Ethiopia’s Ministry of Health: Walking the Talk on Gender Issues

By Belkis Giorgis, PhD, Senior Technical Advisor for Gender, LMG Project

Three women in Ethiopia.Photo: Seble Daniel

“The Gender Directorate’s mandate is to ensure that gender is mainstreamed throughout the ministry of health in Ethiopia. This is a very difficult and important mandate. Building our capacity is the first step to fulfill this responsibility. We must plan, design, advocate, implement and monitor interventions to mainstream gender, and this requires leadership, knowledge, awareness, and skills.

The Leadership, Management & Governance (LMG) Project has contributed significantly to helping us fulfill this mandate by building our capacity in various ways. One of the reasons for the success we have had working with LMG is that they were able to align the technical assistance they provided with our needs and priorities. We have shared our priorities before the program started, and we are happy to report that so far, we are on target with our collaboration.”

- Mrs. Yamerot Andualem, Director of Gender Directorate,

Federal Ministry of Health of Ethiopia

 

When There Is Political Will, Things Can Change

Efforts to institutionalize gender into the workings of a health ministry are often relegated to a few individuals who don’t have the political support or resources to bring about tangible changes. However, when there is strong political will, it is possible for a ministry to take on the task of addressing visible organizational and programmatic gaps that have a pronounced impact on women and girls.

Ethiopia’s National Policy on Women (“Women’s Policy”), formulated in 1993, seeks to mainstream a gender perspective into national institutions by establishing equitable and gender-sensitive public policies, and ensuring that men and women participate on equal terms (See also box on gender mainstreaming as defined by ECOSOC  below). The Ethiopian Federal Ministry of Health (FMOH) formulated a Gender Directorate in 2008 as a way to align policy with practice within the ministry.

However as a relatively new directorate, the Gender Directorate faces many challenges in mainstreaming gender within the larger ministry. Some of these challenges include minimal staffing as well as a lack of tools, methodologies, and plans to effectively advocate for the integration of gender into all of the FMOH departments. To overcome these challenges, the Gender Directorate asked the LMG Project to provide technical assistance to build the capacity of the directorate, and to help close these gaps.

Building Capacity within the Gender Directorate

The Gender Directorate was facing a major challenge because of its limited capacity to institutionalize gender within the framework of the Ministry. Technical capacity and know-how was required to identify and use existing programmatic areas to increase equal participation, benefits, and outcomes for men and women by focusing on the needs of both sexes.

To move this work forward, LMG Project staff worked in collaboration with staff of the Gender Directorate and other stakeholders to chart a course to institutionalize gender into the all Ministry activities through two main activities, the development of a strategic plan, and the preparation of a National Gender Training Manual that offers practical “How-to” guidance on mainstreaming, which assesses the implications of all policies and practices for both men and women, and fully integrates gender concerns into all levels of decision-making within the Ethiopian health system so that men and women benefit equally.

The First Step: A Strategic Plan

To guide the process of mainstreaming gender at all levels of the health system, LMG worked with the Gender Directorate and various stakeholders to prepare a strategic plan. The strategic plan, prepared through extensive engagement with scores of stakeholders and partners, helps guide meaningful progress to secure gender equality and gender mainstreaming throughout all levels of the Federal Ministry of Health, including regional and sub-regional health offices, and at local health facilities.

To help ensure successful implementation, the plan has allocated accountability among staff; begun the process of identifying partners who can help in the implementation; and identified practical indicators and measurements that will facilitate the careful monitoring of the collective progress to plan by all other directorates. The results of this training will be measured to determine if there are any qualitative changes in how the health workforce is addressing gender in its work. The following quantitative indicators will also be used to measure impact:

  • Number of regions, federal hospitals and agencies securing funding for gender-related activities
  • Amount of resources allocated for gender structures at all levels of the health sector
  • Existence of gender criteria in supervision checklist
  • Proportion of health sectors performing sex-disaggregated data analysis

The Gender Manual: A How-to for Health Leaders and Managers

The National Gender Training Manual for the health workforce builds on various tools and methodologies adapted from the World Health Organization and other entities that mainstream gender into overall programs in the health sector. The manual was written in a way that considers the sensitivities and challenges posed by gender training in Ethiopia, and recognize that addressing gender is challenging and requires support at all levels. Since Ethiopia has a decentralized health system, training sessions using the new gender manual will benefit those in the health workforce at the federal, regional, and woreda (district) levels. To ensure that the gender training is not abstract and complicated, the manual utilizes real-life examples based upon the experiences of Ethiopian health practitioners and clients to promote greater understanding on the part of both men and women.

The Gender Directorate prepared a draft of the manual and held a consultative workshop with ministry leaders, in which their feedback was incorporated into the draft. The manual was pre-tested with gender focal points, gender program officers and representatives of FMOH agencies and hospitals, and further changes were made. Finally, the Human Resources Development and Administration Directorate (HRDA) of the Federal Ministry of Health provided additional feedback, after which the Gender Directorate worked in collaboration with the LMG Project to conduct a first round of training of trainers at the federal level.

The gender training sessions are designed to help the Ethiopian workforce at the federal regional and woreda levels to:

  • Apply the concept of gender in understanding the overall situation of women in Ethiopia
  • Appreciate gender as a critical factor in the health sector
  • Address misconceptions related to gender issues
  • Gain an understanding of where there are gender issues at various levels and design synergistic interventions to address them
  • Understand fundamental principles and the different tools which facilitate and accelerate the process of gender mainstreaming

With regard to next steps, the LMG Project will provide technical support to the Gender Directorate to: 1) translate the manual into Amharic; 2) cascade the training manual to regional health bureaus; 3) monitor the number of trainings conducted in the regions using the manual and the impact of the training on their work; and 4) monitor implementation of work plans developed through the trainings over the next six months. We will keep our readership abreast of the rollout of the health manual as well as the outcomes of the evaluation.

Related Links:

LMG Conducts Survey on Mentoring of Women Health Leaders on LeaderNet

Creating Conditions to Allow Women to Move into Health Leadership

An Open Mind and a Hard Back: Conversations with African Women Leaders

The Gender in Health Governance Tool—A Simple Test