Gender sensitivity in the service delivery environment

Definition:

“Gender sensitivity” is the way service providers treat male or female clients in service delivery facilities and thus affects client willingness to seek services, continue to use services, and carry out the health behaviors advocated by the services. This indicator also measures aspects of the services themselves (e.g., in the case of family planning (FP), whether a range of male as well as female methods is offered).

Data Requirement(s):

Scores from items selected below:

Menu of Indicators: Gender-Sensitive Service Delivery Context

Availability of services to adolescents, single women, widows, homosexuals;
Absence of requirements that clients have permission of husband or mother-in-law (for married women) or parents (for adolescents);
Availability of condoms both to women and men;
Percent of providers in the health facility who are female;
Availability of a full range of services whatever the sex of the provider (e.g., male doctors provide IUDs for female clients);
Percent of physicians who are women;
Availability of female physicians for women who prefer them;
Non-stigmatizing attitudes toward clients (e.g., unmarried female clients with sexually transmitted infections (STIs), sex workers, homosexuals, postabortion care clients, adolescents);
Number of referrals to other programs that empower women (e.g., related to literacy, income generation, micro-credit, domestic violence);
Percent of personnel (including supervisors of service programs) who receive training in gender sensitivity;
Use of gender-sensitive protocols for counseling (e.g., non-discriminating language, two-way communication, equal attention to women in counseling sessions for couples);
Percent of facilities that, with the permission of the female client, encourage men to visit/attend (to accompany partner, obtain information, or obtain services);
Equal treatment (e.g., waiting time, courtesy, privacy, information given) for male and female clients;

Avoidance of gender stereotyping in behavior change communication materials;
Percent of facilities that are “male-friendly:”

— Hours convenient to men;
— Staff receptive to men in clinic;
— Materials (posters, pamphlets) directed to men visible and available;

Percent of FP service providers trained to detect, discuss, and refer clients to services that handle sexual and gender-based violence;
Services focused on health outcomes for both the child and mother (safe motherhood services); and
Providers describe female and male sterilization as equally desirable, when appropriate (FP only).

Data Source(s):

External assessment by an individual familiar with organizational behavior, gender issues, and reproductive health programs. Alternatively, a self-assessment by senior management, based on international standards adapted to the local setting.

Purpose:

This set of indicators is presented as a menu from which evaluators may select those most applicable to a given service delivery environment. Evaluators may expand this list to include other items of interest in the local context.

For a service delivery facility to demonstrate gender sensitivity, it must adhere to the principles of informed choice, voluntarism and a target-free approach, which might otherwise not be the case given the low status of women in the locality. A gender-sensitive approach has much in common with a quality of care approach. A program cannot be gender-sensitive if both male and female clients fail to receive complete information and to participate fully in decisions regarding their care and treatment. Many women want opportunities to involve their partners in counseling and in decisions concerning contraceptive use and reproductive and child health. Similarly, many men wish to participate in reproductive health counseling as well as in decisions regarding reproductive and child health, but have felt excluded from this arena.