RinGs focuses on three main areas: synthesising research on gender, ethics and health systems; coordinating research projects through a small grants programme and our consortia; and running a learning platform to encourage mutual learning and the use of evidence.

Empirical research

ReBUILD - Following investment in the cadre of community health workers in Sierra Leone, and policy interest in strategies to sustain this critical interface cadre following initial donor investment, ReBUILD is conducting research on identifying how the community health worker cadre can be better supported to play an effective and long term role as part of the broader health system in fragile contexts. This research will involve a range of innovative methods including qualitative life histories and photovoice. The RinGs value added here will enable gender and intersectionality analyses of how experiences, challenges and opportunities faced by community health workers in two districts in Sierra Leone and the ethical implications of using photovoice with this group of health workers. RinGS will also add value to enabling gender and intersectionality lens on policy analyses on close to community providers that will be conducted in Libera and DRC. RinGs will also support other core ReBUILD research, for example on financing and strategies to develop a gender sensitive post conflict health financing strategy.

Resyst - In the Resyst gender and leadership study conducted under the previous round of funding, we explored the gendered career and leadership experiences of senior healthcare managers in Kenya, Nigeria and South Africa in order to provide insights for leadership development and supportive organisational processes and structures. An emergent theme in the initial analyses and country specific papers was intersectionality: how gender intersects with other social identities (e.g. race, ethnicity) to shape the leadership approaches of, and challenges faced by, senior healthcare managers. In the extension period the question of intersectionality will be examined in more depth through additional analyses of the existing data to understand how identity and specifically the intersection of multiple identities (i.e. gender, race, ethnicity etc.) mediates the career trajectories, leadership approaches and capacities of senior healthcare managers. This will also require additional reviews of the relevant literature.

Strengthening governance and leadership within health systems is critical to their development and performance. Our review of the literature and past learning site research suggests that organisational relationships and leadership practices are likely to be key in health system resilience. Although leadership initiatives have attracted significant investment over the last decade, there has been limited research on, or evaluation of, this investment. Investigations are therefore needed into how mid-level manager leadership practices, organisational relationships and their underpinning values influence health system resilience. Our past learning site experience suggests that accompanying those working within health systems over time is an important research approach for understanding the complex and long-term processes of health system change (our ‘learning site’ work in Resyst). In Resyst they will continue our learning site activities in Kenya (one site) and South Africa (two sites), with a focus on everyday health system resilience and how these are influenced by health manager leadership practices, organisational relationships and their underpinning values. In particular, they will include implementation and tracking of how leadership interventions aimed at building the soft skills of mid-level managers of the health system (e.g. emotional management participatory courses, and coaching interventions) help build resilience and responsive health systems.

COMDIS-HSD – The RinGs work in COMDIS-HSD takes a two-pronged approach. Firstly, all the COMDIS-HSD partners in Pakistan, Bangladesh, Swaziland and the Malaria Consortium are part of an action-learning set for researchers from all partners to enable their researchers to address gender and intersectionality throughout all stages of the research cycle in their projects, from designing the public health interventions, developing interview guides and quantitative and qualitative anlysis process. The action learning group is coordinated by Chandani Kharel, who is leading work on gender and intersectionality within HERDi, in Nepal. Secondly, funds for additional primary data collection will be provided to HERDi, Nepal to understand the gender and intersectionality issues in relation to their urban health project. Their work to-date has highlighted the challenges facing the predominantly female health workforce (limited opportunities for training and career development, poor supervision and monitoring) and the limitations of innovations (such as in m-health) to reach these often-forgotten health workers and to provide the data required to understand and respond to health problems facing sections of the community (e.g. slum-dwellers). The additional funding will allow HERDi to collect primary data on the gender and intersectional aspects of a supportive supervision model for health professionals in urban health centres in Nepal. The project will also develop and assess a process and guide for use with community committees linked to the urban health centres. This will facilitate committee members to identify individuals and groups within their communities who may face barriers to accessing quality care at the urban health centres and then suggest and try out ways to overcome these barriers.

Future Health Systems - Community Score Cards have been recognized as an important mechanism for accountability, transparency and quality adherence. Community Score Cards engage communities to assess the quality of services provided and as a tool for advocacy. They can be used to collect feedback form service users and improve communication between service providers and the communities. In both Uganda and Bangladesh, it is well established that access to health is inequitable, with exclusions occurring along various social strata: gender, age, socio-economic status, rural/urban residence and migrancy. While Community Score Cards have been used to improve quality, equity and accountability in health services, their appropriateness for particular categories of people remains untested. This means that more work needs to be done exploring how Community Score Cards might work for particular marginalised people within communities. Future Health Systems will explore the value of Community Score Cards as a mechanism to contribute to accountability for particular marginalised constituents of a community, using an intersectionality lens. This research will explore how gender intersects with categories, such as disability and socioeconomic status, to understand: a) their health service delivery needs, b) their experience of service delivery; and to influence: c) their use of and engagement with community score cards and ongoing community integration.

