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COVID-19 and Disability Invite containing date and time of the Chat

05 04 2020

Disability and COVID-19 Expert Tweeters

On Monday 6 April from 11.00-12.30 BST we will be coordinating a Twitter Chat on Disability and COVID-19. To join in please use the hashtag #DisabilityC19. If you want to prepare some answers or find out more about how a Twitter Chat works just follow this link… You are all very welcome, we need to share and learn together.

Expert Tweeters

To help guide the Chat and to offer their wisdom, we have put together a group of Expert Tweeters. We are very grateful that they are involved.

Rasak Adekoya, Sightsavers International

@Iamrasakadekoya

Rasak Adekoya is a social entrepreneur, disability-inclusion and communication specialist. Currently, he works with Sightsavers Nigeria on the DFID Inclusion Works project and serves as the Speaker of the Nigerian Peoples Disability Parliament. Rasak is an author of four books and the co-founder of the African Volunteering Week.

International Disability and Development Consortium

@iddcconsortium

The International Disability and Development Consortium (IDDC) is a network of civil society organisations promoting inclusive international development and humanitarian action with a special focus on the full and effective enjoyment of human rights by all people with disabilities.

Sapana Bista, Liverpool John Moores University

@sapanabasnet

Sapana is an academic and humanitarian health and wellbeing expert who specialises in an inclusive risk assessment, disaster impact analysis and service strengthening during crisis, displacement in terms of disability, gender and marginalised people. She has expertise in participatory visual methods, innovative MEAL tools, and Inclusive Disaster Risk Management.

Shikuku Obosi, Sightsavers International

@ShikukuObosi

Shikuku is an inclusion specialist currently working for Sightsavers International as a Disability Inclusion Technical Advisor. Shikuku has over 15 years’ experience leading disability inclusion projects with INGOs, intergovernmental organizations, bilateral donors and Disabled Peoples Organizations across diverse multi-cultural contexts in over 20 countries across Africa, Asia and Europe. Before taking on the Sightsavers position, Shikuku developed the Africa Union Disability Strategy, the successor framework to the Continental Plan of Action for the second African Decade of Persons with Disabilities (2010-2019). Shikuku has a personal, lived experience of disability discrimination and chairs the Africa Advisory Council for AbleChildAfrica.

International Disability Alliance

@IDA_CRPD_Forum

The International Disability Alliance is an Alliance of 14 global and regional organisations of persons with disabilities. They advocate at the United Nations for a more inclusive global environment for everyone. Since the outbreak of the COVID-19 pandemic, and its disproportionate impact on persons with disabilities, the International Disability Alliance (IDA) has compiled a list of the main barriers that persons with disabilities face in this emergency situation along with some practical solutions and recommendations. IDA has also written an open letter to the Director General of the World Health Organisation, calling for the elimination of discrimination against persons with disabilities in the COVID-19 response. IDA is continuing its advocacy and working with partners to ensure that the COVID-19 response is inclusive of all persons with disabilities. More information can be found at: http://bit.ly/2IYu7VF

Joseph Baraza Etyang, LVCT Health

@josephEtyang7

Joseph Baraza Etyang has 14 years experience on HIV Testing and Counselling/Field Officer 1. He is a founding member and former Leader of Liverpool Coast Deaf VCT Post Test Club -Mombasa. He is now a member of Kilindini HIV Deaf Post Test Club. He also holds among other qualifications; Associate Certified in FP/RH for People Living with HIV, First AID & Safety Studies, TOT of Peer Educators, Gender, sexual and reproductive Health, Alcohol Abuse Intervention for Key Population, CHEW- Community Health Extension Worker, Family Planning Counselling, MTCT of HIV, FMP, Antimicrobial Resistance, Data Quality, IUD, Counselor support supervision and CBHCT.

He was a former Disability Programme Assistant for a year and a half and is currently working at LVCT Health in Nairobi, Kenya. When not working he enjoys to travel, writing articles, research on disability issues and learning new skills.

Gordon Rattray, European Disability Forum

@GordonRattray

European disability Forum (EDF) is the umbrella organisation for disabled people’s organisations in Europe, representing over 100 million people with disabilities. Gordon works for the EDF on international cooperation. They have a comprehensive page of resources on COVID-19.

Wanja Maina

@wanjaah

Wanja Maina is a Kenyan woman with a disability who is 29 years old. She has been in mainstream disability activism for the past 12 years. She is also a feminist.

She is currently coordinating a disability and Covid 19 loose network of 25 organisations of people with disabilities across Kenya (@Covid19PWDsKe). She is a renowned and respected gender and communications practitioner and an award winning positive change agent.

