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Usaid's Malaria Action Program for Districts

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Usaid's Malaria Action Program for Districts USAID’S MALARIA ACTION PROGRAM FOR DISTRICTS GENDER ANALYSIS MAY 2017 Contract No.: AID-617-C-160001 June 2017 USAID’s Malaria Action Program for Districts Gender Analysis i USAID’S MALARIA ACTION PROGRAM FOR DISTRICTS Gender Analysis May 2017 Contract No.: AID-617-C-160001 Submitted to: United States Agency for International Development June 2017 USAID’s Malaria Action Program for Districts Gender Analysis ii DISCLAIMER The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. June 2017 USAID’s Malaria Action Program for Districts Gender Analysis iii Table of Contents ACRONYMS ...................................................................................................................................... VI EXECUTIVE SUMMARY ................................................................................................................... VIII 1. INTRODUCTION ...........................................................................................................................1 2. BACKGROUND ............................................................................................................................1 COUNTRY CONTEXT ...................................................................................................................3 USAID’S MALARIA ACTION PROGRAM FOR DISTRICTS .................................................................6 STUDY DESCRIPTION..................................................................................................................6 3. METHODOLOGY ..........................................................................................................................8 ANALYTIC FRAMEWORK ............................................................................................................8 3.1.1 PATTERNS OF ILL HEALTH ........................................................................................................................ 8 3.1.2 FACTORS AFFECTING ILL HEALTH .............................................................................................................. 8 3.1.3 FACTORS AFFECTING RESPONSES TO ILL HEALTH .......................................................................................... 8 STUDY PROCESS ...................................................................................................................... 10 3.2.1 DESK REVIEW ..................................................................................................................................... 10 3.2.2 FIELDWORK ........................................................................................................................................ 10 3.2.3 DATA COLLECTION ............................................................................................................................... 11 3.2.4 DATA ANALYSIS ................................................................................................................................... 11 3.2.5 STUDY STRENGTHS AND LIMITATIONS...................................................................................................... 12 4. MAIN FINDINGS ........................................................................................................................ 13 PATTERNS OF MALARIA INFECTION, RISK, AND EXPOSURE ........................................................ 13 4.1.1 WOMEN’S EXPOSURE RISK .................................................................................................................... 13 4.1.2 MEN’S EXPOSURE RISK ......................................................................................................................... 14 4.1.3 ADOLESCENTS’ EXPOSURE RISK .............................................................................................................. 15 MALARIA PREVENTION ............................................................................................................ 15 4.2.1 PREVENTING MALARIA IN PREGNANCY .................................................................................................... 15 4.2.2 INCREASING USE OF AND ACCESS TO LLINS .............................................................................................. 22 MALARIA DIAGNOSIS AND TREATMENT ................................................................................... 27 4.3.1 IMPLEMENTATION OF INTEGRATED COMMUNITY CASE MANAGEMENT OF MALARIA (ICCM) ............................. 27 4.3.2 MEN’S TREATMENT-SEEKING BEHAVIOR .................................................................................................. 33 STAKEHOLDER CAPACITY TO PROVIDE GENDER-RESPONSIVE MALARIA SERVICES ..................... 35 4.4.1 SERVICE PROVIDERS’ CAPACITY .............................................................................................................. 35 4.4.2 DISTRICT SUPERVISORS’ CAPACITY .......................................................................................................... 36 4.4.3 DISTRICT-LEVEL GENDER CAPACITY ......................................................................................................... 36 4.4.4 NATIONAL MALARIA CONTROL PROGRAMME (NMCP) CAPACITY ............................................................... 37 5. CONCLUSION ............................................................................................................................ 39 6. RECOMMENDATIONS ................................................................................................................ 41 June 2017 USAID’s Malaria Action Program for Districts Gender Analysis iv PREVENTION ........................................................................................................................... 41 DIAGNOSIS AND TREATMENT .................................................................................................. 43 CAPACITY BUILDING ................................................................................................................ 45 REFERENCES ....................................................................................................................................47 APPENDIX A .....................................................................................................................................51 APPENDIX B .....................................................................................................................................81 June 2017 USAID’s Malaria Action Program for Districts Gender Analysis v ACRONYMS ACT Artemisinin-based combination therapy AIDS Acquired Immune Deficiency Syndrome ANC Antenatal care CDO Community development officer DHMT District health management team FGD Focus group discussion GII Global Inequality Index HIV Human Immunodeficiency Virus HMIS Health management information system iCCM Integrated community case management IPTp Intermittent preventive treatment (of malaria) in pregnancy IPV Intimate partner violence IRS Indoor residual spraying ITN Insecticide-treated net KII Key informant interview LLIN Long-lasting insecticide-treated net M&E Monitoring and evaluation MGLSD Ministry of Gender, Labour, and Social Development MIP Malaria in pregnancy MIS Malaria Indicator Survey MoH Ministry of Health NMCP National Malaria Control Program PEPFAR President’s Emergency Plan for AIDS Relief PMI President’s Malaria Initiative RDT Rapid diagnostic test SBCC Social behavior change communication SP Sulfadoxine/pyrimethamine TBA Traditional birth attendant TWG Technical working group June 2017 USAID’s Malaria Action Program for Districts Gender Analysis vi UDHS Uganda Demographic Health Survey UMIS Uganda Malaria Indicator Survey VHT Village health team WHO World Health Organization WRA Women of reproductive age June 2017 USAID’s Malaria Action Program for Districts Gender Analysis vii EXECUTIVE SUMMARY Gender norms, roles and relations are powerful social determinants of health risks, results, and outcomes. Inequalities between women and men result in different levels of exposure and vulnerability to disease, different responses to ill health, different health outcomes, and different consequences. This study examined the gender dynamics behind women’s, men’s, girls’, and boys’ differential exposures and responses to malaria in Uganda. It provides recommendations to improve the gender-responsiveness of USAID’s Malaria Action Program for Districts (hereinafter called the “project”), a flagship activity of the President’s Malaria Initiative in Uganda. The study was composed of a desk review and four-week field mission in Uganda (January- February 2016) to collect qualitative data using semi-structured interviews with key informants at the national, district, and community levels, and focus group discussions (FGDs) with community members in six districts spread evenly across the West Nile, Central, and Mid- Western regions of Uganda. The study’s framework drew from the Liverpool School of Tropical Medicine’s Guidelines for the Analysis of Gender and Health, which is composed of three parts: patterns of ill health, factors affecting who gets ill, and factors affecting responses to ill health. The analytical framework was applied to the three objectives of the project: 1. Effective malaria prevention programs implemented in support of the National Malaria Control Strategy 2. Effective malaria diagnosis and treatment activities implemented in support of the national malaria
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