The role of ngos in promoting a gender approach to health care
Marianne Haslegrave, Commonwealth Medical Association
Traditionally non-governmental organizations (NGOs) have always been in the forefront of promoting new ideas and in encouraging governments to implement them. At all levels - local, national and international - NGOs represent the voice of the people. They have taken on roles such as advocacy, education and training, and have been active in monitoring what has, or has not, been achieved. During the past two decades NGOs have actively advocated that the fullest recognition should be given to the enormous contribution that women make to the family, society and development. NGOs have been among the strongest advocates for implementation of the outcomes of the series of UN world conferences on women which began with the International Womens Year Conference held in Mexico City in 1975.
Developing the concept of a gender approach from an NGO perspective
Much of the major debate on womens issues among NGOs during the past few years has focussed on moving from a women-centred approach to a gender approach particularly in the context of their contribution to development. Health has been one of the most recent issues to be approached in this way. The NGO Symposium Health for All women and men: a gender perspective, held in Geneva in October 1997, recognized that:
. . . the concept of gender refers to womens and mens roles and relationships which are shaped by social, economic, political and cultural factors rather than by biology. Gender, moreover, is a dynamic concept which examines the nature of these roles and relationships between women and men in the context of the perspectives and beliefs of society. These socially constructed roles and relationships have a direct bearing on the health and well being of both sexes. A gender perspective helps identify the inequalities between women and men which in the field of health can lead for both to increased illness or death from preventable causes. A gender approach to health examines how gender differences determine access to benefits and the way in which technology, information, resources and health care are distributed. It provides the foundation for maximizing human resources in development because the result of equal access to resources, benefits and opportunity to all will be a more enlightened, educated, healthy and independent society. Society as a whole will therefore be better placed and equipped to contribute to development. On the contrary the denial of opportunity and access to benefits and resources to women who make up more than half the worlds population will continue the inadequate use of this valuable human resource.=
NGOs, moreover, recognize that gender inequalities in many different sectors that are not readily identified as concerned with health can have an adverse effects on womens health eg
- discrimination against girl children (a) before birth through pre-natal sex selection; (b) at birth through infanticide and (c) during childhood through neglect and son preference, compounded by their unfair share of food and of domestic chores, can lead to anaemia, malnutrition and stunting of growth;
- widespread and largely unreported prevalence of violence against women, including psychological and sexual abuse can cause lasting damage to their health and is not infrequently fatal;
- womens bodies are far more susceptible to infection by sexually transmitted diseases (STDs) including HIV/AIDS, and the risk of infection is compounded by their inability to insist upon safe sex. The associated complications include infertility and even death.
- unfair share of family income received by women and girls, together with their reduced opportunities for education and training, and consequential inability to obtain gainful employment, may force them to resort to commercial sex, and increased exposure to risk of contracting STDs or HIV/AIDS;
- early arranged marriages, a practice over which the girls concerned have little or no control, can lead to too early and unspaced pregnancies with associated health risks;
- cultural practices which preclude womens rights to make their own decisions, such as female genital mutilation (to which two million girls are subjected every year) and widow inheritance can have a serious and long term effects on their health.
NGOs as advocates
One of the most important roles that NGOs undertake is advocacy. The aims and objectives of the NGOs are usually focussed on improving the lives of their constituents and the communities in which and with which they work. NGOs have, for example, been in the forefront in protecting womens rights as human rights, by exposing violence against women, by promoting the needs of the girl child and by promoting and developing a comprehensive, holistic and rights-based approach to health services for women.
In order to bring about change it is necessary to convince the key stakeholders, whether they work in government, in administration, or as providers of the necessary funding, to bring about the change. It is also necessary to ensure that the electorate understands and supports the changes which need to be made.
NGOs are well placed to promote the need for a gender approach to health care. They have become increasingly effective as advocates at all levels - local, national and international. This has been shown at international level by the activities of networks and coalitions such as Womens Caucus, Advocacy for Womens Health, and HERA at the recent series of UN inter-governmental conferences and at the five-year reviews of the conferences that are currently underway. NGOs have also been active in identifying key decision-makers, preparing position papers and lobbying documents, and in contacting the media by means of press releases and press conferences and arranging press visits and encounters.
