The USAID Applying Science to Strengthen and Improve Systems Project (ASSIST) has been working globally since 2012 to improve the quality and outcomes of health care and other services by enabling host country providers and managers to apply the science of improvement. ASSIST seeks to build the capacity of host country service delivery organizations in USAID-assisted countries to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the health and family services they provide.
As part of USAID’s emergency response to Zika, ASSIST has been implementing health systems strengthening efforts in Latin America and the Caribbean since 2016. ASSIST is working to improve the capacity of Zika-related health services to deliver consistent, evidence-based, respectful, high-quality care with a focus on pregnant women, newborns, and women of reproductive age.
ASSIST achieves this by supporting Ministries of Health and Social Security Institutions in the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Paraguay, Peru, Ecuador and Jamaica to:
- Increase knowledge of Zika risks and prevention measures among health care providers and clients, such as the use of condoms in preventing sexual transmission of Zika during pregnancy;
- Improve clinical screening for signs and symptoms of potential Zika infections during pregnancy and implementation of recommended care;
- Improve clinical screening for microcephaly and other manifestations of congenital syndrome associated with the Zika virus in newborns and increase the number and proportion of affected infants receiving recommended care; and
- Strengthen the provision of quality psycho-emotional support services for women and families affected by Zika.
WI-HER, LLC, a women-owned small business and international development consulting firm, provides technical leadership on integrating gender into the Zika emergency response under the ASSIST Project. To integrate gender, WI-HER developed an innovative, results-oriented approach that draws heavily from the science of quality improvement, called iDARE, which is an acronym for Identify, Design, Apply/Assess, Record, Expand. The Identify and Design steps ensure that a contextually appropriate intervention is implemented.
These steps have a gender perspective that takes into consideration the different needs and behaviors of women, men, girls and boys. The final three steps ensure that this approach is constantly examined, evaluated and adjusted in order to ensure continued effectiveness and improved development and humanitarian outcomes. The iDARE approach has been proven effective at multiple levels and across 35 countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East.
WI-HER applied the iDARE Approach to address gender integration in Zika emergency response in the Dominican Republic by conducting a rapid gender assessment followed by a series of gender integration trainings for local ASSIST staff, members of the Quality Improvement teams, and training of trainers sessions for Ministry of Health (MoH) and National Health Service (NHS) staff in April 2018.
These trainings sensitized participants on gender issues affecting women and men, boys and girls, and the difference between gender and sex; enhanced understanding about gender-based violence, its relevance within the response to Zika and to the quality improvement in the health sector; enhanced understanding about gender integration in Zika emergency response programs, and how to utilize the iDARE Approach to develop ideas and activities to address gender issues and gaps affecting outcomes in the Zika program.
During the gender assessment, many gender issues came to light that affect the quality and the outcomes of health services meant to prevent Zika transmission in antenatal care, postnatal care and family planning. Some of these issues included: female limited decision-making power on their sexual and reproductive health; resistance to use condoms by couples who are in a long-term relationship, above all resistance to using condoms during pregnancy; low participation of males in antenatal care counseling; and biased attitudes of sexual and reproductive health service providers.
Through the training, WI-HER team was able to transfer gender integration knowledge in an effective, efficient and sustainable manner leading local ASSIST staff and the national health system of the Dominican Republic to become more responsive to gender issues in their Zika program.
The capacity building training in the Dominican Republic strengthened the ability of the ASSIST, MOH and National Health Service staff in gender integration, gender-based violence prevention and response and in addressing gender issues in emergency response situations. Trained local health facilities in turn shared this knowledge with their local staff, contributing to an institutionalization of gender integration process and methodology. WI-HER will continue to provide technical support in gender integration in Zika emergency response programs in all countries where ASSIST is providing technical support to achieve improved health outcomes and strengthened system with a focus on emergency response.
In 2008, Dr. Taroub Faramand founded WI-HER with the goal of addressing systemic health issues in an integrated, holistic way. The company, based in the Washington, DC area, works to identify and implement creative solutions to social challenges, to help communities achieve sustained development, and to improve the health outcomes and the lives of women, men, boys, and girls around the world. WI-HER projects are far-reaching, ranging from global health initiatives to education programming to the energy sector. WI-HER’s unique approach comes from a commitment to theoretical gender equity as well as from a promise of improved results through gender integration and sensitivity.