VI Competition on Best Practices that Integrate Equality and Equity in Gender and Interculturalism in Health
We are no longer accepting applications for the 2013 competition.
The Office of Gender, Diversity and Human Rights (GDR) of the Pan American Health Organization (PAHO) invites participation in the VI Competition on Best Practices that Integrate Equality and Equity in Gender and Interculturalism in Health.
The sixth edition of the competition is part of the 2012-2013 GDR work plan. The office provides technical cooperation to the different program areas and member States of PAHO in order to promote gender and ethnic equality, and to advance human rights and bioethics. In this regard, GDR promotes health policies, plans, programs and legislation aimed at guaranteeing access to quality health services, participation in decision-making and equitable resource allocation.
Since 2008, GDR has, together with the Organization of American States, organized the Competition on Best Practices that Integrate a Gender Perspective in Health, which formed part of the celebration of International Women’s Day.
The Best Practices Competition has had a wide range of participants from both the public and private sectors. In the former, ministries such as those on women, health and education have taken part. Participants from civil society have included diverse organizations that work in areas related to sexual and reproductive health, adolescent pregnancies, HIV and women’s empowerment. It is important to note that the scope of participation in the competition also includes the active contribution of groups and organizations that work with indigenous peoples, Afro-descendants, female victims of violence and sexual minorities.
In addition, during these years GDR has enriched its database with these best practices and has sought to disseminate them with other programs, such as the PAHO Safe Maternity and the “Faces, Voices and Places” initiatives.
Previous best practices have allowed GDR to count on a wide panorama of efforts, in both the public and private sectors, to integrate a gender perspective and its different interventions in health. A brief summary of the award-winning best practices is found in Annex II of this document.
It should be mentioned that the Best Practices Competition has relied on the generous financial support of the Spanish Agency for International Cooperation and Development, the Canadian International Development Agency, UNAIDS and the Pan American Health and Education Foundation, among others, as well as the technical and logistical support of different technical areas of PAHO. The contributions and support received have been key to consolidating this competition and its subsequent development over the past five years, in which over 294 programs from 19 countries in the region have been evaluated.
This year, the sixth Best Practices Competition will have two categories: Gender and Health and Health, Gender and Ethnicity. Unlike in previous years, the 2013 edition will form part of the celebration of the International Day of Action for Women’s Health on May 28.
The 2013 competition seeks to identify programs that best address the differences and opportunities among men and women in the area of health with a gender-sensitive and gender-transformative focus and that promote the recognition of and respect for cultural diversity.Objectives
The sixth competition aims to identify best practices in Latin America and the Caribbean that deal with both the divergent needs and opportunities among men and women in the area of health. In particular, they should demonstrate efforts and strategies that seek to transform the attitudes of men, women and health providers through a gender perspective and the promotion of the respect for and recognition of ethnic equity as strategies to improve opportunities to enjoy optimal health.
This year’s competition will recognize two best practices in the following categories:
1. Gender and Health: recognition of a public or private sector organization (ministry of health, ministry of education, national women’s institutions, NGOs, academic institutions, etc.) that works congruently with the public health sector and that is developing a program that has a gender-equality perspective in health.
2. Health, Gender and Ethnicity: recognition of a public or private sector organization (ministry of health, ministry of education, national women’s institutions, NGOs, academic institutions, etc.) that works congruently with the public health sector and that is developing a program that seeks to achieve equity in health through a gender perspective and the promotion of the respect for and recognition of cultural diversity in regard to indigenous peoples or ethnic/racial groups.
Best practices are those programs that incorporate a gender-equality and/or ethnic equity perspective and that lead to concrete change in regard to inequality and the relationship between men and women, as well as in the attitudes of the people and health institutions involved.
It leads to a real change in inequality, relationships between men and women, as well as in the attitudes of the people and institutions involved.
The practice generates sustainable processes in the medium- and long-term through capacity-building, leadership, and equitable allocation of opportunities and benefits for women and men.
It demonstrates a capacity to respond to the different needs and interests identified for women and for men.
It shows evidence of inequality in the state of health, decision-making, and access to resources by men, women, indigenous peoples and ethnic/racial groups.
