Of the over 1.7 billion people affected by neglected tropical diseases, women and children bear a significant burden of NTD illness. Recent reports on gender and NTDs from Uniting to Combat and The Access and Delivery Partnership have highlighted that NTDs impact men and women differently, with gender playing a major role in the ways that people live with a NTD. It is important to be proactive in looking at NTD programs through a gender lens to better understand how different people are affected by NTDs, and ways our NTD programs can address some of the inequalities. If we do not apply a gender lens to our work, we will leave many people behind.

Effect Hope, a Canadian global health organization working on people-centered approaches to end suffering from diseases of poverty, had the opportunity to share their Canadian expertise in gender equality with the global NTD community at this year’s NTD NGO Network conference. In the workshop, Effect Hope discussed how their Every Child Thrives project in partnership with Global Affairs Canada provided a platform for integrating NTD and nutrition interventions and promoting gender equality and inclusion among children, caregivers and health providers.

Every Child Thrives

The Every Child Thrives project provided deworming treatment and vitamin A supplementation to children under five in Côte d’Ivoire and Kenya from March 2016 to March 2020. Deworming and vitamin A programs were integrated to address both soil-transmitted helminth (STH) infections and vitamin A deficiency, which both affect young children. STH infections are caused by intestinal worms and are one of twenty diseases WHO classifies as neglected tropical diseases.

Intestinal worms are a problem, especially for children, as worms absorb vitamin A and other micronutrients and take away from their growth and development. Combining treatment for intestinal worms and improving nutrition is a more effective strategy than implementing those two solutions independently: ensuring children absorb the vitamin A they need for proper growth and development, while also treating the worms that prevent good nutrition. Health systems also benefit as multiple essential services are delivered together which reduces the financial and human resource burden on NTD and nutrition programs.

Applying gender equality and inclusion in NTD interventions

A community-based gender analysis was conducted at the start of the project to better understand the local context and situation. The findings from the analysis were used then used to develop a gender equality strategy for the project. The strategy identified gender and inclusion barriers that could be addressed within the project.

The gender equality strategy focused on:

• Providing equal health service to girls and boys and including children with disability.
• Promoting equality of girls and boys in households.
• Promoting women’s decision-making.
• Promoting men’s involvement in their children’s health.
• Improving sex-disaggregated data collection.

This strategy was adapted for each country and used to develop implementation plans for gender equality and inclusion activities related to deworming and vitamin A programming. Including gender and inclusion into the programming helped the ministries of health to consider gender differences when delivering health services and make them more equal for girls, boys, women and men.

Some of the activities that took place included:

• Conducting gender equality and inclusion training with health professionals and project staff to improve their understanding of these concepts and how to apply them in health services.
• Developing communications and engagement plans for deworming and vitamin A supplementation that include gender equality messaging and considerations for reaching women and men with important health information.
• Ensuring that data collection tools recorded information about gender and disability to allow ministries of health to monitor how services are reaching participants.
• Holding community gender dialogues with health workers, community leaders and parents in Kenya.
• Collaborating with ministries for social affairs (for women, families, people with disability) in Côte d’Ivoire.

Important steps toward gender equality were achieved through these activities. As data collection tools recorded information about gender, the project could show the percentage of children receiving deworming and vitamin A was equal between girls and boys. In Côte d’Ivoire, the training manuals developed are now being used across the country, and the collaboration with ministries for social affairs helped support the Ministry of Health to continue improving gender equality in the long term. In Kenya, community gender dialogues helped raise awareness on how gender equality issues can impact children’s health and well-being.

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A father encouraged to get involved in his child’s health

In Yakassé-Attobrou district in Côte d’Ivoire, the local hospital provided deworming, vitamin A and vaccinations to young children as part of the Every Child Thrives project.

Participants in the Every Child Thrives project

Many mothers were there to make sure their children received these essential health services. A project coordinator visiting the hospital was pleasantly surprised to see in the line a man holding a baby with a woman by his side. This is a rare sight. That day, he was the only father present in a line of mothers with their babies.

In Côte d’Ivoire, men usually give money to the women to go to the hospital on their own, and don’t get directly involved in their children’s health. Women and children sometimes are not able to get health care because this is not supported by the men in their life. Husbands, fathers, brothers, or uncles make decisions on whether to spend time and money on medical visits, medicines and transport to the clinic or hospital.

Participants in the Every Child Thrives project

The father told the project coordinator that he was happy to accompany his wife to the hospital for their maternal and child health checks. This father was made aware of gender issues by health workers and volunteers during the community awareness activities that happen in preparation for deworming and vitamin A. He also learned that his involvement in his child’s health is beneficial. This father said he found the awareness campaign helpful and recommends that other fathers attend health checks like this.

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What did Effect Hope learn?

The achievements of the project provide examples of success in promoting gender equality and mainstreaming it into health services for children. Although achieving complete gender equality cannot be completed within the short duration of a single project, Effect Hope learned valuable lessons for addressing gender and equality barriers.

First, completing a good quality gender analysis at the start of a project is critical for understanding the context and gender-related barriers in society that affect health and well-being. Without this, Effect Hope could not address some of the attitudes about girls and children with disability that prevent them from receiving deworming and nutrition services.

Second, cross-sectoral partnerships should be extended to social ministries and include women and people with disability. This would improve understanding of gender equality and disability across sectors and ensure NTD programs are equitable, accessible and appropriate for everyone.

Third, gender equality and inclusion components require a separate budget in projects and in health programs to make sure there are enough resources to complete the work needed to truly achieve gender transformation.

Overall, the project made important steps toward gender equality and re-affirmed that gender equality and inclusion are important for everyone’s good health.

Want to hear more from the presentation? Check out the NNN Conference recording for Workshop 1.4 Applying gender equality and inclusion in NTD interventions to achieve equitable health services.

Every Child Thrives was implemented by the ministries of health in Côte d’Ivoire and Kenya, by partners MAP International and Helen Keller International, with the financial support of the Government of Canada and Effect Hope, and drug donations from Vitamin Angels.