FACTSHEETThe Gender Dimensions ofNeglected Tropical Diseases
The inaugural World Neglected Tropical Diseases(NTD) Daya brings together policy-makers, civil society
advocates, community leaders, and global healthexperts working across the NTD landscape. It unifies
partners behind a single shared goal: #BeatNTDs. For
good. For all.

vulnerable to and experience NTDs in different ways,
responses to NTDs can be accelerated, and help
deliver prevention, diagnosis and treatment services
more equitably.

NTDs affect some of the world’s poorest people andcommunities. Because they impact the vulnerable
and those left furthest behind, progress against
NTDs can also contribute to the achievement ofother Sustainable Development Goals (SDGs) suchas poverty (SDG 1), education (SDG 4), water andsanitation (SDG 6), decent work and economic growth(SDG 8), reduced inequality (SDG 10), climate change(SDG 13) and global partnership (SDG 17).

A new discussion paperb produced by the UNDP-led
Access and Delivery Partnership (ADP) reviews thecurrent evidence of how gender impacts NTD risk andoutcomes, epidemiology and prevalence. It explores
who accesses preventive medicines, who is diagnosed
and treated, and who is exposed or vulnerable to NTDs.
It also highlights how gender inequities related to NTDs
can be more actively addressed.

Current evidence

Gender-related power relations are based on establishednorms, beliefs, roles, access to resources and decisionmaking [5, 6]. These relations interact with other social
determinants of health, such as age, socioeconomic
status and structural dimensions of daily life andsocial hierarchies [7]. Gender inequality and inequity
are predominantly governed socially, but are oftenactionable. Gender analysis and mainstreaming in policy
development, advocacy, legislation, resource allocation,planning, implementation, and monitoring of NTD
programmes can help the NTD community move beyond
dialogue to action [8]. A ‘whole-of-society’ approach is
required, which engages civil society, patients’ rights
advocacy groups, communities, private sector, UNentities, bilateral and multilateral donors in ensuring that
NTD programmes meet the needs of all genders.

Gender, NTDs and the social
determinants of health
Understanding how sex and gender intersect with social
determinants of health such as poverty, educationand livelihoods is essential to ensure no one is left
behind in the fight against NTDs. For instance, illness
from schistosomiasis has been linked to decreased
school attendance and substantial reductions in future
earnings [1], and also affects cognitive developmentof young children and reduces learning opportunities[2]. Furthermore, girls from households with individuals
infected with onchocerciasis and other NTDs, especiallythose that result in blindness and skin disease, are atincreased risk of receiving less education, as they areoften required to care for the family member [3, 4].

To achieve this goal, the discussion paper proposes
five practical recommendations for action as part ofthis collaborative, multisectoral approach.

To ensure that responses to NTDs leave no one behind,
it is imperative that the global health community pays
closer attention to the often-overlooked intersections
between sex, gender and NTDs. By understanding how
people of all genders, including women and girls, areb The Gender Dimensions of Neglected Tropical Diseases
was launched in November 2019 by the Access and Delivery
Partnership/UNDP, the COUNTDOWN initiative/Liverpool Schoolof Tropical Medicine and TDR (UNICEF/UNDP/World Bank/WHO
Special Programme for Research and Training in Tropical Diseases).

a World NTD Day is on Thursday 30th January 2020.

1

Intensified case management, health seeking,diagnosis and holistic treatment

Recommendation 1

Account for how gender-related divisionof labor, everyday practices, social
norms and beliefs impact NTD risk

Intensified case management (ICM) for NTDs that are
not addressed by MDA requires ongoing care for affectedindividuals. The interplay between poverty, gender, age,disability and other factors that drive inequity can affectan individual’s health-seeking behavior and their ability
to access health care or outreach services for screening,
diagnosis and case management [10]. Education offrontline health workers, such as through gender andculturally sensitive communication techniques, isnecessary to address such inequities, promote the earlyreporting of disease signs and enhance access to healthservices [11].

Established division of labor (within and beyond
households) intersects with other determinants – such as
age and socioeconomic status – to affect NTD exposurerisk. Understanding who does what in terms of paid/
unpaid work, and the everyday practices of people ofdifferent genders, is important when designing effective
health promotion and prevention campaigns. For example,
this might include bed net distribution programmes, vector
control measures and/or identifying NTD ‘hotspots’.