It has an evident and measurable impact on public policies, existing legislation, allocation of resources, accountability, and public opinion.
It proposes an innovative approach to health challenges.
It has a multiplier effect in the training of key actors in other contexts on the incorporation of a gender and/or intercultural perspective in health.
It is relevant to the extent that it contributes directly or indirectly to the incorporation of a gender-equality perspective into health promotion, prevention of problems as well as conflict resolution.
It promotes the recognition of and respect for cultural diversity as a strategy to achieve equity in health.
Public or private sector organizations that work with the public health sector and that are developing programs that have a gender-equality and/or ethnic equity perspective in health can participate in the competition.
The best practice must be submitted by organizations, groups or associations that have designed and/or implemented them.
The best practice must have been active for at least two years. Those programs that have operated for less than two years will be disqualified.
Best practices implemented in any Latin American and the Caribbean country will be accepted.
The documentation of the best practice can be presented in English, French, Portuguese or Spanish.
During the adjudication process, the program under consideration will have to provide a letter from the ministry of health of the country in question verifying that it works congruently with the public health sector.
Selection and Awards
The sixth Best Practices Competition aims to honor and promote the best programs that include a gender-equality and/or ethnic equity perspective in health in the context of health services in Latin America and the Caribbean.
The selection process will apply available assessment protocols involving the participation of a jury comprised of a minimum of five people, including the PAHO Director.
The winners will receive a certificate, publication in English and Spanish, and $2500 to invest in strengthening the best practice. In addition, $1500 will be given to the PWR of the headquarters of the winning country to be used toward expenses for the award ceremony. GDR will provide assistance with this process and will include the publication of the best practices in its database.
PAHO will invite a representative of each winner to PAHO headquarters in order to receive the prize during an event to mark International Day of Action for Women’s Health on May 28, 2013.
Key gender and ethnicity concepts
Gender equity in health: Gender equity in health is manifested in the effort to eliminate all avoidable, unjust, and remediable inequality between women and men, in different populations or groups (indigenous, Afro-descendant, migrant and displaced persons) in the state of health, health care, and participation in health sector work.
Integration of a gender perspective: “The mainstreaming of a gender perspective is the process of assessing the implications for women and men of any planned action, including legislation, policies and programs, in any area and at all levels. It is a strategy for making women’s as well as men’s concerns and experiences an integral dimension in the design, implementation, monitoring and evaluation of policies and programs in all the political, economic, and social spheres, such that inequality between men and women is not perpetuated. The ultimate objective is to obtain gender equality.”
Gender sensitive: A key criterion that considers the determinants in health and identifies the differences in the health of men and women of divergent ages and population groups. It also takes into account health results that are influenced by gender norms, roles and relationships, such as gender-based violence. It encompasses the structural issues, processes or health results that lead to increased gender equality in health.
Gender transformative: Gender-transformative policies or programs include actions that alter detrimental gender norms, roles and relationships. Their aim is to promote gender equality. Gender-transformative policies seek to change power relationships through active and meaningful participation of different groups of women and health providers.
Ethnicity: It refers to a process of collective consciousness construction. Ethnicity is formed through the sharing of one or more of the following: ancestral myths, common origins, religion, territory, memories of a collective past, clothing, language as well as physical attributes.
Interculturalism: This is an interactive social process that recognizes and respects cultural differences in any environment, and is essential for constructing a society founded on social justice where health is considered a fundamental right for human development.
Interculturalism in health: This is understood as the capacity to act in an environment with different cultural knowledge, beliefs and practices in regard to health, illness, life, death and other biological, social and relationship-based factors, such as spiritual and cosmic dimensions of health. It is way of organizing services to achieve respect for all cultures and recognition of cultural diversity.
Download factsheet of all winners here.
ECUADOR: “Improving Lives and Strengthening the Identity of the Andean Population of Cotacachi through Reinforcing Intercultural Practices in Ancestral Health,” Ministry of Public Health and Asdrubal de la Torre Hospital
The rates of maternal and infant mortality are indicators of inequity and the increased vulnerability of the indigenous population. This initiative seeks to strengthen the cultural identity of the Andean population of Cotacachi. Healthcare personnel are trained and their awareness raised in relation to an intercultural health model, ancestral health and culturally-adequate births, and the program includes ancestral healthcare providers such as midwives in the formal healthcare system.
