Background and Resources for Module 4
Session Objectives:
- Analyze the organization and administration of sexual and reproductive health programs.
- Identify institutional strategies that facilitate more effective responses to the identities, needs, rights and possibilities of different users.
Specific Objectives:
- Develop capacity for critical analysis of sexual and reproductive health policies, institutional structures and management practices.
- Learn criteria for evaluating health services from a gender perspective.
- Identify feasible and possible changes that we can make on personal, interpersonal and institutional levels.
Key Concepts:
- Institutional administration and management for equity and quality
- Criteria for institutional assessments of gender-sensitive quality
Activities:
- Criteria for evaluating gender sensitivity and quality care
- Assess and improve institutions in which we participate
- Reflect on institutional strengths and weaknesses
- Multiple changes towards better care
- Evaluation of the learning experience
Time:
4 hours
Activity 1: Criteria for Evaluating Gender Sensitivity and Quality Care
Objectives:
- Become familiar with IPPF criteria for gender-sensitive quality care in sexual and reproductive health, and understand how these criteria are applied.
- Identify factors in institutional organization and function that promote or impede quality care.
Procedures:
- Introduce the background and basic concepts of the IPPF evaluation criteria (included in session resources). If possible, circulate copies of IPPF literature concerning gender-sensitive quality care.
- Present the list of quality criteria, written on poster paper. Distribute photocopies of the list to each individual.
- Ask each participant to read one criterion aloud.
- Discuss and comment on the IPPF proposal for institutional assessment.
Time:
30 minutes
Materials:
- IPPF'S proposal for institutional evaluation
- List of IPPF criteria on poster paper
- Photocopies of IPPF criteria
- Copies of IPPF publications concerning gender-sensitive quality care
Activity 2: Assess and Improve Institutions in Which We Participate
Objective:
Apply gender-sensitive quality criteria in a simulated institutional assessment.
Procedures:
- Participants divide in groups; preferably, each group will gather participants who work in or know one particular institution.
- Each group identifies one health project or institution to assess. It is not necessary for participants to have exact knowledge of all aspects of the institution, as they will simulate an assessment based on the familiarity that they have, and on approximations concerning information they lack.
- Each group uses the IPPF evaluation criteria as a basis for assessing the chosen institution. In many cases participants will have to invent details; they should feel free to imagine missing data in order to construct a complete institution for the simulated assessment.
- Once the criteria have been applied, the group carries out the most important stage of the assessment, which is to interpret the results, identify the strengths and weakness of the institution and make recommendations for improvement.
- Participants join together so that each group can present the most interesting and important aspects of its assessment and conclusions.
Activity guide:
The desired result of this activity is NOT to produce an authentic evaluation of a real institution; it is to provide skills and experiences that will prepare participants to participate in such an evaluation in the future. We choose to focus on projects and institutions with which we are familiar because it facilitates a more meaningful learning process. It is not necessary that each group stick to exact and verifiable details; what is important is that participants learn to identify and evaluate pertinent criteria and - most importantly - to reflect on, discuss and interpret the profile which emerges from the evaluation and to make recommendations based on this interpretation.
Time:
1 hour, 30 minutes
Materials:
- Photocopy of sheet explaining the IPPF proposal
- Photocopy of list of IPPF criteria
- Poster paper
- Markers
Expected results for participants:
- Get to know criteria for evaluating gender sensitivity and quality care, as proposed by IPPF.
- Gain experience through simulated assessment of a health care project or institution.
- Develop capacity for critical analysis of aspects of the institutions and programs in which we work.
Activity 3: Reflect on Institutional Strengths and Weaknesses
Objective:
Identify and reflect on opportunities and strengths for improving gender-sensitive quality care in specific sexual and reproductive health projects and institutions, as well as weaknesses and threats to be overcome.
Procedures:
- Form the same groups that worked together in the preceding activity.
- Distribute copies of the sheet explaining SWOT, which is a method for analyzing the strengths, weaknesses, opportunities and threats in an institution and its context.
- Ask each group to carry out the SWOT analysis on the basis of the institutional profile developed during the prior assessment. Seek strengths and opportunities that will enable the institution to develop respect for gender differences and identities and to develop a comprehensive and compassionate approach to sexual and reproductive health care.
- Join together so that each group can comment on the process and share the most interesting things that they learned in the application of SWOT.
