19th SESSION OF THE SUBCOMMITTEE OF THE EXECUTIVE COMMITTEE ON WOMEN, HEALTH, AND DEVELOPMENT

Transcription

1 PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION 19th SESSION OF THE SUBCOMMITTEE OF THE EXECUTIVE COMMITTEE ON WOMEN, HEALTH, AND DEVELOPMENT Washngton, D.C., USA, March 2001 Provsonal Agenda Item 4 MSD19/3 (Eng.) 7 February 2001 ORIGINAL: ENGLISH REPORT ON THE ACHIEVEMENTS OF PAHO S WOMEN, HEALTH, AND DEVELOPMENT PROGRAM, Ths document covers the achevements of PAHO s Women, Health, and Development Program (HDW). Snce the 18th Sesson of the Subcommttee of Women, Health, and Development, the Program and ts natonal counterparts have consoldated the ntegrated model for addressng ntrafamly volence whch has been nsttutonalzed n over 100 communtes, n the health and other sectors, as well as n polces and legslaton n 10 countres. HDW s takng a leadng role wthn the Lves Free from Volence Group of UN agences and regonal women s networks n organzng the Symposum 2001: Gender Volence, Health, and Rghts, to moblze the health sector n addressng gender volence. As a follow-up of the 18th Sesson, the Program developed, receved fundng for, and s launchng a project to address gender equty n health sector reform, by developng materals and operatonalzng these wth stakeholders n Chle and Peru. It has also spearheaded research on ths ssue n sx countres. HDW contnues to collaborate wth PAHO dvsons and Member States to ncorporate gender equty n research, projects, and polces: male nvolvement n reproductve health, gender and qualty of care, nvolvng ndgenous women s groups n health promoton and care, and addressng the needs of women wth ther partcpaton n envronmental, and occupatonal health projects. The Women, Health, and Development Program counts on the support of the Subcommttee to strengthen PAHO s and Member States commtment to mplement the ntegrated model for addressng gender volence, to partcpate n and mplement the plans and recommendatons of the Symposum 2001, to nclude stakeholder partcpaton and gender n health analyss and montorng of health sector reform processes, to form allances wth local, natonal and regonal women s groups, and to dssemnate ts tools, research results and publcatons throughout the Regon.

2 MSP19/3 (Eng.) Page 2 CONTENTS Page 1. Introducton Adressng Gender Volence The Integrated Model Publcatons and Tools for Preventng Gender Volence Techncal Collaboraton Symposum 2001: Gender Volence, Health, and Rghts Includng Gender Equty n Health Sector Reform Manstreamng Gender Equty at the Natonal Level Manstreamng Gender Equty at the Regonal Level Research on Gender Equty and Access to Health Gender Equty n Qualty of Care Involvng Indgenous Women n Health Promoton, Care, and Tranng Involvng Men n Reproductve Health Programs Incorporatng Gender Equty n PAHO Provdng Informaton on Gender Equty Strengthenng Gender Equty n Health and Development: the Subcommttee s Role Concluson...11

3 MSD19/3 (Eng.) Page 3 1. Introducton The bennum saw a surge of nterest n health equty and the negatve health consequences of wdespread nequtes. Whle poverty s effects on mortalty and lfe expectancy receved the lmelght, gender nequtes contnue to receve lttle attenton. Most countres stll do not dsaggregate by sex ther health data on whch much plannng and resource allocaton s based, whle women and ther sngle-headed households contnue to femnze the poverty ranks. These poor famly members make up most of the persstent numbers of communcable dseases, maternal mortalty, and malnutrton. Whle our populatons age, chronc dseases predomnate n terms of morbdty and causes of death n developed and developng countres of the Amercas. But poverty plays a role n these dseases as well, as does gender. Accordng to the Unted Natons World s Women 2000 women lve an average of sx more years than men. Whle women have longer lfe expectancy n most regons of our world, they do not have equal health expectancy or lfe expectancy n good health compared to men. Women suffer more dsease and dsablty throughout ther lfe span, wth ncreased dsablty n ther older years. Durng these years women are more lkely than men to be wdowed, and a majorty lve n poverty and are not nsured, whch deterorates ther health, lmts ther access to care, and dmnshes the qualty of ther lves. Cardovascular dseases are the man kller that n some developng countres result n greater mortalty among poor women than poor men. Cancer mortalty n most countres s hgher among women than men, mostly due to breast and cervcal cancer. Increasngly, studes show that these dseases affect women and men dfferently and that wth the excepton of some cancers, the poor are dsproportonately at rsk. Most of these dseases are preventable and have well-known rsk factors that are adopted durng youth and are transgeneratonal, such as cgarette smokng, substance and alcohol abuse, unhealthy det, and lack of exercse. Ther preventon, therefore, should target changng the behavors that are determned n a large part by socal constructs such as class and gender and are nfluenced by socal polcy. There s some evdence that on-gong health sector reform processes n many countres ncrease gender nequtes n access, fnancng, and care, and ultmately n health status. Ths nformaton s derved from solated studes, snce few countres montor these effects of ther health sector reform. As a result of reforms, many governments have reduced basc health care packages to essental obstetrc and prenatal servces, excludng other reproductve servces that were so strdently fought for durng the last decades. Promoton and preventon servces, so mportant for strengthenng healthy behavor throughout the lfe cycle, were too often reduced or elmnated n favor of curatve care. Whereas at one tme most of

