A review of gender-transformative approaches and promising practices in health, nutrition and HIV programming in Africa: from theory to practice – World


Author | Mary Picard

lay the foundation

The growing emphasis on gender transformative approaches (GTA) in UNICEF programming comes at a crucial time; In the wake of the COVID-19 pandemic, the multiplier effect of deep-seated gender inequalities has hit hard with a rise in gender-based violence (GBV), intimate partner violence and unpaid care work. Service disruptions and lockdowns limited women’s and girls’ access to services, resources and income. UNICEF country offices (COs) in the East and Southern Africa Region (ESAR) and West and Central Africa Region (WCAR) noted the devastating impact of school closures on adolescent girls and children and the rise in teenage pregnancy. Additionally, the intersection of gender with key populations, people with disabilities and other groups at risk of being “left behind” has increased inequalities for many groups as the pandemic has progressed.

UNICEF’s commitment to gender transformative programs is formalized in its recent Gender Action Plan 2022-25 (GAP). In recent years, UNICEF has created the conceptual and political foundations to advance this agenda. This study contributes to a broader set of efforts to take stock of where COs are on the gender inclusion continuum, how their understanding of gender transformative approaches is taking shape, and what lessons can be learned from it. The study focuses on health, including nutrition and HIV, within the relevant target areas of the GAP, which include interventions targeting adolescents and especially adolescent girls. Because of their target audience, interventions in these thematic areas face a significant risk of reinforcing gender stereotypes (e.g., women’s reproductive and caring roles). However, as the results indicate, the increasing awareness of this risk and the opportunities that come with prioritizing the second decade of life bode well for UNICEF’s intention to position women and girls in their primary role as rights holders.

A gender-transformative approach is concerned with eliminating gender inequalities, removing structural barriers such as unequal roles and rights, and empowering disadvantaged populations. In practice, this means advocating for changes in: laws and policies, systems and services; distribution of resources; norms, beliefs and stereotypes; and behavior and practices.
Background Paper Series: Gender Transformative Programming

The conceptual framework for evaluating gender transformative approaches

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The model in the PDF summarizes the combination of the interactive components of gender transformative programming:

  • The desired dimensions of change with the transformation of unequal power relations between the sexes are the focus
  • Strategies in action that contribute to the changes
  • The phases of the program cycle, showing the actions and results

This conceptual model served as the main tool for evaluating the program initiatives within the framework of this study.

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All elements of this model are derived from UNICEF’s basic understanding of the key elements of a gender-transformative approach and are corroborated by similar theoretical work on gender transformation. For a full explanation of the strategies employed, see UNICEF’s background papers on Gender Transformation.

The study: scope, objectives and methodology

The aim of the study is to promote learning around gender-transformative programming by identifying examples with empirical evidence that meet the dimensions of the model for evaluating gender-transformative approaches. It is hoped that the study’s findings will assist UNICEF in its broader goal of developing gender-transformative theories of change in health, diet and HIV programming, and expanding models that address gender barriers in both the short and long term.

The methodology for this study consisted of an intensive desk review using a model-based assessment criteria template, supplemented by interviews and follow-up questions with some UNICEF representatives in West and Central Africa (WCA) and East and Southern Africa (ESA). .

The review evaluated country initiatives/programs against the four dimensions of change of the Model for Assessing Gender Transformative Approaches and against the eight different implementation strategies that contribute to these dimensions – socio-environmental, multisectoral, engaged men and boys, positive masculinity, gender socialization, empowerment of Women, Intersectional/Inclusive and Life Cycle. The review also considered whether any type of gender barrier diagnosis had been performed and ranked the progress of program initiatives as early (still in the diagnosis or planning phase), emerging (Implementation phase with proof of measures and strategies) or demonstrate a certain level of results (output or outcome level). These characteristics combined were the basis for determining whether an initiative qualified as either gender transformative in its approach or promising practice. Four gender transformative initiatives were identified and selected for further scrutiny. These case studies – conducted for Côte d’Ivoire, Ghana, Tanzania and South Africa – included interviews with CO staff and for Côte d’Ivoire and Tanzania focus group discussions with beneficiaries. Readers are referred to the full report, Case Studies in Gender-Transformative Approaches: UNICEF Tanzania, Côte d’Ivoire, South Africa and Ghana.

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Promising practices are those initiatives that are moving in the right direction but do not yet meet all the necessary conditions to be gender transformative. Many are still in the early stages of development. These are displayed as sidebars under each subject area with illustrative actions and recommendations to improve gender transformation issues.

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