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Unpacking Gender Equity Interventions

This project was born from the realisation that while we know what barriers women face in accessing eye care services, we also know that we have some assumptions about what might mitigate these barriers.
Published: 05.03.2020

At The Fred Hollows Foundation we take gender equity seriously. That is why we have a team of researchers, advocators and communicators dedicated to implementing gender programmes as part of our work.

“There are no ‘quick programmatic fixes’ to gender equity work. Identifying the problem doesn’t mean that the issue is resolved.”

– Anita Afford, Senior Gender Program Advisor, The Fred Hollows Foundation

Our Nepal team is implementing a trial to test what really works when it comes to Nepalese women in rural areas accessing eye care. This trial will be conducted over a one and a half year period in conjunction with our partners at the Tilganga Institute for Ophthalmology (TIO).

This project was born from the realisation that while we know what barriers women face in accessing eye care services, we also know that we have some assumptions about what might mitigate these barriers. This trial will help us get a definitive answer.

Why is a pragmatic trial to test gender intervention needed?

A pragmatic trial is a form of research that is designed in a practical way to suit the surroundings, and enables researchers to test out the effectiveness of interventions in real-life conditions. This also allows us to be continually translating and using evidence as it comes in.

How is the test being conducted?

There is already a comprehensive eye care project in place in two rural areas of Nepal, supported NGO Eye Hospitals, Geta Eye Hospital  and Shree Janaki Eye Hospital. Instead of just tacking “gender-sensitive” strategies into this existing project, we decided to test out some of these strategies in one facility, known as the “intervention site”, while keeping the other facility as a “control site”.

We further broke down the intervention site into another control/intervention site to further test one specific strategy, which involved offering transport to women in very remote and rugged areas so they could make the journey needed to receive cataract surgery.

What have we learned so far?

It is important to not just gain information about gaps and barriers, but to test potential solutions to these barriers  onsite and in real time. By setting up a pragmatic trial, we are able to test these assumptions in a more rigorous way than usual programme monitoring and evaluation would allow. We are able to set up tools and processes, and have a dedicated team of workers to collect and analyse specific data from the different intervention areas.

Our findings so far have shown that at each level of intervention, there is a range of gender-related barriers and facilitators that need to be explored.

Using a pragmatic trial design is beneficial because it gives us the space to unpack gender-related challenges as they arise. It allows us to address the assumption that the barriers faced by women trying to access eye health care has a simple solution. In order to work towards a gender transformative approach, it is important to recognise that equity barriers are systematic and linked to multiple factors. We need to address the structural issues causing the gender inequality to begin with.

An example of this approach is examining what are the various reasons why women access transport less than men in order to go and get cataract surgery done. Once the significance of these reasons is analysed, we should then develop solutions that challenge gender stereotypes, change behaviour and allow women to gain access safely and easily.

Why gender equity is not an ‘add-on’ to business as usual?

For any organisation doing work around gender equity, it must be acknowledged that it is not an ‘add-on’ to business as usual programming. We need to acknowledge that equity work is attempting to challenge structural and historical practices and policies that disadvantage women. Therefore, it requires appropriate human resources and a commitment to relationship-building on the ground as well as appropriate funding, and this needs to be accounted for.

At an organisational level, management and relevant teams need to be committed to the hard and detailed work that is required for sustainable change to occur, not just for beneficiaries’ access to eye health, but within the eye health workforce, and with partners.

“Gender equity requires that processes and outcomes improve health and work to change negative gender norms at the same time.”

– Anita Afford, Senior Gender Program Advisor, The Fred Hollows Foundation

What happens next with the trial?

As part of the outcomes, we want to see what happens when you analyse the small things – listening to what women say about the “why” and “how” – and take the time to dissect the results, and question our own assumptions. The final results of this pragmatic trial will be released within the next couple of months, and we look forward to sharing the results with you.

To read the full article visit the Fred Hollows Foundation website

Image on top: Two women after cataract surgery by Sunita Kunwar K.C. 


[vc_row_inner css=”.vc_custom_1502714171653{background-color: #e7ecf3 !important;}”][vc_column_inner width=”1/2″][vc_column_text el_class=”light-row cellspace”]The IAPB Global Assembly 2020 (GA2020) programme has several sessions on Gender Equity and Eye Health. If your work is around the topic, do submit an abstract–the sector needs to know!


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