Gender analysis tool for ITN distribution: Section One – Gender within the operational context

Completing the following section will help national malaria programmes understand the gender context in their country, or in the area targeted for the particular campaign, and how this will (or should or can) influence campaign planning and implementation. It must be noted that even if gender is not an "issue" for the national malaria programme or the ITN campaigns, it should be taken as an "opportunity" to reinforce and strengthen women’s contribution to campaign planning and implementation.

To complete this section, national malaria programmes will need to access health and demographics data that can often be found using health national health surveys (example, the Demographics and Health Survey (DHS) programme, the malaria indicator survey etc). Many organisations have regrouped the different data sources (for national level) and these can be find on various websites, including:

From the UNDP website:

• https://hdr.undp.org/data-center/documentation-and-downloads)
• Table 4: Gender development index The women’s empowerment dashboard can be found at https://hdr.undp.org/womens-empowerment

From the UNICEF website:

• https://data.unicef.org/resources/resource-type/country-profiles/

From USAID:

• The USAID Women’s Empowerment and Equality dashboard can be accessed at https://idea.usaid.gov/women-e3
• The DHS programme Gender dashboard: https://dhsprogram.com/data/visualizations/gender-dashboard.cfm

CONSIDERATIONS FOR PREGNANT WOMEN

Pregnant women (PW) and children under five are more vulnerable to malaria. Their needs, and ensuring they have access to ITNs should be considered as a priority when developing the ITN distribution strategy.

Routine distribution through ANC and EPI can help ensure that PW and children under five are receiving ITNs and other critical health interventions (intermittent preventive treatment [IPTp], seasonal malaria chemoprevention [SMC] etc.) but it is important that this target group:

• Is sleeping under these ITNs every night of the year when the ITN is taken to the household
• Have safe access to these routine distribution channels when they need them

To complete this section, national malaria programmes will need to access health and demographics data that can often be found using health national health surveys (example, the Demographics and Health Survey (DHS) programme, the malaria indicator survey etc). Many organisations have regrouped the different data sources (for national level) and these can be find on various websites, including:

From the UNDP website:

• https://hdr.undp.org/data-center/documentation-and-downloads)
• Table 4: Gender development index The women’s empowerment dashboard can be found at https://hdr.undp.org/womens-empowerment

From the UNICEF website:

• https://data.unicef.org/resources/resource-type/country-profiles/

From USAID:

• The USAID Women’s Empowerment and Equality dashboard can be accessed at https://idea.usaid.gov/women-e3
• The DHS programme Gender dashboard: https://dhsprogram.com/data/visualizations/gender-dashboard.cfm

A lot of these indicators can be found on national health surveys such as DHS. A lot of the information has also been aggregated and can be found on the UNICEF website.

CONSIDERATIONS

Women’s access (or lack thereof) to professional healthcare is a good indication of their vulnerability to diseases such as malaria. Access to professional healthcare can ensure good health for both women and their children and ensure that they are able to contribute to the development of their communities and reduce household medical expenditure.

PW are more vulnerable to malaria and part of antenatal care is to ensure that they are protected through intermittent preventive treatment (IPTp). Many countries also use ANC visits as a routine ITN distribution channel, targeting PW specifically.

Where women have poor access to professional healthcare services (whether through physical or socio-economic access), it is even more important to ensure that they have access to malaria prevention measures such as ITNs in the short term. Longer term programmes need to include activities that can support sustainable access to services and commodities.

The following indicators from UNDP’s Women’s Empowerment dashboard can help identify gender development in your country as compared to others. Three-colour coding is used to visualize partial grouping of countries by indicator. For each indicator countries are divided into three groups of approximately equal size (terciles): the top third, the middle third and the bottom third. Please refer to the dashboard: https://hdr.undp.org/womens-empowerment.

GREEN: Women in your country are likely to have high access to healthcare and sexual health services. For pregnant women, this may indicate that they are receiving all doses of IPTps and if your country has a functioning routine distribution system, access to ITNs. This may indicate that pregnant women are well protected against malaria.

