PAN AMERICAN HEALTH ORGANIZATION o EXECUTIVE COMMITTEE OF THE DIRECTING COUNCIL VE,~; SPECIAL SUBCOMMITTEE ON WOMEN, HEALTH, AND DEVELOPMENT

14th Meeting Washington. D.C.. 4-6 April 1994

Provisional Agenda Item 4 MSD14/4 (Eng.) 11 March 1994 ORIGINAL: SPANISH

QUADRENNIAL REPORT 1991-1994: PROGRAM ON WOMEN, HEALTH, AND DEVELOPMENT

The purpose of this document is to report on the delivery of technical cooperation under the Program on Women, Health, and Development (WHD) during the quadrennium 1991-1994. To this end, the document has been divided into three parts. The first part includes a review of the purpose of the Program, identifying the principal problems that required intervention by the Regional Program and became the point of departure for establishing the Strategic Orientations and Program Priorities (SOPPs) on women, health, and development for the four years under consideration. The report then presents the advances achieved by the Regional Program in fulfilling the established goals at the Headquarters and country levels.

Finally, the document will present for consideration by the Special Subcommittee on Women, Health, and Development the prospects and recommendations for the work of the Program in 1994, requesting its approval for these lines of action. MSD14/4 (Eng.) Page 2 l

CONTENTS

Page

1. Program on Women, HeIalth, and Development: Identification of Needs and Formulation of Goals ...... 3

2. The Program at the Regional Level ...... 4

3. The Program at the Country Level ...... 6

4. Achievements, Challenges, and Lines of Action in 1994 ...... 15

e MSDI4/4 (Eng.) Page 3

1. Program on Women, Health, and Development: Identification of Needs and Formulation of Goals

The Program on Women, Health, and Development (WHD), which took shape during the previous quadrennium, has as its fundamental purpose collaboration with the Member States of the Pan American Health Organization (PAHO) to direct actions to eliminate gender gaps in health, addressing its causes and promoting the development of women and their rights in the area of health'.

As a result, the WHD Program has been conceived as a specialized program for technical cooperation with a mandate to facilitate the implementation of PAHO's strategic orientation on women, health, and development. This facilitating role started with the identification of the principal problems requiring intervention by the WHD Program, including:

(a) Lack of knowledge and available information that would make it possible to document the gender gap in health and the inequity of conditions faced by women as compared to men in terms of access to, control and use of resources for health promotion and protection;

(b) Limited development of methodologies and operational tools to facilitate the incorporation of gender analysis in the production of knowledge and the utilization of knowledge for implementing policies, programs and service models adapted to the needs and interests of women;

(c) As a result of the above, limited recognition of the existence of the gender gap and of women's disadvantaged situation and thus, limited response and interventions by health policies, programs and projects seeking to reduce the disparities between the sexes and improve the condition of women;

(d) Persistence of health approaches and interventions at the local and community levels that emphasize the traditional role of women as a vehicle and instrument for promoting the health of their children, families, and communities, to the detriment of the development of their power, leadership, and organization for defending their own interests and making autonomous decisions about their bodies and how to promote, monitor, and protect their health;

Regional Program on Women, Health, and Development, Washington, D.C., September 1992. MSD14/4 (Eng.) Page 4

(e) Limited priority given to gender programs as part of public health policies and thus, a lack of resource mobilization and allocation on the part of institutions and services to address the problems mentioned above.

Accordingly, the WHD Program established two broad goals for the quadrennium 1991-1994:

- To strengthen institutional capacity to mobilize national and international resources for the promotion and development of women and their health;

- To facilitate the formulation and evaluation of health policies, programs, and services from a gender perspective, as well as the review of legal instruments directly or indirectly affecting the health of women and their access to certain services:.

2. The Program at the Regional Level

The Regional Program consists of two components: management of the Regional WHD Program and support for the WHD initiative in Central America within the framework of the project Comprehensive Health of Women in CentralAmerica (SIMCA). The following expected outcomes were integrated within these components, in accordance with the two goals set in the Strategic Orientations and Program Priorities 1991-1994 (SOPPs):

- Initiatives to improve the level of knowledge and information available on gender gaps in health and the women's health situation at the regional and subregional levels and in selected countries;

- Actions to strengthen the sector's institutional capacity to develop health policies, programs, and services using the gender approach;

- Development of health policies, programs, and services using the gender approach in the Region;

- Advocacy and promotional activities for the legal equality of women;

- Strategies to mobilize, organize, and develop women's leadership abilities in promoting, protecting, and monitoring their health.

