The influence of gender dynamics on polio eradication efforts at the community, workplace, and organizational level

Abstract

Background Globally, gender as a barrier or facilitator in achieving health outcomes is increasingly being documented. However, the role of gender in health programming and organization is frequently ignored. The Global Polio Eradication Initiative, one of the largest globally coordinated public health programs in history, has faced and worked to address gender-based challenges as they emerge. This paper seeks to describe the role of gender power relations in the polio program across global, national, subnational, and front-line levels to offer lessons learned for global programs. Methods We conducted qualitative key-informant interviews with individuals purposively selected from the polio universe globally and within seven country partners: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, and Nigeria. The interview tool was designed to explore nuances of implementation challenges, strategies, and consequences within polio eradication. All interviews were conducted in the local or official language, audio-recorded, and transcribed. We employed a deductive coding approach and used four gender analysis domains to explore data at the household, community, workplace, and organizational levels. Results We completed 196 interviews globally and within each partner country; 74.5% of respondents were male and 25.5% were female. Male polio workers were not allowed to enter many households in conservative communities which created demand for female vaccinators. This changed the dynamics of front-line program teams and workplaces and empowered many women to enter the workplace for the first time. However, some faced challenges with safety and balancing obligations at home. Women were less likely to receive promotions to managerial or supervisory roles; this was also reflected at the global level. Some described how this lack of diverse management and leadership negatively affected the quality of program planning, delivery and limited accountability. Conclusions Gender power relations play an important role in determining the success of global health programs from global to local levels. Without consideration of gender, large-scale programs may fail to meet targets and/or reinforce gender inequities. Global disease programs should incorporate a gender lens in planning and implementation by engaging men and boys, supporting women in the workplace, and increasing diversity and representation among leadership.

Understanding Factors Influencing Polio Vaccine Uptake in Ghana—Developing Meaningful Community Mobilization and Engagement Strategies in Collaboration with Religious Leaders

“…40 The use of "champions" is known to be an effective way to change community norms. 40 In addition, community outreach efforts could also focus on those who are more reluctant to take the vaccine by using community leaders' in-depth understanding about the reasons for their reluctance and developing targeted and personalized messages to address them. 54 The study includes in-depth insights into community perceptions about polio and the polio vaccine.…”

“… 39 In South Sudan, healers have been sucessfully sensitized on the importance of the polio vaccine and engaged in community mobilization activities. 40 Overall, it is important that religious leaders are given an opportunity to consider various cultural and traditional aspects to determine appropriate vaccine demand creation strategies and messages to use when creating polio vaccine demand in their communities.…”

“…Community outreach activities can focus on those women and engage them as champions and role models for polio vaccine demand generation. 40 The use of “champions” is known to be an effective way to change community norms. 40 In addition, community outreach efforts could also focus on those who are more reluctant to take the vaccine by using community leaders’ in-depth understanding about the reasons for their reluctance and developing targeted and personalized messages to address them.…”