A human rights-based framework to assess gender equality in health systems: the example of Zika virus in the Americas

Figures & data

Table 1. Details of the sources reviewed.

Main search term(s)	Number searched	Number selected/reviewed	Key documents (full references in bibliography)
Gender inequality in health	84	51	Muralidharan et al. [18] Transforming gender norms, roles, and power dynamics for better health: evidence from a systematic review of gender-integrated health programs in low- and middle-income countries
Gender and health systems	22	12	Percival et al. [13] Health systems and gender in post-conflict contexts: building back better?
Gender and primary health care	10	7	WHO (31) Gender, women and primary health care renewal. A discussion paper
Gender and human rights	80	45	Nordic Trust Fund and World Bank (2013) Report of gender and human rights-based approaches in development
Gender, health, and human rights	13	7	WHO [10] Human rights and gender equality in health sector strategies: how to assess policy coherence WHO [1] Gender, equity and human rights
Human rights	8	5	United Nations Development Group (2003) The human rights based approach to development cooperation towards a common understanding among UN agencies
Right to health	15	12	Office of the High Commissioner for Human Rights [8] CESCR General Comment No. 14: the right to the highest attainable standard of health (Art. 12)
ZIKV general	14	8	Centers for Disease Control and Prevention (n.d.) Clinical guidance for healthcare providers for prevention of sexual transmission of Zika virus
ZIKV, gender, and human rights	31	17	Pan American Health Organization. ZIKA ethics consultation: ethics guidance on key issues raised by the outbreak. 6–7 April 2015 Rao [23] ZIKV virus outbreak: reproductive health and rights in Latin America
Frameworks	14	5	WHO [10] Human rights and gender equality in health sector strategies: how to assess policy coherence

Table 2. (a) Framework (Part 1) to assess gender-related health systems’ obligations vis-à-vis ZIKV.

	Gender-related programmatic obligations
	Prevention			Care and treatment
Health system (duty bearer) perspective	Pregnancy and childbirth	Sexual transmission	Counselling	CZS and autoimmune neurological conditions
1. Leadership and governance	-Policies ensuring women’s and partners’ access to relevant reproductive health (RH) options	-Policies ensuring access to protective options for at-risk sexually active people	-Policies ensuring women’s and partners’ access to confidential RH counselling	-Policies for appropriate, gender and culturally sensitive treatment (Rx) and care
	-Oversight mechanisms exist, with community input	-Relevant oversight mechanisms exist	-Policies ensuring access of at-risk sexually active people to gender and culturally sensitive confidential counselling	-Oversight mechanisms exist
			-Oversight mechanisms exist
Obligation met (yes/no, comment)
2. Health financing	-Affordable reproductive insecticide treated nets (ITNs) provided -Access to safe and affordable RH care, including MTP -Budgeting for chronic care related to ZIKV	-Access to safe and affordable contraceptive methods	-Affordable, confidential, gender and culturally sensitive counselling services provided by health system	-Comprehensive and high-quality care and Rx provided free of cost to those in need
Obligation met (yes/no, comment)
3. Health workforce	-Health workers trained in appropriate prevention measures -Strengthened laboratory and surveillance capacity	Health workers trained in range of appropriate contraceptive methods	Counsellors trained in ZIKV prevention and related gender and cultural issues	Health workers trained in gender and culturally sensitive care and Rx
Obligation met (yes/no, comment)
4. Health services	-Timely screening and diagnosis of asymptomatic pregnant women, testing for symptomatic pregnant women and testing for infants with possible CZV implemented in gender and culturally sensitive way -ZIKV-related ANC services integrated with detection and Rx of malaria, dengue, as appropriate -Strengthened laboratory and surveillance services -Safe abortion and post-abortion services provided	Guidelines implemented in gender and culturally sensitive way	-ANC counselling integrates information with HIV, malaria, dengue, as appropriate -Counselling provided. including on abortion, in gender and culturally sensitive way	Comprehensive and high-quality care and Rx, including abortion, provided in gender and culturally sensitive way
Obligation met (yes/no, comment)
5. Medical products	-ITNs and appropriate insecticides available -Full range of RH products available, including for MTP	-Adequate supply of male and female condoms available	-ITNs and appropriate insecticides available for demonstration -Full range of contraceptives available for demonstration	-To extent possible, state-of-art Rx available (e.g. ventilators) for those infected and symptomatic, in gender and culturally sensitive way
Obligation met (yes/no, comment)
6. Health information and research	-Data disaggregated by sex and social determinants relevant to ZIKV widely disseminated in appropriate languages and formats -Surveillance ongoing and adequate -Comprehensive, timely information on ZIKV risks and pregnancy prevention universally disseminated in gender and culturally sensitive way -Open access/data sharing platforms for ZIKV information	-Comprehensive information on ZIKV risks and prevention of sexual transmission widely disseminated in gender and culturally sensitive way -Surveillance ongoing and adequate -Research (if feasible) conducted with full consent, in gender and culturally sensitive way	-Comprehensive information on ZIKV risks imparted in gender and culturally sensitive way -Patient feedback sought on quality of care and Rx, and results shared with relevant health services	-Research on Rx supported, with attention to sex differences in effects -Information on research results disseminated in timely manner, in gender and culturally sensitive way -Patient feedback sought on quality of care and Rx, and results shared with relevant health services
Obligation met (yes/no, comment)
(b) Framework (Part 2) to assess clients’ realization of gender-related health care rights.
Client perspective (right held)	Benchmarks (Yes/no, comment)
Obligations	Available	Accessible	Accessible	Quality
Access to discrimination-free health facilities, goods, andservices
Access to essential drugs
Equitable distribution of health facilities, goods, and services