2 Strategic Orientations and Program Priorities 1991-1994. Pan American Health Organization. O MSD14/4 (Eng.) Page 5

Tables 1 to 5 contain the activities and initiatives developed to achieve the five expected outcomes indicated above. In addition, the WHD Program coordinated activities with other programs of the Secretariat:

Health Policies (HDP/HDD)

- Health in equitable productive transformation: differential profiles according to sex; - Comparative study of legislation on abortion and abuse against women in selected countries; - Case studies: aspects of discrimination against women in the social security systems of selected countries.

Research (HDP/HDR)

- Proposed plan of work to promote and develop research on women, health, and development.

Health Situation Analysis (HDP/HDA)

- Analysis of differentials between the sexes and gender-based inequities in epidemiological profiles.

Communicable Disease Prevention and Control (HPC)

- Program to support research on women, gender, and tropical diseases; - Preparation of proposal to promote multicenter research on women, gender, and tropical diseases.

Health Education (HSS)

- Study of sexist stereotypes in health education in selected countries; - WHD participation in subregional health education meetings in the Central American and Andean subregions; - WHD contribution to the Health Initiative for Indigenous Peoples.

Health Promotion and Protection (HPP)

- Regional action strategies for promoting women's health; - Andean subregional workshop on promoting women's health with communication strategies; MSD14/4 (Eng.) Page 6

Workshop on health promotion within the framework of healthy towns; development of the women's health component in the town of Baruta (Caracas, ); Regional action plan on violence and health.

Maternal and Child Health and Populantion (HPM)

- WHD participation in technical discussion panel on family planning and population; - Project on sex education to liberate women; - Research project on -friendly services: comprehensive nature of health care in selected services.

Initiative with NGOs (DEC)

- Women's health project with NGOs in Chile; - Organizational and technical support for meetings with NGOs in selected countries.

3. The Program at the Country Level

During the quadrennium, focal points were designated within the PAHO Representative Offices to promote and monitor the goals established in the SOPPs. There has been marked progress in implementing initiatives at the national level to achieve inclusion of the gender perspective in the work of health and development.

To compile the information presented below, the Representative Offices were requested to send information on achievements in each country with regard to the five expected outcomes proposed by the Program. The countries' response to this request has been significant and numerous actions have been undertaken to promote a new awareness of gender, equity, and development. The limited length of this document makes it impossible to detail the volume of activities carried out. Therefore, this section attempts to highlight some of these initiatives, presenting examples related to each anticipated result.

3.1 Initiatives to improve the level of knowledge and information available on gender gaps in health and the health situation of women at the regional and subregional levels and in selected countries

Argentina: following through on its commitments regarding the elimination of all forms of discrimination against women and the integration of women in health and development, Argentina has taken specific national actions such as starting a MSD14/4 (Eng.) Page 7 specialization in women's studies at the School of Psychology of the University of Buenos Aires.

Brazil: there are few materals and technical references available on the gender approach in Portuguese. This limits the ability to promote understanding of this concept among professional groups. Therefore, the translation of materials to Portuguese has been promoted and they have been disseminated throughout the country.

Belize: in collaboration with the Ministry of Health, the Department on Women' s Issues, the NGOs, UNICEF, and focal points of the WHD Program, research was carried out on in this country, on health, and on morbidity from a gender perspective. An informative manual on the Law Against Domestic Violence was prepared and distributed in addition to Equity, a publication issued every four months that discusses subjects related to women.

Colombia: the Ministry of Health was supported in preparing a diagnosis of the women's health situation and formulating the health policy for women.

Costa Rica: to make available materials appropriate for supporting the training activities conducted by health personnel, training manuals were produced for local and regional health personnel, such as the Basic Manual on Women, Health, and Development, the manual on Gender Planning and manual on Controlling Stress. Days of reflection were organized with members of the mass media on subjects related to women and health. In addition, two research projects were carried out: the Situation of Health and Women in Costa Rica in the 1990s: a gender approach, to add to the knowledge on women's health in the country; and Prescriptionand Utilization of Benzodiazapines: a gender approach, which is to be published soon and will provide more information on the consumption of tranquilizers by women.

Mexico: information was published on sociodemographics and health at the national and state level and according to stages in the life cycle of women to facilitate identification of priorities. In addition, diagnoses of women's health in 26 of the 32 states were prepared. Several studies were carried out, published and disseminated widely, including Women 's Health in Mexico, Adolescent, Adult and Elderly Women and Their Health, and Women Using the Health Services. Mexico was the headquarters for the World Mental Health Congress which, through its organization into 12 work groups on women, for the first time gave consideration to the subject of women's mental health and proposed alternatives for action.

