Why Gender Matters? TB, Gender and the Global Fund

Motoko Seko

Technical Advisor, GenderCommunity, Rights and Gender Dept. The Global Fund

January 2015

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Why gender matters to the Global Fund:Seizing the opportunities of NFM with the GES

• Gender-responsive programming for HIV, TB and malaria is solidly anchored in both human rights and scientific evidence, and essential to achieve impact.

• The Global Fund has Gender Equality Strategy (GES) designed to achieve strategic, high impact, gender-responsive investments that will save lives, prevent new infections and help provide care – operationalizing GES is the cooperate priority.

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The Global Fund Gender Equality Strategy (GES)

GES agreed by Board in 2008, Overall aims to:

- Fund gender-responsive programmes- Support proposals to scale-up services

that reduce gender-related risks and vulnerabilities

- Decrease the burden of diseases and mitigate impact

- Address structural inequalities and discrimination

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GES Action Plan 2014-2016

4 focus areas of the GES1. Ensure that the Global Fund’s policies,

procedures and structures effectively support programs that address gender inequalities

2. Establish and strengthen partnerships for effectively support development and implementation of programs addressing gender inequalities and reduce women’s and girls’ vulnerabilities

3. Robust communications and advocacy strategy to promote the GES

4. Provide leadership to support and advance the GES

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The Global Fund Expectation and requirement for Gender Integration

• Systematic inclusion of gender issues at all stages of the Global Fund grant cycle.

• Inclusive country dialogue: gender experts and representatives of women and girls have to be included in the concept note development and grant-making process

• CCM has to have “a balanced gender representation” (at least 30%) to be fully compliant with eligibility requirement.

• Achieving impact through programmatic prioritization based on epidemic: need using sex- and age-disaggregated epi-data to inform decision making

• Community, rights and gender (CRG) focused programming is encouraged by the Secretariat and TRP.

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Focal points training 130612 2300.pptx

Engage more! Illustrative “women’s participation”Women’s limited participation in the Global Fund decision-making at country level: CCM participation (data as of end 2013)

63%6%

12%

9%

3%1% 6%0%

All male CCM membersfemale: ML/BLfemale: GOVfemale: NGOfemale: PLWDfemale: KAPother female memberstransgender

Female Gov’t Reps

Female NGOReps

Female PLWD

It is improving

but too slowly!

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Recap: the new funding model process

2nd

GACConcept

NoteGrant-Making

Board

TRP

GAC

Ongoing Country Dialogue

NSPdetermined by

country

Grant Implemen-

tation3 years

Unpacking NFM process for maximizing opportunities for gender responsive programming

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Illustrative

2nd

GACConcept Note

2-3 months

Grant Making

1.5-3 months Board

TRP

GAC

Ongoing Country Dialogue

NSP/Investment

Case

Grant Implemen

tation3 years

Ensure gender responsive programs

are included and prioritized (and gaps identified) in NSPs

Evidence-based advocacy for prioritizing gender-

responsive interventions

Inform GFS to further advocate

for gender programming, if in-

country efforts have “failed”

Gender assessment

report as TRP or GAC reference

Gender assessment to inform programming decisions

Monitor retention of proposed activities incl.

gender-related TA

Demonstrate strategic values of gender-

responsive programs based on epidemics

Continued community monitoring

Women’s Caucus for consolidated inputs

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In the real world…

• We are not asking for token gender interventions to be implemented, at cost of other disease intervention.

• Delivery of disease interventions that take into account of special needs of women, men, boys and girls are our priority. Thus, there is no “gender module” to tick and to forget implementing!

• No one need to address gender-related challenges alone – Partner with or link to existing gender-focused programs for maximum impact!

i.e., HIV, TB and malaria interventions delivered with/through RMNCH; support/strengthen women’s organizations to deliver HIV, TB and malaria programs; link with clinical post-GBV care with social/legal support.

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Responding to the GF requirement…

• Findings of the first 20 concept notes review (Sept. 2014)• Gender integration into TB or TB component of the TB/HIV concept

notes was hardly seen

• TB concept notes have limited sex-disaggregated data (both epi- and program outcome data) but better linkages to interventions where exist

• Only a few included sex-disaggregated target for key interventions such as ACSM, TB diagnosis and treatment, etc.

• HIV concept notes with solid gender analysis rarely linked to concrete, related, evidence-based gender-responsive programming nor sufficient budgeting.

• CCM representation by TB community• Countries struggle to ensure TB community representation in the

CCM (re: new CCM requirement 4). Only 35 CCMs have TB-PLWD/KP representative as of October 2014. Additional 20 has NGO reps with TB expertise..

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Also beware of:

• Women’s share of CCM became a requirement, January 2015 (>30% or 15-29% with at least one member with expertise and constituencies)

• Great network of W4GF advocates in 34 countries: work with them! (Women4GF http://women4gf.org)

• Additional funding for CRG-related technical assistance is available – apply for a free TA to better integrate CRG issues into Global Fund grants http://www.theglobalfund.org/en/fundingmodel/technicalassistance/communityrightsgender/

• Use UN and CS developed tools:

• UNDP Checklist for Integrating Gender into the NFM (http://on.undp.org/xOcqd )

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BACKUP SLIDES

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Gender responsive intervention doesn’t have to cost extra!

http://www.mashpedia.com/player.php?q=92dT_1kbbek

Example:

Give instruction towomen to producedeep sputum privately, or letting womenreturning with anearly-morningspecimen

Quality of sputumimproved dramatically, increased case detections amongfemale population.

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One thing common about this world…

• Gender inequality exists in every country

• Women earn less than men (incl. female-headed households’ poverty) Access barriers for services that require payment or transport Impoverishment: Risk factors for TB infection Difficult to leave abusive relationship for economic reasons

• Men and boys are not accessing health education / services as much as girls and women Lower self-assessment of one’s vulnerabilities by men Men accessing treatment too late Less likeliness of forming communities, not peer-educating

• Women who are victims of gender-based violence are 50% more likely to have acquired HIV. Key affected women are facing more risk of violence.

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Focal points training 130612 2300.pptx

Sample gender issues to be aware of and corresponding interventions

Issue Sample interventions

Women do not have decision making power on when and how to access services

• Bring services closer to beneficiaries – provide mobile or community-based services instead of facility-based

• Community mobilization and advocacy for changing gender norms

• CSS for women’s organizations • Integration of ATM and RMNCH services

Gender based violence (GBV) making women and girls vulnerable to HIV, which can make them more susceptive of TB

• Linking GBV and HIV/TB and other health services (comprehensive package)

• Support initiatives to strengthen law enforcement on GBV

• Community mobilization and advocacy• CSS of GBV survivors’ support groups

Men do not seek health care because of gender norms for men

• Peer education / workplace programs• Making health services accessible without being seen

publicly, or out of working hours

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Identifying appropriate interventions6