This document discusses integrating gender into monitoring and evaluation of health programs. It begins by defining sex and gender, explaining that gender refers to societal roles and relationships between women and men. Gender inequality impacts health outcomes and health care utilization. New global priorities emphasize addressing gender in health programs and policies. Effective monitoring and evaluation requires collecting sex-disaggregated data and gender-related indicators to understand impacts on women and men and progress toward gender equality. Resources and tools are available to help strengthen gender-sensitive monitoring and evaluation.

1. Getting the G into M&E
Gender and Monitoring and Evaluation
Shelah Bloom, ScD

2. Overview
 Gender—what are we talking about?
 Why gender and health?
 New strategic developments
 Health programming models
 Getting the G into M&E

3. Definitions1
Sex: Biological
difference
between males &
females
1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

4. Definitions1
Gender: Beliefs about the
appropriate roles, duties, rights,
responsibilities, accepted
behaviors, opportunities and
status of women and men, in
relation to one another
Vary between places & change
over time in the same place
1 WHO 2009: Integrating gender into HIV/AIDS programmes in the
health sector

5. Definitions1
 Gender Equality
 Equal treatment in laws and policies,
equal access to health resources and
services within families, communities
and society at large
 Gender Equity
 Absence of unfair/avoidable or
preventable differences in health
between women and men.
 Accounting for different barriers
affecting women and men in benefiting
from health-care programs
1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

6. Gender inequality is
the most pervasive
form of social
inequality
Gender inequality
cuts across all
other forms such
as class, caste,
race and
ethnicity1
1 WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector

7. Why Gender?
 Gender inequality influences
 Higher child mortality, rates of stunting and wasting
 Lower rates of health care utilization for maternal, child,
and reproductive health services (including STI/HIV)
 Higher maternal mortality
 Higher GBV
 Gender Inequality recognized as driver of the AIDS
pandemic

8. Why Gender?
 Gender inequality index (75 countries)
 Low birth weight, higher fertility, infant & <5 mortality1
 Lower women’s empowerment
 Trafficked FSWs , increased HIV risk in India2
 Decreased use of maternal health services in India3
 Increased neonatal mortality in Bangladesh4
 Increased family planning use in Ghana5
 Increased wasting in 6 African countries6
1Varkey et al. 2010;2 Silverman et al., 32011;Bloom et. al, 2001,
4Hossain et al., 2007 5 Norwood 2011; 6Singh et al. 2011

9. New Strategic Developments

10. Addressing gender is a global priority

11. Addressing Gender in Health Programs

12. Addressing Gender in health programs:
Gender integration continuum1
1USAID Training of Trainers: Gender and Reproductive Health 101

13. Accommodating or Transformative?

14. Accommodating or Transformative?

15. Addressing Gender in health programs:
Gender-Based Analysis1
 Analyze: gender differentials
 Health status & determinants
 Care utilization needs
 Ability to pay
 Participation of in health management
 Gender-related influences, omissions & implications
in health policy, programming & planning
 Leads to addressing gender explicitly
1PAHO (2009). Guidelines for gender-
based analysis of health data for
decision making. PAHO.

16. GBA Data requirements 1
 Quantitative
 Collecting, reporting & analyzing sex
disaggregated
 Socioeconomic determinants
 Gender measures
 Qualitative
 Personal experiences and perspectives,
motivations, attitudes, behaviors, choices etc.
 Gets to the why of what quantitative data shows
but often cannot explain
1PAHO (2009). Guidelines for gender-
based analysis of health data for
decision making. PAHO.

17. Getting the G into M&E

18. Monitoring
 Indicators that measure gender-specific outputs
 Indicators that track progress and effectiveness of
gender-specific elements of programming
 Disaggregated data collection and analyses
 Data collection in areas such as attitudes and
behavior that reflect gender norms
USAID IGWG 2009, A manual for integrating gender into
reproductive health and HIV programs

19. Evaluation
 Measuring impact on outcomes that relate to gender-
specific programming
 Elements that address gender equality
 Data used to demonstrate progress and impact,
influences demand for richer data
USAID IGWG 2009, A manual for integrating gender into
reproductive health and HIV programs