Nicaragua: a study was conducted on income and drop-out rates among female students at the School of Educational Science of the National University to determine gender factors in the drop-out problem. MSD14/4 (Eng.) Page 8

Panama: PAHO supported research on the health of Ngobe women conducted by the University's Institute of National Studies; there was also support for research with NGOs on the subject of domestic violence in Panama.

Suriname: a study was carried out on female mortality in Suriname between 1982 and 1992 to increase knowledge on women's health. Research was also done on the problem of violence in the country; the findings will be disseminated to generate awareness of violence as a threat to public health.

Trinidadand Tobago: support was provided for the establishment of an inter-Ministry committee to study and discuss subjects related to women and their health and development. Several studies were conducted, including an analysis of women's health conditions in the country and a pilot study to explore the attitudes of private and public sector managers towards breast-feeding in the workplace. Technical advisory services and financing were also provided for the preparation of a document on the incidence of sexual violence in the Caribbean Subregion, and there was collaboration with the Caribbean Feminist Association for Research and Action, the Trinidad and Tobago Rape Crisis Center and ECLAC in conducting a regional meeting on women, violence, and the law.

Venezuela: diagnoses were prepared on the situation of women in Venezuela and on women's mental health, with a proposal for strategies and program priorities for the period 1991-1994. The results were disseminated and emphasis was placed on the need for in-depth studies on early pregnancies and violence against women. For this purpose, two interinstitutional commissions were formed to promote activities in education and health care, bringing together students, health care personnel, the communications media, NGOs and women in communities.

3.2 Actions to strengthen the sector's institutional capacity to develop health policies, programs and services using a gender approach

Argentina: in each province of the country, a focal point was established for the work on women, health, and development, working interprogrammatically with other governmental programs. During this period technical groups were also briefed in 60% of the provinces on several gender-related issues such as sexuality and gender, women and AIDS, health of rural women and health of aboriginal women.

Brazil: to disseminate the gender approach and facilitate its discussion and analysis among the teams responsible for women's health programs, in the last two years support has been provided for conducting conferences and seminars on women's health from a gender perspective. These events have been held jointly with centers for women's studies created at several universities in the country. MSD14/4 (Eng.) Page 9

Belize: workshops were carried out to create awareness of gender, self-esteem, and self- care among nursing personnel, school teachers, and women leaders of groups organized to combat domestic violence. Medical personnel in local districts were given training on the Law against Domestic Violence and on the objectives of the WHD Program.

Colombia: seminars and workshops were held to sensitize Ministry of Health staff at various regional and local levels concerning the health diagnosis of women and the gender perspective. This information was also disseminated to the academic community at different universities and the area of women, health, and development was incorporated in the graduate-level public health curriculum of the School of Nursing at the University of Antioquia. The gender perspective was also disseminated among the faculty in the health sciences at the Universities of Cartagena, Antioquia, Valle and the Free University of Cali.

El Salvador: training days and sensitization were carried out regarding the health situation of women due to their gender at the management and policy levels of the health sector. To train the personnel of four nursing schools in gender analysis, the subject of gender and health was incorporated in the curriculum of the nursing schools.

Nicaragua: thirty workshops were conducted to sensitize health personnel of comprehensive local health systems and introduce them to the gender approach in health. In addition, methodological tools were developed to facilitate the incorporation of gender in local health programs.

Panama: the training activities of the health team were increased by creating regional focal groups on women, health, and development in all health regions of the country. This has created greater awareness of the need to analyze with greater specificity the gender factors influencing women's health.

Paraguay: a document was prepared on gender aspects and education in the practice of nursing, proposing innovative alternatives to permit changes in health care for women.

Suriname: a seminar was carried out on gender analysis and the structural adjustment processes with the participation of women from NGOs and staff members from government and universities. The seminar provided them with the elements they need to analyze the adjustment programs, with special emphasis on the impact on women's living conditions.

Trinidad and Tobago: a national workshop was carried out on WHD in 1990 with personnel from the health and social services, universities and NGOs. Seven priorities and the respective strategies were identified for action. In October 1992, a subregional MSD14/4 (Eng.) Page 10 l

workshop on WHD was carried out to determine the strategy for implementing the Plan of Action in the Caribbean for YI'HD.

Venezuela: training workshops were designed and developed in preparing projects from a gender perspective for represenitatives from women's centers, women's offices, health care centers and NGOs involved in women's issues, so as to train them in project methodology and promote the preparation of projects.

