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WI-HER Series: breaking barriers and raising the bar on measurement  Part I: What is empowerment? And how do we measure it? By Kelly Dale, Gender Specialist The international development community frequently uses buzzwords or jargon such as mainstreaming, sustainability, equity, or empowerment without a concrete understanding or unified definition of what these terms represent. This makes addressing and measuring these concepts a significant challenge. This blog is part of a series—for five weeks, I will explore some of these concepts in greater detail, defining and explaining how we monitor and evaluate them. This blog will explore the concepts of empowerment and agency and the challenges in measuring them. In 2012 USAID developed its gender policy with a strong focus on female empowerment. Since then, the gender and social inclusion sector has put a strong emphasis on empowerment. But I have found different understandings of the concepts of empowerment and agency makes it difficult to define and measure them, which often leads to inaccurate, incomplete, or not easily comparable data about the lives of women, men, girls and boys. We are still grappling to collect and use data that highlight the unique experiences of women, men, boys, and girls, reveal barriers to equality, and prove what works to improve the situations of people around the world. This lack of data not only restricts effective programming, but masks and at times even perpetuates inequities. To understand empowerment and agency, I find it useful to explore the theoretical underpinnings of these concepts. Naila Kabeer (1999) defined empowerment as “the process by which those who have been denied the ability to make strategic life choices acquire such an ability.” Empowerment is a relatively broad concept that also includes resources—knowledge and material and human resources-- and achievements—improvements in well-being and life outcomes (see figure 1). Kabeer’s definition of empowerment also emphasizes the importance of agency and gaining the ability to make informed and autonomous choices. It is the process that connects resources and achievements, through voice, participation, influence, negotiation and decision-making power. Any program must also bear in mind that their intervention or activities are affected by the informal and formal social, political, cultural, and economic institutions in which they are implemented. These institutions greatly affect an individual’s agency and possibilities for  empowerment. Measuring these three components-- resources, agency, and achievements--can be an effective way of measuring empowerment. However, personal preference must also be considered and proxy indicators for agency must be selected carefully to adequately recognize choice. Currently, researchers and implementers are capturing empowerment through proxy indicators such as education achievement, financial capital, or exposure to the media. However, these indicators only represent resources and achievements and do not actually capture the full spectrum of agency—they do not account for preference, choice, or the unique constraints that a person may face when defining and acting on preference or choice. They are therefore missing the more subjective process of empowerment. In doing so, our measurements of empowerment are incomplete, reflect biases, and potentially impose preference [...]

Por Elga Salvador, asesora en género senior, WI-HER, LLC El 10 de abril 2019, el equipo del Proyecto de USAID Aplicando la Ciencia para Fortalecer y Mejorar los Sistemas de Salud (ASSIST) de la República Dominicana llevó a cabo la Segunda Sesión de Aprendizaje de Equipos de Mejora de la Calidad del Colaborativo de Atención Prenatal, integrado por el personal de salud y autoridades de hospitales de distintas regiones de salud del país. El evento miraba a ser una ocasión para que los equipos de mejora de la calidad compartieran experiencias y, específicamente, buenas prácticas que dieron buenos resultados en el ámbito de la atención prenatal. Al mismo tiempo se apuntaba a fortalecer las habilidades de los equipos de mejora en el manejo de metodologías de mejoramiento continuo de la calidad. En el evento participó, entre otras expositoras y expositores, la asesora senior en género de WI-HER, Elga Salvador, presentando el proceso de integración de género en la respuesta al Zika llevado a cabo gracias a la colaboración entre ASSIST República Dominicana y WI-HER entre 2018 y 2019. ASSIST República Dominicana fue el primero de los 13 países de América Latina y el Caribe donde USAID está liderando la respuesta al Zika, que asumió el reto de fortalecer las capacidades de los socios locales de identificar y abordar asuntos de género. Tomando como referencia el abordaje orientado a resultado y basado en la ciencia de la mejora, i-DARE, ideado en el marco del proyecto ASSIST por la presidenta de WI-HER, Taroub Faramand, a inicio del 2018 WI-HER en colaboración con ASSIST y el apoyo de otros socios, realizó una extensa revisión bibliográfica y un análisis de los asuntos de género que influyen en la mejora de la calidad de la respuesta frente al Zika en el país, a través de trabajo de campo en tres de las áreas más afectadas por el virus del Zika: Santo Domingo, Santiago y Barahona. Los hallazgos de este análisis de género fueron clave para contextualizar una actividad formativa a través de la cual se sensibilizaron en género y fortalecieron las capacidades de asistentes técnicos de ASSIST, así como de representantes del Servicio Nacional de Salud (SNS) y de equipos de mejora de la calidad del colaborativo de atención prenatal de diferentes hospitales, quienes a su vez replicaron entre sus colegas los conocimientos adquiridos a través de jornadas informativas. Tras este proceso, los equipos de mejora han podido identificar brechas de género que en sus servicios limitaban los resultados el proyecto y han diseñado ideas de cambio para abordarlas. En ocasión de su presentación, Elga Salvador presentó algunos hallazgos del análisis de género y una recopilación de prácticas prometedoras de integración del género implementadas por diferentes servicios de salud asistidos por ASSIST República Dominicana, culminando la sesión con un ejercicio durante el cual las mesas de trabajo elaboraron nuevas ideas de cambio para enfrentar algunas de las causas subyacentes relacionadas con el género que contribuyen a limitar los resultados del proyecto y que fueron previamente identificadas por sus colegas. [...]

