This document discusses integrating gender considerations into quality improvement activities. It outlines USAID ASSIST's gender integration strategy, which includes building local capacity, integrating gender into improvement work, documenting and sharing learning, and scaling up efforts. It provides examples from Uganda of testing changes like involving men to improve retention of mother-baby pairs in HIV care and integrating gender into voluntary medical male circumcision services. Metrics show improved outcomes like increased partner participation and follow up rates after implementing these gender-sensitive changes. The document emphasizes that quality improvement should focus on outcomes, use systematic and efficient methods, and promote country ownership and learning to effectively integrate gender.

1. 1
Gender Integration in
Quality Improvement
Taroub Harb Faramand, MD, MPH
President
WI-HER, LLC
USAID Applying Science to Strengthen
and Improve Systems Project

2. USAID Applying Science to Strengthen and Improve Systems
ASSIST Gender Integration Strategy
 Build local capacity and foster local partnerships
 Integrate gender in improvement activities
 Document and share learning through
knowledge management strategies and research
 Scale up and institutionalize

3. USAID Applying Science to Strengthen and Improve Systems
Tuberculosis Treatment Success in Swazil
The Power of Data

4. USAID Applying Science to Strengthen and Improve Systems
The Power of Data

5. USAID Applying Science to Strengthen and Improve Systems
Results-Disaggregated by Sex

6. USAID Applying Science to Strengthen and Improve Systems
Science of Improvement
• The Science underlying improvement draws on
psychology, adult learning, organizational
behavior and statistical analysis of variation
and is grounded in a systems understanding of
work.
• The fundamental concept of improvement is
that improvement requires change
• Not every change leads to improvement, we
therefore study and act
6

7. USAID Applying Science to Strengthen and Improve Systems
Testing Changes
Identify gender gaps and issues
affecting health outcomes
Analyze gender constraints, social
political affecting health outcomes
Develop activities to address
issues and test changes

8. USAID Applying Science to Strengthen and Improve Systems
Example: Male Participation in Prevention of
Mother-to-child transmission (PMTCT) of HIV
Improve PMTCT
Services
Tradition and
culture
Aim Primary Driver
Knowledge
about PMTCT
One education
sessions during
work hours
Lack of Male
participation
Reproductive health
issues are “women’s
responsibilities”
Secondary Drivers Illustrative Activities
• Education on how men’s
health affects wives
and children
• Community/ religious
leaders’ announcements
• Facilities sent invitations
to men
• Education sessions held
3 times
• Women accompanied by
a partner are seen first
Taroub Harb Faramand MD, MPH
WI-HER LLC
Staff unfriendly
towards men

9. USAID Applying Science to Strengthen and Improve Systems9
Ivukula Health Facility-Eastern Uganda
Gender Integration

10. USAID Applying Science to Strengthen and Improve Systems
Ivukula Health Facility-Eastern Uganda
Gender Integration
Changes tested:
• Involve male community
leaders/volunteer health
workers
• Utilize family support groups
• Combine education sessions
• Involve fathers in child health
• Offer priority to couples and
male-focused services

11. USAID Applying Science to Strengthen and Improve Systems
Proud Team: 100% Retention in Care
Ivukula Health Facility-Eastern Uganda
Joyce Draru, QI Advisor, ASSIST & QI team Maria
Nakato and Teopista Bamuleese.
Twelve-month results showing 100% retention of
mother-baby pairs in care.
Enable—Engage—Exemplify—Encourage

12. USAID Applying Science to Strengthen and Improve Systems
Uganda results: Retention of mother-baby
pairs in treatment
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
No. MB pairs who came in the month 11 12 12 15 19 18 25 15 22 24 29 31 28
No. of MB who should be accessing
care
27 28 28 29 29 29 31 30 32 35 34 35 31
Percentage retained 41 43 43 52 66 62 81 50 69 69 85 89 90
Started improvement work
One service point, pairing
mother and baby cards, same
appointment date, involve
men
Synchronized appointments
for family support group
meetings and clinic
appointments. Tagged MB
pair appointment dates to
male partners' appointment
dates for clinic visits
Repackaged the health care
talks to focus on roles of male
partners in PMTCT
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of mother-baby pairs retained in care at Ivukula HCIII,
February 2013- February 2014

13. USAID Applying Science to Strengthen and Improve Systems
Uganda: changes tested to integrate gender in
VMMC
• Train on importance of gender in SMC
• Talking points to mobilize partners
• Document partner participation
• Friendly clinics for women and men
• Collaborate with other organizations
• Technical brief to give more information
to staff
• Services provided for women
• Male champions in communities
Since the SMC gender component was
introduced, improved outcomes have
been documented
Client register showing services offered to partners

14. USAID Applying Science to Strengthen and Improve Systems
Uganda results: Gender integration in VMMC
14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14
# attend with partners at HCIV 0 0 0 0 0 0 36 61 54 29 59 23 38 72
%age attend with partners at HCIV 0 0 0 0 0 0 7 16 14 28 26 30 30 32
%age attend with partners at 18 sites 0 0 0 0 15 13 15 15 13 17 19 8 8 25
# with partners at HCIV 0 0 0 0 0 0 509 392 377 102 227 76 127 228
# attend with partners at 18 sites 0 0 0 0 110 60 110 175 166 278 135 72 110 501
# with partners at 18 sites 81 41 30 77 749 452 731 1170 1311 1664 712 945 1362 2042
Percentage of SMC clients that attend with their partners at
18 sites and at Buyinja HCIV
Collaboration
with Marie
Stopes to
provide cancer
screening
Start of gender
integration

15. USAID Applying Science to Strengthen and Improve Systems
Uganda results: Gender integration in
VMMC
15
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
O-12 N-12 D-12 J-13 F-13 M-13 A-13 M-13 J-13 J-13 A-13 S-13 O-13 N-13 D-13 J-14 F-14 M-14
Oct-12Nov-12Dec-12Jan-13Feb-13Mar-13Apr-13May-13Jun-13Jul-13Aug-13Sep-13Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14
Percentage that return within 48 hrs post
operation 58 59 38 18 60 34 33 36 58 69 67 68 78 82 89 86 84 98
Percentage that return after 1 week follow up 54 56 31 59 45 47 25 13 29 43 33 33 52 56 64 62 63 94
Percentage that return after 6 weeks 0 0 0 0 0 30 4 2 5 13 6 6 13 25 31 16 5
Percentage of male circumcision clients who attend follow up visits at
48 hours, 1 week, and 6 weeks after surgery
Female partner
involvement

16. USAID Applying Science to Strengthen and Improve Systems
Changing Behavior

17. USAID Applying Science to Strengthen and Improve Systems
Gender Integration and QI
• Focus on Outcomes
• Systematic & Efficient
• Regular monitoring
• Systems and Processes
• Test, adjust and scale
• Change from within
• Research operationalized
• Less resistance to gender
• Simple, clear & practical
• Learning & Sharing
• Team work
• Country ownership
• Leadership

18. USAID Applying Science to Strengthen and Improve Systems
For more information about gender
integration in quality improvement
please contact:
Taroub Harb Faramand: tfaramand@wi-her.org
or Elizabeth Romanoff Silva: esilva@wi-her.org
Learn more about our gender work through the USAID
ASSIST project on our new knowledge portal at:
www.usaidassist.org/topics/gender