UWCScholar :: Browsing by Author "George, Asha"

Browsing by Author "George, Asha"

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African governments must build on Covid-19 responses to advance gender equality
(NLM (Medline), 2023) Bello, Kéfilath; George, Asha; De Jong, Michelle
Gender inequality remains a major threat to development in Africa, with millions of women in the continent not reaching their full potential.1 The covid-19 pandemic and related quarantine and lockdown measures exacerbated these gender inequalities. The effects included increased reports of gender based violence,1-4 the economic consequences of reduced income and unemployment for women and families,5-13 and disruptions to essential health services.14-17 In addition, school closures as a part of responding to the pandemic, further exposed girls and adolescents to violence, unintended pregnancies, and a risk of permanent dropout from schools across the region.
Between rhetoric and reality: Learnings from youth participation in the adolescent and youth health policy in South Africa
(Kerman University of Medical Sciences, 2022) Jacobs, Tanya; George, Asha
Youth participation makes an essential contribution to the design of policies and with the appropriate structures, and processes, meaningful engagement leads to healthier, more just, and equal societies. There is a substantial gap between rhetoric and reality in terms of youth participation and there is scant research about this gap, both globally and in South Africa. In this paper we examine youth participation in the Adolescent and Youth Health Policy (AYHP) formulation process to further understand how youth can be included in health policy-making.
Building a transformative agenda for accountability in SRHR: Lessons learned from SRHR and accountability literatures
(Sexual and Reproductive Health Matters, 2019) Boydell, Victoria; Schaaf, Marta; George, Asha; Brinkerhoff, Derick W; Belle, Sara Van; Khosla, Rajat
Global strategies and commitments for sexual and reproductive health and rights (SRHR) underscore the need to strengthen rights-based accountability processes. Yet there are gaps between these ambitious SRHR rights frameworks and the constrained socio-political lived realities within which these frameworks are implemented. This paper addresses these gaps by reviewing the evidence on the dynamics and concerns related to operationalising accountability in the context of SRHR. It is based on a secondary analysis of a systematic review that examined the published evidence on SRHR and accountability and also draws on the broader literature on accountability for health. Key themes include the political and ideological context, enhancing community voice and health system responsiveness, and recognising the complexity of health systems. While there is a range of accountability relationships that can be leveraged in the health system, the characteristics specific to SRHR need to be considered as they colour the capabilities and conditions in which accountability efforts occur.
Democratic South Africa at 25 – A conceptual framework and narrative review of the social and structural determinants of adolescent health
(Springer Nature, 2021) Jacobs, Tanya; George, Asha
Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take stock of the social and structural determinants of adolescent health. Those born in democratic South Africa, commonly known as the ‘Born Frees’, are perceived to be able to realise equal rights and opportunities, yet many factors constrain their lives. In bringing together approaches to understanding context in health policy and systems research and the social determinants of health, the paper develops a conceptual framework to guide the narrative review examining the key contextual social and structural determinants of adolescent health in South Africa. Illustrative examples drawing from 65 papers from public health and the social sciences describe and link these determinants across micro, meso and macro levels of society, their global determinants, and their intersections with compounding axes of power and inequality. At a micro level individual adolescent sexual and gender identities are expressed through multiple and evolving forms, while they experience growing autonomy and agency, they do so within a broader context characterised by regressive social norms, gender inequality and other intersecting power relationships. At the meso level, organisational and sectoral determinants shape adolescents health and rights, both in being supportive, but they also replicate the biases and inequalities that characterise South African society. In addition, the macro level national and global determinants, such as the structural colonial and apartheid legacies, shape adolescents' health. Despite constitutional and other legislative rights, these determinants and compound economic, geographic, gender and other intersecting inequalities.
District governance and improved maternal, neonatal and child health in South Africa: Pathways of change
(Health systems and reform, 2020) Schneider, Helen; George, Asha; Mukinda, Fidele; Tabana, Hanani
District-level initiatives to improve maternal, neonatal and child health (MNCH) generally do not take governance as their primary lens on health system strengthening. This paper is a case study of a district and sub-district governance mechanism, the Monitoring and Response Unit (MRU), which aimed to improve MNCH outcomes in two districts of South Africa. The MRU was intro- duced as a decision-making and accountability structure, and constituted of a “triangle” of managers, clinicians and information officers. An independent evaluation of the MRU initiative was conducted, three years after establishment, involving interviews with 89 district actors. Interviewees reported extensive changes in the scope, quality and organization of MNCH services, attributing these to the introduction of the MRU and enhanced support from district clinicians. We describe both the formal and informal aspects of the MRU as a governance mechanism, and then consider the pathways through which the MRU plausibly acted as a catalyst for change, using the institutional constructs of credible commitment, coordination and cooperation. In particular, the MRU promoted the formation of non-hierarchical collaborative networks; improved coordination between community, PHC and hospital services; and shaped collective sense-making in positive ways. We conclude that innovations in governance could add significant value to the district health system strengthening for improved MNCH. However, this requires a shift in focus from strengthening the front-line of service delivery, to change at the meso-level of sub-district and district decision-making; and from purely technical, data-driven to more holistic approaches that engage collective mindsets, widen participation in decision-making and nurture political leader- ship skills.
