1
Gender Integration in Quality Improvement
Taroub Harb Faramand, MD, MPH
President
WI-HER, LLC
USAID Applying Science to Strengthen
and Improve Systems Project
USAID Applying Science to Strengthen and Improve Systems
ASSIST Gender Integration Strategy
Build local capacity and foster local partnerships
Integrate gender in improvement activities
Document and share learning through knowledge management strategies and research
Scale up and institutionalize
USAID Applying Science to Strengthen and Improve Systems
Tuberculosis Treatment Success in Swaziland
The Power of Data
USAID Applying Science to Strengthen and Improve Systems
The Power of Data
USAID Applying Science to Strengthen and Improve Systems
Results-Disaggregated by Sex
USAID Applying Science to Strengthen and Improve Systems
Science of Improvement
• The Science underlying improvement draws on psychology, adult learning, organizational behavior and statistical analysis of variation and is grounded in a systems understanding of work.
• The fundamental concept of improvement is that improvement requires change
• Not every change leads to improvement, we therefore study and act
6
USAID Applying Science to Strengthen and Improve Systems
Testing Changes
Identify gender gaps and issues affecting health outcomes
Analyze gender constraints, social political affecting health
outcomes
Develop activities to address issues and test changes
USAID Applying Science to Strengthen and Improve Systems
Example: Male Participation in Prevention of Mother-to-child transmission (PMTCT) of HIV
Improve PMTCT Services
Tradition and culture
Aim Primary Driver
Knowledge about PMTCT
One education sessions during work hours
Lack of Male participationReproductive health issues are “women’s responsibilities”
Secondary Drivers Illustrative Activities
• Education on how men’s health affects wives and children
• Community/ religious leaders’ announcements
• Facilities sent invitations to men
• Education sessions held 3 times
• Women accompanied by a partner are seen first
Taroub Harb Faramand MD, MPHWI-HER LLC
Staff unfriendly towards men
USAID Applying Science to Strengthen and Improve Systems9
Ivukula Health Facility-Eastern UgandaGender Integration
USAID Applying Science to Strengthen and Improve Systems
Ivukula Health Facility-Eastern UgandaGender Integration
Changes tested:
• Involve male community leaders/volunteer health workers
• Utilize family support groups• Combine education sessions• Involve fathers in child health• Offer priority to couples and
male-focused services
USAID Applying Science to Strengthen and Improve Systems
Proud Team: 100% Retention in CareIvukula Health Facility-Eastern Uganda
Joyce Draru, QI Advisor, ASSIST & QI team Maria Nakato and Teopista Bamuleese.
Twelve-month results showing 100% retention of mother-baby pairs in care.
Enable—Engage—Exemplify—Encourage
USAID Applying Science to Strengthen and Improve Systems
Uganda results: Retention of mother-baby pairs in treatment
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
No. MB pairs who came in the month
11 12 12 15 19 18 25 15 22 24 29 31 28
No. of MB who should be ac-cessing care
27 28 28 29 29 29 31 30 32 35 34 35 31
Percentage re-tained
40.740740740
7408
42.857142857
1424
43 52 65.517241379
3107
62.068965517
2414
80.645161290
3226
50 69 68.571428571
4281
85.294117647
0588
88.571428571
4281
90
500%
1500%
2500%
3500%
4500%
5500%
6500%
7500%
8500%
9500%
Started improvement work
One service point, pairing mother and baby cards, same appointment date,
involve men
Synchronized appointments for family support group meetings and clinic ap-
pointments. Tagged MB pair appointment dates to male partners' appointment dates
for clinic visits
Repackaged the health care talks to focus on roles of male partners in PMTCT
