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Gender-sensitive malaria interventions, now!

By Sungano Mharakurwa Moderator | 07 Nov, 2016

Gender is being recognized as an important factor in determining malarial burden. The UNDP paper (attached) and also their closely-related resource (http://www.aidsdatahub.org/checklist-integrating-gender-processes-and-mechani...) formulates integration of gender in the Global Fund funding model. However, others can also a for sensitivity in addressing the family as a unit to avoid disturbing stability. Thoughts and experiences are welcome.

Malaria is not gender blind simply because the mosquito does not discriminate in biting men or women. There are many ways in which gender can influence who gets malaria and how it is treated. An estimated 10,000 maternal deaths each year are associated with malarial anaemia, but this number is likely severely under-estimated. In addition to children and pregnant women being biologically more susceptible to malaria, social, economic and cultural factors play a crucial role in determining differences in women’s and men’s vulnerability to malaria and access to malaria prevention and treatment services. In particular, there is growing evidence that the gender-specific effects of malaria are felt most acutely by poor, rural and marginalized women, indicating that development, gender equality and health outcomes are intrinsically linked. And yet very little work has explored the ways in which the risks and effects of malaria are determined by the intersections of sex, gender roles and poverty. Pregnancy is the sole sex-specific area on which significant research and programmatic effort has focused, but even here the analysis of the social, political and economic drivers of pregnant women’s insufficient access to key prevention and treatment modalities remains weak.
In recognition of this gap in our understanding, the Global Fund to Fight AIDS, TB and Malaria (Global Fund) and Roll Back Malaria has called for greater attention to gender, HIV, malaria and their intersections. Moreover, through the new Sustainable Development Goals (SDGs), governments have committed to several goals related to poverty reduction, gender equality and health, accompanied by specific targets to eradicate malaria, and to have malaria incident data gender-disaggregated (target 3.3), create national pro-poor and gender-sensitive development strategies (target 1.7), and erradicate other non-communicable diseases that contribute to malaria susceptibility (target 3.4). In many ways gender-specific malaria vulnerabilities and effects are both causes and consequences of poverty. As such, a focus on gender-sensitive malaria interventions is a development imperative. The time to act is now.
While the need is acute, the resources are finite. The Global Fund, among other key players, has adopted strategic investment approaches to allocating funds, which place a premium on optimizing impact, cost-effectiveness and sustainability of malaria interventions. This means that programme planners and managers are increasingly being asked to draft ‘investment cases’ or evidencebased documents that outline how allocating resources to certain interventions will lead to concrete, measurable and sustainable results. Since addressing the gender dimensions of malaria is essential to combating the disease, malaria interventions based on gender equality and human rights are essential to achieving successful outcomes. In this way gender-sensitive malaria interventions make economic sense.
This Discussion Paper on gender and malaria is intended to support practitioners, civil society and government partners wishing to make the investment case for increased and improved malaria programming that addresses the specific vulnerabilities and needs of both males and females who are affected by or at risk of malaria. The paper summarizes the existing evidence base, demonstrating the ways in which gender impacts on malaria risks and effects (including those that intersect with HIV), and highlighting existing data and implementation gaps. This information is useful for UNDP in its role in supporting governments to implement and operationalize the development agenda by 2030, by turning commitments into action. The evidence, and particularly the recommendations presented in this paper will also be useful for practitioners preparing concept notes for the Global Fund resources.



Sungano Mharakurwa Moderator Replied at 3:02 AM, 8 Nov 2016

We have had decades of interventions targeting particular vulnerable groups, but now school-age children are emerging as a neglected group with high malarial burden. The question is whether the targeted approach is the answer, when elimination is the goal?

Gonzo Manyasi Replied at 4:04 AM, 8 Nov 2016

Demographic targeting would be somewhat counterproductive. Whatever component of the community that appears neglected should just be incorporated into the programme for more effective elimination efforts.

Menyanga Abu Replied at 7:00 AM, 9 Nov 2016

It is a fact that women are sometimes denied some basic health services often because their lower social and economic status increases their

If there is life there is always a way

Menyanga Abu Replied at 8:23 AM, 9 Nov 2016

It is a fact that women are denied some basic health services often because their low social and economic status increases their special biological vulnerabilities. Women's productive role also imposes particular stress on them for much of their lives. The factors above put women at a disadvantage both as children and later on as adults. There is need for integrating malaria care services into reproductive health care beyond IPTP and make them easily available.
We should understand that as mothers, women are the frontline providers of care within the family and the key to human development and well-being as such their health has strong impact on that of the children they rear and raise.
It is important to note that women education is crucial because women who are educated are better able to enhance not only their own health but also that of their families and the community at large. They are better informed on malaria preventive measures and treatment. They are better able to develop strategies to avoid mosquito bites and better equipped to make right decisions concerning children and family health.
Women should be encouraged to come together to form their own supportive networks for malaria control and elimination as they are the primary care givers in the family. Women's knowledge and experience in maintaining, protecting and promoting good health for their families and themselves have been passed down and built upon through many generations. Women tend to treat both health and diseases with a touch of realism and practicality.
I want to believe that women are responsible for ensuring that the chain of life remains unbroken, if so, a focus on gender-sensitive malaria intervention is imperative.
Though malaria is gender blind simply because mosquitoes do not select sex to bite, gender does influence who gets malaria and how it is treated.
Investment in malaria services package and well-being for women will no doubt accelerate positive malaria elimination process.

Pierre Bush, PhD Moderator Replied at 10:31 PM, 9 Nov 2016

Hello Abu,
Well articulated. Women, Children, elderly and those who suffer from other infectious diseases (HIV/AIDS, tuberculosis) are the most vulnerable groups where malaria is concerned. A program targeting these groups, especially women is definitely to be recommended.

Sungano Mharakurwa Moderator Replied at 12:06 AM, 10 Nov 2016

Thanks Gonzo for your reply. I can see your point in that interventions should be integrated together.

Sungano Mharakurwa Moderator Replied at 12:43 AM, 10 Nov 2016

Hi Menyanga. Many thanks for the detailed and thoughtful perspectives. Thanks also Dr. Pierre for echoing the same sentiments. These issues of gender are critical and yet also sensitive in their own right. The approach will likely be a key determinant of whether the intended outcome will be realized. Some argue that the family should be the treated as a sacrosanct unit. In other words, men must be also involved in the interventions targeting women, and women must be involved in those meant to target vulnerabilities of men. Any thoughts?

Maimunat Alex-Adeomi Moderator Replied at 3:32 PM, 10 Nov 2016

Hello everyone,

Thank you for an interesting discussion on gender-sensitive malaria interventions. I think this ties in with a broader conversation like the earlier points have alluded to on developing integrated programs/interventions that en-compass all groups. One extra point I would like to highlight is that we should always be mindful of the cultural contexts of where we are implementing our interventions. It would be helpful to tailor these interventions to suit and be applicable to various cultural contexts.

Sungano Mharakurwa Moderator Replied at 6:47 AM, 14 Nov 2016

Many thanks Maimunat. That sums it up very well. In the age of elimination, we must definitely aim for universal coverage. The package of interventions should at the same time be tailor-made to suit gender, age-group, culture, and, one must add, religion as well. There are certain religious groups that frequently shun health interventions, and even avoid seeking care at health facilities altogether. The challenge is presumably how best to integrate and not divide or disrupt the family, religious or other community units in any way.
Thanks all for this delicate and important discussion.

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