Does having a mobile phone matter? Linking phone access among women to health in India: An exploratory analysis of the National Family Health Survey
(Public Library of Science, 2020) George, Asha; Mohan, Diwakar; Bashingwa, Jean Juste Harrisson
The disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women’s access to phones, their influencing factors, and their influence on health care utilization. Methods Data drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women’s access among different population subgroups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself. Findings Phone ownership at the household level was 92.8% (95% CI: 92.6–930%), with rural ownership at 91.1% (90.8–91.4%) and urban at 97.1% (96.7–97.3%).
Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach
(BMJ, 2022) Kinney, Mary; Bergh, Anne-Marie; Rhoda, Natasha; Pattinson, Robert; George, Asha
Introduction Maternal and perinatal death surveillance and response (MPDSR) is an intervention process that uses a continuous cycle of identification, notification and review of deaths to determine avoidable causes followed by actions to improve health services and prevent future deaths. This study set out to understand how and why a perinatal audit programme, a form of MPDSR, has sustained practice in South Africa from the perspectives of those engaged in implementation. Methods A multiple case study design was carried out in four rural subdistricts of the Western Cape with over 10 years of implementing the programme. Data were collected from October 2019 to March 2020 through non-participant observation of seven meetings and key informant interviews with 41 purposively selected health providers and managers. Thematic analysis was conducted inductively and deductively adapting the extended normalisation process theory to examine the capability, contribution, potential and capacity of the users to implement MPDSR. Results The perinatal audit programme has sustained practice due to integration of activities into routine tasks (capability), clear value-add (contribution), individual and collective commitment (potential), and an enabling environment to implement (capacity). The complex interplay of actors, their relationships and context revealed the underlying individual-level and organisational-level factors that support sustainability, such as trust, credibility, facilitation and hierarchies. Local adaption and the broad social and structural resources were required for sustainability. Conclusion This study applied theory to explore factors that promote sustained practice of perinatal audit from the perspectives of the users. Efforts to promote and sustain MPDSR will benefit from overall good health governance, specific skill development, embedded activities, and valuing social processes related to implementation. More research using health policy and system approaches, including use of implementation theory, will further advance our understanding on how to support sustained MPDSR practice in other settings.
Health systems for all in the SDG era: Key reflections based on the Liverpool statement for the fifth global symposium on health systems research
(Health Policy and Planning, 2019) George, Asha; Olivier, Jill; Glandon, Douglas; Kapilashrami, Anuj; Gilson, Lucy
The year 2018 marked anniversaries of several significant milestones in public health: the birth of the UK National Health Service, the Alma Ata declaration and the Commission on Social Determinants of Health. The Fifth Global Symposium on Health Systems Research in Liverpool reflected on these foundational events and their significance for the maturing field of health policy and systems research (HPSR) and for our growing professional association, Health Systems Global (HSG; Text Box 1). The Symposium’s theme, Health Systems for All in the Sustainable Development Goal Era, encapsulated the spirit of those historical commitments and brought them forward into current con- texts, framing universal health coverage and beyond (5th Global Symposium on Health Systems Research, 2018). Our democracies are under threat, our societies more polarized and our ecosystems undermined. Conflict and epidemics are not given adequate political attention, and across countries gender and intersectional inequalities remain glaring. It is amidst these contexts that our histories remind us of the progressive values that underpin ideal health systems. A key aim of HSG is to strengthen health systems by combining socially relevant science with effective, accountable and inclusive institutions to guide diverse social actors on the path to health and equity. In doing so, it is critical for health policy and systems researchers and practitioners to, above all, remain undaunted in striving for the realization of our aspirational goals despite these contemporary challenges.