4 MSP19/3 (Eng.) Page 4 these servces were free, now even the most austere packages are subsdzed and have a prce that s too often beyond the reach of the poorest, many of whom are women. There s some evdence that among the poorest strata, women use publc servces even less than men and, despte these women s ncreased need, ther use s certanly less than women and men who are better off. Health sector reform promotes prvatzaton and decentralzaton of servces. Agan, the poor usually cannot afford these prvate servces, and snce most women spend ther productve lves n unpad work and the nformal sector, few have access to nsurance polces that cover these servces. Whle women have advocated hard to senstze and be represented among natonal polcymakers, most local leaders contnue to be men who are not gendersenstzed and, often formulate programs and polces that do not take the dfferent needs of women n ther communtes nto consderaton. But there have been advances. Gender volence s no longer nvsble n our Regon, and the role of men n mprovng ther own health, as well as that of ther famles, s ganng recognton. Most countres have ratfed the nternatonal conventons condemnng volence aganst women and passed laws penalzng and addressng the problem. Some countres now are ncludng gender volence ndcators n health survellance systems. Prevalence data are stll scarce throughout the Regon, but there are a number of natonal surveys and an ncreased recognton of the need for data to mprove strateges for volence preventon. However, whle women s organzatons have moblzed the judcal sector and polce to address gender volence, the health sector stll lags behnd. Ths s of specal concern, gven that most women brused by gender volence request health servces more often, wthout the provders awareness or the ablty to deal wth the problem. Efforts to prevent gender volence have called attenton to the need for men to become more actve n mprovng ther own and women s health. In the Regon there s a buddng movement of men who work closely wth women s and reproductve health advocates n changng men s role n ther socetes and n health decsons. In some countres publc and prvate programs have renforced these efforts by supportng men s partcpaton and n developng materals. Galvanzed by ts women s organzatons alles and an ncreasng nterest of mnstres of health, PAHO colleagues and donors, PAHO s Women, Health, and Development Program (HDW) has scored some remarkable achevements n addressng gender nequtes durng the last two years.

5 MSD19/3 (Eng.) Page 5 2. Adressng Gender Volence 2.1 The Integrated Model Snce 1995, HDW, n collaboraton wth ts natonal counterparts and wth support from the Governments of Sweden, Norway, and the Netherlands, has developed an ntegrated model to address gender volence at the communty, sector and polcy levels. PAHO has mplemented ths model n 10 countres (seven Central Amercan countres and Bolva, Ecuador, and Peru), and the Inter-Amercan Development Bank has replcated t n sx others. In these countres, the model has resulted n over 100 ntersectoral communty networks that support, refer, and care for women and famles lvng n volent stuatons and mount educaton and meda campagns for preventon. Counterparts have developed and mplemented tranng modules, procedures, and survellance systems for health provders n all these countres. They have strengthened natonal coaltons that advocate for better laws and the nsttutonalzaton of the projects achevements. Achevements: Incluson of gender volence preventon and the ntegrated model n regonal and subregonal polcy fora: RESSCAD, Parlatno, Frst Lady meetngs, and regonal summts. 100 communty networks made up of health, educaton, and judcal sectors, polce, churches, communty leaders, women s organzatons etc., addressng the problem at the local level. At the natonal level, 10 coaltons n sx countres. Legslaton passed n 10 countres and montorng bodes set up n sx Central Amercan countres. Crtcal Route research n countres. Prevalence study on volence affectng women and on the male role n promotng volence n Bolva, and knowledge, atttudes and practce study n Peru. Development and applcaton of tranng modules n nne countres: more than 13,000 representatves from health and other sectors traned. Communty support groups traned and functonng n eght countres. Masculnty educaton and support groups n fve countres. Volence ncluded n currcula of prmary schools n Belze and Peru, and n college currcula n three countres.

