Advancements in gender statistics and health: experiences from the Western Pacific Region Anjana Bhushan, Technical Officer (Health in Development) WHO/WPRO 3 rd Global Forum on Gender Statistics Manila, October 2010 ESA/STAT/AC.219/34

Keys to accelerating the development and better use of gender statistics Strengthening vital events monitoring with causes of death, through existing civil registration systems, demographic surveillance sites, or hospital statistics Harmonizing health surveys through a country-led national plan with increased focus on gender, equity, and social determinants for health Improving the timeliness, completeness and quality of facility- and survey-generated disaggregated data Developing a multi-sector culture of disaggregated data collection for deriving gender statistics and use aligned with national M&E and HIS frameworks Ensuring skills and capacity available for presentation, interpretation, dissemination, and use of gender statistics with different target audiences

Example 1: Proposed maternal and U5 death surveillance system, Lao PDR Background Based on Cambodia experience 2005 Lao PDR census: about 2 maternal deaths; 36 under-five child deaths, including 26 infant deaths (71% of U5MR), every day Vital registration not functioning Routine reporting/surveillance system unreliable Provincial/district hospitals report deaths, but only about 13% births in health facilities (2005) Mobile phone network used by 60% of rural families Objectives (May 2010-March 2011) Provide timely information on maternal and child deaths, followed by death review Monitor MNCH trends and strengthen achievement of MDGs 4, 5 Inform MNCH programme planning, policy development and interventions' targeting

Proposed approaches (1)Case reports –By villagers, village health volunteers, health workers, witnesses –Report all maternal and child (under-5) deaths anywhere –Set up toll-free landline at central level for case reporting –Encourage reporting through: –government circular to all districts, health centers and village committees –mass media campaign –incentives to reporters (2) Case records –Call related health center to verify report, collect more information and enter into computer Epi-Info program –Health centers to keep copy of death confirmation sheet for regular reporting and death audit (3) Information utilization –Update summary of records weekly on national map, by written report, on MOH website –Set up maternal and child death information room in Ministry of Health –Analyze data and report monthly to MOH, provinces, districts –Conduct maternal and neonatal death review and report annually –Incorporate the surveillance system into HMIS

Case report by community or health facility to toll-free line Case confirmation with HC or health facility MCHC Team MOH Info Room Regular reports MOH – HMIS website

Example 2: Understanding gender-based violence in the Pacific Background WHO Multi-country Study on Women's Health and Domestic Violence Against Women 2005 –gathered comparable data from over women interviewed in 15 sites in 10 countries (including Japan, New Zealand, Samoa [Polynesia]) –found that VAW is widespread, with far-reaching health consequences, and demands a public health response –called on governments to take concerted action, recommended actions for health, education, criminal justice sectors Objectives –estimate the prevalence of violence against women, with particular emphasis on physical, sexual and emotional violence by male intimate partners; –assess the extent to which intimate partner violence is associated with a range of health outcomes; –identify factors that may either protect or put women at risk of partner violence –document and compare the strategies and services that women use to deal with violence by an intimate partner

Using the methodology in the Pacific Socio-Cultural Research on Gender-Based Violence and Child Abuse in Melanesia (Kiribati, 2008) and Micronesia (Solomon Islands, ) project (funded by UNFPA, AusAID; implemented by SPC) Kiribati: National representative study on intimate partner violence (Kiribati Family Health and Support Study), 2008 Findings: –68% of ever-partnered women reported experiencing at least one act of physical or sexual violence, or both, by an intimate partner; 73% of all women aged have experienced some form of physical or sexual violence, either by a partner or a non-partner –VAW has a devastating impact on women, their families and communities –Unequal power relations between men and women are the root cause Legal framework : no specific domestic violence/VAW and VAW not addressed appropriately in existing laws Services : Social Welfare Unit: day-to-day services, counseling; limited capacity; few NGOs active; limited reach and capacity; Catholic Womens Crisis Centre: shelter and care; underutilized due to social and cultural barriers faced by victims

Using the methodology in the Pacific Kiribati Government response: –Family Affairs and Sexual Offences Unit established in 2004 to manage cases of domestic violence, rape, abuse and other sexual offences –Study endorsed by government, launched by President –National Action Plan for elimination of VAW developed, policy being drafted Partners response: Support to multi-sectoral VAW action : AusAID/WHO Gender Health and Development Programme, (Solomon Islands) Planned Multi-year UN Joint Programme to EVAW, 2011 (Kiribati) Pacific UNiTE Campaign to End Violence Against Women Additional studies using WHO methodology: Vanuatu (nearing completion); Fiji: (commencing)

Findings: M/F ratio in TB cases increased from 1.6 to 2.1 Why? –Partly: biological/ epidemiological factors –Partly: gender- related barriers to access Trends in SM+ Viet Nam: ) Example 3: Gender in the national TB programme review, Viet Nam

Viet Nam NTP findings Women have longer delay before diagnosis, because: –they may consult less-qualified health care providers or self-medicate –they may face barriers to access: distance and mobility –they are less likely to present with typical symptoms Women may produce sputum of poorer quality and quantity, decreasing their chances of diagnosis

Example 4: Other promising developments in Viet Nam General Statistics Office and line ministries, with UNDPs support, are developing a M&E framework for the implementation of: –the Law on Gender Equality –the Law on Domestic Violence Control General Statistics Office, with WHOs support, is finalizing the first national study on violence against women National Strategy on Gender Equality ( ) and National Targeted Programme for Gender Equality ( ) are under development Joint Annual Health Review includes key indicators to assess health sector, including some on gender and health issues (e.g., sex ratio at birth, gender-based violence)

Example 5: Womens health in the Western Pacific Region Women's Health: Western Pacific Region, –Contains country profiles –Reviews progress and lessons learned in implementing Beijing Declaration and Platform for Action (1995) –Identifies constraints, priority areas, and areas of collaboration among partners Women and Health: Todays Evidence, Tomorrows Agenda, –provides evidence on women's health needs and challenges over the life- course –includes latest figures on health and leading causes of death in women. Agenda item on Womens health, Western Pacific Regional Committee Meeting, Oct Key messages: –Women face distinct health needs through the lifecycle –There are multiple determinants of womens health –Health systems are failing women –The unfinished agenda canand shouldbe addressed, through multisectoral action, health systems strengthening, and partnerships Women and Health in the Western Pacific Region, planned 2011: new regional report on women and health

Priorities for improving national HIS in the Western Pacific Region Advancing countries along HIS continuum Improving data collection, analysis, quality, and use Providing better training, tools, and techniques Improving interoperability of databases and systems

Thank you