Gender analysis tool for ITN distribution: Section Two – Maintaining a gender lens during macroplanning

As well as using the information and considerations from the "Context" worksheet, there are other specific considerations to take into account when developing the ITN distributions and the respective plan of action. The following set of questions can help ensure a gender lens to the distribution’s plan of action.

Malaria burden by gender and by age group

If there is a large disparity in the malaria burden borne by a gender/age group, it is important to assess the cause of this disparity and discuss whether the issue can be addressed during ITN distributions, or whether this will require longer term solutions for national malaria programmes that can be developed post campaign. Some of the causes may be beyond the scope of an ITN mass campaign, such as when there are no laws protecting women, or when cultural norms dictate specific roles for different genders. While these types of barriers may be beyond the roles and responsibilities of the national malaria programme and partners, they should still be identified and addressed by the relevant stakeholders as part of a strategy to advocate for relevant change that will increase sustainable access to malaria prevention, diagnosis and treatment services.

Other barriers can be directly linked to access issues such as insufficient ITNs in the household, or households not receiving key malaria information and these should be addressed in the ITN campaigns.

Considerations

If the malaria burden is higher amongst one group than another, undertake a detailed analysis to understand the root causes of this disparity. Knowing the causes can help national malaria programmes and partners design activities to overcome some of these barriers. Activities can include:

• Strengthening SBC messaging to raise awareness that everyone is vulnerable to malaria, especially pregnant women and children under five.
• Employing communication channels that are being used by both men and women to ensure that both genders have equal access to the information. (See the section on “social and behaviour change” which addresses “equitable” access to information.)

When developing specific programmes and activities to address women’s malaria burden, national malaria programmes should ensure that men are not disadvantaged by these programmes, i.e. activities should benefit women without making men more vulnerable to malaria. For example, only distributing ITNs to women might mean that men will not be protected from malaria at night.

Some of the root causes of the malaria burden might be beyond the scope of the ITN distributions or the role and responsibilities of the national malaria programme. In this case, the national malaria programme and partners should collaborate with the Ministry for Women/Gender (or equivalent) and other partners that work for gender equality to address any issues/barriers that need a longer-term programme.

Considerations

Adolescent boys are often overlooked for prevention activities because of a perceived “reduced” vulnerability to malaria. If malaria is significantly higher amongst adolescent boys than other groups, then consider:

• Strengthening SBC messages to raise awareness that malaria affects everyone and that all household members should sleep under an ITN every night of the year.
• Researching whether adolescent boys are missing out on ITNs because there are not enough ITNs to cover all household members. In which case, ensure that the strategy is about reaching all targeted households with sufficient ITNs. This could mean (amongst other things) increased social mobilization, better quantification, improved microplanning and/or improved household registration.

Considerations

Most malaria programmes (including ITN distribution and SMC campaigns) target all children under five, as they represent one of the most vulnerable groups to malaria. If there is a disparity in the malaria burden between girls and boys that are under five years of age, it is critical that the national malaria programme and partners undertake a detailed analysis of the causes of this disparity. The national malaria programme can then develop a short- and long-term strategy on how to overcome this disparity. It is important to note that some of the root causes may be beyond the capacity of the ITN campaigns (e.g. if the root cause is culturally accepted sleeping patterns for boys vs. girls). The national malaria programme should seek the support of partners working specifically with children to see how these issues can be addressed.

Access to ITN

If there is a large disparity in access to ITNs within a household, it is important to assess the cause of this disparity. Some of the causes may be culturally related and may require a longer-term SBC strategy to change behaviour. Some of the causes may be beyond the scope of the ITN distribution, such as when cultural norms dictate specific roles for different genders. This kind of issue should still be raised to the relevant stakeholders as part of a strategy to advocate for relevant change that will increase sustainable access to ITNs in the long term. Other causes may be more immediate and should be addressed directly as part of the ITN distribution. They may include, for example, insufficient ITNs to cover the household, perception or beliefs that malaria only affects certain groups, etc.