Figure 1. The reciprocal relationship between the duty bearer and rights holders.⁶

Table 3. Example of implementation process.

Suggested steps	Participants/contributors
I. Obtain health system perspective
1. Select health system component(s) (e.g. hospital, clinic, specialized service) and building block(s) to be assessed	Responsible personnel or task force identified for assessment (usually concerned health officials, researcher/evaluator)
2. Select health issue/condition, as relevant	Consult with biomedical specialists, concerned non-governmental organizations and civil society regarding health issue/condition and its impact
3. Garner expert advice on recommended policies and best practices	WHO and/or other relevant expert organizations; gender and human rights experts
4. Stakeholder consultations	Range of relevant stakeholders, including health staff, other relevant public and private sector stakeholders, and clients of all genders
II. Obtain client perspective
1. Stakeholder interviews and consultations	Representatives of gender and human rights groups, and civil society, preferably of different genders, roughly representative of their distribution in the service area
2. Visit areas particularly affected by the weaknesses identified in the health system response	District health and local health staff, civil society representative of demographic and socioeconomic groups most affected
III. Analysis
1. Complete draft framework based on analysis and synthesis of findings	Responsible personnel or task force from I(1) above, with assistance from health information/research staff
2. Prepare draft action plan, with built-in targets, indicators, and milestones	Responsible personnel or task force from I(1) above, and key persons responsible for eventual implementation
IV. Feedback to main stakeholders
1. Provide feedback and obtain comments from stakeholders	A representative selection of key stakeholders involved in previous consultations and those who will be mainly affected by/involved in proposed changes
2. Share draft action plan and revise according to stakeholders’ input	As above
V. Implementation and monitoring of action plan	Health system representatives, clients and other stakeholders identified in Step IV above

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Office of the High Commissioner for Human Rights. (2000) CESCR general comment no. 14: the right to the highest attainable standard of health (Art. 12) adopted at the twenty-second session of the committee on economic, social and cultural rights, on 11 August 2000. (Contained in Document E/C.12/2000/4). [cited 2018 Jun 2]. Available from: http://www.refworld.org/pdfid/4538838d0.pdf

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