ARGENTINA: “Much More Than Two,” Health Secretariat of Municipality of Florencio Varela
The regulations for the prevention of the vertical transmission of HIV, with available testing for all pregnant women and placing responsibility for the health of the child on her, favors their access to an early diagnosis. This opportunity is not offered to men, who have a higher proportion of late HIV diagnoses, thereby exposing women to infection during pregnancy and breastfeeding. This program encourages co-responsibility and the participation of men in procreation and women’s empowerment, and improves men’s access to the timely prevention, diagnosis and treatment of HIV and other sexually-transmitted infections.
BOLIVIA: “Municipal Public Hearings on Health,” DIMA-COMIBOL.
The objective of this program was to ensure the participation of women in the accountability process in the Municipal Hearings on Health in Colquechaca. The result has been public hearings that enjoy active participation from women, resulting in clear improvements in infrastructure, team configuration and prevention activities. There are already efforts to implement this program in other communities.
PERU: “Participation of Women and Men from Tutumbaru in Communal Surveillance in Maternal and Infant Health - Ayacucho, Peru,” Management Sciences for Health.
The management of health issues in the community of Tutumbaru saw little participation from women because decisions were made solely by men. The program sought, and achieved, increased participation from women in decision-making and involvement from men in areas of health traditionally assigned to women.
COLOMBIA: “Safe motherhood the Cauca Pacific coast: the road toward a happy and safe childbirth,” PAHO Colombia, Cauca Departmental Secretariat of Health, Municipal Secretariats of Health of Guapi, López de Micay y Timbiqui; Empresas Sociales del Estado de Guapi and ESE Occidente; Red de Mujeres Matamba y Guasa; and Grupo de Parteras del Pacífico Caucano.
The program prioritized indigenous and Afro-descendant peoples as well as displaced populations in the Pacific region of Cauca, Colombia. It sought to train midwives so that they could identify risk factors and warning signs among pregnant women and newborns, which, in turn, would reduce barriers to accessing formal health services. The training was done through educational materials that focused on cultural diversity and has already been replicated in other communities.
URUGUAY: “Change in Health Relationships: the Uruguay Model of Risk and Harm Reduction in Unsafe Abortions,” Asociación Civil Iniciativas Sanitarias.
This initiative was aimed at implementing and monitoring a strategy to reduce risks and harms resulting from unsafe abortions by way of integrated interventions from health professionals, health teams, users and service providers. The model developed clinical guides with expert and ethical information so that women could make decisions in a free, responsible and safe manner on whether to continue with or stop the pregnancy, with guaranteed comprehensive care following an abortion. This initiative is adaptable to countries that have restrictive legislation when it comes to abortion.
ARGENTINA: “Promotion of sexual and reproductive health and HIV prevention for adolescents and youth living in marginal areas of Buenos Aires,” Fundación Huesped.
This initiative aimed to generate an integrated program that actively engages key youth groups, including HIV positive youth, those living in poverty, migrants and indigenous groups. The experience is based on evidence that highlighted inequalities between men and women, particularly qualitative ones. Starting with the transformation of attitudes and practices, it strived to improve the quality of life of men and women by enabling them to exercise their right to sexual and reproductive health. The initiative resulted in a significant increase in the number of appointments, particularly by boys, as well as in the use of condoms. The project had a multiplier effect, demonstrated by formation of the Network of United Latin American Youth in Response to HIV, comprised of six countries in the region and approximately 100 organizations.
TRINIDAD AND TOBAGO: “Prevention between discordant heterosexual HIV positive couples,” Tobago Health Promotion Clinic with PAHO support.
Discordant heterosexual couples were an increasing group with a high risk of HIV infection in the country. There were no strategic plans aimed to address their needs, specifically prevention and sexual and reproductive health needs. In this context, the program aimed to support diverse groups, including 100 discordant heterosexual HIV positive couples, in order to reduce the number of separations, the level of domestic violence related to the HIV status, as well as to train participants in conflict resolution techniques. The program helped to decrease anxiety related to HIV status disclosure, especially when coupled with pregnancy. It was expanded around the country to include HIV positive mothers, while obtaining support from local medical practitioners, the community and some church leaders on issues related to HIV.
