Gender for the Health Sector Guidelines Policy Gender Contents Why a gender policy guidelines for the Public Health Sector? 3 What is the gender policy guidelines for the Public Health Sector comprised of? 5 Policy Guidelines 6 Implementation Guidelines 7 Division of departmental responsibilities 8 Gender Focal Points 9 Function and location 9 Areas of involvement of the GFPs 10 Resourcing of Gender Focal Points 12 Coordination between GFPs, departmental directorates and other State organs 13 Inter-sectoral coordination 15 Participation by civil society 16 Gender Policy Goals 18 Monitoring and Evaluation 20 Much needed change 22 Vision and Mission 23 Why a gender policy for the Public Health Sector? The social norms and values within society that discriminate against women often have a hidden impact on the quality and efficiency of the activities of the Department of Health. Amongst other constrains, women health providers experience gender discrimination from two sources – at home and at work. The health service does not take into account the physically debilitating double shift that women work – paid employment plus their home and family responsibilities. Also, women health workers, such as nurses working alone in clinics at night, face the societal hazard of violence against women. Within the health system as a whole, women are at the bottom of a gendered institution, with rules, procedures and a culture established without women’s input. The doctor-nurse relationship perceives nurses as subordinate – at the receiving end of instructions. Yet, as front-line health providers, running rural services on their own, their ability to innovate and make responsive decisions contributes to the effectiveness of the health system. The effects of this inequality impact adversely on all receivers of health services – men as well as women. Page 1 South Africa’s Constitution guarantees equal rights and opportunities for all, irrespective of race, creed or gender. The Government’s gender equity policy is spelt out in the National Policy Framework for Women’s Empowerment and Gender Equality 2000, which is in keeping with South Africa’s international responsibilities to the Convention on the Elimination of All Forms of Discrimination against Women. All government departments, and organs civil society as well, are legally and morally committed to this policy framework. In addition to its constitutional commitment to promote gender equacity and equity, the Department of Health has its own wide-ranging equity commitments, namely to those who have been previously marginalized and to improve the productivity and quality of its services to the public. The benefits of the Public Health Sector gender equacity equity policy will thus include: - Equal rights and opportunities for women and men workers at all levels in the Department; - Enhanced service delivery through the optimal use of all of its human resources; - Equitable attention to the health needs of women and men, girls and boys, and equal access to quality care at all levels of the health system. Page 2 What is the Department’s gender policy comprised of? The Department’s gender policy, which applies to public health institutions at the national, provincial and local levels, consists of: - Policy Guidelines according to which gender- related issues must be “mainstreamed” – i.e. taken into account in the planning of all actions (legislation, policies and programmes); - Implementation Guidelines to guide the political leadership and administrative arm in the establishment of institutional arrangements that will ensure successful implementation of the policy; - Gender Policy Goals that spell out the specific objectives to which those charged with implementing the policy must aspire; - A Monitoring and Evaluation Process to measure the implementation of the policy according to short-term and long-term indicators, and to monitor the impact of the actions taken. The findings will form part of the periodical Performance Progress Reports to the Minister of Health. They will also be reported to the Office on the Status of Women as part of its overall monitoring strategy. Page 3 Policy Guidelines The Gender Policy Guidelines provide the administrative arm of the Department with a broad scenario of what is required by the Gender Policy. In brief, the requirement is to systematise the process of gender mainstreaming – i.e. to take gender into account in the planning of all actions (legislation, policies and programmes). The Guidelines help the Department and all public health institutions to identify and address gender-related issues. They require the administrative staff involved to: - Create an enabling environment for translating the Department’s gender equality commitments into reality; - Establish an institutional framework within the Department and the public health sector to advance the status of women and achieve equality between women and men; - Integrate the empowerment of women and transformation of gender relations into policies and programmes at all levels of the health system; and - Promote new attitudes, values and behaviour, and a culture of respect and gender equality throughout the health system. Page 4 Implementation Guidelines The purpose of the Implementation Guidelines is to provide those responsible for developing the Policy Guidelines with specific details of what is required of them in setting about the development of the system. Firstly, the Implementation Guidelines set out the division of departmental responsibilities – “who is responsible for what”. Then they go into detail on the Gender Focal Points (GFPs) – where in the departmental structure they should be located, their areas of involvement, and how they should be resourced. Finally, the Implementation Guidelines spell out the relationships between GFPs and the various directorates in the Department, and between GFPs on the national, provincial and local levels of government. The Implementation Guidelines also look to the coordination of efforts with civil society, such as NGOs, the health professional associations and practitioners of complementary and traditional medicine. Page 5 Division of departmental responsibilities - Senior management, whose role it is to build understanding of the gender policy and commitment by health providers to promote gender equality as an integral part of health service provision, and also to monitor the progress of the process; - Human Resources Directorates, whose role it is to implement the policy guidelines as they apply to the internal workings of the Department, to build the understanding and commitment of health officials to promote gender equality in the process of managing health services, and to monitor the progress of the their efforts; - Gender Focal Points, which play an advocacy role for gender equity in the Department and public health institutions, support senior management with information and expertise in its gender equity functions, and monitor the implementation and impact of the gender policy. A