Fatma Haji, Inclusion Africa

@Fatmawangarehaj

Fatma is a mother to a daughter with an intellectual disability, she is the regional coordinator for Inclusion Africa which is a pan African regional network for family- based organizations for persons with intellectual disabilities and their families. She is one of International Disability Alliance BRIDGE-CRPD-SDGs lead trainers in Africa. She has over 10 years’ experience working with persons with intellectual disabilities and their families

02 04 2020

Experiences of conducting research in an informal settlement

By Samiha Ali

Dusty roads, narrow passageways, every three feet or so a small shop selling tea and snacks. A child wailing in the distance and the smell of freshly fried samosas in the air. To a qualitative field researcher, this scenario is not an uncommon scenario. Walking down the winding streets of Korail slum with the children smiling down at you and shopkeepers greeting you, it is almost easy to forget that you are an outsider in the community. Almost.

The reality is that however much I would like to forget that I am an outsider in the community, it is really difficult to gain an insider perspective of the daily struggles of community members. As outsiders, it is important for us to develop skills and self-awareness to ensure that the challenges faced in the field don’t hamper the research process itself. I would like to share some challenges I have faced and factors that must be overcome while working in the urban slums of Dhaka, Bangladesh.

Community entry

Streets of Korail Gaining entry into a research site might seem like the easiest step of the whole research process but is actually the most di fficult and the most cruc ial. To put it simply, if the initial entry in a field is not done properly then the data collection process is jeopardized! Imagine someone asking for permission to come inside your house for an interview. Their approach would essentially be the make or break factor in you welcoming them into your house. Similarly, our initial approach towards the community members eventually becomes the deciding factor in how organically the community members respond to you.

Before starting the research process, it is crucial for us to build rapport with community members. In my experience I have found that being a member of the BRAC broader family gives us an added advantage and provides an easy pathway for rapport building. This privilege cannot be expected in a setting which has experienced less BRAC intervention as there is often a general distrust among the community members. The presence of BRAC programmes essentially means that we face less resistance.

Case in point, our ARISE research team went to Korail slum in order to pre-test the Participatory Action Research (PAR) tools that we had developed for qualitative field data collection. We wanted to understand if our theoretical knowledge could be used in practice. We had previously worked in Korail and had ongoing BRAC programmes thus access was relatively easy. In this particular case, we enlisted the help of the field personnel working in the BRAC Maternity Center at Korail as our first point of contact to navigate through slum. Seeing our team with the BRAC field personnel, the community members talked to us openly and we were able to do our work relatively easily in a short time frame.

Positionality

Samiha Ali

Understanding our environment and being aware of our positionality within that setting is crucial. Especially so when we are working within a marginalized community who enjoy less privileges than you. This one is a no-brainer but is one that we as researchers often tend to forget or overlook.

As a qualitative researcher, our primary goal should be to interact with the community in such a way as to get mixed with the community – in terms of our clothing, our manner of speaking, our posture and our general behavior and gestures. In 2018, as a young researcher just starting out in this field, I often wore leggings and a kurta to the field. I realized that this attire made it more difficult for me to connect to my respondents as most of them considered me foreign, an outsider. Based on my experiences, I started wearing salwar kameez, which is more traditional and worn by the women in research site, I noticed that it was much easier for me to approach my respondents and engage them in conversation.

At the beginning, I also had difficulty in my way of talking. I would often end up talking to informal settlement dwellers in very formal Bengali, which would sometimes illicit limited response. This led me to speak in a less formal tone over the last two years, my interview skills improved. I became much more adept at extracting meaningful qualitative data. Understanding the demography and context of the study population and being aware of our privileged position is crucial to engaging with the community in a respectful manner.

Conducting research, especially in a participatory research as we wish to do in ARISE, imposes challenges on a researcher that must be sufficiently handled with care and caution. Engaging the community and adapting to it is a crucial phase before the research phase even begins. Failure to do so will ultimately affect the quality of data from our research.

31 03 2020

Disability and COVID-19 Twitter Chat – #DisabilityC19

On Monday 6 April between 11:00am and 12:30pm UK time (BST) we will hold a Twitter Chat on disability and COVID-19.

Read all about the Expert Tweeters who are joining the chat to share their knowledge and wisdom.

A Twitter Chat is where a group of Twitter users ‘meet’ at a pre-determined time to discuss a certain topic, using a designated hashtag (#DisabilityC19) for each tweet contributed.

The objectives of this chat are to:

Help identify people, organisations and networks with expertise in disability and COVID-19 and source further resources
Highlight the particular needs of people with disabilities and potential gaps in the COVID-19 messaging and response (with a focus on low- and middle-income countries)
Explore how people with disabilities are being included in the COVID-19 response

Questions

The questions we will be asking are:

Q1: Who are credible sources for further information on COVID-19 and disability (globally and in different countries)?

Q2: What specific risks do people with disabilities and chronic illness face in relation to the COVID-19 response? What disabilities make people more vulnerable?

