4 lessons on how to promote gender equality and social inclusion in health programming

World leaders have committed to achieving universal health coverage (UHC) by 2030. Time is ticking and if we are truly going to make affordable healthcare accessible to in the next seven years, urgent action is needed.

In 2023, women are still dying during childbirth from complications that are preventable. Only 56% of married or in-union women aged 15 to 49 are able to make their own choices around their sexual and reproductive health. People with disabilities, including people with mental health conditions, face challenges accessing basic healthcare services and the specialised care they might need is not always available.

These examples show that we must consider gender equality and social inclusion in our global heath interventions and respond to the specific needs of those most marginalised.

At Options, our priority isn’t just to say that we believe in the importance of gender equality and social inclusion (GESI) in the development process. We are committed to making sure that our programmes actively contribute to shifting social norms and changing behaviors that discriminate against certain groups, and to enabling them to have a voice and decision-making power, access quality services and enjoy healthy lives.

To ensure that these commitments translate into truly inclusive and transformative programmes, we have developed the GESI self-reflection tool.

What is the GESI self-reflection tool?

The GESI self-reflection tool was developed by myself in collaboration with a group of passionate ‘GESI champions’ from different teams across Options.  The aim of the tool is to assess a programme’s key components on a scale from GESI-unequal to GESI-transformative.

Teams regularly come together at different stages of the programme cycle to discuss a programme’s situation analysis, objectives, activities, budgets, monitoring and evaluation approaches, participation of marginalised groups and partnerships. The tool enables them to critically reflect on whether each of these elements adequality incorporates considerations and enables them to identify recommendations to make the programme more GESI transformative.

Lessons learned from using the GESI self-reflection tool

1. A tool is helpful but not enough

A tool alone isn’t sufficient to make our programmes GESI transformative. A change in staff mindset and an increased understanding of key concepts around GESI are essential to make the self-reflection meaningful and ensure that practical actions are identified to improve our interventions.

To do this, we rolled out both the tool and a GESI induction training to all staff. The training introduces basics concepts such as gender, disability, intersectionality and equity while exploring how patriarchal norms and discriminatory practices affect individuals’ health seeking behaviors, access to services, and the structure and governance of health systems.

As Options’ GESI Principal Consultant, I also use my support to programmes’  GESI review process as an opportunity to increase staff’s understanding of Options’ GESI approach and prompt collective reflection. The organisation also established a GESI working group to provide additional technical support to teams as needed and to encourage sharing lessons and best practices.

“Before the enrolment of the GESI self-reflection tool, most of our interventions were GESI neutral, with no deliberate efforts to recognise or respond to the specific needs of different groups. The introduction of the tool within our programme was an eye opener to many implementers as we were able to identify opportunities missed which could improve availability and accessibility of sexual and reproductive health and family planning services for people with disabilities.”

Jeremiah Makula, Deputy Regional Lead, Women’s Integrated Sexual Health (WISH) programme.

2.  GESI considerations need to be integrated at all stages of the programme cycle

When we initially conducted the self-reflection on programmes that were already being implemented, we soon realised that there is only so much that can be changed once programme objectives, log frames and budgets have been agreed.

Applying the tool at the programme design stage is the best opportunity to harness its potential to be GESI transformative. This ensures that programme scope and objectives can address issues identified through a gender and inclusion analysis, that the target population includes marginalised and hard to reach groups, and that discriminatory social norms and structural barriers are targeted through programme activities to create more inclusive health services and systems from the outset.

3. A GESI tool can help with intersectionality

The reality we live in is complex. By bringing together gender equality and social inclusion, the tool allows us to simultaneously reflect on both gender and other individual characteristics as part of the same intention to address unequal power relations and inequalities, reduce disparities and ensure equal rights, responsibilities, opportunities, and respect for all individuals.

As a result of using the tool, the programme conducted a literature review to better understand how gender intersects with disability and mental health, which among others, makes women with disability more likely to be accused of witchcraft or suffer from gender-based violence, including sexual violence. This allowed the programme to identify interventions that address the double discrimination women with disability face and to make a concious effort to provide grants to women-led organisations working in the disability and mental health space.

“For us, it was exciting using [the tool] at trialing stage to test and fine tune it. We have found it useful [to identify recommendations to improve the gender element of our programme].”

Vivian Fiscian, Leadership and Governance Advisor, Ghana Somubi Dwumadie

4. Political will is essential to walk the talk

The GESI self-reflection tool is just one element of our organisational efforts to promote greater gender equality and social inclusion. Mainstreaming GESI considerations across all our programmes is one step in achieving transformative change. A leadership that sees the importance of staff diversity, values each individual and their expertise, and that promotes an inclusive working environment are also vital steps in legitimizing this process.  At Options, the roll out of the self-reflection tool has been well received because it has been accompanied by a new set of organisational values, conversations around diversity and inclusion and the review of our recruitment practices.

With the GESI self-reflection tool we feel confident that Options can strategically contribute to greater social justice and an inclusive development process in order to achieve universal health coverage.