Healthy Images of Manhood: A “Male Engagement” Approach

for Workplace Health

Pauline MuhuhuDavid WoffordExtending Service Delivery ProjectFebruary 11, 2010

What is the Extending Service Delivery Project (ESD)?

Global project in reproductive health and family planning (RH/FP) funded by USAID

Addresses unmet need for RH/FP and increases access to services by the poor and underserved at the community level

Project Organizations: Pathfinder International – Managing partner IntraHealth – gender, religious leaders, BPs Management Sciences for Health – Health

systems Meridian Group International Inc. – CSR

What are ESD’s main technical focuses for reproductive health/family planning?

Best Practices – identifying BPs in and promoting use of BPs

CSR and Corporate Partnerships Family Planning-HIV Integration (of

services) Healthy Timing and Spacing of

Pregnancy Gender – launching HIM approach for

companies and workplaces

What is ESD’s experience in Africa?

Country-level projects: Kenya (North East Province APHIA –HIV/AIDS); Burundi; Guinea; Angola; D.R. Congo; Ethiopia; Sudan

Tanzania Unilever Tea: HIM + service delivery Medical Women Association of Tanzania: healthy

timing and spacing of pregnancy

Kenya Dadaab/Kakuma – religious leaders training; youth

training in gender-based violence prevention

Who are ESD’s Corporate, NGO Partners?

Unilever Tea Tanzania and Kenya Ltd. – workplace peer education project using the Healthy Images of Manhood approach

Business for Social Responsibility – (Health Enables Returns) HERproject technical advisor

Levi Strauss & Co. – Workplace health program in 3 supplier companies in Egypt/2 suppliers in Pakistan

Bayer Schering Pharma – Healthy Timing and Spacing of Pregnancy education materials

The Calvert Group (social investment firm) – the Calvert Women’s Principles/Gender Equity Principles

Global Business Coalition on HIV/AIDS, TB, and Malaria – HIM in Kenya; CSR workshop on health

Where did HIM come from?

HIM takes the best of: Proven “community-based”

gender programs – Project H, Raising Voices, and Men as Partners AND

Integrates ESD’s expertise in reproductive health/family planning and workplace programs

TO address the needs of companies & workplaces.

What is the HIM approach?

HIM is about men’s and women’s empowerment to improve health: Helping men to reflect on negative social

norms that lead to unhealthy behaviors Providing peer educators “gender”

knowledge and skills to influence their peers to adopt healthy behaviors

Linking health education to health services Taking a holistic approach to health –

integrating of HIV, family planning etc.

What is the meaning of Gender?

What is the meaning of Gender?

Sex or Gender:

Breastfeeding? Changing Nappies? Driving a trailer truck? Getting a vasectomy? Giving birth? Going to a bar? Washing clothes?

Definition of Sex and Gender Sex refers to the physiological

characteristics that identify a person as male or female.

Gender refers to the widely shared, expectations and norms about BOTH men and women and their behaviors.

Sex is a fact of biology (genitalia, hormones etc.)Page 24 – HIM Training Manual

Why is male engagement important in general and for companies?

Many good health education programs fail to address the effect of cultural beliefs on men’s behavior

Companies are not getting as much out their investments in worker health

Why is male engagement important in general and for companies?

Men’s unhealthy choices and behaviors harm more men– but also their families and entire communities

Peer health educators need specific knowledge and skills for addressing men’s cultural beliefs

What is unique about HIM as a gender program?

It shares many elements BUT

1. Gender programs are not tailored to the workplace realities

2. They are focused on a narrow, specific area: Gender-Based Violence; HIV/AIDS and care-giving;

3. Family planning & reproductive health are not integral

How is HIM different from most peer education training?

Many elements are the same BUT

1. Gender skills/knowledge are made integral to development of communication skills and health knowledge and outreach

2. Personal behavior change by PHEs themselves is essential

3. HIM takes a “whole person” approach to health

What are the main elements of HIM?

What are the main elements of HIM? Core Curriculum blending:

Gender skills/knowledge Health knowledge (RH/FP/HIV/Child health) Participatory outreach skills

Modular curriculum adaptable to each workplace Other valuable elements

Linkages/improvements to health services Capacity building:

Strong supervision – focused on mentoring, Ongoing skills development for PEs Company management ability to

maintain/expand program on its own

What other elements are in the HIM approach?

