Section 3: Steps & Tools

Description of GPIH Steps

This section gives a brief description of the four steps and tools mentioned above.

Step 1: Who gets ill, when and where: Patterns of Ill-health

Examine sex-disaggregated information on morbidity and mortality (health outcomes data) to delineate-

·       Who gets ill- women and men of different ages, socio-economic & ethnic groups?

·       What types of illness women and men get?

·       When do women and men get sick or need help (season, labor pains during night?)

·       Where women and men become sick (eg: snake bite in the field; exposure to indoor pollution while cooking…)

 

This bird’s eye view of patterns of illness will further be enriched if caste, class, communal, ethnic groupings and physical ability are also considered. Some rows or columns may remain blank as the category may not be relevant for the problem being analyzed or the information may not be available. For example, in case of worm infestation, rows like day/night, menstruation/pregnancy etc may not be relevant. What follows is a prototype which should be adapted to local specificities.

 

Tool 1

Who gets this illness? Who is affected more?

Name of illness/condition……

0-5 years

6-10 yr

11-18 yr

>18 yr

Upper class/caste

Lower class/caste

Upper class/caste

Lower class/caste

Upper class/caste

Lower class/caste

Upper class/caste

Lower class/caste

Sex ®

G

B

G

B

G

B

G

B

G

B

G

B

W

M

W

M

Day/night

Summer/winter/rainy/all

At home/fields/ workplace/ others- specify

During menstruation /pregnancy/ delivery/postnatal

Remarks

 

For example, in some situations having a middle and lower class might suffice. Elsewhere, putting up the names of popular caste or tribe may be a better idea. Other axes of social divisions should also be considered and added to the above format: Landless / Landowners; Muslim, Hindu, Parsi; Married / unmarried etc. Age bracketing (0-5, 6-10 etc) should also be changed depending on the issues being studied.

Step 2: Health Service Provider Analysis

·        List the health services and facilities, private and public, formal and informal, traditional/indigenous and allopathic/bio medical available for treatment.

·        List the persons who go to the respective health care services. For which illness do they go/for which they will never go.

·        Reasons for those persons going and for others not going (e.g. timing, location, money, confidentiality, effectiveness, norm, appropriateness) to the health care service.

 

Tool 2 Name of service	Average Distance	Pvt/Public/ Informal	System- Traditional/ Allo/ Homeo	User charge	Clientele: W/M, Upper/Middle/Lower class etc.	Go for what ailments?	Will never go for what ailments	Reasons for not going	Remarks

 

For each service provider, following questions could be asked:

·      Timing (eg. inconvenient timings of a Government Hospital)

·      Location (distance, locality, lack of transport)

·      Money (eg. high fee structure of a private hospital, costly rituals of a faith healer)

·      Confidentiality (HIV + client in a Government service: how long her/his identity remains confidential?)

·      Effectiveness (medicines at Government PHC are often considered useless.)

·      Norm (are women free to go to a male gynecologist? Will an upper caste Dai attend to a low caste client?)

·      Appropriateness (For delivery in a village, who is more appropriate as a service provider – Dai or a Nurse, even if both are available?)

Step 3: Factors affecting who gets ill

Here we move on from “who gets ill” to “why certain groups of people are more susceptible to illness than others?” This susceptibility often is more than just a question of biological differences[1]. This would involve examining the important social, cultural and economic factors that affect health and experience of sickness. This susceptibility may vary according to the context (extreme right column in the outline above).

 

To facilitate analysis following grid is used, where column heads represent context and the row heads indicate specific loci of different factors:

 

Tool 3 Why do different groups of men and women suffer from ill-health	Household	Communities	Influence of States/markets international relations
How does the ENVIRONMENT influence who becomes ill?			e.g. lack of health and safety legislation to protect workers
How do the ACTIVITIES of men and women influence their health?	e.g. cooking on biomass fuel increases women’s chances to develop conjunctivitis
How do the BARGAINING POSITIONS of men and women influence their health?		e.g. male community members decide to use funds to build a meeting house, not to build a well as favored by women members
How does access to and control over RESOURCES influence the health of men and women?		e.g. women’s lack of income earning opportunities may lead them to commercial sex work as a livelihood strategy	Box 12
How do GENDER NORMS influence health?	e.g. son preference may mean that daughters are fed last and receive less nutritious food

 

See more examples.

 

Step 4: Factors affecting responses to illness

How are women and men’s responses to illness influenced by gender and other differentials? Here too various socio-cultural and economic influences should be considered and analyzed. Following grid is used to facilitate asking relevant questions:

 

Tool 4 How are men’s and women’s responses to ill health influenced by gender?	Household	Communities	Available health (& other) services
How do the ACTIVITIES of men and women influence responses to illness	e.g. women are responsible for caring for sick family members		e.g. formal care schedules may not fit the schedules of different groups of men and women
How do the relative BARGAINING POSITIONS of men and women influence responses to illness?	e.g. a man with an STD may be able to decide to seek care without his wife’s knowledge but she would need to ask him before seeking care
How does access to and control over RESOURCES influence how men and women respond to ill health?			e.g. traditional healers may accept payment in kind, while cash is required for user fees at formal services
How do GENDER NORMS affect responses to illness		e.g. the social consequences of suffering from a stigmatized diseases such as leprosy may be more severe for women	More examples

 

A little thought makes one realize that step 3 above - Factors affecting who gets ill, will generate useful information for preventive intervention at different levels: Information and counseling at individual and family levels, advocacy and policy changes at community and state level, preventive occupational interventions at home and workplace etc.– so that women or men do not fall sick in the first place.

 

Similarly, analysis in step 4 - Factors affecting responses to illness, will generate useful leads for program, so that affected groups / individuals can access services better and recover their health easily. Again, these interventions would be operational at various levels: If the reason is – women are not able to access ready cash at household to seek services of available Gynecologist / Nurse practitioner, then, instead of providing more of the same services, program will have to find better/ alternative ways of ensuring ‘cash flow’ for the services or improving women’s access to cash income. In other words, step 3 will generate information to make curative components of the program more relevant and effective.

Where Next? From Analysis to Program Planning

Are the current programs addressing these factors, as uncovered in step 3 and 4? If yes, to what extent? What more needs to be done? Here in this last step GPIH graduates from analytical tool to a program tool: a tool to help review and plan the programs in a more gender responsive way.

 

Figure 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By the time, participants complete the GPIH analysis of the given problem, they have a detailed list of socio-economic factors, which make women sick and keep them that way, just because they are women. They also discover that same applies to men too in many cases. It is also understood by now that, prior to obvious sickness, there are many shades of health issues, conditions & sub-clinical states, which afflict women and men similarly ie. because of their ‘gender’.

 

Confronted with this comprehensive list of factors responsible for production of ill-health and its continuation, participants naturally want to know, how many of these are being addressed by their program. Can they collaborate with other players to tackle bigger factors, like policy issues? Can there be significant synergy between their program and the government one? These are the questions which GPIH helps participants confront and address.