Considerations

When it comes to ITN use, adolescent boys are often left out because of perceived reduced vulnerability to diseases such as malaria. If the ITN access:use ratio is high, this will most likely mean that ITN use amongst adolescent boys will increase. This should, however, be confirmed by looking at the trend of use when access is high, as compared to when access is low. The strategy should therefore be to ensure that HHs receive sufficient ITNs to cover all members, including eliminating “capping” as much as possible. The strategy should also include a strong SBC component that promotes the need for everyone in the household to be sleeping under ITNs every night of the year.

Considerations

Many countries specifically target children under five years of age for routine ITN distribution through EPI campaigns. There is also very often considerable SBC messaging about vulnerability to malaria of children under five and the need for them to sleep under an ITN every night.

A disparity in ITN access between girls and boys under five could signify barriers that are preventing one gender from having equitable access to ITNs. The national malaria programme should undertake further research to understand the root cause of this disparity.

Access to malaria diagnosis and treatment

If there is a large disparity in access to malaria diagnosis and treatment between genders it is important to assess the cause of this disparity. Some of the barriers to malaria diagnosis and treatment may be beyond the scope of the ITN distribution, such as geographical access to health facilities or national health protocols, and will require the development of long-term programmes for which the national malaria programme can advocate. Some of the causes should be directly addressed during the ITN distribution, such as providing key information to correct misinformation about malaria, diagnosis and treatment.

Considerations

Women often do not have access to prevention, diagnosis and treatment measures for various reasons, including their social status in the family/community, lack of self-efficacy, economic hardship, social norms, insecurity etc.

Human resources

It is important for all members of the targeted groups, irrespective of their gender, to implement positive ITN use, care and maintenance behaviour. Part of realizing this is to ensure that all targeted groups have “equitable” access to the necessary resources: ITNs, diagnosis and treatment, as well as the accompanying up-to-date information.

Considerations

It is important to understand the reason why campaign workers may not have access to a household. It is also important that households are reached with ITNs and key messages. In this respect, consider collaborating with partners who have existing programmes and activities that reach affected women to ensure that all HHs are registered, receive nets and receive correct ITN use, care and maintenance messages.

Considerations

Assess how the campaign will be affected if male campaign workers do not have access to compounds. Can this mean that some HHs within some compounds are not registered? If there are certain risks to the quality of campaign implementation because men do not have access to compounds, consider recruiting sufficient women to have mixed campaign field teams, or where that is not possible, collaborating with partners who have a pool of female workers that can go to the field for HHR, distribution and SBC activities.

Social and behaviour change

Considerations

It is critical that both men and women have equitable access to information on the ITN distribution, ITNs, and how to correctly use, care for and maintain them.

While it may not be cost-effective to engage all preferred communication channels before, during and after the ITN campaign, it is critical to ensure that one gender is not disadvantaged by a lack of information because planning did not consider how communities get their information.

Considerations

While male workers may have access to females in a households, it may be culturally or socially unacceptable for them to be openly speaking to women from the community. If this is the case, consider recruiting sufficient women to have mixed teams, or where that is not possible (or where that will not resolve the issue), collaborating with partners who have a pool of female workers that can safely engage with women from a household.

Security and freedom of movement

The varying levels of insecurity caused by conflict or the threat of conflict can severely restrict the movement of ITN distribution workers and community members. Sometimes these restrictions can affect one gender more than the other. Women are usually more restricted/vulnerable when it comes to movement in an insecure environment because of social structure, lack of laws to protect women and children, lack of law enforcement, etc. Men can also be a major target in insecure settings if they are seen as a physical threat to parties in the conflict or for forced recruitment.

Considerations

Where one gender is more likely to be a victim to insecurity (including GBV), consider what strategy should be used to distribute ITNs to households without compromising the safety of household members.

This can mean (amongst other things):

• Encouraging only the gender that is not targeted to come and pick up ITNs from fixed distribution points. Even if this is the chosen strategy, strengthen SBC messaging to ensure that both genders have equal access and use of the ITNs within the household
• Implementing door-to-door distribution with workers distributing ITNs to the target group directly at their household
• Increasing security measures by advocating for support from security forces (government forces and/or opposition/rebel groups etc.) to allow household members access to distribution points

Considerations

The safety and security of ITN campaign workers is critical. In certain areas, one gender may be more at risk than others. Examples can include:

• During the conflict in DRC, many women were survivors of rape which was being used as a weapon of war.
• In northern Cameroon, young males were being forcibly recruited by rebel groups.