How to use relevant data for maximal benefit with minimal risk: Digital health data governance to protect vulnerable populations in low-income and middle- income countries
(BMJ Global Health, 2019) Tiffin, Nicki; George, Asha; LeFevre, Amnesty Elizabeth
Globally, the volume of private and personal digital data has massively increased, accompanied by rapid expansion in the generation and use of digital health data. These technological advances promise increased opportunity for data-driven and evidence-based health programme design, management and assessment; but also increased risk to individuals of data misuse or data breach of their sensitive personal data, especially given how easily digital data can be accessed, copied and transferred on electronic platforms if the appropriate controls are not implemented. This is particularly pertinent in low-income and middle-income countries (LMICs), where vulnerable populations are more likely to be at a disadvantage in negotiating digital privacy and confidentiality given the intersectional nature of the digital divide. The potential benefits of strengthening health systems and improving health outcomes through the digital health environment thus come with a concomitant need to implement strong data governance structures and ensure the ethical use and reuse of individuals’ data collected through digital health programmes. We present a framework for data governance to reduce the risks of health data breach or misuse in digital health programmes in LMICS. We define and describe four key domains for data governance and appropriate data stewardship, covering ethical oversight and informed consent processes, data protection through data access controls, sustainability of ethical data use and application of relevant legislation. We discuss key components of each domain with a focus on their relevance to vulnerable populations in LMICs and examples of data governance issues arising within the LMIC context.
Integrating community health assistant- driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: Mapping key actors, points of integration, and conditions shaping the process
(Reproductive Health, 2019) Zulu, Joseph M.; Kinsman, John; Hurtig, Anna-Karin; Michelo, Charles; George, Asha; Schneider, Helen
Introduction: Although large scale public sector community health worker programs have been key in providing sexual and reproductive health (SRH) services in low- and middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants (CHAs) gained entry and acceptability into community health systems to provide SRH services to youth in Zambia. The country’s CHA program was launched in 2010. Methodology: A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically. Results: In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders. CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. CHAs used their existing social networks to deliver SRH services to adolescents. By embedding the provision of information about SRH into general life skills at community level, the topic’s sensitivity was reduced and its acceptability was enhanced. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth. Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits.
Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: Mapping key actors, points of integration, and conditions shaping the process
(Reproductive Health, 2019) Zulu, Joseph M.; Kinsman, John; Hurtig, Anna-Karin; Michelo, Charles; George, Asha; Schneider, Helen
Introduction: Although large scale public sector community health worker programs have been key in providing sexual and reproductive health (SRH) services in low- A nd middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants (CHAs) gained entry and acceptability into community health systems to provide SRH services to youth in Zambia. The country's CHA program was launched in 2010. Methodology: A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically. Results: In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders. CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. CHAs used their existing social networks to deliver SRH services to adolescents. By embedding the provision of information about SRH into general life skills at community level, the topic's sensitivity was reduced and its acceptability was enhanced. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth. Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits. Conclusion: Strengthening CHAs' ability to negotiate and navigate and gain acceptability in the community health system as they deliver SRH, requires support from both the formal health system and community networks. Limitations to the acceptability of CHA-driven SRH services are a product of challenges both in the community and in the formal health system.
Lenses and levels: the why, what and how of measuring health system drivers of women’s, children’s and adolescents’ health with a governance focus
(BMJ, 2019) George, Asha; LeFevre, Amnesty Elizabeth; Jacobs, Tanya; Kinney, Mary; Buse, Kent; Chopra, Mickey; Daelmans, Bernadette; Haakenstad, Annie; Huicho, Luis; Khosla, Rajat; Rasanathan, Kumanan; Sanders, David; Singh, Neha S; Tiffin, Nicki; Ved, Rajani; Zaidi, Shehla Abbas; Schneider, Helen
Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.
No pandemic preparedness and research without gender equality
(NLM (Medline), 2023) Clark, Jocalyn; George, Asha; Khosla, Rajat
The covid-19 emergency may have been declared over, but its effects are not. Pre-existing inequities worsened during the pandemic, and the crisis has hardened societal fault lines. Sex and gender mark many of these. Early on, sex and gender featured visibly as men seemed at higher risk of infection and hospital admission, and women of longer term illness and caregiving burdens. Over time, it became evident that covid-19 was exacerbating multiple and intersecting vulnerabilities, with substantial effects on women and girls: increased care burdens, amplified gender based violence during lockdowns, catastrophic drops in income and employment for women and families, disrupted essential health services, and school closures that heightened risk of unintended pregnancies and permanent dropouts.