Time:
1 hour
Materials:
- Sheet describing the SWOT method
- Poster paper
- Markers
Activity 4: Multiple Changes toward Better Care
Objectives:
- Reflect upon across-the-board changes that are necessary and/or possible in health services.
- Apply ideas generated in sessions on gender, sexual and reproductive health, rights, and quality care to the problem of incomplete abortions in Bolivia.
Procedures:
- Watch the video El aborto: Un problema de salud pública, produced by Ipas and the Bolivian Ministry of Health.
- Form groups to discuss the video, oriented by questions in the discussion guide.
- Bring the entire group together to continue the discussion.
Discussion guide:
- How do the gender identities and relations predominant in Bolivia influence the situation of the user in this video?
- Considering this reality, what gender considerations need to be taken in the response to and treatment for this case?
- What role do men play in this situation (sexual partner, father, persons who help women get medical help or accompanies them to the clinic, provider)?
- What special attention does a woman need to recover from this type of experience?
- What does the idea of comprehensive sexual and reproductive health care have to do with this case?
- What is the policy of the institution depicted in the video concerning sexual and reproductive rights of men and women?
- What rights do women have when they suffer an incomplete, illegal abortion?
- How can we characterize the human relationships within the institution depicted in the video? Among personnel in that institution?
- Do these relationships have anything to do with the kind of care that is provided to the woman suffering an incomplete abortion?
- What changes can be made by all kinds of actors within the health care center in order to provide more compassionate quality care for women who arrive needing help for incomplete abortions?
Activity Guide:
The video fosters a critical analysis of institutional policies and providers' attitudes and practices. Training in earlier sessions about gender analysis and sexual and reproductive rights allows participants to address the problem of incomplete abortions in a new light.
Time:
45 minutes
Materials:
- Video
- Discussion guide
Discussion:
Women who have decided to interrupt a pregnancy and end up with an unsafe and incomplete abortion have suffered trying experiences. Even though providers may not approve of the woman's decision or action, it is their duty to provide her with quality care and treat her with compassion. Each woman has her own unique story, identity and situation, but they all deserve quality care.
Quality in human relationships, technical skills and institutional administration are interdependent. To better address any health issue, such as incomplete abortion, we need to work on all levels in an integrated manner.
Activity 5: Evaluation of the Learning Experience
Objectives:
- Evaluate the development of knowledge and understanding among participants.
- Appreciate the diversity of understandings and approaches generated on the basis of individual experiences and education.
- Verify the level of motivation that has been generated to initiate the process of personal, professional and institutional change.
- Identify advances in participants' analytical capacity and ability to develop strategies for applying gender-sensitive quality care.
Procedures:
- Each participant, including facilitators, fills out an evaluation form without identifying themselves. Place evaluations in a box.
- As a group, discuss the seven questions on the evaluation form, and any other questions or issues that arise. Facilitators may read and share some of the written evaluations as part of the discussion.
Time:
15 minutes
Materials:
Photocopies of evaluation sheets
Background and Resources for Module 4
IPPF's Proposal for Institutional Evaluation
IPPF developed a guide to assess the relationship between a focus on gender and improvements in quality care and management within institutions that provide sexual and reproductive health services (Cardich et al. 1998).
Recognizing the need to bring together work carried out on gender-focused quality care, IPPF organized a conference on the theme in Lima in 1995, which brought together professionals with a great deal of experience in reproductive health, women's health, human rights and gender. The objective of the conference was to develop a set of criteria for gender-sensitive quality care. On the basis of existing studies and documents, and together with the experience of those participating, the group came up with a long list of criteria. They also worked on ways to carry out institutional analysis based on these criteria and formulate recommendations and corrective measures to help institutions improve their quality and gender focus.
Proposal for evaluation and improvement
Quality care and gender sensitivity require changes in focus and in attitude within the institution, which naturally requires political and personal commitment, dedication and time. The evaluation proposal is designed as an instrument to support and accompany this process.
The proposal includes evaluation criteria, methodological orientation, a review of existing practices and materials and the formulation of recommendations within an integrated plan that requires the participation of diverse actors within the institution and an external consultant specialized in the field.
Criteria Listed in the IPPF Proposal for Evaluating Gender Sensitivity and Quality Care
- The existence of policies that prohibit sex discrimination in hiring, salaries, benefits and promotions.
- The existence of policies that prohibit abuse of power and sexual harassment within the institution.
