TB Gender Assessments April 17, 2018 Agenda Welcome and - - PowerPoint PPT Presentation

W4GF Webinar TB Gender Assessments

April 17, 2018

Agenda

• Welcome and introduction
• Removing gender related barriers to TB diagnosis, treatment, care and

support

• Updates from the Global Fund Secretariat
• Country experience from Tanzania
• Discussion and Questions
• Closure

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Removing gender related barriers to TB diagnosis, treatment, care and support 17 April 2018 James Malar jamesm@stoptb.org

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W H O E n d T B S t r a t e g y

Ending TB by 2030

Stop TB Partnership Global Plan to End TB Global Fund Investing to End Epidemics Strategy

01 END TB STRATEGY

• Strong coalitions with civil society

and community organizations

• Protection and promotion of

human rights, ethics and equity

• Patient Centered Care

02 GLOBAL PLAN TO END TB

• Community and people centered

approaches

• Human Rights-based and Gender

sensitive Approaches 03 INVESTING TO END EPIDEMICS

• Promote and Protect Human

Rights and Gender Equality

CRG approaches to TB in countries

CFCS Round 7: Mapping Results 2017

[VALUE]% [VALUE]% [VALUE]% 10 20 30 40 50 60 70 80 90

Service Delivery Advocacy and enabling environment Community Monitoring

Types of Community Services / Responses

CRG and the TB Response

• A human rights-based and

gender-sensitive TB approach

• Changed and more inclusive

leadership

• People centered and

community driven approaches

Stop TB Grants to test CRG Innovation Stop TB CRG Tools & Technical Assistance Stop TB supported Global & Regional Community Platforms & Advocacy

CRG at the heart of the TB Response

With the support of USAID and Global Fund to Fight AIDS, Tuberculosis and Malaria

Strategies (in addition to the Global Plan)

• Nairobi Strategy
• Key Populations Policy Briefs

Tools

• Legal Environment Assessment
• TB/HIV Gender Assessment Tool
• Key Population Data for Action Framework
• Stigma Assessment Tool (in development)

Support

• Technical Assistance

CRG Tools and Technical Assistance

Addressing the barriers people experience

Key Population Data for Action Framework Purpose: To build the evidence base on missing people from the most vulnerable and marginalized TB communities and tailor interventions accordingly. Legal Environment Assessment Purpose: To identify the legal and policy barriers that impede access to TB prevention, treatment, care and support services and pose remedies.

Addressing the barriers people experience

Gender Assessment for National HIV and TB Responses Purpose: To identify how gender impacts health seeking behavior and treatment outcomes plus pose interventions that amend programmes to take account of these factors. Community Monitoring for Social Accountability Purpose: To systematically document and review the availability, accessibility and quality of TB care and support services, for the purpose of doing advocacy with providers and policy makers to improve programs and services.

Affected Communities & National Partnerships to End TB

Stage 1: Preparing for the Assessment Step 1: Secure high level support Step 2: Estab Team – inclusive of NTP, communities and suitable consultant – attend training. Step 3: Developing Framework and Developing Resource Plan Step 4: Desk Review of Relevant Documents (incl identifying key pops) Step 5: Conduct an assessment commencement meeting– include communities, NTP, UN, USAID… Stage 2: Knowing the Epidemics & Country Context Step 6 : Review existing data/ baselines/asses. and Collate prevalence and behavioral information Step 7: Consider Social, cultural & economic factors Step 8: Legal and political factors Includes focus groups/ dialogues

Stage 3: Knowing the Country TB response & filling the data gaps

Step 9: Review TB policies & programmes Step 10: community inputs

• n
• perationalizing

policies / Data sampling Stage 4: recommendations for interventions and sampled data Step 12: Analysis

• f information,

application and recommendations Step 13: Technical Assistance – reviewing draft recommendations and data Step 14: Conduct a Validation workshop with broad stakeholder representation

Stage 5: Build support and secure resources to implement recommen ded Legal and gender interventio ns and scale up KP data

Jan – Feb March – April - May – June – July – Aug – Sept – Oct – Nov - Dec

Preparatory / Training Phase Project ( CRG tools, OneImpact, CFCS) Implementation

(Bangladesh, Cambodia, DRC, India, Indonesia, Kenya, Mozambique, Myanmar,

Nigeria, Pakistan, Philippines, South Africa, Ukraine, Tanzania)

CRG Tools Roll out

With support from USAID and Global Fund

• Connecting gender and effective TB services and care is a relatively new are for

TB programmes and civil society and effort is needed to understand this area more.

