1.
Jessica Fehringer, PhD, MHS
Brittany Schriver, MPH
MEASURE Evaluation
July 14-22,2015
Routine Health Information Network
(RHINO) Online Forum
Collecting,Analyzing, and
Using Sex-disaggregated and
Gender-sensitive Data in
RHIS

2.
Overview
• Definitions
• Gender and Health
• Gender and RHIS
• Q&A
• Definitions

3.
Definitions: Sex
• Determined at birth based on
biological characteristics
• Universal for all human beings
• Hard to change
Source: USAID March 2012 Gender Equality and Female Empowerment Policy
Biological classification
of males and females

4.
Definitions: Gender
Culturally defined set of
roles, duties, rights,
responsibilities, and
accepted behaviors
associated with being male
and female
Source: IGWG training resources; USAID Gender Equality and Female Empowerment Policy
• Power relations between and among
women & men, boys & girls.
• Vary across cultures and over time.

5.
Definitions: Gender Equality
The state that affords women, men,
transgender persons equal enjoyment of
human rights, socially valued goods,
opportunities, and resources.
Source: WHO 2009: Integrating gender into HIV/AIDS programmes in the health sector
Gender inequality is the most pervasive form of social inequality; it
cuts across all other forms such as class, caste, race and ethnicity
• Expanded freedoms and improved quality of life for all
people.
• Comes from written and unwritten norms, rules, laws and
shared understandings.

6.
Definitions: Gender Equity
The process of being fair to women &
men, boys & girls, transgender persons.
Source: IGWG training resources
• Stress is on fairness as the end goal
• Different/unequal needs & barriers affecting women, men,
and transgender persons in accessing/benefiting from
health-care facilities/programs must be considered in
resource allocation & design
• Should be inherent to policy/program M&E

7.
Overview
• Definitions
• Gender and Health
• Gender and RHIS
• Q&A

8.
Gender and Health
Adherence to rigid
gender roles can
create a gender gap
Women Men
Source: WHO, Why Gender and Health?
• unequal options,
opportunities and realities
that women and men
experience

9.
Source: World Health Organization http://www.who.int/gender/genderandhealth/en/index.html
A teenage boy dies
in accident because
he tried to meet
peers’ expectations
that young men
should take risks
A woman cannot
access needed
maternal health care
because she does
not have control of
the household
money.
A women contracts HIV because societal norms prevent
wives from insisting on condom use with husbands, and yet
tolerate husbands’extra-marital sex
Gender and Health

10.
Gender inequality is associated with
poor outcomes such as
• Higher child mortality, stunting & wasting
• Lower maternal health care utilization,
higher maternal mortality
• Higher fertility, lower family planning use
• GBV
Gender inequality is a major driver of
the AIDS epidemic and leads to
lower awareness, knowledge
• Higher risky sex & PMTCT, lower VCT &
ARV
• Higher prevalence & incidence
Gender and Health

11.
Addressing gender in health systems
An integrative approach considers the impact of gender on
the people, the health services, and the results
Health
problem
Gender-
specific
needs and
barriers
Desired
health
outcomes
Gender and Health

12.
Overview
• Definitions
• Gender and Health
• Gender RHIS
• Q&A

13.
Gender and RHIS
RHIS provides evidence to:
Raise
awareness
Advocate for
change
Address
gender
dimensions
Demonstrate
Progress
Demand
richer data

14.
• National M&E strategic plans address gender
inequalities in their objectives, frameworks,
indicators and results
• Data are sex- and age disaggregated at all stages of
monitoring and evaluation (i.e., data collection,
analysis and reporting)
• HIS data are used for gender-related analyses and
evaluations
• There is coordination, information sharing and use
of gender-related data across sectors
What does a gender-
integrated RHIS look like?
Gender and RHIS

15.
Sex Disaggregation
Routine data: what do we need?
Sex disaggregated data
Allows for basic analysis:
Are there gender differences in use of/access to
services/treatment?
For example:
• Use of ART? Adherence?
• Detection of TB? Referral for treatment?
• Malaria testing and treatment?
Gender sensitive data
Focus on gender equality:
For example:
• Gender Based Violence (GBV) service
encounters
• Male attendance at antenatal care (ANC) visits