- The existence of policies and procedures that promote the development of all staff, independent of sex.
- Percent of users who find the service hours convenient.
- Mechanisms that do away with the requirement of spousal consent before a woman can be treated.
- Presence of a declaration that promotes the empowerment of women within the mission statement of the institution.
- Mechanisms through which users' opinions can be known, including evaluation sheets and studies to evaluate user satisfaction.
- Mechanisms to promote programmatic changes in response to users' requests, complaints and suggestions.
- Percent of administrative positions held by women.
- Percent of users who were addressed with respectful titles and not called by diminutive or pejorative names (little mother, dear, my child, my queen, etc.).
- Percent of users who note that providers greeted them.
- Percent of users who note that providers looked them in the eye during conversation.
- Presence of educational activities in the waiting room (educational talks, videos, group discussions led by personnel).
- Existence of sufficient number of chairs in waiting room.
- Percent of user visits in which the provider discussed reproductive health issues, such as prevention of STDs and AIDS, breast and cervical cancer or unwanted pregnancy.
- Percent of user visits in which the provider discussed sexual heath issues, such as satisfaction with sex life, presence of sexual abuse or mistreatment, risks and ways of contracting STDs and AIDS, feelings of guilt or low self worth in sexual relations, partner's attitudes about fertility control, advantages and drawbacks of different methods.
- Use of educational materials in provider explanations.
- Percent of staff who feels that the workplace is equitable.
- Percent of providers who report that they provide advice and information to users who ask about abortion.
- Provision of Pap tests, breast exams, analysis of vaginal secretion and STD tests.
- Percent of personnel that promote the practice of double protection, regular Pap tests and self breast exams.
SWOT Analysis
SWOT is a tool for conceptual analysis that permits us to explore and address the underlying structural causes that generate institutional situations. It also enables an analysis of the dynamics between what goes on within and outside of an institution or program in question. In order to carry out this analysis, we need to examine the dynamics inside the institution, as well as external factors that condition institutional change. The analysis is carried out through group discussion and characterization of each of the following four elements, followed by group interpretation and analysis of the dynamic relationships across the four elements (Wolff et al. 1991).
What does SWOT mean?
S: Strengths. What strengths exist within the institution? What positive aspects, abilities, qualities make the institution in question stand out? These may include: unity and solidarity; human, technological or financial resources; good organization; threshold ideas; infrastructure or equipment, etc.
W: Weaknesses. What weak points exist within the institution and how can they be addressed? These may include: lack of knowledge; inadequate infrastructure or resources; hierarchical and non-democratic organization; etc.
O: Opportunities. What positive situations outside the institution support its growth and help it achieve its goals? These may include: financial support; changing values and paradigms in the social context; favorable political or historical situations; innovative methods and ideas; etc.
T: Threats. What external situations threaten to impede the progress of the institution? These may include: politicization of certain aspects of the work; economic or political instability; conservative social pressure against change; conflicts concerning resources; etc.
Discussion Guide
Video on Postabortion Care
- How do the gender identities and relationships predominant in Bolivia influence the situation of the user in this video?
- Considering this reality, what gender considerations need to be taken in the response and treatment of this case?
- What role do men play in this situation (sexual partner, father, persons who help women get medical help or accompanies them to the clinic, provider)?
- What special attention does a woman need to recover from this type of experience?
- What does the idea of comprehensive sexual and reproductive health care have to do with this case?
- What is the policy of the institution depicted in the video concerning sexual and reproductive rights of men and women?
- What rights do women have when they suffer an incomplete, illegal abortion?
- How can we characterize the human relationships within the institution depicted in the video? Among personnel in that institution?
- Do these relationships have anything to do with the kind of care that is provided to the woman suffering an incomplete abortion?
- What changes can be made by all kinds of actors within the health care center in order to provide more compassionate quality care for women who arrive needing help for incomplete abortions?
Evaluation Form
Date & Place of workshop
- Describe an idea that developed during the training that affected you personally.
- Comment on a concept or proposal that caused confusion, raised doubts, or that you rejected for whatever reasons.
- What topics and methods explored in the sessions are related in some way to your own work?
- What topics or methods have nothing to do with your work, or were irrelevant to you?
- In which topic or method were you most interested? Why?
- Did the workshop satisfy your expectations for learning? Why or why not?
- What suggestions do you have to improve the workshop?