Percentage of mother-baby pairs retained in care at Ivukula HCIII, February 2013- February 2014
USAID Applying Science to Strengthen and Improve Systems
Uganda: changes tested to integrate gender in VMMC
• Train on importance of gender in SMC• Talking points to mobilize partners• Document partner participation • Friendly clinics for women and men• Collaborate with other organizations• Technical brief to give more information
to staff• Services provided for women• Male champions in communities
Since the SMC gender component was introduced, improved outcomes have been documented
Client register showing services offered to partners
USAID Applying Science to Strengthen and Improve Systems
Uganda results: Gender integration in VMMC
14
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14
# attend with part-ners at HCIV
0 0 0 0 0 0 36 61 54 29 59 23 38 72
%age at-tend with partners at HCIV
0 0 0 0 0 0 7.0726915520628
8
15.561224489795
9
14.323607427055
7
28.431372549019
6
25.991189427312
8
30.263157894736
8
29.921259842519
7
31.578947368421
%age at-tend with partners at 18 sites
0 0 0 0 14.686248331108
2
13.274336283185
8
15.047879616963
1
14.957264957265
12.662090007627
8
16.706730769230
8
18.960674157303
3
7.6190476190476
2
8.0763582966226
2
24.534769833496
6
# with partners at HCIV
0 0 0 0 0 0 509 392 377 102 227 76 127 228
# attend with part-ners at 18 sites
0 0 0 0 110 60 110 175 166 278 135 72 110 501
# with partners at 18 sites
81 41 30 77 749 452 731 1170 1311 1664 712 945 1362 2042
500%
2500%
4500%
6500%
8500%
Percentage of SMC clients that attend with their partners at 18 sites and at Buyinja HCIV
Collaboration with Marie Stopes to pro-vide cancer screening
Start of gender integration
USAID Applying Science to Strengthen and Improve Systems
Uganda results: Gender integration in VMMC
15
O-12 N-12 D-12 J-13 F-13 M-13 A-13 M-13 J-13 J-13 A-13 S-13 O-13 N-13 D-13 J-14 F-14 M-14
Percentage that return within 48 hrs post operation
57.538237436271
58.9937973811164
37.542662116041
18.0035650623886
60.4102564102561
33.9651957737725
32.7522710532774
36.3827349121467
57.6546612182834
69.3173565722585
66.7374500976811
67.5819754576539
78.4907790741438
82.0609926250748
88.7388244245768
86.3944138806602
84.3083545294463
98.1481481481482
Percentage that return after 1 week follow up
54.4404973357015
56.0521415270019
30.8392315470172
58.8607594936709
44.9320148331273
46.9003400470835
25.4746136865342
13.16766343576
29.1434421567512
42.6766449606373
33.2138895998631
32.6692826240064
51.8819334389858
55.8811802232852
64.1527355623093
61.5742699957679
62.646828504307
94.3396226415094
Percentage that return after 6 weeks
0 0 0 0 0 30.168034388433
4.06032482598608
1.57582298974636
4.58235140089029
13.4956224642323
6.31871311190835
6.35549072723484
12.7215439149271
25.3593429158111
31.2376779846659
16.2724692526017
5.43283582089549
NaN
500%
1500%
2500%
3500%
4500%
5500%
6500%
7500%
8500%
9500%
Percentage of male circumcision clients who attend follow up visits at 48 hours, 1 week, and 6 weeks after surgery
Axis Title
Female partnerinvolvement
USAID Applying Science to Strengthen and Improve Systems
Changing Behavior
USAID Applying Science to Strengthen and Improve Systems
Gender Integration and QI
• Focus on Outcomes• Systematic & Efficient• Regular monitoring• Systems and Processes• Test, adjust and scale• Change from within • Research operationalized• Less resistance to gender• Simple, clear & practical• Learning & Sharing• Team work• Country ownership• Leadership
USAID Applying Science to Strengthen and Improve Systems
For more information about gender integration in quality improvement
please contact:
Taroub Harb Faramand: [email protected]
or Elizabeth Romanoff Silva: [email protected]
Learn more about our gender work through the USAID ASSIST project on our new knowledge portal at:
www.usaidassist.org/topics/gender