   By Elga Salvador, Senior Gender Technical Advisor, WI-HER, LLC On April 10, the USAID-funded Applying Science to Strengthen and Improve Health Systems (ASSIST) Project held the second “Learning Session” with the Quality Improvement (QI) teams of the Prenatal Care Collaborative in the Dominican Republic. This Collaborative is implemented by health authorities and staff from hospitals located in different regions throughout the country. The event enabled QI teams to share experiences and best practices that produced concrete and improved results in ​​prenatal care, while strengthen the skills of QI teams in managing quality improvement methodology. Among the diverse set of speakers, the WI-HER Senior Gender Technical Advisor, Elga Salvador, presented WI-HER and ASSIST’s approach to gender integration in Zika response, implemented in the Dominican Republic in 2018 and 2019. The Dominican Republic was the first of the 13 countries in the Latin America and Caribbean region that focused on strengthening local partners’ capacity to identify and address gender issues. They utilized the result-oriented and science-based approach to improvement, iDARE, developed by the president of WI-HER, Taroub Faramand. At the beginning of 2018, WI-HER conducted an extensive literature review and, with support of the ASSIST team and local partners, an analysis of gender issues that influence quality improvement implementation in Zika response in the country. The team conducted field work in three of the areas with the highest rates of Zika infection: Santo Domingo, Santiago and Barahona. The findings of the gender analysis were integrated into a training for ASSIST technical staff, representatives of the National Health Service, and QI teams from the Prenatal Care Collaborative. The training focused on gender sensitization and strengthening capacities in gender responsiveness. Participants then replicated the training among their colleagues in their health facilities. Through this process, the QI teams have been able to identify gender gaps in their services and design interventions to address them. At the Learning Session, Elga Salvador shared key findings from the gender analysis along with best practices for gender integration implemented by different health services under ASSIST. Her presentation also included a hands-on exercise for session attendees where they worked in teams to design gender responsive programs to address some of the underlying gender gaps that impact health outcomes in Zika response, previously identified in health facilities in the Dominican Republic. For example, one key issue was resistance to condom use as a method for Zika prevention due to cultural barriers. One underlying factor contributing to this issue, is limited knowledge about sexual transmission of Zika, the consequences of Zika infection during pregnancy, and condoms as an essential method of prevention, specifically among men who are not usually targeted by informational campaigns in the health system. Participants also discussed effective actions to address gender gaps associated with gender-based violence which can contribute to sexually transmitted Zika, like limited male participation in prenatal care, the lack of gender sensitivity of health personnel and women’s limited power to negotiate condom use with their partners. Several participants in different health services have [...]

By: Tisa Barrios Wilson Sofía is 20 years old and lives in a rural town in Northern Peru. She was recently married to Mattias and soon after was thrilled to learn that she was pregnant with their first child. Her family and community celebrated the good news and looked forward to welcoming the child with much enthusiasm. But when the day of the birth came, Sofía and her family were devastated to learn that her child was born with with microcephaly, a condition where the head is much smaller than normal because the brain has only partially formed, which is a manifestation of Congenital Syndrome associated with Zika (CSaZ). Aside from the concern they feel about the health and development of her child; she and her family must also grapple with the costs that incurred by families caring for infants and children suffering with CSaZ. Screening and diagnostic tests might require MRIs, EEGs, and other expensive examinations.1 Depending on the severity of the CSaZ, her child might need a breathing apparatus, feeding tubes to swallow, and wheelchairs for mobility. Sofía and her family will have to travel long distances to regional hospitals to seek specialized health professionals and equipment for physical therapy, paying out-of-pocket for transportation, food, and other incidental costs.2 Her child may also suffer from other associated complications that require additional medical attention and expensive medicines including seizures, hearing and vision problems, and increased susceptibility to pneumonia and infections.1 One study estimates that each case of microcephaly incurs USD 91,102 in direct medical costs per lifetime in Latin America.3 This financial cost in inconceivable to most families, and does not consider the added costs resulting from the loss of income and productivity due to full-time care of a child with developmental delays. Psycho-social costs take a heavy toll on families with high rates of male partner abandonment and the social stigma associated with microcephaly.2 Luckily for Sofía and her family, Peru has been continuously working towards Universal Health Coverage (UHC) that will help address these devastating costs; but that is not the case for everyone. Today, at least half of the world’s population does not have coverage of essential health services and an estimated 100 million people fall below the poverty line because they are subjected to financially crippling, out-of-pocket payments for health services.4 To address this issue, many countries in Latin America and worldwide have been implementing programs to work towards UHC. The aim of UHC, rooted in a human rights and equity based framework, is that everyone should be able to access the quality health care they need without suffering financial hardship.5 This year’s theme for World Health Day (April 7th) was “Universal Health Coverage: Everyone, Everywhere,” highlighting and celebrating the progress made around the world toward UHC. The aim of UHC is to improve overall population health by increasing accessibility of health services while also protecting individuals and households from high, out-of-pocket health expenditures, usually accomplished by increased government spending on healthcare or through retooling [...]