3.3 Development of health policies, programs and services using a gender approach in the Region

Brazil: within the framework of the Viva mujer project being carried out in 12 towns of the State of Ceará where local health system experiments are being started, there was participation from technicians, politicians and women's organizations at the local health system level to promote discussion of the gender approach through seminars analyzing women's health indicators and gender determinants, seeking to incorporate this new approach within health activities developed with respect to women.

Costa Rica: the first national forum on women and health was carried out. The forum identified mechanisms to facilitate recognition and implementation of the changes needed by the health services to achieve comprehensive and interprogrammatic care.

Colombia: in collaboration with the Ministry of Health and UNICEF, the first phase was undertaken in a plan for educating human resources in the gender perspective, geared for staff members at the level of the local health systems of Santa Cruz, Medellín, Cali, and Bogotá. This plan will establish three local programs for the care and prevention of family abuse in selected local health systems in these cities. It is expected that by the end of the project 30 staff members in each local health system, as well as community representatives, will have been trained in the gender perspective and that programs for the care and prevention of family violence will have been implemented with community participation, with interinstitutional service networks for the comprehensive care of victims of family violence.

El Salvador: to provide a health sector response to the victims of sexual assault, support was provided for the creation and operation of comprehensive care clinics for the victims of sexual assault, with three such clinics being created in different locations in the country. This was achieved with the participation of medical, nursing, social work, and judicial system personnel as well as specialists in gynecology, psychology, and psychiatry.

Guyana: to improve the diagnosis of HIV in the country, particularly among the female population, and also to sensitize health workers to a gender perspective on psychosocial MSD14/4 (Eng.) Page 11 aspects influencing the individual's willingness to be tested, training was provided to health personnel on the importance of ensuring the confidentiality of pregnant women who are HIV-positive.

Jamaica: the number of women who go to clinics for examinations during pregnancy increased; this was achieved through training workshops for community leaders on subjects related to maternity without risk. At the same time, an attempt was made to identify through these leaders the factors that would improve the quality of services. Two birthing centers have been established and a sizable number of women have utilized them.

Mexico: to improve the quality and warmth of maternity care provided to women at the institutional level, 51 hospitals were certified as and Child Friendly out of a total of 456 registrations. At the community level, 9,232 of the 18,000 traditional midwives identified in the country were trained in aseptic delivery at the community level, and 450 birthing centers--houses or sites hygienically adapted for delivery care--were installed and are in operation.

Nicaragua: a study was done on services and quality of care for women in 17 services at the national level in order to propose a different model for women's care. Support was also given to training personnel at four clinics of the Association of Field Workers to improve the care provided to users. A training program was developed in the management of patients in crisis, victims of family abuse with personnel of the Ya Action Center.

Venezuela: support was provided for the creation and strengthening of two Comprehensive Care Centers for Women, as alternative models for the care of women's problems with emphasis on caring for women who are victims of abuse. Their activities were reorganized and expanded, their staff was trained and a computerized information system was established with a connection to the Local Health System network. As a work strategy, a health diagnosis of women in their area of influence was prepared, problems were prioritized and a plan of action was defined and carried out.

3.4 Advocacy and promotional activities for the legal equality of women

Argentina: specific national actions have been undertaken such as the approval of a law requiring that the political parties' lists of candidates for legislative elections be 30% women. Interinstitutional conventions have been created to implement special programs such as the national program to promote and provide equal opportunity for women in the area of education, an agreement which has the participation of the National Institute of Public Administration (INAP), the Ministry of Culture and Education, and the National Council of Women. The Ministry of Health and PAHO are members of joint working MSD14/4 (Eng.) Page 12

commissions which keep the Natiional Council of Women informed on women's health programs in the country.

Belize: in 1992, the law on the national policy on women was approved. This law was prepared in collaboration with ministers of government, including health, with NGOs and international organizations, including PAHO. The law against domestic violence was also approved in 1993. The law against sexual harassment has been presented to the cabinet, but has not yet been approved.

Costa Rica: to analyze the situation of women in terms of the country's legislation and the relationship between legislation and health, studies were carried out on women and legislation in Costa Rica and women and labor legislation and health. These documents were distributed.

El Salvador: sessions were held to review current legislation in light of the Convention to eliminate all forms of discrimination against women. An interinstitutional team was set up to review legislation; the team included the Office of the Attorney General, the General Office of the Public Prosecutor, the Ministries of Health and Education, NGOs, the Central American University and the Bureau of Statistics and Censuses. The Family Code and the Penal Code and Procedures were reviewed and reforms suggested and the changes suggested by the team were incorporated in the Family Code. To improve the legal condition of women, a project on legal literacy for women and a pilot plan to create the offices for defense of women were developed.