Performance Management System is in place to monitor service delivery by all the implementers involved. Page 6 Gender Focal Points (GFPs) Function and location The Gender Focal Points (which function at national and provincial levels, and also at local level if the size of the local authority warrants it) do not manage the gender equity programme vertically within the Department or organisation. They function horizontally – i.e. their task is to influence decision-making and support officials at management level across the organisation, thereby to guide them in their task of instituting the required organisational transformation. For this reason, the GFPs are located at the heart of management and management decision-making, that is, in the office of the Head of Department at provincial level and Director-General at national level. This is as stipulated in the National Policy Framework for Women’s Empowerment and Gender Equality. The gender policy guidelines require changes in attitudes and behaviour, and the reviewing of policies and programmes, throughout the department. For this reason, it is required that national and provincial GFPs be full- time positions (at local level too depending on the size of the local authority and the scope of work required) – and not “add-on” tasks of staff engaged in line functions. Page 7 Areas of involvement of the GFPs Policy • Gender-based analysis • Policy formulation • Programme design and planning Gender mainstreaming • Statistical analysis • Gender-based analysis • Training skills • Research skills • Planning Coordination and Planning • Strategic planning • Communication skills • Quantitative and qualitative • Evaluation skills • Coordination Page 8 Advocacy • Social and economic skills • Research/analytical skills • Planning • Training • Monitoring and evaluation Liaison Networking • Communication • Grasp of stakeholders’ interests • Organisational skills • Reporting skills Capacity Building • Management skills • Facilitation skills • Analytical skills • Insight into social situation Page 9 Resourcing of Gender Focal Points For Gender Focal Points to be able to optimally play their intended role, they need to be equipped with sufficient financial and human resources. To this end, thus, the policy guidelines recommend the executive and legislative structures at national and provincial level to: • Allocate financial and human resources to enable GFPs to implement the policy guidelines; • Allocate resources, including information technology, and personnel to facilitate coordination, capacity building of GFPs, communication, networking and collaboration; • Provide the national, provincial and local GFPs with regular technical, mentoring and advisory services; and • Enable GFPs to function effectively towards the goal of women’s empowerment and gender equality by providing institutional infrastructure, disseminating information, monitoring and evaluation. It is thus clear that government is “putting its money where its mouth is” in respect of gender equity. Page 10 Coordination between GFPs, departmental directorates and other State organs There is a clear distinction between the line functions of the Maternal, Child and Women’s Health (MCWH) directorates and the functions in which the Gender Focal Points are involved. The MCWH directorates are responsible for their programmes which address health issues pertaining to motherhood, children and women. This includes responsibility for health promotion events targeting these groups. The GFPs are not involved here. As a separate issue, ALL directorates throughout the Department and health care institutions have the responsibility for identifying and addressing gender inequity or inequality in their structures and activities. They must incorporate gender awareness into their programming – and HERE it is that the GFPs carry responsibility, namely to provide support. Within the Department of Health, each directorate at national level will work with and support its equivalent at provincial level in implementing these policy guidelines; and likewise at provincial in relation to local levels. The national GFP will likewise work with the provincial GFPs and, through these, with local GFPs to build their capacity for implementation. Page 11 The Department’s gender policy provides for the Gender Focal Points to liaise with specific committees and offices to ensure that gender issues receive the required attention. These include: • MINMEC, a committee composed of the Minister and the nine provincial MECs for Health, their top officials, and representatives of the SA Local Government Association and the SA Military Health Services (SAMHS); • PHRC (Provincial Health Restructuring Committee), composed of the Director-General of Health and top officials of the national and provincial health departments, local government and the SAMHS; • The Minister and the Director-General of Health, whose offices liaise with the Presidency on gender issues; • The Office on the Status of Women; and • The Workplace Gender Forum which is mandated to provide strategic direction for the effective implementation of the Health Sector Gender Action Plan. At national level, the Workplace Gender Forum is comprised of provincial GFPs, and at provincial level it is comprised of provincial, local and district GFPs. Page 12 Inter-sectoral coordination The Gender Focal Points also have an inter-sectoral coordination function to promote implementation of the gender equity policy among key external role players (outside of the State health sector). This is in line with the framework stipulated in SA’s National Policy Framework for Women’s Empowerment and Gender Equality. The coordination process is centred in the Presidency, through the Office on the Status of Women. Other bodies involved are the Commission on Gender Equality, the Health Sector Coordinating Committee, and the GFP Social Sector Cluster (comprised of GFPs in the Departments of Agriculture, Education, Health, Home Affairs, Housing, Justice, Land Affairs, Social Development, and Sport & Recreation, and the SA Police Services). Page 13 Participation by civil society The National Framework recognises further that “The national machinery alone cannot shift public policy agendas for women without the participation of organisations of civil society”. A further important coordinating role of the Gender Focal Points is thus in respect of civil society organisations, the private sector and international development agencies. Valuable partners will be the various non-governmental organisations (NGOs), which have extensive experience of advocacy involving the identification of key decision- makers, preparation of position papers, lobbying, using the media and press conferences. Health professional associations should also be involved in advocacy because their members are likely to be among the first to be affected by the changes brought about by these policy guidelines. A coordinated approach by these associations and NGOs representing different constituencies