YELLOW: Women in your country may not have high access to healthcare and sexual health services. Depending on the actual % of pregnant women attending all four antenatal visits, this may mean that pregnant women may not be effectively protected against malaria during their pregnancy. Your ITN mass distribution might benefit from a strategy that specifically targets pregnant women, example: providing one extra ITN for all households with a pregnant women and/or robust SBC on the dangers of malaria during pregnancy.

ORANGE: It seems that women in your country may not have good access to healthcare and sexual health services. It is critical that one of the objectives of your ITN campaign is to target pregnant women, example: providing one extra ITN for all households with a pregnant woman and/or robust SBC on the dangers of malaria during pregnancy. It is critical that your SBC messages reach not only pregnant women, but also husbands, mother in laws, and head of households.

GREEN: Women in your country are likely to have high access to healthcare and sexual health services. For pregnant women, this may indicate that they are receiving all doses of IPTps and if your country has a functioning routine distribution system, access to ITNs. This may indicate that pregnant women are well protected against malaria.

YELLOW: Women in your country may not have high access to healthcare and sexual health services. Depending on the actual % of pregnant women attending all four antenatal visits, this may mean that pregnant women may not be effectively protected against malaria during their pregnancy. Your ITN mass distribution might benefit from a strategy that specifically targets pregnant women, example: providing one extra ITN for all households with a pregnant women and/or robust SBC on the dangers of malaria during pregnancy.

ORANGE: It seems that women in your country may not have good access to healthcare and sexual health services. It is critical that one of the objectives of your ITN campaign is to target pregnant women, example: providing one extra ITN for all households with a pregnant woman and/or robust SBC on the dangers of malaria during pregnancy. It is critical that your SBC messages reach not only pregnant women, but also husbands, mother in laws, and head of households.

GREEN: Women in your country are likely to have high access to healthcare and sexual health services. For pregnant women, this may indicate that they are receiving all doses of IPTps and if your country has a functioning routine distribution system, access to ITNs. This may indicate that pregnant women are well protected against malaria.

YELLOW: Women in your country may not have high access to healthcare and sexual health services. Depending on the actual % of pregnant women attending all four antenatal visits, this may mean that pregnant women may not be effectively protected against malaria during their pregnancy. Your ITN mass distribution might benefit from a strategy that specifically targets pregnant women, example: providing one extra ITN for all households with a pregnant women and/or robust SBC on the dangers of malaria during pregnancy.

ORANGE: It seems that women in your country may not have good access to healthcare and sexual health services. It is critical that one of the objectives of your ITN campaign is to target pregnant women, example: providing one extra ITN for all households with a pregnant woman and/or robust SBC on the dangers of malaria during pregnancy. It is critical that your SBC messages reach not only pregnant women, but also husbands, mother in laws, and head of households.

To complete this section, national malaria programmes will need to access health and demographics data that can often be found using health national health surveys (example, the Demographics and Health Survey (DHS) programme, the malaria indicator survey etc). Many organisations have regrouped the different data sources (for national level) and these can be find on various websites, including:

From the UNDP website:

• https://hdr.undp.org/data-center/documentation-and-downloads)
• Table 4: Gender development index The women’s empowerment dashboard can be found at https://hdr.undp.org/womens-empowerment

From the UNICEF website:

• https://data.unicef.org/resources/resource-type/country-profiles/

From USAID:

• The USAID Women’s Empowerment and Equality dashboard can be accessed at https://idea.usaid.gov/women-e3
• The DHS programme Gender dashboard: https://dhsprogram.com/data/visualizations/gender-dashboard.cfm

It is important to ensure that women and men have equitable access to information on malaria and the ITN campaign. It is therefore important to use communication channels and tools that ensure that both genders are receiving key information about malaria, campaign dates, channels and ITNs. As an example, if literacy rates are lower amongst women, consider reducing the use of written materials to disseminate key information, or implement parallel communication activities that are more accessible to women, ensuring that both men and women are receiving key information.

