family members are ill. The woman usually has to compensate for any losses in income or
employment.
 What are the different ways that people make a living in your community? Are some of these
occupations associated more with men? With women? Why? What are the health
implications of these occupations?
 Discuss biological (bacterial cataract, arthritis, viral-HIV, helminthiasis), chemical
(pneumoconiosis – silicosis, bargassosis), psycho-social (stress, neurosis, psychosis) under the
following headings: causes, signs and symptoms, gender.
 Based on your observations of men and women patients with occupational illnesses, discuss
with health authorities and community leaders what can be done to improve occupational
health and safety.
CHE 253 – CARE OF THE AGED
 The process of aging is different for men and women, although there are many commonalities.
Apart from menopause in women, both men and women experience similar deteriorations in
their bodies, including loss of eyesight and hearing, arthritis, and general aches and pains.
There are also illness and diseases that are associated with old age, such as dementia and
Alzheimer’s disease. In many African countries, the life span does not extend to old age, and
therefore the number of old people may be fewer than in countries where average life
expectancy reaches early 80s.
 In many African societies, phases of life are marked by different traditions and ceremonies.
When women get older, at approximately age 51, they stop menstruating and can no longer
have children. They take on new roles as mothers, mothers-in-law and grandmothers.
 In rural communities, elderly women may look older than their age, because of overwork and
hardship.
 If their husbands die of old age or illness, women become widows. When widows are elderly,
they usually do not re-marry, but go to reside with their adult children. If no adult children are
living close or nearby, widows may live by themselves, but are often destitute and dependent
on the generosity of their communities. Some elderly women are discriminated against in their
communities because, as they have become older, they are perceived to be more outspoken and
critical. Some are even accused of being “witches” and are outcast from their communities.
 When their husbands die of illness or old age, women are generally not protected by law. The
deceased husband’s relatives may come to take everything away from a new widow, even
things that she bought from her own money. Moreover, she may be blamed for causing her
husband’s death. Widowhood in Africa is very difficult for women, and many become
destitute and marginalized from society.
 In some African societies where HIV is prevalent, grandmothers take care of their orphaned
grandchildren. This is a huge burden for grandmothers, who often do not have enough
resources to support themselves.

 Men do not go through menopause, and thus are able to continue to have children into old age.
If a man’s wife dies of illness or old age, he will probably marry again, perhaps even a younger
woman. He will be expected to have more children with his new wife. It is possible for a man
to have adult and very young children. Because a man has control of resources, such as land,
he can continue to support himself and his family.
 In African society, as men get older, they are sought after to solve cases of dispute and to
provide advice. They remain close to their age mates, are members of community associations
and involved in local politics. Mostly, old men are respected and honoured until they die.
 What are the characteristics of elderly men and women in your community? What are the
differences and what are their causes?
 Identify the elderly women in your community who are most vulnerable. Meet with
community leaders to determine how to protect these women’s livelihoods or to provide better
care.
CHE 254 – CARE OF THE HANDICAPPED
 Many handicapped people are born with their disabilities. However, some boys and girls, men
and women are handicapped after birth. Young men are more prone to becoming epileptic
because they have more head injuries, as a result of accidents. Handicaps also are incurred
because of war or armed strife – men are also more involved in conflict. We tend to see more
boys and men who are handicapped because they are able to get out of the house and access
assistance and services. We tend to see more men in wheelchairs, having paid employment or
their own businesses, than we do women. Handicapped girls and women are often confined to
their homes.
 Women and girls with disabilities are often at greater risk, both within and outside the home of
violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation.
 Less than 5 per cent of children and young persons with disabilities have access to education
and training; and girls and young women face significant barriers to participating in social life
and development.
 People with disabilities in general face difficulties in entering the open labour market, but, seen
from a gender perspective, men with disabilities are almost twice as likely to have jobs as
women with disabilities. When women with disabilities work, they often experience unequal
hiring and promotion standards, unequal access to training and retraining, unequal access to
credit and other productive resources, unequal pay for equal work and occupational
segregation, and they rarely participate in economic decision-making.
 Women with disabilities, of all ages, often have difficulty with physical access to health
services. Women with mental disabilities are particularly vulnerable, while there is limited
understanding, in general, of the broad range of risks to mental health to which women are
disproportionately susceptible as a result of gender discrimination, violence, poverty, armed
conflict, dislocation and other forms of social deprivation.
 What types of handicaps or disabilities do you see in your community? Which handicaps are
more commonly seen in women? In men? Which are common to both? What are the reasons
for these handicaps?

