ACCELERATE TO EQUAL: INCREASING THE INVOLVEMENT OF WOMEN AND - PowerPoint PPT Presentation

ACCELERATE TO EQUAL: INCREASING THE INVOLVEMENT OF WOMEN AND COMMUNITY IN VECTOR CONTROL Indonesia Kenya Mary Hayden, PhD, Research Professor, University of Colorado Kacey Ernst, PhD, Associate Professor, University of Arizona

PROJECT OBJECTIVES • The primary objectives of the project were to: • Understand the current role and perceptions of women in vector control and • Identify potential strategies for accelerating the involvement of women in sustained support for vector control interventions at multiple levels and across sectors.

WOMEN C AN BE INTEGRAL MEMBERS OF VECTOR CONTROL STRATEGIES

TIMELINE FOR METHODS • Nov 2015 - Formative research (FGDs; KIIs), East Sumba Island, Indonesia • March-April 2016 – Cross-sectional household surveys, East Sumba Island, Indonesia • June 2016 – Formative research (FGDs; KIIs) western Kenya • July-August 2016 – Cross-sectional household surveys, western Kenya • August-November 2016 – Online stakeholder survey • December 2017 – Stakeholder/Decision-maker workshop, Lake Naivasha, Kenya • March 2018 - Stakeholder/Decision-maker workshop, Bali, Indonesia

KEY FINDING 1: GENDER NORMS MUST BE ADDRESSED AS PART OF ENGAGEMENT • Gender norms are associated with women’s willingness to carry out vector control work in Kenya and Indonesia.

ASSOCIATION BETWEEN GENDER NORMS AND WILLINGNESS TO CARRY OUT VECTOR CONTROL ACTIVITIES: KENYAN FEMALES 11.0 10.0 9.0 8.0 7.0 6.0 5.9 5.9 5.5 5.0 4.0 3.5 3.5 3.1 3.0 2.5 2.4 2.0 1.0 0.0 Fogger Educate Sell Products Deliver Job in VC Leave before Stay Travel Products sunrise overnight Odds ratio: Compare top 25 th percentile to rest adjusted for age, education, and parental status

ASSOCIATION BETWEEN GENDER NORMS AND WILLINGNESS TO CARRY OUT VECTOR CONTROL ACTIVITIES: INDONESIAN FEMALES 11.0 10.0 9.0 8.0 7.0 6.6 6.0 5.0 4.6 4.0 3.0 2.6 2.5 2.3 2.0 1.9 1.4 1.0 1 0.0 Empty Educate Sell Deliver Job in VC Leave Stay Travel Water Products Products before overnight sunrise Odds ratio: Compare top 25 th percentile to rest adjusted for age, education, and parental status

KEY FINDING II: BOTH MEN AND WOMEN SUPPORT WOMEN IN VECTOR CONTROL • Despite gender norm associations, both men and women equally support women taking part in initiatives in vector control at household and community levels.

KENYA: WILLINGNESS TO CARRY OUT VC ACTIVITIES Participants who answered 'yes' to being willing to do the following: 87 Take a job to control mosquitoes? * 81.7 Deliver mosquito control products to households? 77.8 78.3 77.7 Sell mosquito control products 72.5 Educate the community about mosquito diseases? 86.4 * 80.7 97.3 Empty containers with water? 94.7 84.6 Help get rid of the places mosquitoes breed in shared… 82.5 Clean up trash in public spaces? 81.5 81.8 81.8 Assist the community in clearing the grass and brush … 80.5 Help a neighbor clear the grass and brush around your … 81.3 75.8 Clear the grass and brush around your own compound? 97.3 97.1 0 20 40 60 80 100 Male Female * 𝑦 " p − value < 0.05

INDONESIA: WILLINGNESS TO CARRY OUT VC ACTIVITIES Participants who answered 'yes' to being willing to do the following: TAKE A JOB TO CONTROL MOSQUITOES? 76.7 81.6 DELIVER MOSQUITO CONTROL PRODUCTS TO HOUSEHOLDS? 34.3 33.2 SELL MOSQUITO CONTROL PRODUCTS 23.7 28.8 EDUCATE THE COMMUNITY ABOUT MOSQUITO DISEASES? 63.6 46.6 EMPTY CONTAINERS WITH WATER? 81.4 81.0 HELP GET RID OF THE PLACES MOSQUITOES BREED IN SHARED AREAS IN THE 80.1 COMMUNITY ON ROADS BY DIGGING DITCHES AND COVERING STANDING … 70.2 CLEAN UP TRASH IN PUBLIC SPACES? 81.8 78.5 ASSIST THE COMMUNITY IN CLEARING THE GRASS AND BRUSH AROUND EVERYONE’S 94.5 COMPOUND? 91.9 HELP A NEIGHBOR CLEAR THE GRASS AND BRUSH AROUND YOUR NEIGHBOR’S 82.2 COMPOUND? 63.1 CLEAR THE GRASS AND BRUSH AROUND YOUR OWN COMPOUND? 98.7 98.5 0 10 20 30 40 50 60 70 80 90 100 * 𝑦 " : statistically significant Male Female

KEY FINDING 1II: NEW STRATEGIES ARE NEEDED • Current strategies to engage more women are not perceived as effective.

