Gender blind? An analysis of global public-private partnerships for health
TL;DR: GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability, and the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk.
Abstract: The Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system. We identified 18 GPPPH - defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors – and conducted a gender analysis of each. Gender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women – up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases – none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens. We propose two areas of action in response to these findings. First, GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.
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United Nations Foundation1, World Bank Group2, University College London3, Johns Hopkins University4, Joint United Nations Programme on HIV/AIDS5, Stanford University6, University of California, Los Angeles7, Bill & Melinda Gates Foundation8, University of California, San Diego9, Harvard University10
TL;DR: An agenda for action to reduce gender inequality and shift gender norms for improved health outcomes is proposed, calling on leaders in national governments, global health institutions, civil society organisations, academic settings, and the corporate sector to focus on health outcomes and engage actors across sectors to achieve them.
143 citations
82 citations
TL;DR: Future research should focus on developing theory-informed interventions and evaluations, on improving the understanding of specific subpopulations of men, and on broadening the evidence base beyond the few countries that produce most research in this field.
71 citations
Johns Hopkins University1, Makerere University2, Indian Institute of Health Management Research3, University of Zimbabwe4, University of Nigeria, Nsukka5, University of the Western Cape6, University of Leeds7, University of Oxford8, Kenya Medical Research Institute9, Muhimbili University of Health and Allied Sciences10, Ifakara Health Institute11, Liverpool School of Tropical Medicine12, Philippine Institute for Development Studies13
TL;DR: 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.
Abstract: 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. 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. 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. 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.
67 citations
41 citations
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01 Jan 2003
11,232 citations
"Gender blind? An analysis of global..." refers background in this paper
...Stop TB, jointly with UNAIDS, has recently released a gender assessment tool to assess country-level HIV and TB epidemics and guide development of gender sensitive and transformative responses [37]....
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...The Global Fund’s gender strategy is strong in its commitment to addressing gender inequalities that fuel the HIV epidemic (with a focus on women and girls), yet evaluation of its implementation and monitoring indicators suggests a major gap between policy intent and practice with too few grant agreements found to specify, fund or monitor gender-sensitive or transformative activities [40, 41]....
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...Wu D, Hawkes S, Buse K. Prevention of mother-to-child transmission of syphilis and HIV in China: what drives political prioritization and what can this tell us about promoting dual elimination?...
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..., consumption of tobacco [42], alcohol [43], highly processed foods [46])....
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...Hanefeld et al. reviewed the impact of three global health initiatives on health equity, with a specific focus on HIV and women, but concluded that there was little evidence of long-term impact on equity [28]....
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Christopher J L Murray1, Katrina F Ortblad1, Caterina Guinovart1, Stephen S Lim1 +367 more•Institutions (179)
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TL;DR: In a special issue of Social Politics as discussed by the authors, the authors take these debates forward in many significant ways, including the meaning of gender equality, the project of gender mainstreaming, and the relationship between theory and practice in diverse European settings.
Abstract: The articles in this special issue of Social Politics take these debates forward in many significant ways. Most of the articles contributed to and drew from a series of seminars funded by the U.K. Economic and Social Research Council on gender mainstreaming. They address the meaning of gender equality as well as the project of gender mainstreaming (Verloo) engage with diverse inequalities and their intersectionality and their implications for theories of democracy (Squires) consider the implications of the wider economic and political context for the potential of gender mainstreaming to create change (Perrons) address the tension between the agenda-setting potential of the strategy and integration into the mainstream (Lombardo) and investigate the relationship between theory and practice in diverse European settings (Daly). (excerpt)
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"Gender blind? An analysis of global..." refers background in this paper
...Yet, the contributions of GM in placing gender as “a critical axis of power” (ibid) and improving effectiveness of policies “by making visible the gendered nature of assumptions, processes and outcomes” [27] are widely acknowledged....
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TL;DR: In this article, the current state of knowledge in relation to public-private partnerships (PPPs), taken to mean working arrangements based on a mutual commitment (over and above that implied in any contract) between a public sector organization with any organization outside of the public sector, is explored.
Abstract: This article explores the current state of knowledge in relation to public–private partnerships (PPPs), taken to mean working arrangements based on a mutual commitment (over and above that implied in any contract) between a public sector organization with any organization outside of the public sector. Since it originally became fashionable over 25 years ago, the concept of PPPs has been strongly contested. However, PPPs are now to be found in the public domain in many countries around the world and their number has been increasing in recent years. This article looks at how this has happened, what have been the strengths and weaknesses of this development and what the future may hold for PPPs. It argues that we are still at an early stage of learning which types of PPP are appropriate for which tasks and at managing PPPs to increase public value. It will be essential to apply principles of good governance to the future development of PPPs — but it will also be necessary to ensure that these principles are ...
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