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20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community
  1. Sally Theobald1,
  2. Eleanor E MacPherson2,
  3. Laura Dean2,
  4. Julie Jacobson3,
  5. Camilla Ducker4,
  6. Margaret Gyapong5,
  7. Kate Hawkins6,
  8. Thoko Elphick-Pooley7,
  9. Charles Mackenzie8,
  10. Louise A Kelly-Hope9,
  11. Fiona M Fleming10,
  12. Pamela S Mbabazi11
  1. 1Department of International Public Health, COUNTDOWN Consortium and RiNGs Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
  3. 3Bill and Melinda Gates Foundation, Seattle, Washington, USA
  4. 4Department for International Development, London, UK
  5. 5COUNTDOWN Consortium, Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
  6. 6RiNGs Consortium and Pamoja Communications, Brighton, UK
  7. 7Uniting to Combat NTDs, Brighton, UK
  8. 8Department of Parasitology, Liverpool School of Tropical Medicine, Decatur, Georgia, USA
  9. 9Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
  10. 10Schistosomiasis Control Initiative, Imperial College London, London, UK
  11. 11Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Eleanor E MacPherson; eleanor.macpherson{at}


Neglected tropical diseases (NTDs) affect the poorest of the poor. NTD programmes can and should rise to the challenge of playing a part in promoting more gender equitable societies. Gender equity shapes poverty and the experience of disease in multiple ways; yet to date, there has been little attention paid to gender equity in NTD control efforts. Drawing on a synthesis of relevant literature, the tacit knowledge and experience of the authors, and discussions at a meeting on women, girls and NTDs, this analysis paper distills five key lessons from over 20 years of gender mainstreaming in health. The paper links this learning to NTDs and Mass Drug Administration (MDA). Our first lesson is that tailored gender frameworks support gender analysis within research and programming. We present a gender review framework focusing on different MDA strategies. Second, gender interplays with other axes of inequality, such as disability and geographical location; hence, intersectionality is important for inclusive and responsive NTD programmes. Third, gender, power and positionality shape who is chosen as community drug distributors (CDDs). How CDDs interact with communities and how this interface role is valued and practised needs to be better understood. Fourth, we need to unpack the gender and power dynamics at household level to assess how this impacts MDA coverage and interactions with CDDs. Finally, we need to collect and use sex disaggregated data to support the development of more equitable and sustainable NTD programmes.

  • health systems

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  • Handling editor Seye Abimbola

  • Contributors All authors (ST, EEM, LD, JJ, CD, MG, KH, TE-P, CM, LAK-H, FMF, PSM) actively contributed to the developing of ideas, through commenting on the paper, sharing tacit knowledge and relevant literature, editing drafts and the final version of this paper. The paper draws in part on discussions from a meeting on women, girls and neglected tropical diseases; JJ, CD, TE-P, FMF, PSM were key organisers of the meeting which was also attended by ST, CM and LAK-H. EM led on synthesising different author inputs, ideas and editing.

  • Funding This study was funded by Department for International Development (grant no: PO6470).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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