6 MSP19/3 (Eng.) Page 6 Norms and protocols developed and appled n 10 countres. Survellance systems n fve countres. Preventon campagns n 10 countres. Incorporaton of model n health sector reform processes n fve countres. 2.2 Publcatons and Tools for Preventng Gender Volence HDW publshed the Englsh and Spansh verson of the Protocol: The Crtcal Route that Women Take n Dealng wth Volence (Ruta crítca), as well as ts shorter Rapd Assessment Verson (RAP), and an analytcal comparson of the Crtcal Route Studes results of the 10 countres; the Spansh versons are avalable on HDW s webste. Prototype tranng modules for health provders and the norms and protocols can also be obtaned on the webste. 2.3 Techncal Collaboraton To facltate the sharng of experences, HDW promoted the techncal exchange of gender volence preventon experences between sx countres on topcs rangng from polcy promoton to tranng of health provders and the settng up of communty networks and support groups. HDW staff and focal ponts collaborated wth WHO on the multcenter study on gender volence prevalence n Brazl, Chle, and Peru. The Program translated and dssemnated WHO s Ethcal Gude for carryng out ths and other gender volence studes. 2.4 Symposum 2001: Gender Volence, Health, and Rghts As part of the nteragency Lves Free from Volence Group, PAHO/HDW played a leadng role n organzng the Symposum amed at moblzng the health sector n addressng gender volence. Intersectoral and nteragency groups from 30 countres submtted reports on the health sector s experences, from whch model approaches were selected for presentaton durng the Symposum. Agences are collaboratng n sponsorng partcpants from more than 30 countres, representng mnstres of health and of women, and leadng volence preventon NGOs. Durng the Symposum, natonal partcpants wll develop subregonal plans and are commtted to mplementng these plans and replcatng the presented experences n ther countres. PAHO and ts sster agences wll support the natonal coaltons that wll facltate ths process.

7 MSD19/3 (Eng.) Page 7 3. Includng Gender Equty n Health Sector Reform HDW and women s organzatons have recognzed the growng gender nequtes resultng from health sector reform processes. In 1998 HDW convened a group of experts to dentfy strateges to address ths ssue. Durng the 18th Sesson of the Subcommtte on Women, Health, and Development n 1999, members presented country reports on gender equty and health sector reform and drafted recommendatons for the Executve Commttee s consderaton. As a result of these meetngs, HDW launched an ntatve to develop, valdate, and mplement analyss, advocacy, and plannng nstruments to ncorporate gender equty crtera n natonal health stuaton analyss and polcymakng. The strategy was presented n a proposal that was funded by the Ford and Rockefeller Foundatons. 3.1 Manstreamng Gender Equty at the Natonal Level The proposal also ncludes the mplementaton of these nstruments n three countres. Wth Ford Foundaton support, HDW s launchng the project n Chle, followed by Peru. The Program s seekng support for a thrd country n Central Amerca. The country projects nclude the actve partcpaton of government and cvl socety stakeholders throughout ther mplementaton and components. The man project components are: (1) producton and analyss of nformaton on gender nequtes n health and care; (2) strategc communcaton of results to key audences; and (3) montorng of polcy mplementaton and reform processes. Whle these actvtes are usually mentoned n health sector reform recommendatons, the project provdes an opportunty to mplement these recommendatons wthn a process that fosters stakeholder ownershp. 3.2 Manstreamng Gender Equty at the Regonal Level HDW advocated for ncludng gender n health sector reform n regonal and nternatonal fora: two regonal meetngs of the Latn Amercan Assocaton for Socal Medcne (ALAMES), ECLAC Regonal Women s Status Meetngs, an Internatonal Meetng on Equty and Reform n South Afrca, a meetng wth the Latn Amercan and Carbbean Women s Health Network (RSMLAC) durng two regonal gender and health tranng workshops, and wth the UN Statstcal Bureau tranng workshop for CARICOM statstcans. Durng 2001 and n collaboraton wth PAHO and UN agency colleagues, HDW plans to use ts tools to tran regonal and natonal counterparts n manstreamng gender n health stuaton analyss and polcymakng. Such tranng wll take place n regonal

