In Uganda, gender intentionality improves vaccine access

June 26, 2024 by Elizabeth Rowley

How PATH’s approach to policy advocacy addresses gender-related barriers—including those that keep children from lifesaving vaccines.

The Midwife in Charge checks the medical records of a patient at Mpigi Health Centre IV in Mpigi Town, Uganda. Photo: PATH/Will Boase.

The Midwife in Charge checks the medical records of a patient at Mpigi Health Centre IV in Mpigi Town, Uganda. PATH belongs to a growing group of leaders taking a closer look at gender-related barriers to immunization. Photo: PATH/Will Boase.

Vaccines help children thrive and reach their full potential. And in most low- and middle-income countries, girls and boys have roughly the same likelihood of being vaccinated. However, when you look beyond national averages, gender-related barriers at every level—individual, household, community, health system—all levels hamper efforts to reach children through their caregivers, typically their mothers.

In Uganda, PATH studied the barriers faced by zero-dose children (children that lack access to or are never reached by routine immunization services). We found that in most Ugandan communities, even if a mother understood the importance of immunization, lack of autonomy might prevent her from having her children vaccinated. The study also showed Ugandan women tended to have less awareness of available health services, including vaccination, than Ugandan men.

Policy advocacy is a powerful tool for overcoming such barriers. And, in Uganda, there are four ways that PATH is using gender-intentional advocacy approaches to fight for policies that improve vaccine access.

1. Ground the policy issue in gender evidence

Integration of gender considerations should begin with the overall health policy issue and goal. This means generating and examining relevant evidence with an explicit gender lens and elevating gender in stakeholder discussions about issue framing.

Put plainly—you must take time early on to ask the right questions: How does gender inequity impact the challenge the policy seeks to address? How are women, men, boys, girls, and individuals with diverse gender identities and expressions affected differently by the issue?

Esther Nasikye, PATH’s lead for global maternal, newborn, and child health (MNCH) and immunization advocacy, points out: “Gender-intentional policy advocacy starts with grounding the policy issue in a comprehensive analysis of root causes—looking especially at gender inequities and barriers to health.”

“Gender-intentional policy advocacy starts with grounding the policy issue in a comprehensive analysis of root causes looking especially at gender inequities and barriers to health.”
— Esther Nasikye, Global MNCH and Immunization Advocacy Lead

For instance, Uganda’s human papillomavirus (HPV) vaccination schedule calls for all girls to receive a first dose starting at age 10, and a second dose six months later. Though the national coverage rate is high for the first dose (99 percent by age 15), coverage varies across districts and is low for the second dose in most parts of the country. In part, this is due to parents’ misconceptions about the vaccine, as well as gender-related norms that ignore the sexual and reproductive health rights and realities of adolescent girls and young women.

In 2023, PATH worked with the Ministry of Health through an initiative funded by Gavi, the Vaccine Alliance, to address known barriers to immunization. During the drafting of UNEPI’s Full Portfolio Plan, PATH helped the program articulate the gender-related barriers to immunization and identify activities that the country can implement to address those barriers.


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2. Elevate women leaders and gender-focused civil society voices

Partnerships are essential to policy advocacy. PATH seeks the expertise and participation of women’s rights groups and equality-focused organizations to systematically elevate the voices of women in the policy process.

Research shows that when women are more equally represented in policy decisions, outcomes tend to support gender-equitable health and education initiatives. Beyond the number of women in the room, the potential gender biases and blind spots of the decision-making body and its leaders matter.

That’s why PATH works to ensure that women feature prominently in all policy conversations and can represent the voices of women not at the table. We intentionally engage women-led and gender-focused organizations and parliamentarians through the Uganda Women Parliamentary Association (UWOPA) and the Network of African Women Ministers and Parliamentarians–Uganda Chapter (NAWMP). We also work with gender focal persons in the ministries of Health and Gender, to ensure their voices are well represented in the mostly male-dominated decision-making spaces.

“Our goal is to coordinate budget holders, decision-makers, technical experts, and communities to ensure the national immunization budget is sustained overall and expanded where and when needed,” says Bebona Josephine Babungi, chair of NAWMP. “More recently, we’ve applied our systematic gender integration approach to the challenge of increasing resources for Uganda’s national immunization programs—and it’s made a difference in how we work.”

A child receives the oral polio vaccine during an immunization clinic at Kamuli General Hospital, Eastern Uganda. Photo: PATH/Deogratias Agaba.

A child receives the oral polio vaccine during an immunization clinic at Kamuli General Hospital, Eastern Uganda. Photo: PATH/Deogratias Agaba.

3. Bring gender issues into advocacy messages

Advocacy messages can bring powerful information to any audience—from communities to government officials. With gender-intentional advocacy, it’s critical to frame your message in a way that your audience will hear it and understand the link between health and gender equity.

In some cases, the advocacy message may be direct yet aimed at a broad audience. PATH’s new framework to support coordinated policy advocacy in women’s health research and development innovation is a good example. In other cases, a gender-intentional advocacy message focused on engaging male caregivers in their children’s immunization needs might address a specifically male target audience at either the national or community level.

In Uganda, PATH and partners have created immunization advocacy messages to influence policymakers and budget holders as they prioritize immunization programs in the national health budget. Using a gender-intentional perspective, we’ve examined how budget numbers directly affect immunization access—for example, funding immunization outreach activities that will make it easier for women and girls to access services. The emphasis on access for women and girls is a critical component of our advocacy messaging.

4. Include gender-sensitive indicators in the monitoring and evaluation framework

Measuring change matters, especially for those changes affecting gender equity. Even when we aren’t working on gender-transformative projects, we can still integrate indicators for gender-sensitive advocacy policy output.

For example, to gain insights into gender-equitable participation we collect sex-disaggregated data on the engagement of individual decision-makers. We’re also tracking the number of research studies, analyses, and policy recommendations provided to decision-makers and influencers who seek to examine or address gender gaps, barriers, and norms in policies. When that evidence is used by our target audiences is also tracked

Achieving change for immunization equity

In Uganda, we have applied four concrete gender-intentional components of our 10-part policy advocacy approach in collaboration with partners from civil society, health service delivery, and national parliamentarians in ways that deliver a win for all.

Much remains to be done, and we’re learning all the time by developing evidence on what works to reduce gender-related barriers to immunization access; ensuring women have decision-making roles in immunization policy discussions; and supporting efforts to strengthen the capacity of women’s groups to advocate for the immunization needs of adolescents and young women.

Join PATH in our commitment to expand approaches to gender-intentional policy advocacy, thus promoting health for all.

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