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 2
R G C Removing gender related barriers to TB diagnosis, treatment, care and support 17 April 2018 James Malar jamesm@stoptb.org
Ending TB by 2030 01 END TB STRATEGY • Strong coalitions with civil society y g e t a r t S and community organizations B T d n E O H W • Protection and promotion of human rights , ethics and equity • Patient Centered Care Stop TB Partnership 02 GLOBAL PLAN TO END TB Global Plan to End TB • Community and people centered approaches • Human Rights-based and Gender Global Fund Investing to End sensitive Approaches Epidemics Strategy 03 INVESTING TO END EPIDEMICS Promote and Protect Human • Rights and Gender Equality
CRG approaches to TB in countries Types of Community Services / Responses 90 [VALUE]% 80 70 60 50 40 [VALUE]% 30 20 [VALUE]% 10 0 Service Delivery Advocacy and enabling Community Monitoring environment CFCS Round 7: Mapping Results 2017
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
CRG at the heart of the TB Response Stop TB supported Stop TB Grants to Stop TB CRG Tools & Global & Regional test CRG Innovation Technical Assistance Community Platforms & Advocacy With the support of USAID and Global Fund to Fight AIDS, Tuberculosis and Malaria
CRG Tools and Technical Assistance 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
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 5: Stage 1: Stage 4: Stage 2: Stage 3: recommendations Knowing the Knowing the Build Preparing for the for interventions Country TB Epidemics & Country Assessment support response & filling and sampled data Context and secure the data gaps Step 1: Secure high level resources Step 6 : Review Step 12: Analysis support Step 9: Review TB existing data/ of information, Step 2 : Estab Team – to policies & baselines/asses. and inclusive of NTP, application and implement programmes Collate prevalence recommendations communities and suitable recommen Step 10: and behavioral Step 13: Technical consultant – attend training. community inputs ded information Assistance – Step 3: Developing on Step 7 : Consider Framework and Developing reviewing draft Legal and operationalizing Social, cultural & recommendations Resource Plan gender policies / economic factors and data Step 4 : Desk Review of Data sampling interventio Step 8 : Legal and Step 14: Conduct a Relevant Documents (incl political factors ns and identifying key pops) Validation Includes focus workshop with Step 5: Conduct an scale up groups/ dialogues broad stakeholder assessment commencement KP data representation meeting – include communities, NTP, UN, USAID…
CRG Tools Roll out Preparatory / Project ( CRG tools, OneImpact, CFCS) Implementation Training Phase Jan – Feb March – April - May – June – July – Aug – Sept – Oct – Nov - Dec ( Bangladesh, Cambodia, DRC, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, South Africa, Ukraine, Tanzania ) With support from USAID and Global Fund
Lessons • 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.
Global Fund Updates - TB and Gender Women4GlobalFund Webinar April 17, 2018
TRP Debrief – Window 3 Data, key and vulnerable populations HRG • 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) Recommendations for applicants Recommendations for partners • Continued challenges in settings with severe human rights restrictions • Analyze age and sex disaggregated • To support applicants in conducting gender and data and population specific data to legal assessments better target interventions and • To support the design of interventions (comprehensive determine differentiated approaches to service delivery packages) according to guidelines • To increase scope of, and investments in, • To promote key interventions with public health human rights interventions as integral part arguments as entry point in settings with severe human of intervention packages rights restrictions 15
Doing it Differently • 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 6 October 2017 outcome as men (95% v. 94% treatment completion)
Intensive efforts in 20 countries to reduce human rights-related barriers to services Region HIV Focus (all) TB Focus Malaria Focus KPI 9a HI Africa 1 Cote d’Ivoire Cote d’Ivoire Cote d’Ivoire Vision : Human rights Ghana barriers to services are South Africa South Africa DRC (Province) DRC (Province) reduced, resulting in improved uptake of and HI Africa 2 Uganda Uganda Uganda Mozambique Mozambique adherence to treatment Kenya and preventions HI Asia Indonesia (5-10 cities) Indonesia (5-10 cities) programs. Philippines Philippines Measure: # of priority Central Cameroon Cameroon countries with Africa Benin comprehensive programs MENA Tunisia aimed at reducing human rights barriers to services S&E Africa Botswana Botswana (tbc) in operation W. Africa Sierra Leone Sierra Leone Target: 4 for HIV; 4 for TB Senegal EECA Ukraine Ukraine Kyrgyzstan Kyrgyzstan LAC Jamaica Honduras 17 S&E Asia Nepal
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 occupations 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 of 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.
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