• This process requires partnership between NTP and affected communities.
• TB responses must be sensitized to gender in terms of TB interventions for

general public but in interventions for key, marginalised and vulnerable

• populations. The gender assessment tool can assist sensitization of programmes.
• Need to tailor TB responses to the needs of vulnerable populations (and their

families) and with consideration to gender roles, needs, expectations and norms.

• Miners, migrants, people who use drugs, PLHIV, indigenous persons, health

workers, children – are all key/vulnerable populations in TB – and gender sensitive programming has potential to remove barriers faced by these populations – contributing to finding missing TB people, and end the epidemic.

Lessons

Global Fund Updates -

TB and Gender

Women4GlobalFund Webinar April 17, 2018

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Data, key and vulnerable populations

HRG

• Analyze age and sex disaggregated

data and population specific data to better target interventions and determine differentiated approaches to service delivery

• To increase scope of, and investments in,

human rights interventions as integral part

• f intervention packages

Recommendations for applicants

• To support applicants in conducting gender and

legal assessments

• To support the design of interventions (comprehensive

packages) according to guidelines

• To promote key interventions with public health

arguments as entry point in settings with severe human rights restrictions

Recommendations for partners

• Some iterations have come back with improved HRG interventions
• Good practices starting to appear:
• Comprehensive package of HIV prevention interventions for AGYW, including innovative interventions e.g.

to keep young girls at school

• Social contracting
• Gender and legal assessments are guiding sets of detailed

comprehensive contextualized interventions addressing barriers to access to services.

• Performance frameworks still underdeveloped and underutilized for measuring progress in HRG interventions.
• Limited investment in human rights interventions (outside of matching funds)
• Continued challenges in settings with severe human rights restrictions

TRP Debrief – Window 3

6 October 2017

• 66% of smear positive found in the

homes and 34% in health centers

• Only 1352 (4.8%) were individuals

who had previously received treatment (retreatment cases) – reaching new people

• Change in the gender distribution of

cases from 1.3:1 male-to female ratio in the health centres before the intervention to 1:1 during the intervention.

• Women had a similar treatment
• utcome as men (95% v. 94%

treatment completion) Doing it Differently

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Region HIV Focus (all) TB Focus Malaria Focus HI Africa 1 Cote d’Ivoire Ghana South Africa DRC (Province) Cote d’Ivoire South Africa DRC (Province) Cote d’Ivoire HI Africa 2 Uganda Mozambique Kenya Uganda Mozambique Uganda HI Asia Indonesia (5-10 cities) Philippines Indonesia (5-10 cities) Philippines Central Africa Cameroon Benin Cameroon MENA Tunisia S&E Africa Botswana Botswana (tbc)

• W. Africa

Sierra Leone Senegal Sierra Leone EECA Ukraine Kyrgyzstan Ukraine Kyrgyzstan LAC Jamaica Honduras S&E Asia Nepal

Intensive efforts in 20 countries to reduce human rights-related barriers to services KPI 9a Vision: Human rights barriers to services are reduced, resulting in improved uptake of and adherence to treatment and preventions programs. Measure: # of priority countries with comprehensive programs aimed at reducing human rights barriers to services in operation Target: 4 for HIV; 4 for TB

Western Africa

Case Finding: The TRP requests the applicant to develop an action plan to improve case finding among vulnerable populations with a focus on i) regional peculiarities ii) intensification of case finding amongst children, women, elderly people, people living with HIV/AIDS, prisoners and other at-risk groups iii) intensification of community-based activities iv) people in certain high risk

• ccupations such as gold miners and iv) the transportation of sputum.

Western Africa

Sex Disaggregation, gender gap: The male to female ratio for case notification is 6:1 while the ratio of estimated incidence has a male female ratio

• f 6:4. This implies that a significant number of women are not diagnosed and

treated. Action: The TRP requests the applicant to provide an actionable plan to assess the underlying reasons for this gender gap in access to services between men and women, and to address this gap. The TRP further requests to disaggregate all case finding and outcome data by age and gender to monitor progress.

