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URBAN Shade Sierra Leone flooding

URBAN Shade – New project supports health services in extreme weather response

Pamoja Communications is excited to be part of a new research project that will guide health services for marginalised urban communities in how to respond to extreme weather events caused by climate change.  

Researchers from Liverpool School of Tropical Medicine (LSTM) and The George Institute for Global Health India (TGI) will work alongside SDI-Kenya and three partners in Sierra Leone; Sierra Leone Urban Research Centre (SLURC), Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA) and The Institute of Gender and Children’s Health Research (IGCHR).

The project will be in ten locations in India, Kenya and Sierra Leone, and work in partnership with local communities and health service providers. We will be working alongside the team to provide communications support for the project.

Climate change

The negative impacts of climate change affect the most marginalised and poorest urban communities, particularly the billion people living in informal settlements. The consequences of extreme weather events include landslides, flooding, heatwaves and drought.

These communities often lack access to health services and are particularly vulnerable to poor health and wellbeing, especially among the elderly and people with disabilities.

The new £3m project – URBAN Shade (Project name: Strengthening health access and delivery for extreme weather) – is funded by the National Institute for Health and Care Research, a major funder of global health research and training. Researchers, health providers and government agencies in urban communities will work together to improve the resilience and responsiveness of health service delivery during and after extreme weather events.

Dr Rachel Tolhurst, Reader at LSTM and Co-lead on Urban SHADE, said: “This is an exciting opportunity to build on our existing partnerships between communities and researchers using participatory approaches. Marginalised urban people facing the health effects of extreme weather events have a right to appropriate healthcare and we aim to support both communities and service providers to realise this through collaboration”.

URBAN Shade

URBAN Shade partners will work

  • In Andhra Pradesh and Himachal Pradesh in India with communities living near riverbanks and on hillsides
  • With coastal communities in Mombasa and Kilifi in Kenya
  • In three informal settlements in Sierra Leone’s capital city Freetown

Working alongside communities, community-based organisations, health service providers and public bodies in each location, researchers will assess the health and social vulnerabilities and health service impacts of recent extreme weather events, as well as the capacity of local health services to deliver during and following such events.

They will co-produce new interventions to strengthen these systems, and establish equitable ways of working in partnership in each location. New interventions will then be monitored and evaluated for feasibility and cost, as well as promoted to local, national and international policymakers and the wider sector to encourage more widespread use.

URBAN Shade is one of eight NIHR-funded projects aiming to strengthen health service delivery and resilience in low- and middle-income countries that experience extreme weather events. They align with the World Health Organization’s operational framework for building climate-resilient health systems. The framework identified the need to understand how climate change can affect health.

NIHR CEO, Professor Lucy Chappell said, “Climate change is a real threat to health across the globe – driving natural disasters like flooding and drought and disrupting people’s access to healthcare in many countries. These new research projects will help find the best ways for healthcare to adapt to extreme weather and ensure that people can still get the care they need.”

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Improving Accountability for Equitable Health and Well-being in Urban Informal Spaces: Moving from Dominant to Transformative Approaches

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of power throughout conceptualization, design and conduct of research in this space. We argue that: (a) urban informality reflects the exercise of power to confer and withhold advantage; (b) the dominant biomedical model of health poorly links embodied experiences and structural contexts; (c) existing models of accountability are inadequate in unequal, pluralistic governance and provision environments. We trace four conceptual and empirical directions for transformative approaches to power relations in urban health equity research.

ARISE Consortium (2024). Improving Accountability for Equitable Health and Well-being in Urban Informal Spaces: Moving from Dominant to Transformative Approaches. Progress in Development Studies, 0(0). https://doi.org/10.1177/14649934231225530

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Webinar report – Practical Pathways for Change: Learning how to integrate a gender and equity lens in AMR research projects

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In this blog Hayley Stewart reports back on the recent Practical Pathways for Change webinar, introducing a new resource aiming to incorporate gender and equity considerations into Antimicrobial Resistance innovation, intervention, and implementation research.

Gender, among other social, cultural, and biological factors, can have an impact on susceptibility to antimicrobial resistance and adversely impact the effectiveness of mitigation strategies within a community. Earlier this month the International Centre for Antimicrobial Resistance Solutions (ICARS), in collaboration with the International Development Research Centre (IDRC), Human Sciences Research Council (HSRC), Mahidol Oxford Tropical Medicine Research Unit (MORU), and Jive Media Africa, released a new resource aiming to incorporate gender and equity considerations into AMR innovation, intervention, and implementation research. Here we tell you about what we learned at their recent webinar to introduce the tool.

Erica Westwood from ICARS opened the webinar talking about the importance of considering gender in the context of an emergency like AMR, taking lessons on the necessity of applying a gender lens in crises like COVID-19 and climate change. She outlined how ignoring social and contextual factors risked deepening inequalities. However, gender analysis still remains a weak point in AMR research, with a distinct lack of sex disaggregated data. She then went on to explain how women can be key to understanding AMR, particularly as in rural areas they frequently will be the ones tending to sick animals, collecting water, preparing food, and caring for the sick and the elderly. In this collaborative project, the partners worked together to create a tool that helps us find and create sustainable solutions to AMR that are gender sensitive. And these solutions need to be contextually relevant, locally driven, and enhance equity.