“Not just a journal club – it’s where the magic happens”: Knowledge mobilization through co-production for health system development in the Western Cape province, South Africa
(Kerman University of Medical Sciences, 2022) Brady, Leanne; Gilson, Lucy L.; George, Asha
The field of Health Policy and Systems Research (HPSR) views researchers as active participants in processes of knowledge mobilization, learning and action. Yet few studies examine how such processes are institutionalized or consider their health system or wider impacts. This paper aims to contribute insights by presenting a South African experience: the Western Cape (WC) HPSR Journal Club (JC). The paper draws on collective reflection by its authorial team, who are managerial and academic JC participants; reflective discussions with a wider range of people; and external evaluation reports. The analysis has been validated through rounds of collective engagement among authors, and through comparison with the wider sets of data, documentation and international literature.
Paramedics, poetry, and film: Health policy and systems research at the intersection of theory, art, and practice
(Human Resources for Health, 2019) Brady, Leanne; De Vries, Shaheem; Gallow, Rushaana; George, Asha; Gilson, Lucy; Louw, Moira; Martin, Abdul Waheem; Shamis, Khalid; Stuart, Toni
Violence is a public health issue. It is the consequence of a complex set of interacting political, social, and economic factors firmly rooted in past and current injustice. South Africa remains one of the most unequal countries in the world, and in some areas, the rates of violence are comparable to a country that is at war. Increasingly, paramedics working in high-risk areas of Cape Town are being caught in the crossfire, and in 2018, there was an attack on a paramedic crew nearly every week. These attacks are a symptom of much deeper, complex societal issues. Clearly, we require new approaches to better understand the complexity as we collectively find a way forward. It is in this context that we are collaborating with paramedics, poets, and filmmakers to tell human stories from the frontline thereby bringing the lived experiences of healthcare workers into policy making processes. In this commentary, we share a series of poems and a poetry-film that form part of a larger body of work focused on the safety of paramedics, to catalyze discussion about the possibilities that arts-based methods offer us as we seek to better understand and engage with complex social issues that have a direct impact on the health system.
Paramedics, poetry, and film: Health policy and systems research at the intersection of theory, art, and practice
(BMC, 2019) Brady, Leanne; De Vries, Shaheem; George, Asha
Violence is a public health issue. It is the consequence of a complex set of interacting political, social, and economic factors firmly rooted in past and current injustice. South Africa remains one of the most unequal countries in the world, and in some areas, the rates of violence are comparable to a country that is at war. Increasingly, paramedics working in high-risk areas of Cape Town are being caught in the crossfire, and in 2018, there was an attack on a paramedic crew nearly every week. These attacks are a symptom of much deeper, complex societal issues. Clearly, we require new approaches to better understand the complexity as we collectively find a way forward. It is in this context that we are collaborating with paramedics, poets, and filmmakers to tell human stories from the frontline thereby bringing the lived experiences of healthcare workers into policy making processes. In this commentary, we share a series of poems and a poetry-film that form part of a larger body of work focused on the safety of paramedics, to catalyze discussion about the possibilities that arts-based methods offer us as we seek to better understand and engage with complex social issues that have a direct impact on the health system.
Perceptions of pregnant women of reasons for late initiation of antenatal care: A qualitative interview study
(BMC Pregnancy and Childbirth, 2020) Warri, Denis; George, Asha
Background: Antenatal care serves as a key entry point for a pregnant woman to receive a broad range of services and should be initiated at the onset of pregnancy. The aim of the study was to understand the reasons for the late initiation of antenatal care by pregnant women in Nkwen Baptist Health Centre, Bamenda, Cameroon. Methods: The study applied purposive sampling to recruit eighteen pregnant women and three key informants for data collection through individual interviews. Pregnant women who initiated antenatal care after the first trimester were recruited during antenatal care clinics and were interviewed in a room at the Antenatal Care Unit. Key informants were midwives working at the Antenatal Care Unit. Participation in the study was voluntary. The purpose of the study was explained to participants, and they signed a consent form if they were willing to participate in the research. Data were audio-recorded and analyzed using thematic coding analysis. Results: Pregnant women placed a low value on early antenatal care because they perceived pregnancy to be a normal health condition or to not be a serious issue that required seeking health care. Furthermore, previous positive pregnancy outcomes for which women did not access care made them less motivated to initiate antenatal care early. Participants perceived the booking system to be user-unfriendly and complained of overcrowded conditions, long waiting times and some rude service providers. The cost of services and distance to health facilities that required travel via uncomfortable transport on poor road networks were identified as perceived barriers. The absence of effective community health programmes, perceived lack of support from parents and spouses, fear of bewitchment and stigma due to cultural beliefs about the early initiation of antenatal care were also identified as variables influencing late initiation. Conclusion: Pregnant women lack information on the purpose of early antenatal care. Health facility barriers as well as socio-cultural beliefs have significant influences on the timing of antenatal care initiation. The government of Cameroon should strengthen the health system and implement activities to engage communities in improving care seeking for antenatal care and thereby improving maternal health status of women.
