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. 2018 Jul 6;16(1):58.
doi: 10.1186/s12961-018-0338-5.

Gendered health systems: evidence from low- and middle-income countries

Rosemary Morgan  1 , Richard Mangwi Ayiasi  2 , Debjani Barman  3 , Stephen Buzuzi  4 , Charles Ssemugabo  5 , Nkoli Ezumah  6   7 , Asha S George  8 , Kate Hawkins  9 , Xiaoning Hao  10 , Rebecca King  11 , Tianyang Liu  10 , Sassy Molyneux  12   13 , Kelly W Muraya  12 , David Musoke  5 , Tumaini Nyamhanga  14 , Bandeth Ros  15 , Kassimu Tani  16 , Sally Theobald  17 , Sreytouch Vong  15 , Linda Waldman  18
Affiliations

Gendered health systems: evidence from low- and middle-income countries

Rosemary Morgan et al. Health Res Policy Syst. .

Abstract

Background: Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems.

Methods: The research used a combination of mixed, quantitative, qualitative and participatory methods, demonstrating the applicability of diverse research methods for gender and intersectional analysis. Within each study, the researchers adapted and applied a variety of gender and intersectional tools to assist with data collection and analysis, including different gender frameworks. Some researchers used participatory tools, such as photovoice and life histories, to prompt deeper and more personal reflections on gender norms from respondents, whereas others used conventional qualitative methods (in-depth interviews, focus group discussion). Findings from across the studies were reviewed and key themes were extracted and summarised.

Results: Five core themes that cut across the different projects were identified and are reported in this paper as follows: the intersection of gender with other social stratifiers; the importance of male involvement; the influence of gendered social norms on health system structures and processes; reliance on (often female) unpaid carers within the health system; and the role of gender within policy and practice. These themes indicate the relevance of and need for gender analysis within health systems research.

Conclusion: The implications of the diverse examples of gender and health systems research highlighted indicate that policy-makers, health practitioners and others interested in enhancing health system research and delivery have solid grounds to advance their enquiry and that one-size-fits-all heath interventions that ignore gender and intersectionality dimensions require caution. It is essential that we build upon these insights in our efforts and commitment to move towards greater equity both locally and globally.

Keywords: Financing; Gender; Gender analysis; Governance; Health systems research; Human resources for health; Intersectionality; Service delivery.

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Conflict of interest statement

Ethics approval and consent to participate

‘Women and Leadership within the Cambodia Health Sector’ received ethical approval from the Cambodia National Ethic Committee for Health Research. ‘Gender Mainstreaming in the Posting and Deployment of Health Workers in Zimbabwe’ received ethical approval from the Medical Research Council of Zimbabwe (Ref# MRCZ/A/1688). ‘Exploring Gendered Experiences of Community Health Workers using Photovoice in Rural Wakiso District, Uganda’ received ethical approval from Makerere University School of Public Health Higher Degrees, Research and Ethics committee (304). ‘Are the Women of Indian Sundarbans Living in the Dark? An Intersectional Analysis of Eye Health Care Seeking Among the Elderly’ received ethical approval from the Institutional Committee for Ethics and Review Research under Indian Institute of Health Management Research and Department of Health & Family Welfare, Government of West Bengal, India. ‘Gender Analysis of Family Care for the Elderly: Evidence from Beijing, China’ received ethical approval from the China National Health Development Research Center Review Board. ‘Strengthening Male Involvement in Prevention of Mother-to-Child Transmission of HIV in Enugu State, Nigeria’ received ethical approval from the University of Nigeria Teaching Hospital, Ituku –Ozalla, Enugu, Nigeria, Reference UNTH/F. No 5418/05/06. ‘Male Involvement in the National Health Insurance Fund/Kreditanstalt für Wiederaufbau Prepaid Insurance Card for Pregnant Women in Pangani District, Tanzania’ received ethical approval from the Ifakara Health Institute Review Board with reference number IHI/IRB/No:35-2015. ‘Mainstreaming Gender into PMTCT Guidelines in Tanzania’ received ethical approval from the Directorate of Research and Publications of the Muhimbili University of Health and Allied Sciences. All participants provided written informed consent before participation in the studies.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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