Recruitment of field level staff should take this into account. In addition, national malaria programmes and partners are encouraged to:

• Include security and safety awareness as part of the training (especially for staff that will be out in the field). Collaborate with the security departments to develop this training module.
• Advocate for support from (1) federal and local security forces to reinforce security measures during field activity and/or (2) advocate with opposition forces/rebel groups for safe access to communities.

Routine distribution of ITNs through ANC and EPI is a good strategy to ensure that PW and children under five (who are most vulnerable to the dangers of malaria) receive ITNs as a means of protection. Routine distribution also contributes to ITN coverage at the household level.

Routine distribution of ITNs through ANC and EPI is a good strategy to ensure that PW and children under five (who are most vulnerable to the dangers of malaria) receive ITNs as a means of protection. Routine distribution also contributes to ITN coverage at the household level.

Considerations

If pregnant women and caregivers of children do not have safe access to health facilities, then they will not be able to access their ITNs through this routine channel. The national malaria programme and partners should consider alternative strategies to ensure that they are covered with ITNs, including:

• Developing an outreach programme for ANC and EPI which includes delivery of ITNs at community level
• Implementing community-based distribution for PW and children under five through existing community structures such as village chiefs, CBOs, religious organizations etc.
• Collaborating with NGOs (especially those that are focused on maternal and child health) who are already operational in the conflict area to distribute the ITNs to PW and children under five. This can include National Red Cross Red Crescent Societies, international NGOs such as Save the Children, CBOs etc.

Control over assets

ITNs are an asset for the household, they help ensure a healthy family whose members are able to work and study effectively. Gender disparity on who has decision-making power over how assets are utilized can result in unequal access to ITNs within the household. To maximize the protection that ITNs provide against malaria, it is important that everyone within the household and community is sleeping under ITNs every night of the year. Therefore, ensuring access to ITNs (whether physical, social or economic) within the household should be one of the primary objectives of ITN distributions.

If there is a disparity in which gender/age group has access to an ITN every night of the year, the national malaria programme and partners should assess what is the root cause of this disparity.

If the root cause is cultural, then consider strengthening SBC activities and messages on 1) the need for all household members to sleep under an ITN every night of the year and 2) making ITN use the responsibility of the whole family. As an example, posters can show both parents hanging the ITNs over their children’s sleeping space or hanging the ITN to dry in the shade.

If the root cause is because of insufficient ITNs, then review whether the methodology for macro and micro quantification as well as any capping (if that is the chosen strategy) may contribute to this disparity. Ensure that the microplanning process is strengthened to improve operational quantification and plans.

Digitalization

ITN distributions are increasingly becoming digitalized, helping to improve efficiency and accountability. Ownership of smartphones and tablets, however, and the knowledge of how to use them, are sometimes not the same across genders. This results in one gender not being able to take advantage of the benefits provided by digitalization, including participating as distribution actors or receiving key distribution information being disseminated using this channel.

Considerations

If women’s ownership/use of digital tools and services (including mobile phones, smartphones, internet and social media) in the targeted area are low or significantly less than those of men, consider how these tools will be used for distribution activities to ensure equitable access to services. As examples, if women’s ownership, knowledge and use of mobile phones is significantly lower than those of men, they may:

1. Not get equal access to information if key campaign messages are being sent via SMS.
2. Be disadvantaged as campaign staff and volunteers if smartphones are being used as a key tool for implementation.

Where distributions are being digitalized, consider whether extra time should be spent in training or providing additional on-the-job mentoring to female workers, if they are not as familiar with digital devices as their male counterparts.

Refrain from using digital tools to pass on key information to communities if you know that women do not have equal access to digital tools. Where digitalization of the distribution includes sharing key messages via digital tools, consider parallel SBC activities that use other communication channels and ensure that women in communities are getting the same messages as men.