The DHS programme can provide key information on education within your country.

CONSIDERATIONS

Women’s education can directly determine their access to information, and thus, their access to health services and commodities (including ITNs and IPTp). If information is shared in written format only, many women may miss out on critical information that can affect their health and well-being.

Where a large percentage of women have attended university, the national malaria programmes should look at whether this percentage is also reflected within their own organization or campaign structure.

Education Attainment

In addition, by comparing education attainment we can see where there is a disparity between genders when it comes to education.

Below 10% or -10% difference: There are no significant differences between men and women when it comes to no education attainment. If a large % of the population has no education (please see E1), then your overall SBC strategy should focus specifically on verbal communication taking into consideration language and the preferred communication channels of the target group.

More than 10% difference: There is a considerable disparity between men and women when it comes to no education. It is important to ensure that these women are also considered when developing the SBC strategy. Ensure that there are sufficient verbal mass media and interpersonal communication SBC activities such as community meetings, radio spots and talk shows etc

More than 50% difference: There is a critical difference between men and women when it comes to no education. If a large % of women in your target area do not have an education (please see E1) then it is critical that you develop specific SBC activities that target women as part of the ITN campaign. Ensure that your SBC activities uses communication channels that are preferred by women: this is often available on the DHS or MIS.

Less than 10% difference: There is a considerable lessor % of men that do not have an education. It is important to ensure that these men are also considered when developing the SBC strategy. Ensure that there are sufficient verbal mass media and interpersonal communication SBC activities such as community meetings, radio spots and talk shows etc

Less than 50% difference: There is a critical difference between men and women when it comes to no education. If a large % of men in your target area do not have an education (please refer to the DHS education dashboard) then it is critical that you develop specific SBC activities that reach men as part of the ITN campaign.

Below 10% or -10% difference: There are no significant differences between men and women when it comes to primary education. If a large % of the population has completed primary education (please see E3), then your overall SBC strategy may include some written materials (such as pamphlets), although these must still have simple, clear and concise messages.

More than 10% difference: There is a considerable disparity between men and women when it comes to primary education. If a large % of women have not attained primary education (please see E3), then ensure that there are sufficient verbal mass media and interpersonal communication SBC activities such as community meetings, radio spots and talk shows etc. This may also be an indication that school based SBC activities may not reach all women.

More than 50% difference: There is a critical difference between men and women when it comes to primary education. If a large % of women in your target area have not completed primary school (please see E3) then it is critical that you develop SBC activities that are visual or verbal (example can include community meetings, town criers, radio spots etc). This can also be an indication that girls’ attendance in primary school is low, and therefore school based SBC may not reach a large number of women.

Less than 10% difference: There is a considerable lessor % of men that have not completed primary school. It is important to ensure that these men are also considered when developing the SBC strategy. Ensure that there are sufficient verbal mass media and interpersonal communication SBC activities such as community meetings, radio spots and talk shows etc

Less than 50% difference: There is a critical difference between men and women when it comes to primary school attainment. If a large % of men in your target area have not completed primary school (please refer to the DHS education dashboard) then it is critical that you develop specific SBC activities that will reach men as part of the ITN campaign.

Below 10% or -10% difference: There are no significant differences between men and women when it comes to secondary education. If a large % of the population has completed secondary education (please see E5), then your overall SBC strategy can include written materials (such as pamphlets, newspaper articles), although these must still have simple, clear and concise messages.

More than 10% difference: There is a considerable disparity between men and women when it comes to secondary education. If a large % of women have not attained secondary education (please see E5), then ensure that there are sufficient verbal mass media and interpersonal communication SBC activities such as community meetings, radio spots and talk shows etc. This may also be an indication that school based SBC activities (in secondary schools) may not reach all women.

More than 50% difference: There is a critical difference between men and women when it comes to secondary education. If a large % of women in your target area have not completed secondary school (please see E5) then it is critical that your written SBC tools (such as pamphlets and press releases) are not text heavy. This can also be an indication that girls’ attendance in secondary school is low, and therefore school based SBC (in secondary schools) may not reach a large number of women.