Q3: How can we make the messaging about COVID-19 appropriate for people with disabilities? For example, how can you maintain physical distance if you require personal care?

Q4: Are we producing health communication in appropriate formats, for example sign language? What more needs to be done?

Q5: What barriers do people with disabilities face in accessing treatment and care?

Q6: What steps are being taken to include the views and participation of people with disabilities in the COVID-19 response?

Q7: What are your questions on disability and COVID-19? Are there areas where you need expert advice?

We hope that you can attend. We will collect all of the tweets that contain the hashtag #DisabilityC19 in order to keep a record of the discussion. If appropriate we will collate lists of experts and resources. We will take note of questions from participants that have not received an answer and seek expert advice on these.

Meeting of LVCT Health programme and research staff

24 03 2020

Building partnerships for research

By Mary Kerubo, Faith Munyao, Jane Muturi, Veronica Mwania, Yvonne Ngoya, Beate Ringwald and Grace Wairimu

Partnerships grow when people spend time together, share experiences, listen to and learn from each other. This is what we, LVCT Health programme staff, research assistants and PhD fellow, experienced in a two-day training for the participatory PhD research project “Strengthening community health systems to address intimate partner violence and HIV intersection in Korogocho, Nairobi, Kenya”.

What is research to us?

In order to develop a joint understanding of participatory research, we first discussed what research meant to us. We drew from trainings and work for previous studies and from working in an institution that embraces research. As a summary of individuals’ definitions, we understand research as “a continuous process that involves human researchers and participants and uses scientific methods to answer questions about specific problems to discover new things and generate new knowledge.”

How do we know?

We got to differentiate various ways of knowing and learning as we discussed different research paradigms. We shared our experiences of applying respective research methods and, thereby, appreciated those approaches that we were most familiar with. These ranged from secondary data analysis, where the communities who provided data are not involved in the study, to market surveys, qualitative interviews and focus groups that engage community members as informants, and to studies and programmes that seek to educate, engage and empower participants to identify and implement their own solutions. As a result, we recognized that, within programmes, staff generate a lot of knowledge; for example, about implementing, adapting and adjusting programmes. Without finding an immediate answer, we asked ourselves how this knowledge could become accessible and appreciated as evidence beyond LVCT Health.

Who is visible? Who learns?

We looked at the various stages of the research process from defining the problem to getting published and discussed who was involved. First, we focused on “traditional” (non-participatory) research and found that (1) researchers are involved in almost all stages; (2) research assistants collect data and help with analysis; and (3) community representatives are engaged as informants and sometimes consulted to validate findings. Consequently, research assistants are the face of a study in the community, while researchers are most visible through scientific publications. Overall, researchers have the greatest opportunities for learning.

What if…?

We imagined what happened if the community was involved in the entire life cycle of a study as proposed in participatory research. We imagined that studies would respond to problems that communities define, and research methods and tools would be sensitive to local context. Through representatives, communities could be involved in collecting and analysing data, interpreting and disseminating findings. In this way, both communities and researchers would be able to learn from each other and the issues investigated.

What are the implications?

It became clear to us that building good relationships with the community would be critical for the success of a participatory study. Hence, it was recommended for our study that we follow protocols and meet the “right” people as we introduce ourselves and the research idea to the community. The identification of community representatives was seen as being even more critical. Clear criteria are needed to avoid gossip and favouritism and to ensure that community co-researchers are representative for the community. There could also be risks for co-researchers if the topic was sensitive, including violence and HIV prevention, the focus of our study. The list of risks and challenges is not exhaustive. Overall, the idea of participatory research created curiosity among us and was appreciated as a continuous learning journey.

Getting to know our community

LVCT at the Korogocho DREAMS site

We spent some time on getting basic understanding of the community that we intend to work with. All of us were familiar with the study site as outsiders from visiting, working or doing research there and as insiders from growing up, living and working in Korogocho. In two mapping exercises we shared knowledge, experiences and questions about the community. We recognized that the communities across the nine villages are diverse, and so are the social groups that form the community in Korogocho. While risk of HIV and intimate partner violence may be similar among people within social groups like adolescent girls, young women or people with disabilities, we also identified diversity within these groups. Our understanding is preliminary as we intend to repeat these exercises with community co-researchers and members to learn how they define and describe their community.

Who is already working in Korogocho?

In preparation for visits to potential study partners in the study area, we identified 30 institutions and organisations that provide HIV and gender-based violence prevention or response services in Korogocho or from outside to the people there. We appreciate the variety of services offered – from community mobilization, economic and social empowerment, conflict resolution to provision of counselling, health and legal aid services. As a next step we will visit most of them. We are grateful that we can build on existing work of LVCT Health in Korogocho – most importantly on relationships with the community.

How to work together?