Guatemala: to better understand the situation of violence and abuse against women, research on violence was developed in 13 health areas, with workshops on the subject with the National Office of Wornen, the Office of the Public Prosecutor for Human Rights and the School of Lawyers. The Defender's Office for Women was created within the Office of the Public Prosecutor for Human Rights and a clinic for the care of women who have been assaulted was created in a departmental hospital.

Guyana: the debate on abortion has arisen for the first time in this country, generating significant progress in research on the subject and promoting the national debate. This national dynamic culminated in a meeting of women legislators from various political parties and other prominent women convened by the Women's Studies Unit of the University of Guyana. The result of this meeting was the 1993 draft law on therapeutic abortion now awaiting approval by the National Assembly. It is hoped that this law will result in improvements in women's health, by increasing knowledge of contraceptive methods and reducing female mortality.

Mexico: an intersectoral coordination was established to implement specific actions on women's health in the State of Guerrero. This coordination involves personnel MSD14/4 (Eng.) Page 13 responsible for the National Women, Health, and Development Program, personnel responsible for the same program in the State of Guerrero, and personnel from the Secretariat for Women of Guerrero.

Nicaragua: an analysis of the legal situation of women was conducted jointly by the National Assembly, the Institute of Women, and the Judicial Branch. This analysis was disseminated widely among women's organizations. A document, Mujer, vos debés conocer tus derechos, was published to disseminate the laws that protect women.

Panama: a draft law to include the subject matter of sex and gender in formal education systems was prepared and submitted, and the topic was discussed with the educational sector; this represents an important step on the road to promoting changes in social, political, and legal standards to foster the equal participation of the sexes in all processes of development.

Paraguay: support has been given to the preparatory meetings of the Constituent National Assembly through the participation of consultants in meetings at various levels. The National contains advanced standards to guarantee the equal participation of the sexes in the political and social life of the country.

Suriname: a series of public forums were developed to discuss the subject of domestic and sexual violence; these forums were widely publicized through the communications media. The general public's awareness of this subject as a social problem was raised. The Stop the Violence Against Women Foundation was established to coordinate the advocacy activities of professionals in social sectors involved in the subject of violence against women.

Venezuela: within the Ministry for Promotion of Women, the National Plan on Women was prepared in 1990; this was included in the VIII Plan of the Nation, and is thus linked to national policies. Subsequently, 1993 saw the introduction in the Congress of the Republic of the law on equal opportunity for women, intended to eliminate all forms of discrimination against women, thus incorporating the gender approach in public policies. This document was approved by Houses of Congress and is to be sent to the President of the Republic for his consideration.

3.5 Strategies to mobilize, organize, and develop women's leadership abilities in promoting, protecting, and monitoring their health

Argentina: to promote the effective mobilization of women against domestic violence, work was carried out with an average of 20 to 25 women leaders of Women's Commissariats and Temporary Women's Shelters, who operate in the various provinces MSD14/4 (Eng.) Page 14 l of the country so that they becorne multipliers; these women were given scientific and technical information on the psychopathology of the batterer and his victim.

Brazil: PAHO supported the execution of strategies to promote the women's movement in national, state, and municipal government agencies with a view to streamlining the process of implementing the Program of Comprehensive Care for Women (PAISM). In addition, support was given to various NGOs events in preparing the Brazilian women's position for the World Population Meeting in Cairo.

Colombia: the different training activities promoted by the program incorporate representatives from women's N(GOs. In addition, there has been participation in events convened by NGOs on women's health conditions. Currently, Women-Bogotá Dialogue, the CAMI and the Future Foundation in Cali assist staff members of the Ministry of Health in executing specific intervention and training programs.

El Salvador: to promote women's self-care in health, training days were conducted on self-esteem with nurses, midwives and community leaders of the local health system in the northern area of the metropolitan region.

Guatemala: to create greater awareness of health self-care, workshops were conducted on self-esteem and self-care with midwives, community women and commercial sex workers.

Jamaica: technical and financial support was provided to the Intersectoral Committee on Women, Health, and Development for a workshop on women's self-care. Programs were also developed for women who go to local services, promoting Pap tests and breast examinations, so that they can do the self examination and prevent breast cancer.

Mexico: to identify and make contact with organizations and institutions involved in different aspects of women's issues, a national directory was published with 317 groups of women in cultural, academic, research, legal, political-labor, religious, and social areas. A workshop was carried out with participants from 45 organizations, with action strategies being prepared to promote women's health in urban areas.