Less than 10% difference: There is a considerable lessor % of men that have not completed secondary school. It is important to ensure that these men are also considered when developing the SBC strategy. Ensure that there are sufficient verbal mass media and interpersonal communication SBC activities such as community meetings, radio spots and talk shows etc

Less than 50% difference: There is a critical difference between men and women when it comes to secondary school attainment. If a large % of men in your target area have not completed secondary school (please refer to the DHS education dashboard) then it is critical that you develop specific SBC activities that will reach men as part of the ITN campaign.

Schools are often used for SBC activities (whether to mobilize households to participate in the ITN mass campaigns, for SBCC activities that see children as change agents to promote positive behaviour within their household, or for continuous distribution to maintain ITN coverage levels in communities).

Low school attendance by girls in some settings may mean that they are not getting equal access to information and ITNs and national malaria programmes should consider whether schools are the appropriate channels for SBC and/or ITN distribution.

Where school attendance by girls is low, national malaria programmes should consider developing and implementing additional activities and using alternative communication channels that will ensure that girls also have equitable access to information and ITNs.

Percentage of current school attendance:

Below 10% or -10% difference: There are no significant differences between men and women when it comes to primary school attendance. If the % of school attendance is high (>80%), then primary school based SBC might be a good activity for the ITN campaign.

More than 10% difference: There is a considerable disparity between girls and boys when it comes to primary school attendance. Primary school based SBC activities might not be reaching a large number of girls and alternative SBC activities should be found to reach girls not attending primary schools.

More than 50% difference: There is a critical difference between girls and boys when it comes to primary school attendance. School based SBC activities will miss a lot of young girls. The ITN campaign should develop special activities to reach women and girls in targeted areas to ensure that they are reached with ITNs and SBC messages.

Less than 10% difference: There is a considerable lesser % of boys that are attending primary school. School based SBC activities may not be reaching a large number of boys and alternative SBC activities should be found to reach boys not attending primary schools.

Less than 50% difference: There is a critical difference between girls and boys when it comes to primary school attendance. School based SBC activities will miss a lot of young boys. The ITN campaign should develop special activities to reach men and boys in targeted areas to ensure that they are reached with ITNs and SBC messages

Below 10% or -10% difference: There are no significant differences between men and women when it comes to secondary school attendance. If the % of school attendance is high (>80%), then school based SBC activities in secondary schools might be a good activity for the ITN campaign.

More than 10% difference: There is a considerable disparity between girls and boys when it comes to secondary school attendance. Secondary school based SBC activities might not be reaching a large number of adolescent girls and alternative SBC activities should be found to reach girls not attending secondary schools.

More than 50% difference: There is a critical difference between adolescent girls and boys when it comes to secondary school attendance. School based SBC activities will miss a lot of adolescent girls and young women. The ITN campaign should develop special activities to reach women and adolescent girls in targeted areas to ensure that they are reached with ITNs and SBC messages.

Less than 10% difference: There is a considerable lesser % of adolescent boys and young men that are attending secondary school. School based SBC activities may not be reaching a large number of adolescent boys and alternative SBC activities should be found to reach boys not attending secondary schools.

Less than 50% difference: There is a critical difference between adolescent girls and boys when it comes to secondary school attendance. School based SBC activities will miss a lot of adolescent boys and young men. The ITN campaign should develop special activities to reach men and adolescent boys in targeted areas to ensure that they are reached with ITNs and SBC messages

To complete this section, national malaria programmes will need to access health and demographics data that can often be found using health national health surveys (example, the Demographics and Health Survey (DHS) programme, the malaria indicator survey etc). Many organisations have regrouped the different data sources (for national level) and these can be find on various websites, including:

From the UNDP website:

• https://hdr.undp.org/data-center/documentation-and-downloads)
• Table 4: Gender development index The women’s empowerment dashboard can be found at https://hdr.undp.org/womens-empowerment

From the UNICEF website:

• https://data.unicef.org/resources/resource-type/country-profiles/

From USAID:

• The USAID Women’s Empowerment and Equality dashboard can be accessed at https://idea.usaid.gov/women-e3
• The DHS programme Gender dashboard: https://dhsprogram.com/data/visualizations/gender-dashboard.cfm

Being financially secure can help women have better access to healthcare services and commodities. Depending on the employment context, this access may not be very secure. As an example, women in informal employment settings may have less access to secure social services.

