Promoting women in leadership within eye health

Gender equity needs ongoing commitment from all areas of society, economy, and government, if we are to achieve true equality and create parity for girls and women. This International Women’s Day is a time to not only celebrate women’s resilience and achievements, but also to address the disparities women face.

The Fred Hollows Foundation is determined to make significant progress to address this inequity and embed gender equity and inclusion across all that we do. Our goal is to ensure all those who need eye care can receive it. To do this, we must ensure equitable access to care for women and girls and an equitable workplace where women have the same opportunities as their male counterparts.

Over the past two years, The Foundation has initiated the Gender Equitable Eye Health Training program with our local partner organisations in China, Ethiopia, Kenya and Nepal. Our teams in these countries performed a gender analysis in partner hospitals, and found that many eye health staff were unaware of gender inequalities, and how gender impacts a person’s ability to access timely eye care.

They also found that support and service work of local women’s groups didn’t include eye health as a focus area, and their staff and community workers were unaware of the link between gender and poor eye health.

Globally women account for 55% of the world’s blind – or about 20 million women.

“Diverse women’s participation in leadership within the eye health workforce needs to be addressed, stereotypes challenged, barriers identified and removed.”

- Anita Afford, Senior Equity and Inclusion Advisor, Fred Hollows Foundation

COVER PHOTO: The Fred Hollows Foundation, Kenya

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Click the links below to go directly to the part you’re most interested in:

Why is gender equity important?
What is the purpose of the gender equitable eye health training program?
How is the gender equitable eye health training program implemented?
What have we learnt so far from the gender equitable eye health training program?
What happens next with this gender equitable eye health training program?

Why is gender equity important?

The Fred Hollows Foundation believes that all those who need eye care can and should receive it. A key element of our strategy to end avoidable blindness is ensuring equitable access to care for women and girls and equal opportunities within the eye health workforce.

Globally, women face more difficulties when accessing health care. Social, cultural and economic barriers stand in the way of women obtaining the same quality of care as men. In eye health specifically, women are more likely to have a debilitating condition that could have been prevented through treatment.

Of the 1.1 billion people with vision loss, 55% are women and most live in low and middle-income countries (LMIC). Beyond this, women experience a higher rate of vision loss than men for many conditions across every stage of life. Overall, women are 12% more likely to have vision loss than men.

Vision impairment and blindness have far-reaching implications, not just for the women affected, but also for their families and communities. In industrialised countries this is largely because women live longer than men, but in LMIC, where cataract is responsible for most blindness, it is often because women do not get to access services with the same frequency as men.

In some parts of the world, if girls are blind or significantly vision impaired, it is almost impossible for them to access education.

Likewise, women are under-represented in leadership positions, yet they occupy 67% of the world's health workforce. This under-representation of women in decision-making positions means that policies, programs, decisions, and regulations are not taking into consideration the unique experiences and perspectives of half our global population.

Systemic and social barriers – such as unemployment, low socioeconomic status and unpaid care duties – have increased during the COVID pandemic, further impacting women’s ability to apply and fulfil leadership positions. The pandemic has also highlighted how women working on the frontline of this health emergency have been undervalued previously, and are overdue recognition for their contributions.

To address these challenges, a gender equity transformative approach has been adopted within The Fred Hollows Foundation’s eye health programs, in order to ensure equal access to services and opportunities for women within the eye health workforce.

Eye health makes an important contribution to the Sustainable Development Goals (SDGs). It is a simple and highly cost-effective means of unlocking human potential. Fundamental to the SDGs is equity and inclusion, and SDG Goal 5 calls on us to ‘achieve gender equality and empower all women and girls’.

Photo: Mark Maina, Ethiopia

What is the purpose of the gender equitable eye health training program?

The aim of the gender equitable eye health training program is to increase gender awareness within partner organisations in the countries where we operate. The purpose is to outline what role they can play in reducing the systemic and social disadvantages women encounter when seeking treatment.

The gender analysis conducted by The Foundation in multiple countries has highlighted that there is limited knowledge around gender equity within eye health workforces. Gender equity is a newer concept for many of the countries where we work, which means that there is a lot of work to be done to improve the eye health of women and girls.