Nicaragua: a course, Defending our integrity, we defend our health, was carried out with 50 leaders from neighborhoods in Managua. Popular defense brigades were formed to strengthen the actions of the women's movement on the issue of violence.

Panama: PAHO has supported the development of self-care groups with the participation of community women and men, promoted and coordinated by the health sector. These groups allow for more and better linkage between women's groups and the health sector. The groups of teenage have fulfilled a similar function. MSD14/4 (Eng.) Page 15

Peru: groups of women were trained to work in small businesses to generate economic resources.

Suriname: a working group was established with women's NGOs and government agencies to call attention to sexual harassment in the workplace.

Trinidadand Tobago: PAHO supported the Ministry of Health in organizing a seminar for NGOs to sensitize them on aspects of maternal and child health and to formulate joint action plans to promote the inclusion of NGOs in the promotion of breast-feeding and prevention and intervention in cases of child abuse.

Venezuela: a training program was designed and carried out to develop and promote women; the program aimed to train this group of women in subjects related to their health and development. In a second stage these caretaker mothers acted as facilitators to bring the message to biological mothers.

4. Achievements, Challenges, and Lines of Action in 1994

There have been important advances in the development of mechanisms to create awareness on the subject of gender and the different conditions faced by the sexes due to the social status of being a man or a woman. This becomes evident particularly at the country level, where numerous workshops and seminars have been carried out on sensitization to the gender approach with the participation of governmental and nongovernmental organizations.

Nonetheless, there is still a need to develop the methodological tools to facilitate health planning from a gender perspective and to contribute to the systematization of this approach in the area of health. Many of the technical programs, both within the Ministries of Health and within PAHO, recognize the importance of incorporating the gender approach in their work so as to have a greater impact on the population's health. However, they still lack the means to incorporate this perspective in their programs and projects.

Therefore, the priority of the WHD Program for 1994 will be to facilitate the implementation of the strategic orientations and program priorities by making available such methodological tools to PAHO staff at Headquarters and in the countries. These tools will be in the form of manuals and workshops on sensitization and the use of these manuals will be carried out with managers and staff from the technical units. It is thus hoped that all technical cooperation in health provided through PAHO will incorporate the gender approach. MSD14/4 (Eng.) Page 16

In view of the limited financial resources allocated to meet the strategic needs of gender in health, the WHD Program will give special importance in 1994 to implementing an aggressive stralegy to obtain and negotiate extrabudgetary resources, looking for support both from resources allocated to international cooperation in development, and from nongovernmental sources in the United States of America.

Recognizing the current changes in the way the traditional extrabudgetary resources are being managed, with a strong tendency toward decentralization of management at the subregional and country level, the WHD Program, in collaboration with PAHO's Office of Extemnal Relations (DEC), will provide information and orientation to the focal points of the Program in the PAHO offices at the country level on local fund-raising possibilities.

As a result of the above, the focal points of the WHD Program in the PAHO/WHO Representative Offices in each country will have a fundamental role as catalysts and/or facilitators of national initiatives to prioritize the inclusion of the gender perspective in the planning of governmental and nongovernmental programs and projects that have an impact on the health of the population. During 1994, efforts will be made to strengthen the linkage between the Program and these focal points in the countries, giving them whatever technical and financial support is possible, so that gender will be incorporated in the work of the Representative's Office and the health sector. In addition, they will continue to receive up-to-date information on aspects related to gender, social equity, and development.

At the country level, there is an important impetus for seeking a closer relationship with the nongovernmental organizations working on women's issues. This relationship will continue to receive priority and greater emphasis will be placed on promoting opportunities for dialogue and joint planning between governmental agencies and NGOs to achieve systematic linkage and complementarity of actions. In addition, the highest level of cooperation with other international development organizations which incorporate the gender approach as a priority in their work will be indispensable for sharing experiences and collaborating in the planning and execution of joint initiatives.

