Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Wolfe St, Baltimore, MD, USA.
University of Ibadan College of Medicine, Ibadan, Nigeria.
Glob Health Res Policy. 2021 Jun 29;6(1):19. doi: 10.1186/s41256-021-00203-5.
Globally, gender as a barrier or facilitator in achieving health outcomes is increasingly being documented. However, the role of gender in health programming and organization is frequently ignored. The Global Polio Eradication Initiative, one of the largest globally coordinated public health programs in history, has faced and worked to address gender-based challenges as they emerge. This paper seeks to describe the role of gender power relations in the polio program across global, national, subnational, and front-line levels to offer lessons learned for global programs.
We conducted qualitative key-informant interviews with individuals purposively selected from the polio universe globally and within seven country partners: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, and Nigeria. The interview tool was designed to explore nuances of implementation challenges, strategies, and consequences within polio eradication. All interviews were conducted in the local or official language, audio-recorded, and transcribed. We employed a deductive coding approach and used four gender analysis domains to explore data at the household, community, workplace, and organizational levels.
We completed 196 interviews globally and within each partner country; 74.5% of respondents were male and 25.5% were female. Male polio workers were not allowed to enter many households in conservative communities which created demand for female vaccinators. This changed the dynamics of front-line program teams and workplaces and empowered many women to enter the workplace for the first time. However, some faced challenges with safety and balancing obligations at home. Women were less likely to receive promotions to managerial or supervisory roles; this was also reflected at the global level. Some described how this lack of diverse management and leadership negatively affected the quality of program planning, delivery and limited accountability.
Gender power relations play an important role in determining the success of global health programs from global to local levels. Without consideration of gender, large-scale programs may fail to meet targets and/or reinforce gender inequities. Global disease programs should incorporate a gender lens in planning and implementation by engaging men and boys, supporting women in the workplace, and increasing diversity and representation among leadership.
在全球范围内，性别作为实现健康结果的障碍或促进因素越来越受到关注。然而，性别在卫生规划和组织中的作用经常被忽视。全球根除脊髓灰质炎倡议是历史上最大规模的全球协调公共卫生项目之一，在出现性别相关挑战时，它一直在努力应对这些挑战。本文旨在描述性别权力关系在全球、国家、次国家和一线层面的脊灰规划中的作用，为全球规划提供经验教训。
我们对全球范围内以及七个国家合作伙伴（阿富汗、孟加拉国、刚果民主共和国、埃塞俄比亚、印度、印度尼西亚和尼日利亚）的脊灰项目中的特定人员进行了定性关键知情人访谈。访谈工具旨在探讨脊灰根除工作中的实施挑战、策略和后果的细微差别。所有访谈均以当地语言或官方语言进行，录音并记录。我们采用了演绎编码方法，并使用四个性别分析领域来探索家庭、社区、工作场所和组织层面的数据。
我们在全球范围内以及每个合作伙伴国家共完成了 196 次访谈；74.5%的受访者为男性，25.5%为女性。在保守社区，男性脊灰工作人员不被允许进入许多家庭，这就需要女性疫苗接种员。这改变了一线项目团队和工作场所的动态，使许多女性首次进入职场。然而，一些人面临着安全和平衡家庭责任的挑战。女性晋升为管理或监督角色的机会较少；这在全球层面也有所反映。一些人描述了缺乏多样化的管理和领导能力如何对项目规划、实施的质量产生负面影响，并限制了问责制。
性别权力关系在从全球到地方各级的全球卫生项目的成功中起着重要作用。如果不考虑性别问题，大型项目可能无法实现目标，或者加剧性别不平等。全球疾病规划应在规划和实施中纳入性别视角，包括让男性和男孩参与、支持职场中的女性，并增加领导层的多样性和代表性。
