Intersectional gender analysis for inclusive health system in Nepal: taking Tuberculosis as a case example

Abstract

Background: Nepal is multi-ethnic, multi-lingual, and multi-cultural state with diverse geography, in its early stage of federalization, where Tuberculosis (TB) remains a major public health problem. TB is a disease, which is high among settings with common practice of gender and social inequities. This study aimed to a) explore inclusiveness of gender and other social stratifiers in the key health related national policies and Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) b) to conduct intersectional analysis with available social stratifiers of TB cases enrolled in the NTP. Methods: Desk review of key policies and HMIS of NTP was conducted. Intersectional analysis was carried out from two secondary sources i.e. annual report data of NTP (2017 - 2021) and 628 recorded TB cases via HMIS 6.5 from two TB centres (2017/18-2018/19). Statistical analysis was carried out to assess association between social stratifers and types of TB, registration category and treatment outcome. Results: Gender, social inclusion and concept of intersectionality are well incorporated into the different health policies and strategies while lacking in its implementation. NTP has initiated collecting age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data is routinely reported. Hence, recorded social stratifiers of TB patients have remained static as they were not analyzed and disseminated. Furthermore, some of the key findings from the intersectional analysis conducted by using TB secondary data, gave significant highlights on sex and age wise variation among TB patients. However, ethnicity was not significantly associated with TB treatment outcome. Conclusion: The study findings illustrated that the biological and the social construct of gender differences are important determinants of TB and treatment outcome. The inadequacy in the availability of social stratifiers in the routine HMIS, limits the NTP’s ability to conduct intersectional analyses, which are essential for unveiling the roles of other social determinants of TB. Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans towards building a more responsive and equitable TB programme and address disparities effectively. Trial registration: Not Applicable