Although there have been significant advances in the availability of up-to-date information on women's health conditions in the Region, it is indisputable that gaps of knowledge still persist, particularly with reference to gender gaps in health. Accordingly, the strategy of promoting and developing research from a gender perspective will continue to be an important approach of the Program in 1994. Support will also be continued for the Information System on Women and Health (SIMUS), by creating and strengthening the mechanisms that facilitate access and availability of information to the different users interested in the subject. MSD14/4 (Eng.) Page 17

The strengthening of the forms of organization and participation on the part of women in monitoring, promoting, and protecting their health shows significant advances in the countries and is one of the aspects that requires significant technical cooperation resources. In this sense, these experiences will continue to be expanded in the countries, by promoting linkages with other technical cooperation programs within the context of the development of local health systems. J

MSDI4/4 (Eng.) Page 18

Table 1 Initiatives to expand knowledge and information on gender gaps and women's health conditions

Initiative/Activity Oeographical arealcoverage Reaulta\Product

Study on the women's health conditions in Regional/Americas Publication and distribution of 5,000 the Americas (1987/PAHO) copies, English and Spanish

Gender, women, and health in the Selected articles st the regional and/or Publication and distribution of 5,000 Americas (1993/PAHO) country level copies, English and Spanish

Women's health and gender differences Regional/Americas Publication of 5,000 copies, English and (circa 1992) Spanish

Study on the health conditions of Central Central America countries including Belize In press American women 1980-1990 (PAHO)

Profile of women's mental health in the Colombia, Venezuela, Bolivia, Peru, and Mimeographed. Publication of papers Andean Area (PAHO) Ecuador from the seminar

Diagnosis of the health situation of Diagnoses carried out in Mexico, Publications of diagnoses and distribution women in selected countries of the Region Guatemala, Honduras, El Salvador, Costa at the national level Rica, Venezuela, Colombia, countries of the English-speaking Caribbean, Suriname, Haiti

Prevalence of domestic and sexual Studies of prevalence in localities of Publications of the studies at the national violence against women and in selected countries: Medellín, Santiago, level in each country selected countries Guatemala City, Managua, Teguci- galpa, San José, San Salvador

Regional Bibliographic Information Region of the Americas Data base (2,500 records). Publication of System on Women, Health, and Bibliographic Catalog. (3,000 copies) Development (SIMUS)

Middle-aged and elderly women in the Region of the Americas 3,000 copies, English and Spanish Americas

Evaluation of the Decade for Women Region of the Americas Joint ECLAC, PAHO, UNESCO, 1985-1995: The health of women in the UNICEF, ILO, UNFPA publication for Americas the 1994 Regional Preparatory Conference on Women and the World Conference in 1995

Program for promotion and development Regional promotion initiative Multicenter protocol/Joint plan of work of research on women's health using a within the framework of the PAHO gender approach Research Grants Program

Program to support research on women, . Program for research and Research protocol proposals for gender and tropical diseases training in tropical diseases consideration by the evaluation commitee (TDR/WHO/World Bank) (PAHO/WHO)

Research on quality of care for women in Costa Rica, Panama, El Salvador, Research protocol/Data collection tools selected health services in countries of the Guatemala, Ecuador, Colombia, and Region Venezuela . MSD14/4 (Eng.) Page 19

Table 2 Actions to strengthen the sector's capacities in the development of health policies, programs, and services using a gender approach

Activities/Actions - :::: Reu Produa S~p:"l of Action/AgenSt

Regional program for sensitization on the gender Production of videotape I77 orher hlf of re Countiesof Latin America and the Caribbean approach in health story (1993/PAHO)

Production of modular educational materiala on Staff members of Ministries of Health, women's offices, gender and health and conduct of sensitization legislatures, women's organizationa, academic and workshopa, Spanish and English (1992-1993/ research centers. Health personnel at the services level PAHO) and women organized at the local level

Regional training program for development of Operational conceptual framework on the Countries of Latin America and the Caribbean gender analysis in the formulation of health relationship between gender, health and policies and projects development Officiala involved in formulating health policies, Manual Incorporatingthe gender analyss in programs, and project at the national and local levela hcalth

Production of audiovisual materiala for training in gender analysis

Production of specific methodologies for Methodology for health planning with gender Central American experience involving officials of local incorporating gender nalysis: experiences in approach in local health systems (PAHO/1993) health systems and women'& organizations countries of the Region Methodology for formulating a health policy on Experience developed in Colombia with the formulation women using gender approach of the policy Heal for women, ~omenfor hJalth

Methodology for analyzing sexist stereotypes in Centr l American experience/study of aix countries the health education materials (PAHO/UNIFEM)

Methodology for gender analysis of legislation Central American experience/study of seven countries and criteria for identifying de jure discrimination against women

Methodology for developing systems of Experiences in local health systems in the cities of nontraditional monitoring at the local level in Maracay, Venezuela and Quito, Ecuador women's health

Recommendations on policies and plans of Strategic orientation on women, health, and Recommendations on regional policies and plans of regional action on women's health, issued by the development; fines of action for technical action, approved by tbhe Special Subcommittee on Governing Bodies of the Pan American Health cooperation Women, Health, and Development of the Executive Organization Committee, by the Executive Committee and the Directing Council of the Pan American Health Lines of regional action for promotion and self- Organization in the period 1990-1993 care in women's health

Violence against women and giris: Recommendations for a regional plan of action

Regional plan of action to reduce maternal mortality in the Americas

Regional system to monitor and evaluate the women's health situation and differences between the sexes k~ ._ MSDI4/4 (Eng.) Page 20 .

