Anjana Bhushan, Technical Officer (Health in Development)
WHO/WPRO
3 rd Global Forum on Gender Statistics
Manila, 11-13 October 2010
ESA/STAT/AC.219/34

• 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

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

(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

MCHC Team
MOH Info Room
Regular reports
MOH
– HMIS website

Background
WHO Multi-country Study on Women's Health and Domestic Violence
Against Women 2005
– gathered comparable data from over 24 000 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

Socio-Cultural Research on Gender-Based Violence and Child
Abuse in Melanesia (Kiribati, 2008) and Micronesia (Solomon
Islands, 2008-09) 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 15-49 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 Women’s
Crisis Centre: shelter and care; underutilized due to social and cultural barriers faced by victims

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
• Support to multi-sectoral VAW action :
• AusAID/WHO Gender Health and Development Programme, 2010-11
(Solomon Islands)
• Planned M ulti-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: genderrelated barriers to access
4000
3500
3000
Trends in SM+
Viet Nam: 1990-1999)
2500
2000
1500
1000
500
0
1990 1992 1994 1996 1998
Male
Female

– 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

• General Statistics Office and line ministries, with UNDP’s 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 WHO’s support, is finalizing the first national study on violence against women
• National Strategy on Gender Equality (2011-2020) and
National Targeted Programme for Gender Equality (2011-
15) 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)

• Women's Health: Western Pacific Region , 2001.
– 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: Today’s Evidence, Tomorrow’s Agenda ,
2009.
– provides evidence on women's health needs and challenges over the lifecourse
– includes latest figures on health and leading causes of death in women.
• Agenda item on “Women’s health” , Western Pacific Regional
Committee Meeting, Oct 2010. Key messages:
– Women face distinct health needs through the lifecycle
– There are multiple determinants of women’s health
– Health systems are failing women
– The unfinished agenda can—and should—be 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

• Advancing countries along
HIS continuum
• Improving data collection, analysis, quality, and use
• Providing better training, tools, and techniques
• Improving interoperability of databases and systems