See the published version of this preprint at International Journal for Equity in Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research
Medhavi Gupta
George Institute for Global Health
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6558-8373
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1-5 years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the impact of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women’s outcomes.
Methods: Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender impacts and outcomes were analysed using FHI 360’s Gender Integration Framework.
Results: The Anchal program was found to be a gender accommodating program as it catered for communities’ gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender impacted program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability.
Conclusions: The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.
Keywords
Gender analysis, Implementation science, Drowning, Child health, Community health workers, Program sustainability
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View the published article at International Journal for Equity in Health.
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Review #2 received
Received 06 May, 2020
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On 27 Apr, 2020
Review #1 received
Received 13 Apr, 2020
Reviewer #2 agreed
On 25 Mar, 2020
Reviewer #1 agreed
On 16 Mar, 2020
Editor assigned
On 10 Mar, 2020
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On 09 Mar, 2020
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Health Policy
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See the published version of this preprint at International Journal for Equity in Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Medhavi Gupta
George Institute for Global Health
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6558-8373
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at International Journal for Equity in Health.
Version 1
Posted 12 Mar, 2020
No community comments so far
Review #2 received
Received 06 May, 2020
Reviewer #3 agreed
On 27 Apr, 2020
Review #1 received
Received 13 Apr, 2020
Reviewer #2 agreed
On 25 Mar, 2020
Reviewer #1 agreed
On 16 Mar, 2020
Editor assigned
On 10 Mar, 2020
Reviewers invited
Invitations sent on 10 Mar, 2020
First submitted
On 09 Mar, 2020
Submission checks complete
On 09 Mar, 2020
Editor invited
On 09 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at International Journal for Equity in Health.
Background: Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1-5 years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the impact of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women’s outcomes.
Methods: Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender impacts and outcomes were analysed using FHI 360’s Gender Integration Framework.
Results: The Anchal program was found to be a gender accommodating program as it catered for communities’ gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender impacted program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability.
Conclusions: The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.
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