In addition, much of a woman’s time is taken with domestic activities leaving them little time to seek professional healthcare services. These domestic activities are also not recognized as work and therefore are unpaid, leaving women financially dependent on others.

All of these factors can affect women’s access to ITNs, IPTp, diagnosis and treatment, thus making them more vulnerable to malaria.

In many settings, women do not have as much decision-making power as men. Combined with unstable employment, this can severely affect women’s ownership of assets, as well as their control over how assets owned by the family are used. This can directly influence access and ITN use. For example, how much decision-making power will women have in deciding whether to obtain ITNs and hang them every night? Who will have access to sleeping under these ITNs, especially when there are insufficient ITNs to cover the whole household?

NMPs should consider how SBC can contribute to 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.

Below 10% or 10% difference: There does not seem to be any significant differences in employment rate between men and women. This could indicate that women have a certain level of economic independence, which would improve their access to health services.

More than 10% difference: There is a larger % of men over women that are in current employment. Depending on the context / setting, this may indicate that women are dependent on male household members for access to health services. It is important that women have access to ITNs during campaigns and that SBC activities target both men and women with key messages

More than 50% difference: There is a significant % of men over women that are currently employed. This could be an indication that women are dependent on male household members for access to health services. It is critical that the ITN campaign ensures women’s access to ITNs. SBC activities should ensure that both men and women receive key information on the dangers of malaria (especially on pregnant women and young children) and correct ITN utilisation by all household members.

Less than 10% difference: There is a larger % of women over men that are in current employment. It is important that both men and women have access to ITNs during campaigns and that SBC activities target both men and women with key messages.

Less than 50% difference: There is a significant % of women over men that are currently employed. It is critical that the ITN campaign ensures both men’s and women’s equitable access to ITNs. SBC activities should ensure that both men and women receive key information on the dangers of malaria (especially on pregnant women and young children) and correct ITN utilisation by all household members.

To complete this section, national malaria programmes will need to access health and demographics data that can often be found using health national health surveys (example, the Demographics and Health Survey (DHS) programme, the malaria indicator survey etc). Many organisations have regrouped the different data sources (for national level) and these can be find on various websites, including:

From the UNDP website:

• https://hdr.undp.org/data-center/documentation-and-downloads)
• Table 4: Gender development index The women’s empowerment dashboard can be found at https://hdr.undp.org/womens-empowerment

From the UNICEF website:

• https://data.unicef.org/resources/resource-type/country-profiles/

From USAID:

• The USAID Women’s Empowerment and Equality dashboard can be accessed at https://idea.usaid.gov/women-e3
• The DHS programme Gender dashboard: https://dhsprogram.com/data/visualizations/gender-dashboard.cfm

Women’s participation and presence in governance at all levels can help shape laws, policies and procedures that directly affect women by bringing gender imbalance and injustices to the forefront of the government’s agenda. This can reduce the malaria burden on women in the short and long term in various ways including:

• Ensuring sufficient ITN and ITPp stock for PW in all health centres
• Putting increasing pressure on law enforcement to enforce laws against domestic or gender-based violence (see security and justice below)

Through the development of policies and procedures that increase women’s safe access to healthcare services.

The following indicators from UNDP’s Women’s Empowerment dashboard can help identify gender development in your country as compared to others. Three-colour coding is used to visualize partial grouping of countries by indicator. For each indicator countries are divided into three groups of approximately equal size (terciles): the top third, the middle third and the bottom third. Please refer to the dashboard: https://hdr.undp.org/womens-empowerment.

