This report from the Kaiser Family Foundation (KFF) assesses how countries are responding to a United States (US) Global Health Initiative (GHI) principle that addresses women, girls, and gender equality. The report examines country strategies for 7 of the 8 GHI Plus nations: Bangladesh, Ethiopia, Guatemala, Kenya, Mali, Malawi, and Nepal. (The eighth, Rwanda, has not yet completed its strategy.) In short, all 7 strategies addressed the health of women and girls as a top priority, and several went further, with efforts such as including women and girls as decision-makers and planners in health care programmes.

As outlined here, the key elements of implementation for the women, girls, and gender equality principle are communication-centred, and include:

1. Ensure equitable access to essential health services at facility and community levels.
2. Increase meaningful participation of women and girls in planning, design, implementation, monitoring, and evaluation of health programmes.
3. Monitor, prevent, and respond to gender-based violence.
4. Empower adolescent and pre-adolescent girls by fostering and strengthening their social networks, educational opportunities, and economic assets.
5. Engage men and boys as clients, supportive partners, and role models for gender equality.
6. Promote policies and laws that will improve gender equality, and health status, and/or increase access to health and social services.
7. Address social, economic, legal, and cultural determinants of health through a multisectoral approach.
8. Utilise multiple community-based programmatic approaches, such as behaviour change communication (BCC), community mobilisation, advocacy, and engagement of community leaders/role models to improve health for women and girls.
9. Build the capacity of individuals, with a deliberate emphasis on women, as health care providers, caregivers, and decision-makers throughout the health systems, from the community to national level.
10. Strengthen the capacity of institutions - which set policies, guidelines, norms, and standards that impact access to, and quality of, health-related outreach and services - to improve health outcomes for women and girls and promote gender equality.

The research found that: "Some of the country strategies went beyond viewing women and girls only as beneficiaries of health services, focusing on them as actors and decision-makers and/or on changing gender norms. These strategies addressed the broader gender issues that impact women's and girls' health....For example, in Ethiopia, the GHI will work to promote women's active participation and leadership in the health arena; in Nepal, the GHI will support the Ministry of Health and Planning in executing its Gender Equity and Social Inclusion Strategy, which is viewed as critical to creating greater equity in the country; and in Mali, the GHI will work with women's groups to help strengthen literacy and economic opportunities for women and girls. A few of the country strategies also included plans to work with country leaders to promote policies and programs that focus on women and girls. In Bangladesh, Guatemala, and Kenya, for example, GHI teams plan to work with parliamentarians and other policy leaders to increase attention to and resources for family planning and population policy..." (Please see the "Findings" section of the document and all of the appendices for detailed findings on all of the elements of GHI's women, girls, and gender equality principle.)

"Going forward, the real test will involve how these strategies are implemented at the country level..."

KFF website, September 16 2011.