We used the two days to clarify what we expect from each other as partners within the study. The PhD fellow will provide guidance and create spaces for planning, communication and reflection. Research assistants and programme staff will not only provide professional and logistical support to the study but also act as cultural interpreters between the international PhD fellow and community. In order to acknowledge the critical contributions of research assistants to the project, it was agreed that we would call them research partners in this study. Over the two days, we got to know each other better, even those who had known each other before. We appreciated the openness and sharing of experiences and found it important that amongst us we model the respectful partnerships that we want to forge with the community.

About the training

All authors participated in the two-day training for the participatory PhD study affiliated with ARISE. These included LVCT Health staff of the DREAMS programme, Grace Wairimu, Mary Kerubo and Yvonne Ngoya; research partners Faith Munyao, Jane Muturi, Veronica Mwania; and Beate Ringwald, the PhD fellow from the Liverpool School of Tropical Medicine as facilitator. The PhD study will be conducted in Korogocho, Nairobi from March to December 2020.

This blog was first published on the LVCT site and is reproduced here with permission.

18 03 2020

Piloting CBPR Training in Sierra Leone: The experience of co-researchers

By Mohamed Bangura, Mohamed Santigie Sesay, Sinneh Turay, Hafsatu Kamara and Zakiatu Sesay

Being part of a team of co-researchers training for the ARISE Community Based Participatory Research (CBPR) was an amazing experience.

This sentiment was shared by a cross section of co-researchers at pre-exploratory research training in Freetown. Three slum communities are being targeted: Dwazark, Moyiba and Cockle Bay.

One of the research approaches in the CBPR process is active learning which promotes peer learning for positive change in intervention communities. This blog gives a collective reflection on the week-long training which created a platform for knowledge sharing among co-researchers and researchers.

What we think of the training

The training session was very educative, as we had the opportunity to learn new ideas. We also had opportunity to learn new research approaches. For instance, we learned the use of social mapping as part of a qualitative research approach. A practical session was conducted for us to imagine our community and think of prominent places and social groups within the community. We also learned how to do a Venn diagram in another practical session, wherein we identified the most influential people, community leaders, and less influential actors, and how their roles link to each other.

Co-researcher group shot

We were also taught how to be a good facilitator and how to ensure inclusiveness during participatory research sessions. The process also involved effectively facilitating interviews/discussions, and being mindful of those that seem to not to partake in discussion. Some of them might be too shy to participate because they might be overshadowed by others who are more vocal. It was also agreed during many of the practical sessions and discussions that it is important to respect and value other people’s opinions, as that which will help to motivate people to share their thoughts. It was also emphasised that there is need for co-researchers to maintain confidentiality as interviewees may expect their information given out to be protected. This is in line with the required ethical principles of research.

Additionally, we learned from sessions in the four days training sessions issues like safeguarding policy and well-being. Safeguarding is a recent strategy in International Development practice and research to protect poor and disadvantaged people from harm. Presenters explained events where women and girls were sexually exploited by the UN, OXFAM and other international agencies in Haiti and other poor countries. The strategy will help shape ethics in research and mitigate potential errors in our work as co-researchers.

On the other hand, well-being was discussed generally as a concept that portrays the general health and socio-economic status of people and how they go about making themselves healthy, taking into consideration people from various classes; the extremely poor, poor, average earners, the rich, the orphans, ghetto youths, widows etc.

How this training has changed co-researcher thinking

Sam with flip chart

The four-day training has reconfigured our thinking about how we used to perceive certain things in our community. Before now, we thought of well-being as a situation where people were believed to be fine if they were rich; Dr. Bintu Mansaray’s presentation provided a different perspective, indicating that even rich people might lack certain things that may affect their well-being. Similarly, poor people might also possess things that make them attain their well-being particularly if they have connections to influential people who make decisions.

Well-being can also be categorized into various levels of people living in the community as we were told. In our own community, Dwarzark for example, we have the poor, average and the rich, and we also have those we might consider the poorest. Hence, the level of poverty is not always equal: So we ask: Which groups of people are average earners and what determinants can we use to say that these people are poor, average or rich? Thus, the workshop helped us to understand all these necessary trajectories and indicators. This is the more reason we have concluded that the workshop reconfigured our thinking about our community, levels of poverty and equality.

The importance of the research to our community

Day two of PAR training

We are confident to say that this research process will help salvage the health challenges we face in our community, and the findings will empower us to create a platform to engage with the decision makers. As emphasised by Mr Braima Koroma, SLURC and its ARISE partners are not implementing agencies, but they find out about community challenges and root causes, and then channel their findings to government and implementing partners. However, we believe that the first step to solving any problem is to identify its root causes. So as ARISE is undertaking such research in our community, we are optimistic that change will come if we are able to understand the problems.

End note

The training was organised jointly by ARISE Sierra Leone partners and Liverpool School of Tropical Medicine as part of a process to test how the CBPR process could work and how to empower local communities for action. It took place from 28-31 January 2020.