Bhensri Naemiratch from MORU talked though the development of the tool, beginning with a systematic scoping review, looking at journal articles from 2017 to 2022 that discussed gender and equity consideration in AMR, focussing on human and animal health in LIMCs. The team engaged with 17 researchers from Sub-Saharan Africa and South East Asia, undertaking a participatory process through online consultation workshops. They then went through a co-creation process with seven researchers to develop the toolkit.

Dr Ingrid Lynch from HSRC in South Africa then took participants through some of the key features of the tool:

Part one provides an overview of key concepts and the relevance of gender, equity and intersectional analysis in AMR. It synthesises research that does exist around the linkages between gender and AMR.

Part two is structured around the research cycle to illustrate how a gender and equity lens can be integrated into research. This is illustrated through the toolkit by two case studies. This section helps with problem identification and proposal development.

The guide includes a user-friendly tool, built on the vast array already available in this area, to guide researchers through a gender analysis at the beginning of their work, with a matrix to help them understand how gender considerations interact with their study topic. The authors see researchers coming back to the tool over and over again, helping them to build context and apply findings.

In stage one the guide helps with problem identification – including a checklist to prompt reflection and a systematic approach. Stage two cover proposal development and integrating gender and equity into study design, while stage three looks at implementation and data collection, including sampling and gender sensitive training for data collectors. Stage four examines data analysis, and outlines some of the common pitfalls when incorporating gender and equity considerations in data analysis. Stage five covers reporting and dissemination, including the use of gender sensitive and inclusive language and representation. Find out more about the resource and download it on the ICARS website.

10 Key Messages from the Webinar on Gendered Approaches to Monitoring and Evaluation in Health

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On the 19 October 2023 the MAGE project convened a stellar panel of experts to explore and advocate for gender-responsive monitoring and evaluation of health programmes. In this blog our Director, Kate Hawkins, has synthesised ten key points from the webinar for health systems researchers to consider.

  1. A gendered approach encompasses needs, rights, and preferences, as well as gender power relations and systems. It is crucial to recognise that gender extends beyond just biological differences and beyond the gender binary of men and women.
  2. Women, who often suffer from inequitable power relations and systemic disadvantages, are often a primary focus of gender-responsive monitoring and evaluation in health. An intersectional lens should be adopted to address issues like class, age, race, ethnicity, and geographical location, recognising that gender intersects with multiple aspects of identity.
  3. Indicators should be sex-specific, sex-disaggregated, and related to gendered power relations and systems, enabling a better understanding of gender dynamics.
  4. Power imbalances disproportionately disadvantage women and girls and affect their health outcomes, posing a threat to achieving universal health coverage. Sexual and reproductive health plays a significant role in empowering women and girls to make choices about their lives, and it is heavily influenced by gender norms. Controlling women’s bodies, sexuality, and reproductive choices is a significant contributor to gender inequality, making it crucial to understand these power dynamics to improve health outcomes in these areas. Health directly affects access to education, economic opportunities, and participation in social and political life, impacting women and girls’ ability to attain gender equity.
  5. Programmatic priorities should have a gender lens from the outset, enabling the creation of indicators to monitor progress on gender-related issues. Equitable participation and representation of diverse groups in interventions are essential for promoting gender equality.
  6. Gendered aspects of health in outcomes and determinants must be measured to prioritise these issues in the analysis and emphasise their importance. Striving for improvement in research and programs is vital while also being vigilant to prevent unintentional gendered harms.
  7. Gender-focused interventions often target women, men, and communities to change gender norms and roles in family planning, but the health systems supporting these communities are often overlooked. Identifying gaps and measuring inequalities within the health system is essential, requiring gender-responsive monitoring and evaluation.
  8. Addressing practical issues, such as inadequate facilities in health centers, lack of access to health insurance, and gender disparities in the health workforce, is crucial alongside normative processes.
  9. Progress should be tracked in real time, and responsive actions must address the specific challenges faced by women and girls.
  10. National health information systems may not capture all necessary gender-related data, and integrating information from other sources, like primary research, may be necessary to fill these gaps. Considerable capacity development may be needed at multiple levels of the health system to introduce and strengthen this approach, including improving political will in this area.

The workshop speakers emphasised that “We measure what we treasure, and we treasure what we measure.” The time for measuring gender in health is now.

MAGE is a partnership between Johns Hopkins University (JHU) and the Global Financing Facility for Women, Children and Adolescents (GFF), a multi-stakeholder partnership housed at the World Bank that is committed to ensuring women, adolescents, and children can survive and thrive. They do this through the advancement and strengthening of gender- and equity-intentional monitoring and evaluation.

Speakers at the webinar included: Anju Malhotra, PhD, Professor of the Practice, International Health, Johns Hopkins Bloomberg School of Public Health, Senior Gender and M&E Advisor, GFF, The World Bank • Choolwe Jacobs, PhD, Head of Department of Epidemiology and Biostatistics at the School of Public Health, University of Zambia, Country Lead, Women in Global Health, Zambia • Rosemary Morgan, PhD, Associate Scientist, Johns Hopkins Bloomberg School of Public Health, USA • Asha George, PhD, South African Research Chair in Health Systems, Complexity and Social Change, School of Public Health, University of the Western Cape, South Africa