20. Measuring Gender
 Sex disaggregated data: differentials in disease
incidence/prevalence and service utilization/delivery
 Complex construct unlike many risk factors
 Gender equality measures that have been used for quantitative
analyses in HIV/AIDS studies
 Norms for women and men, including attitudes about gender-
based violence (GBV)
 Beliefs about roles
 Relationship factors
 Women’s autonomy—decision making power in various areas
 Independent access to economic resources
 Experience of GBV

21. Example of complex gender equality
measure: GEM Scale
 Objective is to measure attitudes towards gender
norms in intimate relationships among men
 Used to predict multiple partners & IPV in varied
contexts (Brazil, India, China, Uganda etc.)
 24 items, 2 sub scales: Inequitable gender norms,
Equitable gender norms
 Requires asking 24 (can be more or less, depending
on context) items, then performing a statistical
analysis

22. Sample Indicators
 Gender Equality Measures
Proportion of people who say that wife beating is an acceptable way
for husbands to discipline their wives
Numerator: Number of respondents in an area (region, community,
country) who respond "yes" to any of the following questions:
Sometimes a husband is annoyed or angered by things that his wife
does. In your opinion, is a husband justified in hitting or beating his
wife if
 she is unfaithful to him
 disobeys her husband
 argues with him
 refuses to have sex with him
 does not do the housework adequately
Denominator: Total number of people surveyed

23. Gender and Health M&E:
Basics
 How can health information systems
address gender inequality? 1
 Involvement of stakeholders at all levels
 Sex-disaggregated data
 Ongoing gender training for M&E system staff
 Gender-integrated M&E plans
1Payne, Sarah (2009). How can gender
equity be addressed through health
systems? WHO, policy brief #12

24. MEASURE Evaluation
 Provide M&E CBT to improve gender data use
 Improve existing data use, new data collection to
capture gender-related effects of programs and
policies
 Research to improve evidence demonstrating effects
of gender on health programming and policy
 Global collaboration to promote knowledge base of
gender M&E

25. Capacity building & training
 Regional M&E trainings: Gender module
 Tailored to region, context (PHN/HIV)
 Understanding gender basics
 Applied gender concepts
 Integrating gender into M&E plans
 Used in India, Senegal (French), Nigeria, South Africa
 Online module

26. Existing Data Use
 Know your HIV/AIDS epidemic from a gender
perspective: Rwanda
 Objectives
 Illuminate gender effects on programmatic response
 Generate demand for richer gender-related data
 Assess existing national level data for potential
 Analyses using gender indicators (menu of options) &
show gender effects
 Enhance data use with tool

27. Research to improve evidence
 WJEI: Benin, Kenya, South Africa, Zambia
 GBV initiative
 Qualitative evaluation
 Influences on design, implementation
 Effects

28. Global Collaboration
 Global AIDS Response Reporting
 “Gender Indicator” wanted
 Prevalence of Recent Intimate Partner
Violence (IPV)
Numerator: Women 15-49, have/had intimate
partner, reporting physical or sexual violence in
past 12 months
Denominator Total women surveyed aged 15-49
who currently have or had an intimate partner

29. Gender M&E Resources and Tools

30. Gender M&E Resources and Tools
 VAW/G compendium
 Gender scales
 http://www.c-changeprogram.org/content/gender-scales-
compendium/index.html
 K4 Health IGWG Gender and Health Toolkit
 http://www.k4health.org/toolkits/igwg-gender
 MEASURE Evaluation gender website:
http://www.cpc.unc.edu/measure/our-work/gender

31. Gender M&E Resources and Tools:
Coming soon
 Gender and HIV indicator menu of options
 Set of harmonized, agreed-on indicators
 TAG includes USG (PEPFAR USAID), UN
(UNWomen UNAIDS, WHO, UNFPA), World
Bank, GFATM & other experts
 Resource guide for gender data and
statistics (WHO, IGWG/USAID & MEASURE
Evaluation)

33. MEASURE Evaluation is a MEASURE project funded by the
U.S. Agency for International Development and implemented by
the Carolina Population Center at the University of North Carolina
at Chapel Hill in partnership with Futures Group International,
ICF Macro, John Snow, Inc., Management Sciences for Health,
and Tulane University. Views expressed in this presentation do not
necessarily reflect the views of USAID or the U.S. Government.
MEASURE Evaluation is the USAID Global Health Bureau's
primary vehicle for supporting improvements in monitoring and
evaluation in population, health and nutrition worldwide.