Data collection & analysis – by and for PHEs

M&E: “feedback loops” among PEs, Health Providers and the community

0

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JAN FEB MAR APR

# of condoms

# of educationalsessions

# of referrals

# of family planningdiscussions

HIM Modules 1 & 2

HIM Modules 3 & 4

HIM Module 5 & 6 (& Appendices)

What materials supplement the HIM approach?

A PE Workbook A HIM Coordinator

Guidebook Pop Council Balanced

Counseling Strategy Video, Brochures, Posters

on Healthy Timing and Spacing of Pregnancy

A Small Taste of HIMExercise 1: Values Clarification

Experiences with HIM

How did we arrive with Unilever at Healthy Images of Manhood

Responding to specific needs of the company High HIV rate; good

health services/ systems

Low use services, particularly by men

Creating a “male engagement” program adapted to a workplace

What were the main goals of HIM at UTTL?

Primary Goal: to increase men’s use of UTTL’s health services (HIV, family planning etc.)

Secondary Goals: Improve the quality of PHEs’ outreach Promote behavior change in PHEs

themselves Create linkages between peer education

activities and service providers

How was the HIM program implemented at UTTL?

HIM Program Start-Up: Training program for 29 male peer health

educators – begun January 2008 (six days) ESD trained an external Tanzanian trainer

in HIM for initial training and capacity building for coordinator

Full-time coordinator assigned: mentoring, support

Monthly follow-up meetings

How was HIM implemented at UTTL?

HIM Development over 18 months: September 2008: 3-day refresher training Full-time coordinator assuming full

management Data collection system improvements

Changes and Scale-Up of program 52 new PHEs trained in HIM in September Half of new HIM PHEs are women HIM elements now in basic PHE training

What has been the impact of HIM to date? Referrals: Increase in male enrollment at CTC In 2009, for first time, men coming STI clinic at same rate as

women (and lower STI rate overall)

Family Planning services: Gradual uptake in FP by HIV clients (not previously offered in

CTC): 17 new FP clients and 70 repeat visits Jan-June 2009

Gradual increase overall of new FP clients: 16/month Jan-June 2009 compared to an average of 11/month for Jan-June 2007

PHE Productivity: 122,492 male and 5,321 female condoms distributed by HIM-

trained PHEs over 17 months

What has been the impact of HIM to date?

Qualitative: HIM-trained peer educators highly positive about

training and personal changes Positive reaction from women: “HIM is our

salvation”- PHEs have been asked to mediate marital

dispute Peer educators are seen as a resource On mobile clinic days (Maternal & Child

Health/FP), PHEs provide health education and assistance

“I always thought I was right. I treated her as a worker rather than a spouse. I have changed my behaviors towards my wife. I have began consulting her in family matters, sharing domestic responsibilities.

“People now come to me for referrals”

“Company leadership has received HIM very well. Unfavorable behaviors of masculinity have gone down at that level.”

Changes in the belief that HIV+ person committed a sin and that condoms are for prostitutes. Less suspicion in the home now when a woman finds a packet of condom in the husbands pockets.

One cited an incident where a woman came to him to thank him for whatever he did to her husband because the beatings have stopped

HIM Exercise 2: Proverbs

Each group will receive a proverb or saying for around Discuss what you think is the meaning of

the proverb Explain what it tells you about what is

that society’s view of men or women

Each group will identify 1-2 similar proverbs/sayings from their communities

The Business Case for HIM

ESD has major focus on Return on Investment analysis: Workplaces in Bangladesh and

Guatemala (studies) Interest in health outcomes and business

outcomes

HIM also is designed with the business case in mind

The Business Case for HIM

Business is investing in health program on HIV/AIDS, TB, Malaria:

HIM is designed to complement these efforts in order to: Get more return from these investments Be easily adapted cost-effectively into

existing PE and health programs Provide easy tools for implementation

Business Case for HIM

Each company has its own business interests:

Fulfillment of CSR commitments and obligations

Legal obligations: eg. The Sexual Offenses Act in Kenya

Better use of resources More impact from existing investments