Globalization, Health Sector Reform, Gender and ... - Ford Foundation

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lobbied local government for a Women’s Health Care Office withinthe Municipal Health Department in charge of managing women’shealth care services at municipal health facilities. It’s “main achievement”was to implement the Women’s Comprehensive Health Program(PAISM) with a gender perspective to improve health indicatorsin the city (Araújo, 2000). They found that introducing agender perspective into the health sector institutions at all levelschallenged the system’s culture and hierarchical structure whichtreated unequal power relations as “natural” (Araújo, 2000).Linking Local Priorities and Initiativesto the Sector-Wide ApproachTo protect and strengthen reproductive health and women’s rightsin the context of SWAPs, the best methods to link local prioritiesand initiatives to the sector-wide approach will depend to a largeextent on country circumstances. There is a clear need, therefore,to think about the best ways to link local strategies to sector-wideprocesses which are controlled from the center by ministry officialsand donor partners, albeit with varying degrees of input fromvarious stakeholders (professional bodies or NGOs, for example).Indeed, local responses to sector-wide reforms will determine theirultimate impact. Women’s perceptions, needs and priorities (amongproviders and potential users) need to be fed into the policy processat both central and decentralized levels.“The reproductive health community, particularly health andrights advocates, have to become fluent in health sector reformissues and must be particularly vigilant in ensuring that reproductivehealth concerns are addressed, especially in internationaland country-level discussions about financing, priority-setting andresource allocation” (Jodi Jacobson, cited in CHANGE and PopulationCouncil, 1998).The evidence so far suggests that initiatives need to take place atlocal, national, regional and global levels.Integrating a Gender Perspective into Sector-WideManagement and Global InitiativesEven in an environment where many responsibilities are beingdevolved to decentralized districts, overall strategies and totalfunding allocations are usually determined at central level, withvarying degrees of input from stakeholders located in health facilitiesand communities. The overall sector framework, whichsets out mechanisms of accountability, identification of prioritiesand allocation of funding is for the most part determined at centrallevels. The monitoring and evaluation of the effectiveness,33
equity and efficiency of sector programs is also concentrated atcentral levels—within the Ministry of Health and among the SWAPdonor consortium.“Now, policy analysis, technical support and national planningare becoming the dominant responsibilities of the center, and weneed to recognize and address that shift in roles” (Iain Aitken,cited in CHANGE and Population Council, 1998).In this context, mechanisms are needed to channel local monitoringand evaluation efforts back to the center. At the same time,mechanisms are needed to shift the systems of accountability (financialreporting, public expenditure review, annual program review,etc.) away from the center to local levels. This can best beachieved by ensuring that a gender perspective is adopted in themanagement of sector-wide process and that explicit attention isgiven to the central importance of ensuring women’s reproductivehealth and rights. We refer to this as an essential aspect of“mainstreaming” gender into sector-wide programs.Initiatives by the Commonwealth Secretariat (UK) in partnershipwith the United Nations offer a potential resource to support strategiesto strengthen women’s health and reproductive rights objectivesin the management of sector-wide programs. A network ofUN organizations is a project of the UN Inter-Agency Committeeon Women and Gender Equality includes, among others, WHO,UNIFEM and PAHO. Publications of this network are centralizedon a website and offer useful and relevant on-line resources whichinclude Gender Mainstreaming: Management (ComSec) and OperationalizingCairo and Beijing: Training in ‘Gender and ReproductiveHealth (WHO, forthcoming). A full list of resources can befound on their website, http://www.col.org/GenderResources.As yet, however, there is no evidence of gender analysis beingintegrated into sector-wide management, and perhaps this objectiveis best addressed as a long-term strategy.34
Page 1 and 2: Globalization CommitteeReproductive
Page 3 and 4: Globalization CommitteeReproductive
Page 5 and 6: ContentForeword 5Understanding the
Page 7 and 8: ForewordMacro-economic and social r
Page 9 and 10: Experts’ Perspectives on Globaliz
Page 11 and 12: 1. The InternationalContext of Heal
Page 13: undermine the reforms themselves. C
Page 18 and 19: certain conditions: where economic
Page 20 and 21: “women’s ability to negotiate d
Page 22 and 23: Structural Adjustment Programs. Sec
Page 24 and 25: Policy-level initiatives (such as t
Page 26 and 27: 2.c. The Private Sector in SWAPsTar
Page 28 and 29: 3. The Experienceof ReproductiveHea
Page 30 and 31: User feesThere is sketchy evidence
Page 32 and 33: Judging from policy guidelines and
Page 36 and 37: ReferencesAfshar, H. and C. Dennis,
Page 38 and 39: Part IIThe Reproductive Health Agen
Page 40 and 41: comparing the different countries w
Page 42 and 43: 2. Can HSR ProvideAccessible,Equita
Page 44 and 45: Some of the greatest obstacles to s
Page 46 and 47: ole of the public sector in health
Page 48 and 49: Decentralization and financing syst
Page 50 and 51: Part IIIAction Points for the Ford
Page 52 and 53: Developing Alternative Approaches
Page 54 and 55: Globalization, Health Sector Reform
Page 56 and 57: Absence of Cross-Country Data,Compa
Page 58 and 59: Evers and Juárez do address this p
Page 60 and 61: 2000c) Although South Africa’s he
Page 62 and 63: Human Rights Relating to Women’s
Page 64 and 65: acceptable, states are in violation
Page 66: Human Rights Needs AssessmentsA nec
Page 69 and 70: References1. Barbara Evers and Merc
Page 71 and 72: In practice, however, the ICPD agen
Page 73 and 74: Incorporating Women’s Health Conc
Page 75 and 76: Interacting with women (users/poten
Page 77 and 78: Appendix 1Center for Health and Gen
Page 79 and 80: Appendix 6Latin American and Caribb
Page 81 and 82: Enemark, U. and F. Schleimann. 1999
Page 83 and 84: Nduati, R., and Kiai, W. 1996. Comm
Page 85 and 86:
Dovlo, D. 1998. “Health Sector Re
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