 What is the general perception of handicapped women in your community? Of handicapped
men? How are they accepted by your community?
 What types of assistance do handicapped women receive in your community?
 Identify and integrate handicapped women in the Village Development Committee.
 Encourage ability of multipurpose cooperative societies for the disabled, ensuring equal
participation of handicapped women.
CHE 255 – HEALTH STATISTICS
 If you want to understand the views of everyone in the community, it is important to
understand the issues and concerns of both women and men, and sometimes even girls and
boys. Men and women often see things differently because of their experiences in and outside
the home, their exposure to information, the work they do, and the control they have over
resources and decision-making. This means that both men and women need to be included in
the sample if the views of all members of the community are sought.
 General random sampling will not ensure that you will obtain equal numbers of men and
women. Use methods of sampling that are ensured of collecting data about both women and
men. This may involve random sampling by sex, or purposive sampling.
 When data is being collected, men participate more than women because men are the heads of
the household and have all the information about its members. Often, women are more
involved in household chores and will not come out to talk to strangers. Sometimes women
would have to get permission from men to participate in research studies. Thus, sampling is
usually biased towards men because men can more easily be reached than the women.
 After data is collected, it needs to be coded according to whether the response is from a man or
a woman. Only then can data be disaggregated and cross-tabulated for sex. Data is not usually
disaggregated by sex because the data collector may not understand the need to do so. Many
researchers assume that men and women are the same, have the same ideas, needs and
concerns. However, that is not the case. Many types of research, especially health research,
need to produce information that is used for better planning of health services –for women and
for men.
 When data is interpreted or analysed, it is important to use the sex disaggregated data to
determine whether there are differences between men and women, and the nature of these
differences. For example, you want to know how many boys and girls had malaria in the last
month. If more girls had malaria, it is possible that they are more exposed than boys. Thus,
you may want to investigate family sleeping habits. If you were looking at school enrolment
and discovered that more boys are going to school than girls, you may have to start a girl child
education campaign in the community.
 Demography clearly shows sex and age distribution. In some communities, especially where
there is high migration of men leaving to find work in cities, you may find higher numbers of
children, women and elderly people. This means that your health programme should be
targeted mainly to these groups.
 The importance of doing quality, sex-disaggregated research is essential for community health
workers.
 Why are women not as accessible to research projects as men?

 Why women are usually not represented in sample size?
 Why is data not usually disaggregated by sex?
 What is the importance of sex disaggregation in development planning?
 In data collection women’s opinion should be sought as well as men’s. Suggest that men
should help out with household chores and take care of the children to enable women
participate in data collection and provide information. Ensure that women who want to
participate are encouraged and not sanctioned by their husbands or community for taking part.
Sensitize communities that women’s opinion is vital in health planning.
CHE 244 – COMMUNICABLE AND NON-COMMUNICABLE DISEASES
 Non-communicable diseases are disease processes that are not contagious or transferable
from one human to another. Random genetic abnormalities, heredity, lifestyle or environment
can cause non-communicable diseases, such as cancer, diabetes, asthma, hypertension and
osteoporosis. Autoimmune diseases, trauma, fractures, mental disorders, malnutrition,
poisoning and hormonal conditions are also in the category of non-communicable diseases.
Factors in non-communicable diseases include gender and sex.
 Cancer: Cancer is a non-communicable disease that affects all ages. The three most common
cancers among women in the USA are breast, lung and colorectal. The three most common
cancers among men are prostate, lung and colorectal.
 Diabetes: Diabetes affects the way the body uses blood glucose. Type 1 diabetes develops
when the immune system destroys the insulin-producing cells in the pancreas, allowing a
build-up of glucose in the blood. In type 2 diabetes, the cells resist the insulin and cause an
increase of glucose in the blood. Both men and women in Africa develop diabetes, but more
women are affected because their statistics for obesity are higher than those of men.
 Hypertension: Hypertension is a non-communicable disease diagnosed when the systolic
reading (top number of the blood pressure reading) is consistently higher than 140 and/or the
bottom number, or diastolic reading, registers higher than 90. A blood pressure of 140/90
millimeters of mercury (mmHg) or higher indicates hypertension. Causes of hypertension
include excessive salt intake, smoking, diabetes, obesity and kidney disease. Women are
reported to have better detection, treatment, and control rates than men in some countries in
Africa. A possible explanation for higher detection among women is the increased chances of
having blood pressure measured on contact with a health facility which usually occurs with
pregnancy and related health conditions. Women probably accept more readily the diagnosis of
hypertension even in the absence of symptoms and recognizing the need to stay healthy to
support their families, are more willing to comply with treatment and get controlled.
 Heart Disease: Heart disease is a broad category of non-communicable diseases that affect the
way the heart and circulatory system performs. Heart disease includes rhythm irregularities,
heart attack, congenital heart disease, heart failure, mitral valve prolapse, unstable angina,
mitral stenosis, endocarditis, aortic regurgitation and cardiogenic shock. The misleading
notion that heart disease is not a real problem for women can be blamed in part on medical
research. For a very long time, heart disease studies have focused primarily on men. Changes
are under way, but some doctors still fail to recognize the warning signs displayed by female
patients. Studies have shown that women may have undiagnosed warning signs weeks,
months, and even years before having a heart attack. Significant differences may exist in the