Small grants programme

RinGs held a competitive call among our three RPCs – Future Health Systems, ReBUILD and RESYST – to submit proposals for small research grants on gender, ethics and health systems issues relevant to low and middle-income countries (LMICs). We used the results of this research to put together a Case Study Reader which is a good introduction to gender analysis in health systems research and useful for teaching and capacity development.

Synthesising research

To help set the agenda for future work RinGs is carrying out scoping reviews which synthesise current thinking and gaps with regards to gender and ethical analysis in core areas of health systems research. These reviews will help set a gender, ethics and health systems research agenda which will also be shaped by policy and practitioner interaction and feedback. To make our findings as useful as possible we will communicate them in a variety of formats which suit the needs of researchers, policy makers and practitioners. Click on the links below to read our resources on UHC, mHealth, and Ebola.

Health Policy and Planning Supplement

Leaving no one behind: the role of gender analysis in strengthening health systems was published in 2017 and brings a gender lens to bear on the health system, uncovering new learning which can help us to build more equitable and people-centred research, policy, and practice globally and in different low- and middle-income countries. The papers cover a range of health issues and health systems areas and use a range of methods. The findings demonstrate that gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems. The supplement is an important step in drawing together emerging evidence on gender and health systems and encouraging others to adopt a similar lens.

For additional information about this supplement read Kate Hawkins’ blog on the Health Policy and Planning website, or listen to this podcast where authors Sally Theobald and Kui Muraya discuss why they think gender analysis is important within health systems research.

Building Back Better

Throughout the world, gender norms, roles and expectations restrict and undermine women's potential, behaviour and freedom. The turmoil and violence of war can exacerbate inequalities between men and women. As the conflict fades, however, possibilities are created for profound change. Donor funds flow, social norms are in a state of flux and there may be an appetite for political change. After the destruction, death and devastation of war, a window of opportunity can open for social reform in gender and health. A chance to ‘build back better’.

This website condenses the main findings from ground-breaking research carried out by the SIPRI working group on gender and the ReBUILD consortium. Their analysis includes: 1) A review of the literature on health system reform in post-conflict settings and developing countries; 2) An examination of international priorities in gender equality through an analysis of consolidated appeals for five countries affected by conflict; 3) Four case studies of countries emerging from conflict.

Book on women’s leadership in global health

There is a growing interest in women’s role in global health leadership. We know that women are the majority of people working to improve health outcomes in communities, health facilities, non-governmental organizations, and multilateral organizations. So why is it that when it comes to leadership positions we have a governance system that privileges men and what can we do to redress the balance?

We are delighted to announce that together with Women in Global Health, with the support of Springer, we will be publishing a book that explores women's leadership in global health.

This ground-breaking collection will explore the leadership roles that women currently play in global health, teasing out the routes that women have taken to leadership, the challenges that they have faced, and what has facilitated their journey. It will bring to the fore the stories of women on the frontlines of this struggle from around the world, highlighting and complimenting these stories with theoretical and analytical explorations of the structures and systems that help or hinder the process. Empirical studies in this volume will demonstrate how women’s leadership is thwarted or supported from a range of different contexts, positions, and starting points.

Learning platform

RinGs coordinates a learning platform focused on project partners and affiliates. It is a peer network of researchers, policy makers and practitioners that motivates, deepens understanding and enables members to share experience regarding gender, ethics and health systems research across low- and middle-income contexts. Through this platform we strengthen efforts within each project partner, as well as contributing to health systems research more broadly. Activities in the platform include face-to-face participatory training, the development of tools and online mentoring and support.

As part of the learning platform we have created a LinkedIn gender and health/health systems group. The group is for anyone interested in the role of gender in health and health systems research, policy, or programmes, and is a place to share resources, discuss important topics, and network.

We have provided external support to organisations such as the European Commission, IDRC, and the research collaboration PERFORM 2 SCALE.

Ethical engagement

We help lead the Health Systems Global Thematic Working Group on the Ethics of Health Systems Research. We are developing a toolkit on the ethics of everyday practice of researching health systems which is a guide for people ‘in the field’. We see gendered analysis as part of ethical practice.

Partnership with Women in Global Health

We are a proud partner of Women in Global Health. Women in Global Health is an organization, built on a global movement that brings together all genders and backgrounds to achieve gender equality in global health leadership. We believe that everyone has the right to attain equal levels of participation in leadership and decision-making regardless of gender. WGH creates a platform for discussions and collaborative space for leadership, facilitates specific education and training, garners support and commitment from the global community, and demands change for Gender Transformative Leadership. We are collaborating on a book and regularly write and present together. We are also in the leadership body of the Gender Equity Hub under the Global Health Workforce Network which they coordinate.

RinGs is comprised of:

  • ReBuild Consortium
  • Future Health Systems