HOME > BLOG 28 FEB 2020 By Cathy Malla, The Fred Hollows Foundation
International Women’s Day is celebrated on 8 March every year. It’s a day when individuals, organisations, governments, and businesses all around the world recognise the contribution women make in every facet of society. It is also a day when we acknowledge the disparities women face in every aspect of life, and the subsequent need to take action in order to achieve gender equity for all. 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 programs as part of our sight-restoring 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, Fred Hollows Foundation
Identifying problems is half the battle. Finding long term solutions, and ensuring proper practices are in place is the other half. One of the projects we are currently testing is a gender equity trial in Nepal. The Fred Hollows Foundation’s 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 and using eye care services, we also know that we have some assumptions about what might mitigate these barriers. But we don’t know for sure which gender interventions work in giving women better access to eye health services. And this trial will help us get a definitive answer. *COVER PHOTO: Michael Amendolia (2019)
We’ll be looking at the following areas in this article:
With the support of The Foundation’s Research team and Gender Advisor, we designed a pragmatic trial. 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 way of doing research also allows us to be continually translating and using evidence as it comes in. A pragmatic trial would allow us to get a deeper understanding of why certain strategies may or may not be successful because tackling gender inequality requires a thorough understanding of everyday factors that are unique to the local area where the intervention is taking place, at the time it is taking place
There was 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. We chose the strategies based on formative research that had been done earlier: Intervention Site 1
Intervention Site 2
Control Site
It is important to not just gain information about gaps and barriers, but to test potential solutions to these barriers and facilitators 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 program 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. This process allows a deeper conversation about ‘doing gender work’ within The Foundation, and more broadly within the sector. 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.
“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, Fred Hollows Foundation
Cathy Malla - The Fred Hollows Foundation Cathy Malla is the Knowledge Management Advisor at The Fred Hollows Foundation. Cathy supports staff with accessing and using evidence to inform effective programming and advocacy strategies. She ensures that correct mechanisms are in place to allow the right knowledge to be available at the right time to the right people. Prior to this role, Cathy spent three years working in The Foundation’s South Asia Middle East team based in Nepal, and feels a special connection with the country and its people. Cathy collaborated with the following team members on the research paper about this particular trial in Nepal: Yadira Perez Hazel (Research Advisor), Anita Afford (Senior Gender Program Advisor), Tessa Hillgrove (past Research Advisor) and Anjila Dahal (Program Coordinator, Nepal) The following experts from Tilganga Institute of Ophthalmology, Nepal also contributed: Dr Reeta Gurung, Sarita Shah, Dr Mohan Krishna Shrestha and Dr Anu Manandhar
The Improving Gender Equity in Eye Health in Nepal project was fully funded by the Australian DFAT under the Australian NGO Cooperation Program (ANCP).
People often say health conditions don’t discriminate. But that’s not true of blindness. Blindness is a gender issue. An estimated 32 million people in the world are blind and two thirds are women. See more of the work we do around the world on our YouTube channel.
