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.