symptoms displayed by women and men. Men typically experience the "classic" heart attack
signs: tightness in the chest, arm pain, and shortness of breath. Women's symptoms may
resemble those of men, but on occasion nausea, an overwhelming fatigue, and dizziness are the
main symptoms and are ignored or chalked up to stress. Women have reported that they have
had a hard time getting their doctors to listen to them about these early warning symptoms.
 Communicable diseases, also known as infectious diseases, are those that can be acquired
from humans and animals through blood, food, air, water, saliva and other forms of contact.
Most diseases are spread through contact or close proximity because the causative bacteria or
viruses are airborne; i.e., they can be expelled from the nose and mouth of the infected person
and inhaled by anyone in the vicinity.
 Sexually Transmitted Infections: Some infective organisms require specific circumstances for
their transmission, e.g., sexual contact in syphilis and gonorrhoea, injury in the presence of
infected soil or dirt in tetanus, infected transfusion blood or medical instruments in serum
hepatitis and sometimes in malaria. Men are more likely to contact STIs communicable
diseases because society permits them to have multiple sexual partners and have authority,
decision making power to take more wives/sexual partners and even economic power (money)
 HIV: In the case of AIDS, while a number of different circumstances will transmit the disease,
each requires the introduction of a contaminant into the bloodstream. HIV is the acronym for
the human immunodeficiency virus. HIV is a slow-acting virus that spreads from person to
person through blood-to-blood contact such as during sexual intercourse and in the sharing of
drug syringes. There are vulnerabilities to HIV that are unique to women. These help to
account for the differences in infection rates between men and women worldwide. Of all adults
living with HIV in sub-Saharan Africa, 61% are women. Some of those vulnerabilities
include:
a. Physical Differences - 70 percent of all new HIV infections are a result of heterosexual
sex; worldwide, 90 percent of all infections are heterosexual. Women are especially
susceptible to heterosexual transmission physically because the mucosal lining of the
vagina offers a large surface area to be exposed to HIV-infected seminal fluid.
b. Easier to Transmit from Men to Women than Women to Men - Again, anatomical
differences between men and women mean transmission from men to women is easier
than the other way around. The mucosal lining of the vagina offers a large surface area
to be exposed to infected seminal fluid. Moreover, the vagina is more susceptible to
small tears and irritation during intercourse than is the penis. These properties offer a
portal for HIV to enter the body and infect the woman.
c. Gender Inequities - Especially in developing countries, prevailing gender inequities
leads to higher-risk behaviors. For instance, in many cultures women are not free to
refuse sex or to insist on safer sex using condoms. Men assume a position of power and
control over women, minimizing the amount of input and consent from women. In
addition, women have less access to employment and education in these developing
countries. Often, the sex trade is one of the few options for women trying to earn
money and support themselves and their children. Finally, sexual violence against
women is very high in some areas, again exposing them to high-risk behaviors without
their consent.
d. Obviously, HIV impacts anyone who has the disease, whether male or female. An HIV
diagnosis, while not a death sentence, will most certainly be a life-changing event.
However, there are some challenges that are unique to women:
e. There is an increased risk of reproductive illnesses including vaginal yeast infections,
pelvic inflammatory disease (PID), Human Papillomavirus (HPV) and cervical cancer.
f. Because women often have lower incomes than men or work lower paying jobs with
minimal benefits, women have less access to HIV care and affordable medical

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