Since most of the decision-makers in the organization and financing of health care delivery tend to be men rather than women NGOs have to a key role to play in convincing them to adopt a gender approach. At national level health professional associations can be most effective as advocates for a gender approach to health care delivery. Not only are their members likely to be among the first to be affected but they usually include among their officers individuals who are in a strong position to influence government eg the current Minister of Health for Ghana is a former Vice-President of the Ghana Medical Association, and there are several other examples. Physicians will have studied for their medical degrees alongside students in other disciplines who will have gone on to take up key decision-making positions in government. It follows that sensitisation of health professional associations should be regarded as a priority so that they can exploit their ready access to Ministries of Health and to other important opinion formers in the interests of achieving the necessary changes.
Health professional associations can also be effective in working with parliamentarians in promoting a gender approach to health care delivery. They will often seek the advice of health professional associations on issues to do with health care, because they know that medical ethics require physicians to provide objective advice on health issues in the best interests of their patients. Health professional associations recognize the importance of developing good relations with the media in their own interests and can use their contacts to promote a gender approach to health care delivery. They can also be effective in persuading the general public by which recognizes their pronouncements as being both independent of government and objective. Together with other health-concerned NGOs they can employ the skills and experience that NGOs have amassed in putting across messages to the public in a way that the public is able to understand, and this will be very necessary in promoting a gender approach to health care.
NGOs and training
Many NGOs are involved in training and training programmes, which is a role which they have traditionally undertaken at all levels. They are therefore well-placed to assist the relevant government departments in bringing about the changes which will have to be put in place to ensure a gender approach to health care. It will, for example, be important to sensitize not only health ministries, but also other ministries such as finance and planning that will have to be involved in gender-sensitivity.
Many NGOs have already developed training programmes in this area which can easily be adapted to take into account the special needs of the health sector. Health professional associations will need to sensitize their own members, who play a crucial role in the provision of health care, in order to ensure that they adopt a gender-sensitive approach at all levels of their health service activities eg it is important that they should adopt a gender-sensitive approach in working with their colleagues as many of the less-trained and less-well paid health care workers are women. It follows that NGOs should be invited by governments to assist as partners in the development of training programmes on the gender approach to health care.
NGOs as catalysts
Account has to be taken of the fact that key government departments which will have to be involved in developing a gender approach to health care are frequently male-dominated and are not usually concerned with the needs of women. In some cases they may initially be resistant to attempts to introduce a gender approach to health care delivery in the belief that it would be more advantageous to women and benefit women more than men. NGOs can act as catalysts by encouraging the various departments concerned with health to become involved. This will be more effective if different types of NGOs work together. Different NGOs have different constituencies - for example in addition to health professional NGOs there are also womens NGOs, that concentrate on activities to improve the status of women, development NGOs that focus particularly on development issues.
When a government decides to undertake a full sector-wide approach to gender sensitivity in health care it will be necessary to involve other ministries other than health that are involved in the provision of health care. health care. In countries where there is high maternal mortality and morbidity the Ministry of Transport can play an important role in ensuring that high-risk women can get to hospitals to receive the necessary treatment, which is often life-saving eg in parts of Nigeria women who are suffering from obstetrical complications are often taken to the nearest main road where a passing truck has to be stopped and the driver asked to take her to the nearest hospital. When the woman arrives at the hospital the driver is paid for bringing her, thereby providing a simple solution to the problem and probably saving her life.
The hugely disproportionate representation of men, and their resulting dominance, among those responsible for the planning and provision of health care, has had serious consequences for the health status of women and girls, particularly in developing countries. Little recognition has been given to the many adverse factors that affect the health of women because they are women, or because women are more seriously affected by them. As a result insufficient account has been taken of them by health planners and providers in meeting the health needs of women and girls. It should also be more widely recognized that women and girls have a right to the enjoyment of health and that discrimination against them in this context amounts to a violation of their human rights.
The situation calls for concentrated advocacy aimed at sensitizing those responsible for planning and providing health services, opinion formers, and the community to the importance of adopting a gender approach to health care, so that the health status of women, who comprise more than half the worlds population, can be improved, and the contribution they make to development can be fully realized. Emphasis is placed on the crucial role that can be played by health professional associations and their practising members as influential members of the community who are knowledgeable about health.
This paper examines the crucial role that health-concerned NGOs, in concert with NGOs from related disciplines, can make as advocates for such an approach, and as partners with government in introducing a gender based system of health care. Unless the skills and experience that NG0s have acquired in putting across messages to the public are recruited in support of this policy it could well founder.