The training emphasises the importance of women in leadership, and how women add value and perspective in these roles. In healthcare, women are often associated as frontline health workers, volunteer community health workers, and nurses. It is clear that women are the backbone of the health workforce, but often their work goes unrecognised.

We aim to shine a light on women healthcare workers and their impactful work, and help amplify their voices within healthcare. They know what the women in their communities need and what barriers they face, and their wealth of knowledge can improve the status of eye care for women globally.

The gender equitable eye health training program not only promotes equal opportunity for women who are accessing eye health services, but also for women within the eye health workforce, who can be invaluable when empowered to enter leadership positions.

Gender equity does not stop at beneficiaries of services, it must be extended into the framework of organisations to ensure systemic barriers for women are challenged and removed.

Photo: The Fred Hollows Foundation, China

How is the gender equitable eye health training program implemented?

The gender equitable eye health training activities were developed in late 2017 by The Foundation’s Gender Equity Learning Network (GELN). Our Gender Equity and Inclusion representatives in the countries where we work suggested a training program for local partner organisations to incorporate gender inclusive initiatives within their workforces.

The training materials were created through a co-design process, where all staff were able to incorporate their own experiences and perspectives. These materials were further tailored to suit each country’s unique context, culture, and key demographics. At the conclusion of each training session, participants were required to reflect on their learnings, and develop an action plan to instate gender equity within their workplaces and their work roles.

CHINA, GUANGXI

The Foundation’s China team conducted a gender analysis with their partners in Guangxi as part of the Guangxi Comprehensive Rural Eye Care project. In response to this analysis, the training materials were formulated and a pilot training session was held.

Feedback from the pilot showed that participants were still struggling to see the link between gender and the prevalence of eye conditions, which prompted the team to focus materials on discussing these concepts in future training.

The training was conducted with three groups:

Health personal and management staff from Hepu, Guangyang and Xingye county
Women’s Federation staff (at a primary and tertiary level)
School teachers from Hepu and Xingye counties

Each group received training appropriate for their prior knowledge on eye health and gender equity. The teachers’ training focused on eye health in the classroom, whereas the hospital staff and Women’s Federation staff delved deeper into gender equity. All training was participatory, something that is not common for training programs in China, meaning participants felt engaged, and this helped cement new concepts.

ETHIOPIA, OROMIA

Many participants in Ethiopia had never attended gender equity training. The training materials focused on explaining new terminology, expanding on gender equity concepts through interactive activities, and providing time for discussion among team members.

The training was conducted by The Foundation’s gender equity and inclusion champion from Ethiopia, who has great local cultural knowledge and adapted the training to suit each participant group.

The training was conducted with:

Goba Hospital staff
Jimma University Hospital staff
Ambo Hospital staff

KENYA, BARINGO

Training in Kenya not only focused on gender equity, but also disability inclusion. The training materials were formulated with the assistance of a disabled people’s organisation, Association of People with Disability of Kenya (APDK), which highlighted how stigma is harmful for those living with a disability, and how difficult it is for people with a disability to access health services.

Having the two themes of gender and disability shed light on the intersectionality between the two, and how vulnerable groups need to have services adapted to suit their unique needs.

The training was conducted with two groups:

Community based organisations (youth groups, men’s representatives and community opinion leaders)
County health management teams (eye care workers and other health workers)

Photo: Fanny Lee, China

What have we learned so far from the gender equitable eye health training program?

The training was well understood by participants, and appropriate for each country's context and demographic. Participants enjoyed the discussion and group activities the training provided, and valued the opportunity to hear the thoughts of peers from other sectors and social groups.

Suggestions were made to expand the training to include more staff, multi-sectoral partners, and community groups. Adopting a multi-sectoral approach to combating gender inequities was outlined by participants as a key solution.

Participants realised that everyone should play a role in creating a more gender and disability inclusive space.

“I had not paid too much attention to female eye health before, but I will promote the importance of female eye health after the training.”
- Hospital staff participant CHINA

Participants were able to reflect and reassess their own biases and prejudices around gender equity and disability inclusion. Many participants have made a conscious effort since the training to engage their peers, community members and families in discussing these social causes.

Some participants feel unsure about how to translate the new information to their communities. Continuous assistance and guidance will be provided from The Foundation in the form of refresher training, mentoring and Information, Education and Communication materials, so that participants can continue their work around gender and disability awareness.