Policy analysis of the global financing facility in Uganda
(Taylor and Francis Ltd., 2024) Wanduru, Phillip; Kinney, Mary; George, Asha
Background: In 2015, Uganda joined the Global Financing Facility (GFF), a Global Health Initiative for Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH). Similar initiatives have been found to be powerful entities influencing national policy and priorities in Uganda, but few independent studies have assessed the GFF. Objective: To understand the policy process and contextual factors in Uganda that influenced the content of the GFF policy documents (Investment Case and Project Appraisal). Methods: We conducted a qualitative policy analysis. The data collection included a document review of national RMNCAH policy documents and key informant interviews with national stakeholders involved in the development process of GFF policy documents (N = 16). Data were analyzed thematically using the health policy triangle. Results: The process of developing the GFF documents unfolded rapidly with a strong country-led approach by the government. Work commenced in late 2015; the Investment Case was published in April 2016 and the Project Appraisal Document was completed and presented two months later. The process was steered by technocrats from government agencies, donor agencies, academics and selected civil society organisations, along with the involvement of political figures. The Ministry of Health was at the center of coordinating the process and navigating the contestations between technical priorities and political motivations. Although civil society organisations took part in the process, there were concerns that some were excluded. Conclusion: The learnings from this study provide insights into the translation of globally conceived health initiatives at country level, highlighting enablers and challenges. The study shows the challenges of trying to have a ‘country-led’ initiative, as such initiatives can still be heavily influenced by ‘elites’. Given the diversity of actors with varying interests, achieving representation of key actors, particularly those from underserved groups, can be difficult and may necessitate investing further time and resources in their engagement.
Policy foundations for transformation: A gender analysis of adolescent health policy documents in South Africa
(Oxford University Press, 2021) Jacobs, Tanya; George, Asha; De Jong, Michelle
The Sustainable Development Goals (SDGs) and the United Nations Global Strategy (2016-30) emphasize that all women, children and adolescents 'survive, thrive and transform'. A key element of this global policy framework is that gender equality is a stand-alone goal as well as a cross-cutting priority. Gender inequality and intersecting social and structural determinants shape health systems, including the content of policy documents, with implications for implementation. This article applies a gender lens to policy documents by national government bodies that have mandates on adolescent health in South Africa. Data were 15 policy documents, authored between 2003 and 2018, by multiple actors. The content analysis was guided by key lines of enquiry, and policy documents were classified along the continuum of gender blind to gender transformative. Only three policy documents defined gender, and if gender was addressed, it was mostly in gender-sensitive ways, at times gender specific, but rarely gender transformative. Building on this, a critical discourse analysis identified what is problematized and what is left unproblematized by actors, identifying the key interrelated dominant and marginalized discourses, as well as the 'silences' embedded in policy documents. The discourse analysis revealed that dominant and marginalized discourses reflect how gender is conceptualized as fixed, categorical identities, vs as fluid social processes, with implications for how rights and risks are understood. The discourses substantiate an over-riding focus on adolescent girls, outside of the context of power relations, with minimal attention to boys in terms of their own health or through a gender lens, as well as little consideration of LGBTIQ+ adolescents beyond HIV. Dynamic and complex relationships exist between the South Africa context, actors, content and processes, in shaping both how gender is problematized and how 'solutions' are represented in these policies. How gender is conceptualized matters, both for policy analysis and for praxis, and policy documents can be part of foundations for transforming gender and intersecting power relations.
Power, people and processes: A gender analysis of adolescent health policy in South Africa
(University of the Western Cape, 2022) George, Asha
The Sustainable Development Goals (SDGs) and the United Nations Global Strategy (2016-2030) emphasise that all women, children and adolescents ‘survive, thrive and transform’. A key element of this global policy framework is that gender equality is both a standalone goal, as well as a cross-cutting priority. Gender power relations are both social and structural determinants of health and shape health policy content, processes and systems. There are critical gaps in knowledge in terms of how gender inequality, and its intersectionality with other axes of power, shape adolescents’ health, as well as health policy and systems in South Africa.

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