Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Taroub Harb Faramand_5.6.14

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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


Tuberculosis Treatment Success in Swaziland

The Power of Data


The Power of Data


Results-Disaggregated by Sex


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

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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


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


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


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


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


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


Uganda results: Gender integration in VMMC

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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


Uganda results: Gender integration in VMMC

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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


Changing Behavior


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


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

Health & Medicine

Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Taroub Harb Faramand_5.6.14