Got vaccines? Got life!

Gender equity: Gavi’s approach

Got vaccines? Got life!

The Vaccine Alliance works to promote gender equality both internally and externally, with efforts encompassing the programmatic, corporate, governance, policy and advocacy spheres.

Gavi’s gender policy was first launched in 2008 and revised in 2013. It aims to increase immunisation coverage by supporting countries to overcome gender-related barriers to accessing immunisation services and to promote equal access and utilisation for all girls and boys, women and men to immunisation and related health services that respond to their different health needs. The policy also promotes gender-sensitive approaches within the Alliance, covering areas such as governance structures, the Secretariat and collaboration with partners.

The gender policy is embedded in Gavi’s wider commitment to ensuring equity in all areas of engagement. The policy will be reviewed and updated in 2019, following an external evaluation of key lessons learnt and challenges faced.

Programmatic approaches

Gavi works in developing countries to ensure that immunisation is equally available to everyone. An important part of the Alliance’s support is assisting countries to identify and overcome social, political, economic and cultural barriers to immunisation, particularly for women and girls. Recent data from India, Pakistan and Nigeria, for example, suggests that as many as two thirds of underimmunised children are not reached because of low demand for vaccines, with gender emerging as a key underlying factor.

Health system strengthening (HSS) grants and targeted country assistance (TCA) are the primary mechanisms for Gavi to help countries address gender-related barriers.

In the current reporting period, the Alliance has intensified efforts to make gender equity a more integral part of its processes. This has included updating guidelines for HSS and new vaccine support to better explain common gender-related barriers as well as give examples of interventions and indicators to tackle them. A specific gender programming guidance document has also been developed to further assist countries in understanding and responding to gender-related barriers. In addition, gender was highlighted as a key equity barrier in Gavi’s new demand generation and data guidance documents.

HSS proposals

All six HSS proposals recommended for approval in the 2017–2018 period showed a greater understanding of gender-related barriers than seen in previous years. Each country directly identified gendered barriers among the reasons for low immunisation equity. The most frequently mentioned demand-side gender barrier was low health awareness among mothers. In Haiti, for example, female caregivers often lack specific knowledge about the vaccination schedule and the diseases against which their children need to be vaccinated. In India and Solomon Islands, rural women are most disadvantaged due to limited access to television, radio and mobile phones.

Interventions to tackle gender barriers were identified by all of the six countries; these include social mobilisation campaigns with local representatives and use of community mobilisers to increase the uptake of and demand for immunisation. For example, the Cité Soleil project in Haiti is extending vaccination hours and implementing weekend vaccination sessions. This will help to overcome the “social distance” between healthcare providers and parents, who are often too busy with their daily work to attend immunisation hours.

Collaboration with partners

The Alliance incorporates a gender perspective into all its grant approval, monitoring and evaluation procedures and activities. This includes developing gender-sensitive indicators and supporting the strengthening of health information systems in cooperation with partners. Given that Gavi largely operates through its partners, collaboration is critical to realising the objectives of its gender policy, as well as complementing their efforts to promote gender equity.

For example, Gavi’s partnership with Unilever on increasing demand for immunisation and handwashing with soap in Uttar Pradesh, India, is tackling gender related barriers by positively including fathers in initial meetings with project promoters, and in project materials; by encouraging father’s role in early childhood development; and by encouraging spousal communication as a tactic to ensure behaviours around immunisation and handwashing with soap are shared priorities. However, further work is needed to ensure that such gender analyses and gender disaggregated data are more routinely used in demand generation interventions.

By calling innovations to help identify underimmunised children, Gavi’s Innovation for Uptake, Scale and Equity in Immunisation (INFUSE) platform is addressing gender equality issues such as the lack of gender-disaggregated data, the need to empower girls and mothers, and the challenge of reaching the most marginalised children – often girls.

Maternal education and immunisation

Gavi’s 2016-2020 strategy includes an indicator on maternal education status as a measurement of women’s empowerment. This indicator measures the average difference in coverage with a third dose of pentavalent vaccine between children of non-educated mothers and those whose mothers have at least completed secondary education.  Because this indicator relies on survey data, which is only available at three- to five-year intervals, monitoring year-on-year variations is challenging.

The Alliance also monitors sex-disaggregated coverage for pentavalent vaccine, as measured through household surveys. A WHO study of 10[1] of the priority countries facing the most severe immunisation challenges showed that while a child’s sex had little or no impact on national-level coverage, substantial differences were evident at the subnational level.

All 10 countries showed a positive association between a mother’s education level and childhood immunisation coverage. For example, median coverage for mothers with primary school education was 14 percentage points higher than for mothers with no education. [2]

Maternal education equity in 10 countries

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Governance

Gavi aims to achieve gender balance throughout its governance structures and human resources processes. In 2018, the Global Health 50/50 Report singled out Gavi as one of the top scorers for gender responsiveness and gender equality. The report assessed gender-related policies of more than 140 global health organisations according to several indicators such as the existence of a gender strategy for programmes, the collection of disaggregated data and gender parity among senior management.

In a further recognition of Gavi’s gender equity focus, in 2018 the Equal Salary Foundation certified the Secretariat an equal salary gender employer. The Alliance is the first global health organisation to commit to equal pay for men and women and obtain this certification.

In 2010, the Alliance adopted a set of guidelines whereby the Gavi Board aims to ensure a gender balance across its governance structures.

Communications and advocacy

Gavi is involved in a range of key global health policy fora to promote the role of gender and immunisation as a key driver of health, social and economic development as well as the achievement of the Sustainable Development Goals (SDGs). This includes the SDG3 Global Action Plan, the Global Compact on Refugees and the Astana Primary Health Care declaration.

The Alliance also participates in the Global Women’s Forum, which gathers decision-makers and pioneers to empower women across society, as well as the Women & Access to Health Daring Circle. The latter aims to improve women’s access to health in both developed and developing markets, by identifying emerging technologies with potential to increase women’s access to quality care.

In 2018, Gavi’s CEO – an International Gender Champion[3] – committed to strengthening Gavi’s expertise in gender-informed analysis and communication, as well as ensuring that the Alliance has a stronger articulation of the role of gender in global development and health policy dialogues.


[1] Afghanistan, Chad, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda.
[2] http://apps.who.int/iris/bitstream/handle/10665/272864/9789241565615-eng.pdf?ua=1
[3] This is a leadership network that brings together female and male decision workers to break down gender barriers. The leaders take the Gender Parity Pledge (which aims to strive for gender parity in all panel discussions in International Geneva).