LEARNING EXPERIENCE
Learn about some of the gender barriers at each step of the Journey to Health and Immunization. As well as an overview of each area of caregiving and the immunization process, case studies will help bring to life some of the challenges that health workers, women and young people face every day. After each step, you can take the self-assessment quizzes to test what you’ve learnt.
The Journey to Health and Immunization
Step 1 – Knowledge, awareness & belief
Gender/equity issues influencing knowledge and beliefs
Step 2 – Intent
Gender norms/equity dimensions impacting uptake and delivery
Step 3 – Preparation, cost & effort
Gender/equity-related costs and benefits of service access/provision
Step 4 – Point of service
Gender/equity considerations in health service delivery
Step 5 – Experience of care
Gender dynamics/equity issues in client-provider interactions
Step 6 – After service
Gender/equity dimensions in follow-up care and services
Learn the Steps
This tool is a guided tour of gender-related barriers and solutions along the steps of the journey for caregivers and healthworkers. The introductory video below gives an immersive overview of the overall journey and the tabs beneath will guide you through each of the 6 steps.
After each of the Six Steps, you’ll get the chance to take a quick questionnaire to test your knowledge about the Journey to Health and Immunization and increase your understanding. Simply read the questions and select your answer. The correct answers will be revealed at the end of the quiz.
Step 1 focuses on clients’ practical knowledge, awareness and beliefs, as well as their perceptions of what others around them believe. This includes whether having vaccinations is an accepted social norm and whether the community trusts vaccines. It addresses the influence of religious and cultural factors, and explores clients’ social positions in families, communities and societies based on the value given to women, men, girls and boys. Step 1 also addresses providers’ knowledge, awareness and beliefs which can influence both their attitudes toward clients and the way they provide services.
Has the video helped increase your understanding of the Knowledge, Awareness and Beliefs that people have regarding vaccinations? Take the test below to find out.
What barriers do some people face in attaining health literacy?
Both low social status and legal restrictions can be barriers to health literacy. For example, women might have to follow the authority of male relatives or not enjoy the same educational advantages, while refugees or undocumented people often can’t access services.
How can a community affect someone’s desire to get vaccinated?
There may be distrust in healthcare systems and healthcare workers at a community level with religious and cultural objections being among the factors that influence decision-making.
What is an example of a barrier that male health care workers may face in doing their job?
In some settings, there are objections to male vaccinators or healthcare workers interacting directly with female patients.
What example in the video was given to include more female health care workers?
To increase community demand, more women vaccinators were hired and paid more to reach remote areas.
Name one indicator for success in gender inclusion in health care
It is important to increase awareness and acceptance for both men and women across the social scale if gender inclusion is to be successful.
Step 2 explores ways to overcome gaps between the intention to get vaccinated, and the actual behaviour to do so. It focuses on local settings and looks at readiness to be vaccinated as determined by clients’ attitudes toward vaccinations, perceptions of what is acceptable in their society, and perceived control over their own actions. This includes gender dimensions of the extent to which women and girls are able to make decisions and take action in a given setting. Step 2 also addresses how gender norms, roles and relations influence the working conditions and choices available for health care providers.
Do you understand the issues around the Intent to be vaccinated and the associated behaviour and attitudes needed? Take the test below to find out!
What percentage of health and care providers globally are women?
70% of health and care providers are women worldwide, but despite their expertise, women are much less likely than men to hold higher-paying decision-making roles within health systems.
What reason is given for Tamara’s child not being vaccinated?
As in many societies around the world, Tamara is unable to take her child to be vaccinated without permission from her husband or other male family member.
How can society negatively affect vaccination uptake?
Gender biases within a society may prevent women from accessing the information they need to keep themselves and their children health. In addition, in some parts of the world, ongoing conflicts make people afraid of venturing out to health centres.
What hardships are female health care workers more likely to face than male health care workers?
Female health care providers may face bias and sexual harassment within the workplace which can lead to ill health, stress and low morale.
In what ways might gender-related barriers to health and immunization affect men and boys?
Gender-related barriers at both the community and individual levels affect men and boys in different ways. Health systems need to ensure that they welcome and encourage both female and male caregivers to bring their children in for care. In addition, when men conform to society’s views of masculinity and fail to recognize the need to prioritize their own health, they may face a variety of health problems, as was evident during the COVID pandemic.
Step 3 focuses on clients’ needs and interests in preparing for vaccinations, and their understanding of available vaccinations and services, and the planning and logistics of accessing services. Clients may have to consider trade-offs, or opportunity costs, that may include financial, social and/or material circumstances. Seeking health services requires effort and time, and decisions about prioritizing choices. The availability of economic, material and social resources similarly influence health care providers, for example with respect to motivation, decision making and effort in preparing and getting to service points on time.
Preparation, Cost and Effort play a huge role in people understanding the need to be vaccinated and accessing services. Do you understand the issues? Take the test below to find out.
What is an example of an opportunity cost for a client to consider when getting vaccinated?
A client will always have to consider the financial, social and material costs. Seeking out health services requires efforts and time to get to the point of service.
What additional burdens did Nigerian female health care workers face during the early months of the COVID-19 pandemic?