8 MSP19/3 (Eng.) Page 8 workshops, as well as n two countres per year, where HDW wll follow up wth techncal collaboraton to complete gender and health stuaton analyss. 3.3 Research on Gender Equty and Access to Health In collaboraton wth PAHO s Research Coordnaton Program, HDW obtaned fundng to call for proposals regardng gender nequtes n access to and fnancng of health servces wthn the context of health sector reform. Of 74 proposals submtted, sx were selected from the subregons of the Amercas. To assure that results translate nto polcy, HDW held an ntal workshop wth researchers to ncorporate a polcy component nto the study. Results are expected n March of 2001 and wll be ntegrated nto HDW workshops and tranng on manstreamng gender equty and health sector reform throughout the Regon. 4. Gender Equty n Qualty of Care Wth the support of the Swedsh Government, HDW mplemented four gender and qualty of care operatons research projects n four Central Amercan countres (El Salvador, Guatemala, Honduras, and Ncaragua). Usng the protocol developed for a smlar study n Argentna and Peru, the project coordnator and natonal researchers agan observed gender dfferences n the way men and women perceved ther dsease status, how ths affected ther seekng of care and adherence to treatment, and how provders perceved ther men and women patents. Tracer condtons used n the study were dabetes n El Salvador and Ncaragua, and tuberculoss n Guatemala and Honduras. Even though study samples were small, results from all sx countres were remarkably smlar. They showed, among others, that men took responsblty for contractng and managng ther dseases, and that ther partners and famles supported them wth treatment. Women, on the other hand, generally felt that the dsease was just another mposton n a dffcult lfe, and that they receved lttle or no support from ther famles. Ther only possble support came from health care provders, who were often unsympathetc and rude, and who had unrealstc expectatons for ther treatment. These results were dssemnated n reports and meetngs wth polcymakers n three countres and were ncorporated n tranng of health care provders usng the WHO manual Health Workers for Change (translated nto Spansh and made avalable through PAHO s subsdzed resources, PALTEX). In Ncaragua the process resulted n the formng of dabetes support groups for women; n Honduras the Natonal Tuberculoss Program ncorporated gender approach n ts natonal polcy.

9 MSD19/3 (Eng.) Page 9 5. Involvng Indgenous Women n Health Promoton, Care, and Tranng Durng , the Program, together wth ts ndgenous and mnstry of health counterparts, wth support from Sweden, developed a model to nclude women s groups n the health servces and to promote t n nne predomnantly ndgenous communtes n Guatemala. Councls organzed by women of these communtes partcpated n health care and promoton tranng wth ther health servce provders, n order to promote modern and tradtonal care and preventon practces wthn ther health centers and communtes. The model also nvolves referrals to tradtonal and modern practtoners and the dspensng of tradtonal remedes n health centers. The Councls play an actve role n promotng such modern preventve measures as breast and cervcal exams and chld vaccnatons. The model serves as the bass for a four-year project presented to Norwegan donors for promotng ntercultural and gender equty n health sector reform n all Central Amercan countres. The project proposal was developed and amply consulted wth the partcpaton of natonal ndgenous groups and the health sector of these countres. HDW and ts counterparts hope to launch ths project n Involvng Men n Reproductve Health Programs The German Government s provdng support for an operatons research project to be mplemented n four Central Amercan countres. The project, whch wll be launched n 2001, conssts of partcpatve studes of men s knowledge, atttudes, and practces regardng ther and ther famly s reproductve health. Based on ths nformaton, HDW wll coordnate wth mnstry of health, men s groups and other partners to develop male nvolvement models n a health center and a recreaton place or sports center. In preparaton for the project and to rase awareness of PAHO colleagues, HDW has publshed an artcle on Men s Partcpaton n Reproductve Health Programs n the Revsta Panamercana de Salud Públca/Pan Amercan Journal of Publc Health, and dstrbuted an annotated bblography, relevant materals, and fact sheets to ts focal ponts and through ts lstserve. 7. Incorporatng Gender Equty n PAHO The prmary mandate of HDW s to ncorporate gender equty n all of PAHO s techncal collaboraton, actvtes, and polces. The Subcommttee on Women, Health, and Development meets bennally to nform PAHO s Drector, colleagues, and the Executve Commttee of mnsters of Member States about key ssues concernng gender equty n

