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Are health systems interventions gender blind? examining health system reconstruction in conflict affected states.

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Percival, Valerie, Dusabe-Richards, Esther, Wurie, Haja, Namakula, Justine, Ssali, Sarah and Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X (2018) 'Are health systems interventions gender blind? examining health system reconstruction in conflict affected states.'. Globalization and Health, Vol 14, Issue 1, p. 90.

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Abstract

BACKGROUND
Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women's health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity.

METHODS
This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks.

FINDINGS
Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy.

CONCLUSION
The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > Health Problems of Special Population Groups > WA 300 General. Refugees
WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WA Public Health > Health Administration and Organization > WA 540 National and state health administration
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12992-018-0401-6
Depositing User: Stacy Murtagh
Date Deposited: 12 Sep 2018 14:55
Last Modified: 12 Sep 2018 14:55
URI: https://archive.lstmed.ac.uk/id/eprint/9287

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