Table 3 Health policies, programs, and services using a gender approach by countries in the Region, 1991-1993

Countries Policies Programas ealth services

Mexico National women, health, snd Health begins at home Services for training and development plan/Ministry of instruction on family health for Health women

Guatemala Policy of social development National women, health, and Health services for care of that includes development of development program/Ministry of victims of violence women Health

El Salvador Policy of comprehensive care Mother-young people program, Comprehensive health services for women/Secretariat of the program for prevention and care for pregnant adolescent women, Family and Ministry of Health for victims of sexual violence health services for victims of sexual violence

Nicaragua Education of women leaders and Training and instruction services promoters for self-care

Honduras Policy of comprehensive care for women/Ministry of Health

Costa Rica National women, health, and development program/Ministry of Health

Belize Policy on the progress of Program for prevention and care Services for care of abused women for domestic violence women

Cuba Program to train women leaders Training and instruction services in health

Colombia Policy on health for women, Program for prevention of Networks for prevention and care women for health/Ministry of violence/health education and of family abuse, training in self- Health promotion of self-care care

Venezuela National policy for development Program on Women, Health, and Training services and training for of women Development women leaders in health

Peru National plan for development Program on Women, Health, and of women Development

Chile National policy for development Program to prevent teenage Comprehensive services for of women pregnancy; program for pregnant young women, clinics to prevention and care for domestic care for victims of violence violence

Bolivia Social policies for women Program on women and reproductive health/women, health and life MSD14/4 (Eng.) Page 21

Table 4 Advocacy and promotional activities for the legal equality of women

Initiatives/activities Area of Action/Agents Results Democracy and health: Countries of the Region, Information and the health conditions of legislators members of the consciousness-raising of permanent health legislators commissions Women, health and Central American women Creation of permanent legislation in Central legislators from the commissions on women America commissions on health and in the legislatures women Comparative study of Current legislation in the Commissions for the legislation for the six Central American review of laws and protection of maternity countries proposals for reforms and breast-feeding and Penalization of violence Countries of the Region, Review of penal codes, against women and girls legislatures judicial branch, proposed reforms, Inter- courts, women's American convention organizations against violence MSD14/4 (Eng.) Page 22

Table 5 Strategies to mobilize, organize, and develop women's leadership in promoting, protecting, and monitoring their health

Level of Actions Activities\Results Spheres of Action\Agents

Actions at the regional level for the Mobilization of Women's Organizations in Regional meeting with 120 Women from Americas the Struggle against the AIDS\Buenos 75 NGOs in 17 countries of Latin Aires Declaration, 1991: Women in the America. World AIDS Action Day, strunggle against AIDS Buenos Aires, December 1991

Infornmational campaign to mobilize for the Region of the Americas, publications and world day of action for women's health/28 bulletins with the Latin American network May and the world day for no violence of women and health, ISIS International against women/25 November

Regional meeting of the women's health network of Latin America and the Region of the Americas, regional plan of Caribbean, Santiago, October 1992 action for the Network

Subregional actions Training for multipliers to train women on Central American experience with the the promotion of self-esteem in women seven countries

Publication of the manual Promoring our self-esteem (PAHO/UNICEF/UNIFEM), Distribution of 5,000 copies to women's Spanish and English organizations in the Region . National and local actions Workshops on health promotion and life Experiences developed in local health with/for women at the community level in systems of Cali, Colombia; Baruta, cities of the Region Venezuela; Guadalajara, Mexico; Matagalpa, Nicaragua; San Salvador, El Salvador; Arequipa, Peru; La Paz, Bolivia

Community networks and self-help groups Experiences developed in the local health for the prevention and care of violence systems of Medellín, Colombia; Sao againsl women, in lower-class Paulo, Brazil; Santiago, Chile; San neighborhoods in the Region Salvador, El Salvador; San José, Costa Rica; Caracas, Venezuela; Lima, Peru; Quito, Ecuador

Participatory research with organized Myths, perceptions, and assessments on groups of women on health subjects women's bodies and health (Cali, Colombia); working conditions and health in the fishing industry (Temuco, Chile); quality of reproductive health care (Santiago, Chile); women and life after sixty (Santiago, Chile)