16.
0
50
100
150
200
250
August 2010 August 2011 August 2012
Number of clients (age 15-24) tested HIV
positive through PIT, by month
Total
0
50
100
150
200
250
August 2010 August 2011 August 2012
Number of clients (age 15-24) tested HIV
positive through PIT, by month
Female
Male
Why do we want to
analyze and report data
by sex?
Sex Disaggregation

17.
Sex Disaggregation
Indicators
HIV referral completion
Proportion of referred clients that completes referral at
receiving service
• Numerator: Number of referred men and women
seen at receiving service.
• Denominator: Number of men and women referred
from initiating service.
Data source: HIS

18.
Sex Disaggregation
Indicators
• Numerator: Number of new smear-
positive pulmonary TB cases
registered in a specified period that
were cured by sex
• Denominator: Total number of new
smear-positive pulmonary TB cases
registered in the same period by sex
Tuberculosis: cure rate
Disaggregation by sex will illustrate if
men or women disproportionately higher
rates of treatment leading to cure
Data source: HIS

19.
Male Engagement
Has there been an increase in male
involvement in reproductive health
programs?
• Data: Percent male clients
receiving RH services (data
collected at multiple time points)
Data source: HIS
Gender Sensitive
Indicators

20.
Gender Based Violence (GBV)
Number of GBV service-encounters at a health facility
(P12.6.D PEPFAR Output)
Disaggregated by the age group and sex of the client
receiving the service.
Gender Sensitive
Indicators
• Numerator: Number of GBV-related service-encounters.
• Denominator: N/A

21.
Gender Based Violence (GBV)
Percentage of health facilities with Gender-Based
Violence and Coercion (GBV) services available (P12.7.D
PEPFAR Output)
Disaggregated by type of service and type of facility
Gender Sensitive
Indicators
• Numerator: Number of health facilities reporting that
they offer (1) GBV screening and/or (2) assessment
and provision or referral to the relevant service
components for the management of GBV-related
health needs as defined below.
• Denominator: Total number of health facilities in the
region or country being measured.

22.
Gender and RHIS
• Ensure data are collected, analyzed and reported
on by sex
• Train all M&E personnel on gender-focused
monitoring, evaluation and research
• Carry out and disseminate gender-based analysis of
health data
• Use gender-based analysis results in program and
policy decision-making
• Create feedback mechanisms to share results of
gender-based analyses and evaluations
How do we ensure RHIS
addresses gender?

23.
Overview
• Definitions
• Gender and Health
• Gender and M&E
• Q&A

24.
MEASURE Evaluation gender website
www.measureevaluation.org/gender
Gender and Health Systems Strengthening e-learning course
https://www.globalhealthlearning.org/course/gender-and-health-systems-
strengthening
Compendium of Gender Equality and HIV Indicators
http://www.cpc.unc.edu/measure/publications/ms-13-82
VAW/G compendium
https://www.cpc.unc.edu/measure/publications/ms-08-30
Gender M&E Online course:
http://www.globalhealthlearning.org/course/gender-m-e
Gender scales
http://www.c-changeprogram.org/content/gender-scales-compendium/index.html
K4 Health IGWG Gender and Health Toolkit
http://www.k4health.org/toolkits/igwg-gender
Resource guide for gender data and statistics
https://www.cpc.unc.edu/measure/publications/ms-12-52
EMAIL US! GenderM&E@unc.edu
Resources and Tools

25.
MEASURE Evaluation is funded by the U.S. Agency
for International Development (USAID) under terms
of Cooperative Agreement AID-OAA-L-14-00004
and implemented by the Carolina Population Center,
University of North Carolina at Chapel Hill in
partnership with Futures Group, ICF International,
John Snow, Inc., Management Sciences for Health,
and Tulane University. The views expressed in this
presentation do not necessarily reflect the views of
USAID or the United States government.
www.measureevaluation.org