“I am more inspired to look inward and challenge myself to tackle the deep-rooted gender-related biases in order to address gender and equity both in personal and workplace circumstances.”
- Hospital staff participant ETHIOPIA

The action plans written by the participants have included a lot of structural changes to hospitals, creating a more inclusive and non-threatening space for women. This includes:

separate queues for men and women
toilets for women only
waiting areas for women
prioritisation of vulnerable patients

Hospital staff have recognised that women and girls have different and unique needs, and this should be accommodated and respected during their consultation.

“Prioritising to address the problems related to gender, see different patients differently based on their need/problem.”
- Hospital staff participant ETHIOPIA

Many participants agreed that there is an under-representation of women in leadership positions within their workplace and communities. After the training, some female respondents felt more empowered to speak out in meetings, however, they still feel like they are unable to make big decisions.

Lack of gender awareness from other staff, including management, was a barrier that prevented a lot of action plan items from being achieved. Many participants felt it would be beneficial to extend the training to those in leadership positions.

“I became confident in myself, I feel I can do things just like my male colleagues, I started to participate actively in meetings.”
- Hospital staff participant ETHIOPIA

Photo: The Fred Hollows Foundation, Kenya

What happens next with this gender equitable eye health training program?

The COVID-19 pandemic has impacted the implementation and evaluation of the training program. There are delays due to barriers of access, lockdowns and competing priorities.

The Philippines will not be implementing the gender equitable eye health training program until an effective vaccination strategy is in place, which could occur in late 2021.

A gender analysis was also to be completed in Eritrea in 2020, however, the team was unable to proceed due to the pandemic restrictions.

Despite these difficulties, the programs and evaluations have been adapting to the changing environment.

Data was collected in four of the countries which implemented the program, and there are safe strategies in place to extend the training into other countries in the near future.

Nepal

The gender equitable eye health training was completed with participants from Tilganga Institute of Ophthalmology and Geta Eye Hospital in 2019-2020. An impact evaluation is in place, and qualitative data is being obtained through Key Informant Interview and Focus Group Discussions involving a selection of participants. Results from this evaluation will contribute to further gender equity interventions within the Nepal project that partners with TIO.

Laos

So far, 30 female district officers have completed an intensive three-day training program on primary eye care and gender equity in eye health. The activities are led by the Gender Development Association. These district officers will return to their communities and share their learnings with their peers, families and friends. This is part of a longer program, where more partners will undergo training during 2021.

China

The Foundation’s team in China will be integrating gender equity training for community health workers as a part of the Guangxi Project in 2021. Gender sensitive Information, Education and Communication materials are being redesigned and developed for partners to distribute to colleagues, patients, families and communities. Refresher training and discussion of gender equity initiatives will also be conducted to ensure partners are fulfilling their action plans and continually learning about gender equity.

Bangladesh

Training sessions will start in 2021 with local partner institutions. The training will be monitored through surveys and questionnaires from participants, and an impact evaluation will be completed at program completion.

Click here to read about the training in full

Interested in learning more about gender equity?

ABOUT THE AUTHOR

Tiffany Angelopoulos - The Fred Hollows Foundation

Tiffany Angelopoulos is a volunteer at The Fred Hollows Foundation. Tiffany assists the Senior Equity and Inclusion Advisor, the Gender Equity and Inclusion Champions, and Country Teams with data analysis and interpretation around gender equity and disability inclusion programs. Tiffany is a student at the University of Melbourne, where she is studying a Masters of Public Health. She has an interest in global health and implementation science, and is committed to continuing her work around global health development.

Tiffany collaborated with the following team members on this project:
Anita Afford (Senior Equity and Inclusion Advisor), Ming Ni (Project Manager China), Wang Jing/Helen (Senior Project Officer China), Sarah Olalo (Program Manager Kenya), Emebet Andarge (Program Manager Eritrea) and Anjila Dahal (Monitoring and Evaluation Coordinator Asia)

The Gender Equitable Eye Health Training materials and program activities in Kenya, Nepal and Ethiopia were funded through the Australian Government under the Australian NGO Cooperation Program (ANCP) and the Australian Embassy in China through the Direct Aid Program.