In Sierra Leone, ARISE is implemented by four organizations: Sierra Leone Urban Research Centre (SLURC), Centre for Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA), College of Medicine and Allied Health Sciences (COMAHS)-University of Sierra Leone and Federation of Urban and Rural Poor (FEDURP).

10 03 2020

International Women’s Day: Moving on from the celebration

By Bintu Mansaray

As we move on from celebrating International Women’s Day, I pay attention to how far the fight of female empowerment has come. We may not be where we want to be, but there is so much we have achieved already. We know what we need to do to get women where they should be. We have done some research, and we have some answers.

UN Women gave us the acronym RESPECT, which are strategies to prevent violence against women. These strategies are; relationship skills strengthened, empowerment of women, services ensured, poverty reduced, environments made safe, child and adolescent abuse prevented, and transformed attitudes, beliefs, and norms. We need to put those recommendations into practice, contextualising them, and learning from mistakes that arise.

But as we fight for women’s empowerment, we also have to include men. Men have been raised as victims of patriarchy, just as we have. They were told their job is to provide and protect. That is their job. Just like a woman’s job was to have babies and take care of the home. We are all unlearning and relearning to abandon the roles that we were born into. Women are being empowered, but men are feeling disempowered and emasculated. Because patriarchy taught them that their worth as a man is linked to how good of a provider and protector they are.

Men standing up for women’s rights. Who are these men?

The theme this year in Sierra Leone is men standing up for women’s rights. Men who believe in female empowerment. Those men are celebrated and given a seat at our table. We have to take a look at the men we allow to occupy our spaces. The alpha males. The successful man. The man who is already confident of his place in society and doesn’t feel threatened by an empowered female. Are these the only men we should target?

Do we think these men can bring the other men to the table? The men who feel less of a man by his empowered sister and partner, and resorts to abuse to bring her down. The men who commit the crimes of sexual and gender-based violence, the men who feel their wives should not work or even if they work, they should earn less. Can they relate enough to them? What about the ‘enlightened’ men who automatically think their empowered wives should stay home when their child is sick because he has a more important job to get to? How do we get them to understand women are equal to them, and they should respect our rights? How do we get their voices heard as we ask and try to understand their reasons if nothing else, but to use these stories as prevention mechanisms? In Sierra Leone, the Husband School was started, to teach men how to unlearn the toxic masculinity they were raised in.

Sharing our personal battles: The women fighting for gender equality

Bintu at the UN

As feminists fighting for equal opportunities, we must continually be reflecting on our cultures and how we were raised. Those in positions of privilege frequently must check their privilege as they fight for the equal rights of women whose shoes, they’ve never walked in. Others like me who were raised in patriarchal cultures and trying to break free from it even as we fight to take every woman and girl along.

I noticed I do not sleep well at night whenever my husband travels. I explored what I was feeling, and I realised I did not feel as safe when he’s not around. Because we have been raised thinking our men are our protectors. That was something I had to unlearn to be able to feel safe alone in my own home. We are raising sons in a changing climate. Boys are being raised by empowered mothers, men who feel disempowered, cartoons with strong female leads. We need to explore how we ensure that this is indeed the generation of equality. An age where there are no defined roles for boys or girls, where both our boys and girls can lead. As we are striving to leave no woman or girl behind in generation equality, we should also leave no man or boy behind, as we need them to end gender inequality. Because when we celebrate Beijing 50, we cannot afford to have gotten it wrong.

07 03 2020

“Now women run the show”: Equality or Illusion?

Ateeb Ahmad Parray

I met Rahima (pseudo name) in Korail slum while doing a group session as a part of a training. She has lived in Korail slum for many years. Now she is a community health worker in BRAC’s health programme. While discussing the changes in the slum over the period, Rahima stated:

What’s changed is that men used to run the slum before. Now women run the show.

I was totally struck by this statement. She explained that her father-in-law wasn’t in favour of her moving to a city with her husband. Mentioning having to “wait for his death” to come, to live with her husband. She also said that now she is viewed as a leader in the community.

All the other women who participated in the session shared similar experiences. Each of their stories is a piece of a larger, inspirational story of fights against social odds and women’s empowerment.

Life changes

Meeting in Korail

I have been visiting the urban slums of Dhaka for more than two years now. I have always seen women engaged in some sort of income generating work. Whenever I talked to them, they told stories of their lives having changed over time with different skills building training, jobs or micro-credits they received from non-governmental organisations. Their stories give strong vibes of economic empowerment, self-sufficiency and leadership. At the same time, these are stories of sorrows, struggles and hardships that each of the woman goes through their daily lives for achieving their financial and social freedom.

Being a woman in a patriarchal conservative society like Bangladesh is a lifetime struggle in all socio-economic classes. And if that woman belongs to a poor socio-economic strata and lives in an informal settlement, then the intensity of her struggles becomes high. As described by a community health worker, living in one of the urban slums of Dhaka:

This is what it takes to handle everything on your own.