EL SALVADOR: “Reducing maternal and neonatal mortality among youth and adolescents,” Ministry of Public Health and Social Welfare and PAHO.
This program was implemented in the Nahuizalco Municipality to address the great inequalities in maternal and neonatal health among adolescent women. It aims to promote health as a sexual and reproductive right through participatory planning that includes capacity building for health service users, improving the quality of health services, and involving different stakeholders from the civil society organizations, municipalities, governmental and non-governmental organizations. Thanks to this participative experience, maternal and infant mortality rates have decreased and pre-natal visits and institutionalized births have increased.
ARGENTINA: “Reducing the risks and dangers in reproductive and sexual health in the context of comprehensive care of adolescents,” Agudos Cosme Argerich General Hospital and Foundation for Adolescents’ Health of 2000 (FUSA 2000).
This program benefits 15% of migrant adolescents, women and men in Buenos Aires. It was developed to respond to the high rates of teen pregnancy, lack of prevention in sexual and reproductive health, and the number of medical referrals due to induced abortions. The comprehensive program transformed waiting rooms into workshops that advise teens on sexuality, gender and rights, and that address the daily life situations of adolescents. Results include an increase in the number of offered workshops, an increase in the number of adolescent boys and girls who participated and sought advice, and a marked decrease in complications related to pregnancy.
The program benefits low-income youth of Rio de Janeiro and aims to engage them in critical reflections on the gender norms and their relation with sexual and reproductive health, gender-based violence and other health issues. It uses group-education and a radio soap opera for youth to address unplanned pregnancy, condom use, and adolescent parenthood. Evaluation impact studies show that, after participating in the program, young men show greater acceptance of domestic work, higher rates of condom use, and low rates of violence against women.
BOLIVIA: “Primary health care with a gender approach” (Star Health Services), Department Health Services, La Paz - Ministry of Health and Sports, and the PAHO/WHO Representative Office.
This program benefits migrant women and Aymara indigenous women living in poverty in urban sections of the La Paz municipality. The initiative emerged in light of the low coverage and participation of women in disease prevention and care, due to discrimination, bad treatment, and their felt needs. Through coordination with health care service providers, groups of women managed to transform the services so that they better respond to the specific needs of the users by using an intercultural approach, thereby increasing care coverage, especially for labor (giving birth).
BRAZIL: “Empowering families in order to combat domestic violence,” Federal University of Sao Carlos, Brazil, School Health Unit (USES), Analytical Laboratory of Violence Prevention (LAPREV).
This program was developed in the city of Sao Carlos and began in the police stations. Subsequently, it became part of health system in order to address the violence prevention and treatment needed because of the high occurrence rates. The program, a university and municipality partnership, worked with mothers and fathers, giving follow up to 800 beneficiaries to change their violent behavior and relationships with their children. The results include a reduction in violent relationships and improvements in the providers’ ability to detect and address cases of violence.
BOLIVIA: “Building bridges between the community and health services with a focus on gender and interculturalism,” Program for Comprehensive Health Coordination (PROCOSI).
Through its focus on women’s empowerment, community participation, and a cultural and gender perspective, this best practice has helped reduce maternal and infant mortality in Calamarca and Morochata. Community health workers, with the active participation of local women, increased these women’s knowledge about their reproductive health and human rights; and, as a result, they demanded and gained access to better health care. The women involved men, health officials, and health care providers so as to garner more support for their rights and demands.
MEXICO: “Incorporation of the gender perspective into the national program for prevention and control of diabetes mellitus,” National Center for Gender Equity and Reproductive Health, Secretariat of Secretary of Health of Mexico.
This best practice, implemented throughout the country, focused on effective information dissemination and improved methods to manage the differences in the way men and women with diabetes behave and the way they are affected by the disease. The initiative was part of the national campaign “Men and women are taking measures”, which included the dissemination of gender-specific information for men and women users as well as for health personnel, in order to improve the health care coverage of this disease.