10 MSP19/3 (Eng.) Page 10 health; t drafts resolutons and advocates for ther approval by PAHO s Executve Commttee. HDW collaborates wth most dvsons n meetng these recommendatons. Wthn the last two years HDW has ncorporated gender ndcators wthn PAHO s health sector reform montorng tools, as well as n volence survellance systems; t has manstreamed gender n the tranng, actvtes, and polces of the Central Amercan Project on Pestcde and Health; t s collaboratng on a partcpatve project to develop health standards for women and men workng n export ndustres and s workng wth PAHO s Mental Health Program to dentfy and mplement communty approaches dealng wth gender and mental health, wth a partcular focus on depresson. 8. Provdng Informaton on Gender Equty One of the key objectves of HDW s to provde current nformaton to ts network of focal ponts, counterparts, stakeholders, and gender and health advocates throughout the Regon. The Program provdes ths nformaton n hard copy and through electronc channels, such as ts webpage where most publcatons, tranng materals, and fact sheets are made avalable, ts lstserve GENSALUD (gensalud@paho.org) and through lnkng partner nformaton centers, such as ISIS n Chle and SIMUS n Costa Rca, to PAHO s Vrtual Lbrary. Publcatons avalable on the Web and n all PAHO s documentaton centers n the Regon nclude: the HDW Tranng Gude on Gender, Health, and Development (Spansh and Englsh), publcatons of the Intrafamly Volence Project; the Spansh translaton of the Ethcal Gude for Research on Domestc Volence, Smokng, and Adolescent Women (Spansh and Englsh), as well as the nstruments developed by the Intrafamly Volence project coordnators and ther natonal counterparts. In addton, several publcatons are made avalable through PAHO s Publcatons Program: Domestc Volence: Women s Way Out (Englsh translaton of the Ruta Crítca), and a Spansh translaton of the Harvard seres on Gender Equty n Health. GENSALUD currently has more than 300 subscrbers and provdes nformaton on webstes, publcatons, conferences, and other relevant nformaton, as well as monthly factsheets.

11 MSD19/3 (Eng.) Page Strengthenng Gender Equty n Health and Development: the Subcommttee s Role Draft and advocate for recommendatons to manstream gender n PAHO s and Member States programs, research, polces and health stuaton analyss and montorng. Strengthen and replcate the ntegrated model for addressng gender volence and mplement the recommendatons of the Symposum 2001: Gender Volence, Health, and Rghts, throughout the Regon. Include stakeholder partcpaton, especally women and ther local, natonal, and regonal organzatons n health stuaton analyss and research, dssemnaton of results, and montorng of related polces. Dsemnate HDW tools, research results, and tranng programs. 10. Concluson Wth the globalzaton of the world s economes and socal agendas, assurng health for all provdes new challenges and opportuntes. Whle there s a general recognton that socal, as well as bologcal, determnants affect health, gender contnues to be an afterthought for most analysts and polcy planners. However, there s a begnnng recognton that: poverty s ncreasngly femnzed; gender volence affects one-thrd to one-half of women n almost all countres; unlke plummetng nfant mortalty rates, maternal mortalty rates change slowly and reflect even larger nequtes between countres and provnces; women are less often covered by health nsurance, whch s ncreasngly determnng access to health servces; globalzaton and sector reform have not always delvered more equtable systems and polces. Gender ndcators should be ncluded n health stuaton analyss that provdes the bass for plannng and polcy-makng. Ths nformaton should be made wdely avalable to women s groups and other stakeholders so they may use t to montor reform processes and partcpate n the decson-makng processes that affect ther health condton and access to health care.