The unheard sigh

As, much as I appreciate the empowerment these women feel, I also sense their ‘unheard sighs’. Given the burdens that these women have to shoulder is this perceived equality just an illusion? Men in the urban slums of Dhaka, often appropriate the income that women generate. Women face the ‘double burden’ earning the money but also taking care of daily chores, managing children and running the household. They are responsible for everything. Does this resonate the true sense of empowerment or are we burdening them with more responsibilities?

Equality now?

Most of the diverse women living in the informal settlements in Dhaka city – ready-made garment workers, shop owners, teachers, NGO workers – are actively participating in income generation and education. But their empowerment depends on support from their families, male counterparts and society. Because of that it is fragile and relational. We must do more to ease their burdens and share the responsibility.

These diverse categories of women all have jobs but are they really able to exert their agency in their lives. It is worth questioning. That is a point where most of their lives converge. I was left with a thought, even though these women are empowered in their own contexts does this empowerment reflect the equality that should exist in society? This makes me think about whether empowerment is a mere illusion for these women.

06 03 2020

Adopting a gender lens in health systems policy

By Lynda Keeru

Momentum is building towards the International Women’s Day marked and celebrated around the world on the 8 March. This indeed coincides with the general international interest among policy makers in knowing what practical steps to take to move towards a more gender-equitable and transformative health system.

This year will also mark 25 years since the Beijing Declaration and Platform for Action adopted at the Fourth World Conference on Women (Beijing, 1995). This conference sought to remove all the obstacles to women’s active participation in all spheres of public and private life through ensuring women a full and equal share in economic, social, cultural and political decision-making.

The creation of a guide for policy makers

As the buzz around Universal Health Coverage continues to build, bringing on board the gender lens to policy deliberations cannot be more timely. In this common spirit, a number of advisers and researchers were brought together in Nairobi in February 2019 and developed this guide (Adopting a gender lens in health systems policy) which does a few things:

Defines what a gender-equitable health system might look like
Provides a set of benchmarks that health policy makers can work towards
Features case studies from a range of countries, including Cambodia, Democratic Republic of Congo, Kenya, Liberia, Malawi, Sierra Leone, South Africa, Tanzania and Uganda. These illustrate how decision making that does not take gender into account leads to sub-optimal health systems. They provide practical examples of strategies that have been effective in addressing gender barriers in health systems.
Lists further resources which are accessible online

The guide was supported and co-authored by ARISE and they contributed an interesting case study from India.

Adopting a gender lens in health systems research

Gender is everyone’s business

To start with, it is important to note that gender is everyone’s business. It is not only about women and girls and excluding others as is often misinterpreted. Owing to gender biases, norms, and power relations, some groups of people are often not factored in decision making processes. This means that their needs and rights are not identified, recognized or prioritized.

Likening the health system to that of a computer, it has both the hardware and software system. The hardware components include the six building blocks identified by the World Health Organization (WHO). These building blocks include: health service delivery, governance, medical products and technology, health systems financing, human resources and health information systems. The software system on the other hand is hard to see but it is critical as it cements and informs the success of work on the building blocks and includes relationships, values, trust, and power. As the authors in this guide: state: “Both the hardware and software of the health system are affected by gender. Gender norms, roles, and relations are also shaped by the health system.”

Health systems building blocks

Gender policy health systems diagram On the second page of this very enlightening guide, the authors delve deeply and even graphically into what gender-equitable health systems look like, providing detailed information on the aforementioned six building blocks.

Take for example the importance of providing accessible, acceptable, affordable and available health services as a core function of a health system. Further down that page, as you’ll see when you read, there is an illustration of how the divergent needs, rights, access, and experience of health services for men, women, and people of other genders affect the range of demand- (patient-led) and supply-side (health service-led) factors. For instance, a case study from Kibuku district in Uganda demonstrates how health facilities are making life more bearable for physically disabled women.

The second building block is very important. It focuses on health workers who are the backbone of the health system. The policy brief in this section outlines very fundamental recommendations for policy makers based on experience from the different implementers as reflected in the case studies and recommended resources like the WHO (2011) Gender mainstreaming for health managers: a practical approach.

An inclusive health system should, by definition, place fairness and equity at its core. However, many health systems’ governance structures and processes fall short of their potential when it comes to gender equity. There is a lack of goal setting for higher representation of women in leadership and policy spaces in the form of targets, quotas and affirmative action. The guide underscores the key issues in gender and accountability and also suggests ways in which these issues can be addressed by policy makers like ensuring gender balance and gender sensitivity of governance structures at all levels down to the facility and community level.