Central Africa

Gender Analysis: The TRP recommends the applicant to conduct a comprehensive mid-term program assessment, including gender-analysis in 2018 to identify overall program constraints, ascertain progress towards impact, provide programmatic recommendations, and allow the opportunity for reprogramming, as may be necessary, in line with the new National Health Development Plan.

CRG – Strategic Initiative TA Program

Supporting civil society engagement in HIV/TB gender assessments and related responses

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Two key areas: 1. Preparation and roll-out of the HIV/TB Gender assessment Strengthening the technical capacity of the national civil society and government stakeholders in leading the process

• Preparing and training the gender assessment team;
• Supporting the assessment team in developing a gender-assessment framework as well as navigating through any of the steps of the assessment
• Support the collection and analysis of data;
• Ensuring data quality and validation;
• Supporting wide constituency/civil society consultations and actively engagement in the rollout of the assessment.

2. For countries that had already conducted the HIV/TB gender assessment To ensure that civil society constituencies are fully and meaningfully engaged in the “response and gap analysis process” to address the main findings

• f the HIV/TB gender assessment in a more focused and equitable way
• Providing support to civil society groups in understanding and making use of the HIV/TB gender assessment findings;
• Facilitating civil society contributions to the response and gap analysis process;
• designing of a roadmap for civil society engagement in the implementation of the response plan;
• Creating of monitoring mechanisms to follow-up on the response plan;
• Supporting to the development of an advocacy plan to support civil society in ensuring political commitment and accountability, among others.

Experience: The TB Gender Assessment Tool in Tanzania

EANNASO 17 April 2018

Recommendations

• Gender responsive policies and plans
• Amend ACSM strategy
• NTLP to participate in gender forum and coordination groups (TWG)
• Gender transformative response
• Strategic information to have age and sex disaggregated data
• Conduct socio-cultural studies to understand extent of stigma and

discrimination and GBV

What went well?

• NTLP ownership of the process from concept writing to validation meeting.
• Engaging stakeholders – UN agencies, implementing partners, community

groups.

• Involvement of communities in the whole process
• Interviews with most of the key informants.
• Data collection and analysis.
• Good technical team that kept to timelines and feed into each others

processes

• Utilized the data action framework for action to carryout FGD
• Flexibility of the process

What didn’t go so well?

• Competing priorities of key informants – unable to attend meetings and

interviews.

• Data for vulnerable groups could not be retrieved and analyzed.
• Slight delay of release of funds.
• Ethical clearance process was not planned for.
• Report template not available but had to come up with our own.
• Desk review but we saw a need to gather additional information and

conducted FII and FGD but no protocol provided. We came up wit our

• wn process.

What could have been done better?

• Early collation of data of KVP from implementing partners.
• Set up an online interviews wherever possible if the KII have time where necessary.
• Enough time to conduct interviews for KII
• Use of the multi-stakeholder task force team to discuss findings & prioritize and

recommend a way forward.

• Review process of the report by other stakeholders should be done before sharing in

the validation meeting

Tips For Successful Rollout

• Ownership of NTLP in the whole process.
• Buy in of stakeholders.
• Prioritization of recommendations and development of a way

forward that feeds into national systems.

• Identification of resources (financial) to kick start the process.
• The need to disseminate findings and way forward with other CS and

community groups

Way forward

• Reports to be shared to NTLP.
• Prioritized recommendations to be given timelines.
• Stakeholders meeting to disseminate the findings.
• Resource mobilization for development of policies, plans and conducting
• perational research.

Technical Assistance Opportunities

• Orientation of TB and Gender assessment tools.
• Training on developing assessment tools.
• Gender-analysis of guidelines, reports and plans.
• Epidemiological analysis of routinely collected NTLP data.
• Partners around gender assessments include STP, GFATM, WHO, USAID,

and CSOs (that have led the processes at country level)

Discussion

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2018 Webinars

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• Gender and Challenging Operating Environments (COEs): May (date TCB)
• Community Monitoring: June (date TBC)
• Gender in the context of Sustainability and Transition: October (date TCB)
• Youth Strategy: Focus on adolescent key populations – November (date TBC)
• Malaria Matchbox: September (date TBC)
• HER Voice: December (date TBC)

Thank you

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