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An increasing gender digital divide limits the extent to which digital health interventions are accessed and used effectively by women in low and middle-income countries who represent most caregivers as well as health workers.

These limits impede the potential for improved health outcomes, especially for women and children. Gender-intentional digital health ensures equitable representation, participation, and meaningful engagement of women, gender-diverse people, and men in the analysis, planning, and monitoring of digital health interventions and relevant enablers such as leadership, governance, and the capacity of the health workforce.

Gender-Intentional Digital Health Intervention & Enabler Prioritization Guide is designed to support the inclusion of gender analyses and prioritization for digital health intervention planning, implementation, and monitoring. It highlights the need to proactively understand and address the gender digital divide and associated gender dynamics in the health sector to achieve the full potential of digital health in low- and middle-income countries.

This guide supports targeted efforts to operationalize Gavi’s Digital Health Information Strategy which includes “gender-intentional” in the vision and prioritization of gender-related activities that can support scale and impact by overcoming negative gender biases, gender dynamics, and the effects of the gender digital divide on digital health interventions.

5 Steps to Close the Gender Digital Divide in Global Health

This resource provides a brief overview of targeted activities, questions, and templates to guide stakeholder prioritization in three phases of activities: 1) Analysis, 2) Planning, and 3) Monitoring.  The process, guidance, and recommendations broken down into five steps are relevant to low- and middle-income country national health programs seeking to create more equitable and effective digital health interventions and enabling environments.

It draws heavily on pivotal bodies of work from the past twenty years related to gender in health and gender in technology and applies them to the specific intersection of gender and digital health.

1. Key Stakeholder Representation & Engagement

To achieve meaningful engagement, relevant stakeholder groups should conduct and be represented in the analysis and planning process. The rapid guide includes a matrix that can be used to guide an analysis of key stakeholders who should be involved in the development of gender-intentional digital health programming.

The matrix enables a systematic way to understand the current gender representation as well as age, geographic location, education, and ethnicity of stakeholder groups to plan specific activities to progress toward meaningful engagement and gender equality.

2. Gender Digital Divide Desk Review

It is important to have a basic appreciation for the intersectional gender digital divide in the community, target population and the institutions involved in the program. This can be accomplished through a rapid desk review of existing documents to understand aspects of digital health, technology, and health systems that will inform gender-intentional prioritization, planning, and monitoring. If helpful, refer to some standard gender frameworks to help organize this data collection process.

By understanding the basic considerations and metrics in the analysis phase, you can also set a baseline that will make it easier and more straightforward to monitor and measure progress across the continuum. Some sources of information for gender-related health and technology statistics, analyses, and country case studies include the World Bank, World Health Organization (WHO), International Telecommunications Union (ITU), and the GSMA.

In cases where these data are not readily available, it is advised to conduct some key informant interviews with key stakeholders familiar with the local digital health, health, and technology landscape to provide any insights they have that can inform prioritization and planning.

3. Formative research and planning

The planning and assessment stage for gender-intentional digital health intervention design should be structured in a way that encourages equitable and meaningful participation in all activities, including the initial formative research design.

The use of well-structured qualitative research methods such as key informant interviews and focus group discussions alongside more targeted quantitative surveys lends itself well to understanding some of the potential gender-related enablers and barriers to planned digital health interventions and enablers.

A checklist is included in the guide to answer some key questions at the start of formative research. In addition to gender, consider other relevant characteristics of participants/ representatives such as rural/urban, socioeconomic status, age, profession, and disability.

4. Participatory Design and Iterative Implementation

Taking a gender-intentional approach to formative research, whether for an intervention or an enabler, provides the foundational information from within the local context needed for greater inclusivity and equity in the design process. This facilitates the identification of relevant activities, solutions, and interventions with a design that is gender intentional.

A checklist and questions within the guide provide a high-level assessment and opportunity for collaborative activity planning to increase gender considerations in design and implementation.

5. Identify Indicators to Measure Progress

To increase accountability for gender-related activity implementation, it is important to include metrics for success to measure progress. A list of sample indicators that can be adapted for use depending on the digital health intervention, enabler or ecosystem that is striving to be more gender-intentional has been provided in the rapid guide.

These can and should be developed and/or incorporated into monitoring, evaluation, and learning plans and/or priorities. The easier they are to measure the more likely they will be measured on a regular basis. It is important to set a baseline, which can be adapted from outputs from Phase 1 and 2 and then measure progress on an annual basis, if not more frequently, to demonstrate progress and areas that require more attention.

Gender analysis and gender-intentional planning is not only about promoting the rights of women, girls, and gender minorities, but about nurturing incremental and progressive changes in the attitudes, beliefs, and social structures that affect all people. With thoughtful attention to gender issues, digital health programs will develop people-centered, equitable services that contribute to human rights and universal health care for all people.

The exercises and templates in this guide can be used to start the journey to understanding how gender affects digital health programming. It is through these actions and intentional efforts that digital health interventions can contribute towards greater equity, inclusion, diversity, and accessibility for all.

By Dr. Patricia (Patty) Mechael  and Sarah Cunard Chaney at HealthEnabled.