The brief also features a very well written and interesting case study on “Gender analysis of community health data in Kenya”. It documents the direct impacts of gender on the quality of data reported by Community Health Volunteers due to gendered barriers in data collection. Case in point, what many would regard as a “simple” issue – like the fact that some health issues are perceived to be the domains of men or women – consequently, inform trends like that of Community Health Volunteers collecting data from women. This leads to men’s perspectives missing from the data routinely reported. These gendered elements of data collection impact on dimensions of data quality such as accuracy, completeness, reliability and confidentiality. There’s a wealth of resources put together by the authors of the brief on the same. Check it out!!

‘The phone is my boss and my helper’ – A gender analysis of an mHealth intervention with Health Extension Workers in Southern Ethiopia, mHealth and Gender: Making the Connection and ‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information are some of the works in the brief that have been done by researchers in the area of medical products and technologies and are useful for actors in this field.

Finally, we turn to health financing, the accumulation and allocation of funding by and within the health system to ensure service quality and access. As quoted in the guide:

The extent that financial protection is available to different groups needs to be considered, in addition to how out-of-pocket expenditure is experienced differently by men, women, and people of other genders. This affects policy makers’ ability to deliver Universal Health Coverage.

Conclusion

Policy makers can give women their rights on international women’s day by taking up this recommendation to:

Ensure that financial protection packages (i.e. prepaid health services under Universal Health Coverage schemes) include essential and routine sexual and reproductive health services, such as childbirth and emergency obstetric care, family planning, cancer care, such as for prostate cancer, and safe abortion.

Gender mainstreaming is challenging and ambitious but we have no choice if we hope to achieve a gender equitable health system and this guide is a gift to all policy makers who are trusted to lead the process.

05 03 2020

Each for equal in a changing world: looking backwards and forwards in 2020

By Rachel Tolhurst and Sally Theobald

2020 is a critical year for advancing gender equality. It is 25 years since the adoption of the Beijing Platform for Action. This coincides with the 20th anniversary of UN Security Council resolution 1325 on women, peace, and security and the 10th anniversary of UN Women.

The theme for International Women’s Day is “An equal world is an enabled world”. Looking around us, we can see huge challenges to creating an equal world. In many spaces rights are being eroded. There are challenges to the citizenship of minorities and there is hostility towards migrants. There have been setbacks in realising sexual and reproductive and LGBTQ+ rights. The marginalisation and impoverishment of people living with disabilities is increasing.

These challenges are magnified by the climate emergency and continued fragility and conflict in many places. The scale of the challenges often feels overwhelming. But we hope to tackle them through solidarity and inclusive partnerships for change. We need to balance unity with sensitivity to all our differences.

A message of hope

We have been working in global health for the last 20 years. It has been a time of solidarity and transformation. We have worked to increase the recognition of the importance of gender in shaping inequities in health and disease experience. Our research has spanned many health issues, such as HIV and AIDS, TB and lung diseases, Neglected Tropical Diseases, maternal and reproductive health, malaria, water and sanitation and air pollution.

Activism on HIV brought visibility to gender inequities and promoted the inclusion of affected women and a focus on their rights. This was the result of advocacy by strong networks of women’s organisations. It included strategic partnerships between the grassroots of the global south and researchers, politicians and others. The scale and severity of violence against women and girls is getting greater attention. Legislatures have put in place new laws against sexual and gender-based violence.

We have learned from feminists in the north and south including disability activists and Black American theorists. To quote Audre Lorde:

There is no such thing as a single-issue struggle because we do not live single issue lives.

As northern feminists it has become increasingly clear that we must ‘check our privilege’. We are actively working to create spaces to amplify the voices and activism of those who are marginalised by patriarchy and structural violence.

The women of ARISE

We have learned from so many inspiring women through our research. ARISE is an exciting space for this. For International Women’s Day we asked all our female colleagues on ARISE for their reflections on the theme of “Each for equal”.

We would like to leave you with some of their thoughts:

“An equal world is an enabled world. If we could only give women equal opportunities as men, what a difference in the world that would make” Nelly Muturi, LVCT Health
“By conducting research, I will amplify the voices of women and girls living in informal settlements. Until every girl is as safe as our boys, none of us are safe.” Bintu Mansaray from College of Medicine and Allied Health Sciences in Sierra Leone
“I will work towards gender equality by breaking structural barriers that enforce and perpetuate patriarchal gender norms and behaviour to provide equal access to rights and opportunities for all.” Samiha Ali from James P Grant School of Public Health in Bangladesh

Eva Muchiri Jackline Waithaka Jane Wairutu

27 02 2020

Urban public spaces for play and wellbeing?

By Dolf te Lintelo

The Tenth World Urban Forum (#WUF10) took place in Abu Dhabi earlier this month. Hosted by UN-Habitat, the human settlements arm of the United Nations, this biannual gathering brought together over 13,000 professionals, practitioners, policymakers and researchers over five days. It offered a rich variety of panels, discussions, and wider exhibitions on current trends and issues relating to the topic of Culture and Innovation in cities.