GREEN: Your country has a good representation of women at ministerial level positions. If this is confirmed by a high %, this can help ensure that malaria issues specifically affecting women might have a greater chance of being addressed. Consider whether any high level advocacy meetings might be beneficial. Example, addressing frequent ITN stockouts during ANC visits.

YELLOW: Women in your country may not have high representation at ministerial levels. This may mean that many health care issues affecting women, including no access to IPTps and ITNs during ANC visits. If that is the case, then consider a strategy that will ensure that pregnant women have greater access to ITNs and key messages during ITN mass campaigns. Also consider whether there is a need to advocate for greater ITN and IPTp access for pregnant women.

ORANGE: Compared to other countries, women are not well represented at ministerial levels. This could be affecting women’s access to proper health services, including ITN and IPTps. It is critical that one of the objectives of your ITN campaign is to target pregnant women, example: providing one extra ITN for all households with a pregnant women and/or robust SBC on the dangers of malaria during pregnancy. It is critical that your SBC messages reach not only pregnant women, but also husbands, mother in laws, and head of households.

If there are frequent stock out of IPTps and ITNs during ANC visits, advocate with the relevant ministries for additional resources to ensure that pregnant women are protected from malaria.

GREEN: Your country has a good representation of women in local governments. If this is confirmed by a high %, this can help ensure that malaria issues specifically affecting women might have a greater chance of being addressed.

YELLOW: Women in your country may not have high representation at local government. This may mean that many health care issues affecting women, including no access to IPTps and ITNs during ANC visits. If that is the case, then consider:

• a strategy that will ensure that pregnant women have greater access to ITNs and key messages during ITN mass campaigns
• Consider whether there is a need to advocate for greater ITN and IPTp access for pregnant women
• Engage CSOs working with women, to ensure that women in communities have access to key messages on malaria and ITNs

ORANGE: Compared to other countries, women are not well represented at local government. This could be affecting women’s access to proper health services, including ITN and IPTps. It is critical that the objectives of your ITN campaign are:

• to target pregnant women, example: providing one extra ITN for all households with a pregnant women and/or robust SBC on the dangers of malaria during pregnancy. It is critical that your SBC messages reach not only pregnant women, but also husbands, mother in laws, and head of households
• (If there are frequent stock out of IPTps and ITNs during ANC visits,) to advocate with the relevant ministries for additional resources to ensure that pregnant women are protected from malaria
• To advocate with local government to ensure that women’s health remains a priority
• Engage CSOs working with women to ensure that women in communities have access to key messages on malaria and ITNs

To complete this section, national malaria programmes will need to access health and demographics data that can often be found using health national health surveys (example, the Demographics and Health Survey (DHS) programme, the malaria indicator survey etc). Many organisations have regrouped the different data sources (for national level) and these can be find on various websites, including:

From the UNDP website:

• https://hdr.undp.org/data-center/documentation-and-downloads)
• Table 4: Gender development index The women’s empowerment dashboard can be found at https://hdr.undp.org/womens-empowerment

From the UNICEF website:

• https://data.unicef.org/resources/resource-type/country-profiles/

From USAID:

• The USAID Women’s Empowerment and Equality dashboard can be accessed at https://idea.usaid.gov/women-e3
• The DHS programme Gender dashboard: https://dhsprogram.com/data/visualizations/gender-dashboard.cfm

Insecurity can severely affect access to healthcare services and commodities. Gender based violence (GBV) which is violence against someone because of their gender, increases vulnerability not only through the act of violence, but also by creating a barrier to existing services, including health and care. Women in particular are very often survivors of GBV and thus need extra support.

Enacted laws to protect women from all forms of violence are a good indication that the country is progressing towards equitable access to services that facilitate socio-economic development of the person and community. The existence of these laws, however, is not sufficient in itself: it is important to ensure that they are being enforced and that women have access to a justice system that is fair and transparent.