is thus needed. Page 14 NGOs should thus support GFPs in mobilizing community support and presenting ideas and information to community members, thereby forging linkages between communities and policy makers. Of particular importance is networking with women’s organisations. It is crucial that women move into decision-making positions at the district level. Many NGOs have already developed training programmes in gender sensitivity which can easily be adapted to take account of the special needs of the health sector. Health professional associations will also need to sensitise their own members as they play a crucial role in providing health services at all levels. The support of the private sector, including pharmaceutical companies and private clinical services, will be sought to collaborate in ensuring quality care and access to services, particularly for poor women. Involvement will also be sought of practitioners of complementary and traditional medicine, for whom codes must be established to prevent practices that violate human rights and especially the rights of women and children. Active community involvement is essential to ensure that the voice of all, in particular women, is heard in designing health services and monitoring action plans. Page 15 Gender Policy Goals The Gender Policy Guidelines comprise broad objectives, each of which are spelt out with accompanying objectives, activities and indicators. In brief, the goals are as follows: Goal 1: To incorporate gender analysis into all public health policies and programmes The objectives that relate to this goal are: • To gain senior management’s commitment and build its capacity to promote, implement and monitor gender mainstreaming; • To facilitate senior managers’ integrating of gender analysis into the strategic planning and business planning processes of their directorates or institutions; • To build an understanding and commitment throughout the health system to address the impact of gender- based discrimination; • To ensure input from civil society, and particularly from beneficiaries of health services; • To integrate gender concerns into the department’s overall plans, and to monitor them accordingly. Page 16 Goal 2: To promote gender equity in organisational development The objectives that relate to this goal are: • To eliminate gender-based discrimination in human resource procedures such as appointments, promotions, pay, conditions of employment and disciplinary procedures; • To ensure equal balance between the sexes in decision- making positions; • To ensure that institutional rules and culture promote participatory decision-making and an environment that is supportive of gender equity; • To build understanding of the purpose of the gender policy and ensure commitment to them by political leadership and senior management; • To sustain gains made in building commitment and capacity for addressing gender inequity as new people are recruited to the department; • To build the capacity of managers and other personnel to conduct a gender analysis of their policies and programmes and to use the findings to improve the quality of health policies and services; • To build the capacity of Human Resources Directorates to offer gender training at all levels so that all staff understand and are committed to addressing gender inequity in their area of work. Page 17 Monitoring and Evaluation An integral part of the policy will be the monitoring of its implementation and evaluation of its impacts. The results of this process will be assembled from local to provincial to national level by the respective Gender Focal Points, and ultimately form part of the regular Performance Progress Reports to the Minister of Health. They will also be submitted to the Office on the Status of Women (in the Presidency), as part of its overall monitoring strategy of the National Policy Framework for Women’s Empowerment and Gender Equality. The GFPs are also responsible for compiling reports to meet international gender equality monitoring efforts. It is thus essential, for monitoring and evaluation purposes, that all health policies developed by directorates and clusters within the Department of Health and other public health agencies include gender issues in their strategies. This will enable service providers to measure the impact of the policy on women and men in their roles as both users and workers. Page 18 The monitoring strategies will establish short-term and long-term indicators. The short-term indicators will assess the gender equity situation as it is, and whether the processes for identifying and addressing gender inequality are functioning. The long-term indicators will measure the impact of changed policies. These indicators can therefore only be specified once the initial activities have taken place. A programme has been compiled according to which information must be assembled to establish the required the short-term indicators. It is on the basis of this that the long-term programme will be established. Page 19 Much needed change The Gender Policy Guidelines will go a long way in helping the Department of Health to maintain its focus and strengthen its impetus for much needed change in respect of gender equity in the public health sector. All users (male and female) of public health facilities – and also users of privately operated health facilities – will benefit from the restructuring of the health sector through the greater efficiencies that will arise from optimal utilisation of the available human resource. The Department of Health’s Gender Policy Guidelines thus deserve the active support of all – health workers and users alike. The gender restructuring of State, provincial and local authority health facilities will be driven by the Government’s equity policies. While privately operated health institutions and practices are not structured into this initiative, they will no doubt perceive (where they have not already done so) that it is in their own interests, too, to apply full gender equity. They are therefore invited to participate in the initiative. Organs of civil society – NGOs, community organisations and women’s organisations in particular – are likewise invited to join hands with the public health sector in helping to advance the role of women in this important sector of South African society. Page 20 Vision: A caring and humane society in which all South Africans have equal access to affordable, good quality health care. Mission: To create an effective enabling framework to guide the process of developing, implementing and monitoring laws, policies, programmes, procedures and practices which will serve to mobilise for • Equitable attention to the health needs of women and men and girls and boys and equal access to quality of care at all levels of the health system; and • Equal rights and opportunities for both women and men within the Department of Health and the Public Health Institutions. Page 21 Published by: The Department of Health Private Bag X 828, Pretoria, 0001, South Africa.