Partnerships towards an inclusive culture of health in cities

My focus at the conference converged around the themes of informality, urban displacement, and wellbeing, and I was privileged to speak on three panels. The first panel was entitled Partnerships towards an inclusive culture of health in cities. Together with Margaret Bayo from Slum Dwellers International (SDI), Sierra Leone, and Caroline Kabaria from the African Population and Health Research Centre (APHRC) in Nairobi, we represented the ARISE Consortium, which jointly hosted this networking session with the Stockholm Environment Institute (SEI) and the International Science Council (ISC). The session focused on urban health and wellbeing in relation to informal settlements and the urban form.

In this session, Jo Boufford (ISC) noted the paradox that despite the importance of the built environment for shaping health outcomes, at the global level, policymakers often don’t understand urbanism. Consequently, they frequently end up thinking about healthcare, not about the broader determinants of health in urban contexts. Jo further highlighted the necessity of urban planning schools to engage more with communities as co-planners.

My presentation outlined how the ARISE programme seeks to work closely with communities in urban informal spaces in Kenya, Sierra Leone, Bangladesh and India to identify their perspectives on what constitutes wellbeing, and how existing political economic relations and accountability dynamics shape health and wellbeing outcomes for diverse groups. Caroline Kabaria then discussed the opportunities and challenges in obtaining good quality data in these settings, whereas Margaret Bayo shared experiences on how women’s savings groups in Freetown slums helped to organise communities, communicate health messages, and conduct research to effectively engage the municipality and mobilise improved services.

Finally, Diane Archer (SEI) presented important new research that explored wellbeing in relation to urban green spaces in Thailand, to find that the latter are often scarce, and increasingly privatized. However, malls and other pseudo-public spaces are often used in similar ways to public spaces, which raises the question: do these spaces also provide important wellbeing services to city dwellers, and if so, how can we account for these? This work also entailed innovative methods to assess not just mental but also bodily perceptions of, and satisfactions with, particular urban spaces by monitoring heart rates and stress.

Harnessing public urban spaces to increase wellbeing

Diane’s was one in a rich seam of presentations across the WUF10 that paid attention to wellbeing in relation to urban public space. As a principal investigator on current research projects investigating placemaking, displacement, urban infrastructures and wellbeing – Displacement, Placemaking and Wellbeing in the City (DWELL) and Wellbeing, Housing and Infrastructure in Turkey (WHIT) – these had my special interest.

In many of the sessions, discussion focused on designated planned use and design, with examples ranging from upgrading a street, a market or a square, to totally reclaiming street spaces by banning cars and repurposing parking spaces as terraces and play areas for the benefit of pedestrians, children, the disabled and the elderly. Such public spaces were presented as prospectively beneficial to urban populations – for instance in cities like Brussels (Belgium) or Lima (Peru) – as they could foster cross-cultural interaction, harmonious relations, reduce insecurity and achieve civic trust that is essential to liveable cities. Public spaces are perhaps most important for children, whose access to these spaces has a big impact on their health and wellbeing, but public spaces also have important benefits for the community at large.

Some speakers argued that political leadership on urban planning and good urban design could have important effects on the community. For example, providing suitable lighting in parks invited night-time use by the community and a feeling of safety, but using popular types of paving stones such as cobbles (much used in European cities) inhibit less mobile groups (for example, the elderly or disabled) from getting to and using these spaces.

Much will depend on whether planners and designers take active cognizance of current users of such public spaces, and for what purposes. In a nice training on ethnography of public spaces, Setha Low (City University of New York) explained that when shoeshiners were removed from Latin American parks to make way for better material structures that did not accommodate them, youth gangs soon took over the park, making it extremely unsafe. Planners had failed to acknowledge that street vendors play a critical role in keeping a watchful eye on what happened in the park, providing support to people, and therefore had provided safety through their presence.

Anandini Dar (a colleague on the DWELL project at Ambedkar University Delhi) noted in her talk on migrant children’s placemaking in informal settlements that in many cities of the global south, such as in India, development visions tend to exclude children from public spaces. Where city governments are unwilling or unable to support public infrastructures in informal settlements, planning and design take a backseat. Intriguingly though, some research in Delhi shows that children favour unkempt parks to formally designed play spaces, as children resist conforming and reinvent spaces in accordance to their own needs for play. Dar’s research also finds that informal settlements themselves pose many opportunities for spontaneous play and wellbeing, offering some nuance to the stories of horror, unsafety and harm that are stereotypically used to label such settlements.

Does this then mean that these children should be left to their own devices? Far from it. Children, and their capacity for imagination and play, must be recognised and become an active part of public planning and design. This could shift focus away from providing highly structured places and objects of play to shape urban environments that encourage playfulness for wellbeing.