During the initial COVID-19 outbreak in Nigeria, many female care workers were forced to stay home to look after children as schools were closed and transportation was limited.
Name one potential solution to address gender dimensions of preparation, cost and effort
Unconditional health insurance access would be hugely beneficial for people from marginalized groups and less wealthy people who need primary health care.
What reason is given to explain that women are more likely to seek care and have more access to vaccinations than men on average?
Women have more regular interactions with the health system for example, to receive pre-and post-natal care.
Even if free health care is provided, what are some additional constraints for women to get vaccinated?
Women face additional financial and geographic barriers to access, even when health care provision is free. They might not be able to take time off from work or childcare and in some places, the costs or difficulties in getting transportation to vaccination sites are prohibitive.
Step 4 looks at the organization of primary health care and vaccination services in relation to gender-equity considerations in primary health care and vaccination services, including the availability of resources, to identify solutions and indicators to track services for gender responsiveness and effective services, including ensuring that all health care providers have what they need to provide quality care. This step focuses on the physical, financial and organizational dimensions of service quality, while the next step focuses on the quality of client-provider interactions.
Do you understand how gender-equality considerations and organization of primary healthcare can impact vaccination decision-making at the Point of Service? Take the test below to find out.
In the case study mentioned, why are female community members reluctant to speak to male health care workers?
For cultural or religious reasons, it might be taboo for a woman to be alone with a man who isn’t a male relative or her husband. A gender balance of health care providers allows for gender-sensitive services to fit the local context.
What was an effective method to distribute vaccines to men like Thato in the video?
Gendered occupations and work time constraints influenced many men to avoid seeking health services in the video. The response, to offer men such services in or near their work place, meant more men took part.
What factor led to health care worker Sanya being trusted more than male health care workers in her community?
Sanya had long been a traditional birth attendant and was known and trusted by women in her local community. Birth attendants are often seen as the first-level care providers for women and children in some regions.
Based on community focus groups for men and women in the video for this step, what changes were made regarding health care practices?
The focus group discussions found that female community health workers found it easier to access local women and caregivers responsible for children’s overall health, including vaccination.
How were community health care workers incentivized to engage in immunization efforts?
It was found that offering a monetary incentive to community health care workers for referring children for vaccinations effectively increased vaccination uptake.
Step 5 looks at interactions between clients and health care providers and how differences in culture and socio-economic backgrounds may influence relationships and communication. It explores clients’ perceptions of treatment by healthcare providers, and health care providers’ provision of services based on their perceptions and experiences. It addresses gaps in socio-economic backgrounds, or ‘social distance’, between clients and health care providers, which can play a big part in the experience and provision of care.
Experience of Care is vital when it comes to encouraging take up of vaccinations. Do you understand how cultural and socio-economic influences impact provision of care? Take the test below to find out.
In the case study mentioned, what crucial element was missing for Nurse Fatou to conduct her vaccinations effectively?
Nurse Fatou only knew a little of the local languages and needed help from a colleague to translate. If she doesn’t have this help, she finds it hard to explain vaccination schedules or to share information about the disease and any potential vaccine side-effects.
What do some people in Khadi’s community believe about vaccines?
A myth that vaccines are a form of population control that makes young men sterile has spread in the community. Health workers and other partners have to fight such misinformation.
What was the main takeaway of the case study?
Difficult working conditions such as language issues and misinformation as well as social gaps between clients and health workers can lead to low levels of understanding about health and vaccines among members of the community.
What is a good example of gender responsive interpersonal communication?
To have a respectful and considerate attitude to clients, especially the vulnerable or those with diverse beliefs, languages or cultural needs is vital for all health workers.
Why is it important to also address the needs of health care workers?
Health care workers are often women who have the same stresses and constraints as their clients. Their needs too must be addressed or the quality of care will be impacted.
Step 6 looks at clients’ access to information about the after-effects following immunizations (AEFI). Clients need reassurance on potential side effects and pain mitigation, and to know when and where to go if there are issues, along with next appointment reminders. Health care providers need to be sure that various types of clients equally understand the information communicated. Both clients and health care providers need respect and support from their families, peers and community.
The immunization process doesn’t stop with the injection. Professional After-service is vital for providing ongoing care, reassurance and continued interaction with clients. Test your knowledge of After-service by taking the test below.
What was a hardship faced by Naina’s family before moving to their current settlement?
Like many other parents in the region, Naina lost her fourth child Arjun during an outbreak of meningitis.
How did Rahul become more accepting of his wife Naina’s role as a community leader?
As Naina gained confidence and experience from her savings group, she was able to start a business that brought in more money to invest in the family. The profile of women as a group has also been raised thanks to the work of mobilizers.
What were the results of Naina’s leadership role in the Community Health Committee (CHC)?
Naina’s leadership role meant that children vaccinations went up and infant deaths decreased over 12 months.
Why is it important to give women a voice in community health?
When women have a voice via leadership, it is more likely that women’s needs and concerns are raised and heard. It also creates community ownership of primary healthcare services.
Why might gender play a role in after service care?
Unequal gender norms mean that women, adolescent girls and other marginalized groups face obstacles to accessing and understanding health care. Low confidence, and social status, travel restrictions and customs are often barriers to getting vital treatment.
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