STRATEGIES CONSIDERED EFFECTIVE & HISTORY OF IMPLEMENTATION Making structural changes to facilities Protective equipment specifically designed for women Ensuring job security during pregnancy Providing funding for micro-enterprises Talking to women's groups for recruitment purposes Talking to opinion leaders Job opportunities distributed through schools Recruiting from media sources Talking to community leaders Recruiting from secondary schools Training existing community health workers 0% 10% 20% 30% 40% 50% 60% 70% Percieved as effective Has already been implemented Perceived as effective Hayden et. al. AJTMH 2018

KEY FINDING IV: STRATEGIES MUST BE TAILORED TO THE COMMUNITY • No one-size, fits all – strategies to focus on the way forward need to be contextualized by setting • Engaging women has be part of a broader process for bringing in new interventions to a community • Different strategies will be preferred and supported in communities • Community buy-in which includes women will increase the effectiveness of the interventions and improve long-term sustainability

STRATEGIES TO NORMALIZE WOMEN’S ROLES IN VECTOR CONTROL Advocate for more Develop sensitization Identify key community Prioritize women’s women in decision- and advocacy materials influencers and employment in vector making through access champions of women in control to information vector control • Promote job ads • Review and identify gaps • School-based in gender equity • Conduct a needs • Sensitization workshops curriculum assessment on existing with key employers • Develop female- • Community theater knowledge gaps centered training • Commitment by govt. programs opportunities • Develop curriculum officials and private geared towards • Use social and industry to enact gender • Require reporting of mainstream media information access at equity policies ratio of men and women platforms to the household level who are employed in VC • Identify female leaders disseminate messaging programs to funders who can act as mentors and role models Ernst et al. Malaria Journal 2018

KEY FINDING V: ENGAGING WOMEN IN VC MAY HAVE BROADER BENEFITS • Barriers and opportunities for engaging women in vector control should be addressed to promote the effectiveness and sustainability of vector control programs • Empowering women to work in vector control may provide a neutral entry point leading to increased agency for women in other sectors • Wide-ranging health impacts

Ernst et al. Malaria Journal 2018

NEXT STEPS: IMPLEMENT PILOT PROJECT Overall objective: To develop a community-led vector control strategy which engages women as leaders but not to the exclusion of men Five primary components : ­ Conduct asset mapping to identify community resources (e.g. women’s groups, NGOs, and key leaders) ­ Design a rapid assessment protocol to identify and address gaps in knowledge VBD and prevention in community ­ Initiate community working group that engages women (and men) from different sectors: community, health, leadership, schools, religious organizations ­ Develop workshop protocol to create a strategic plan for community implementation of vector control; ­ Standardize procedures for introduction of new interventions Standardize tools for Initiate working Conduct asset Identify gaps in Develop protocol for implementation group with specified mapping knowledge strategic planning based on disease proportion of women system

CREATE A SYSTEMATIC PROCESS TO ENGAGE WOMEN AND THE BROADER COMMUNITY IN VECTOR CONTROL • Objective: Implement and evaluate a standardized community-engagement process for targeting women (and other community members) as agents of change through vector control. • Hypothesis 1 : Implementation of a systematic process to engage women in the community in vector control will result in higher acceptability of the proposed intervention(s). • Hypothesis 2 : Indirect benefits of the engagement of women in vector control activities will be an increase in reported agency.

DEVELOP STANDARDIZED TOOLS TO PROVIDE ACCEPTABLE AND SUSTAINABLE INTERVENTIONS • 1. Assess: Conduct asset mapping to identify existing women’s groups, NGOs, and key influencers in the community. Carry out baseline assessment of women’s agency. • 2. Prepare: Hold community-engaged workshops to prioritize and organize community-led strategies for vector control • 3: Train: Educate and train community women as vector-control implementers • 4: Notify and Nudge: Initiate a seasonal alert process at the beginning of the transmission season based on our simple model. Implement a checklist of activities to determine whether the family is prepared for the transmission season. Work with families to design strategies that will motivate them to continue with interventions.

EVALUATE PROCESS • 5: Cost: Identify the economic benefits of the intervention to women and the community. • 6: Evaluate: Evaluate adoption of intervention(s), sustainability of intervention(s) and change in agency among women involved in vector control. • 7. Evaluate: Undertake long-term evaluation of reduction in vector abundance and improved disease outcomes.