Recommendation 3

Recommendation 2

Address gender-related stigma andmental health impacts of NTDs

Account for how gender
impacts the accessibility andacceptability of treatment

Improved understanding of NTD-related stigma andhow it is affected by established gender norms:

Preventive chemotherapy• helps to minimize the negative impacts of stigma;

Gender relations, occupation type and other social factors
affect accessibility and acceptability of medicines duringmass drug administration (MDA) campaigns, including
those delivered by community drug distributors (CDDs)[9]. Gender-disaggregated data collection (including
gender of the distributer) can shed light on potential
gender biases in MDA delivery. The gender of CDDs
matters: district and local level implementers should
consider who is recruited and where they will be bestplaced (see Box 1). Providing training and supportive
supervision can also help CDDs reflect on how they
promote gender equity in their work and identify coverage
improvement strategies for different contexts [8].

• reduces discrimination;• supports social acceptance;• improves disease control and knowledge; and,• prevents disability [12].
Attitudes toward mental health often vary significantly
across contexts and between genders [13]. Genderanalysis is critical when considering co-morbidities
between mental health issues and specific NTDs.
Management of mental health and psychologicalstress caused by gender-related stigma, including as aconsequence of NTDs, should be integrated within healthsystems and services. Awareness of social stigma among
health professionals should also be promoted [14].

Box 1. Questions to help district and local level MDA implementers consider gender impacts
Critical considerations in recruiting CDDs and how this is influenced by established power relations:• Who is chosen to distribute medicines and why? (How is this influenced by community members’ability to participate?)• How are they chosen and who is involved? (What institutions or individuals are making the decision?)• Does the CDD’s gender affect their ability to access certain household members or enter the home?
(What is their access to specific resources or social networks?)• Does this access also influence individual, household and community adherence?
• What are potential coverage improvement strategies?
• Who decides on whether to implement them?

2An example of how sex and gender differentials impact on exposure,transmission, manifestation and treatment for genital schistosomiasis
Gender, social andenvironmental determinants• Stigmatized and referred
to STI clinics instead ofreceiving treatment• Increased risk
from contact withcontaminated water
via household roles –collecting water, washingand cleaning• Religious and cultural
norms can mean womenare covered or haverestricted water-related
activities• Girls not attending
school, due to caring
responsibilities or culturalpreferences to educateboys, miss treatment

FGSMGS

Complex invasive
diagnosis

Diagnosis falsenegatives

Lesions are a risk
factor for STIs

Higher HIV viral loads
Weak erections, rapid
ejaculation, diminishedlibido, infertility andbladder cancer

Pregnancy and childbirthcomplications, anaemia,infertility, high maternal
morbidity/mortality rates

Enlarged organs andpainful urination

Restricted orexcluded from MDA

Sex-related differences• Increased risk withoccupations, e.g. fishing &swimming, involving contact
with contaminated water• Older men in somecontexts will not receive
treatment from younger
women distributers• Efforts to protect amasculine image andfears of economic impact
of diagnosis can preventmen seeking early healthcare

False cancer diagnosis– surgery that alters
reproductive capacityand delays treatment

Young girls stunting
and late puberty
Organ damage andcancer due to chronic
infection(FGS = female genital schistosomiasis; MGS = male genital schistosomiasis;
STIs = sexually transmitted infections; MDA = mass drug administration)

Recommendation 4

Recommendation 5

Collect and use gender-sensitive andsex-disaggregated data and conduct
implementation research

Promote intersectoral working andpeople-centered approaches
NTD programmes benefit from a health systems approachthat identifies positive synergies between diseasespecific interventions, non-targeted health services andother sectors [15]. People-centered approaches placecommunities centrally within NTD programmes so that no
sections of the population are ‘left behind’ in the control
and elimination of NTDs. Health systems need to support
community participation mechanisms that not only engage
people of all genders, including women and girls, but also
ensure their views are listened to and applied within NTD
programme development and implementation. NTD
decision-makers and programme implementers shouldensure that steps towards gender equity are an integral
part of interventions, on an ongoing and permanent basis.

Gender-sensitive and sex-disaggregated data can help
to improve gender equity and responsiveness of NTD
programmes especially at district and community levels.
Data gaps can be addressed by including gender equity
questions in coverage evaluation surveys and as part ofapproaches to data quality assessment. Furthermore,gender-sensitive implementation research that is built
into programmes will help ensure NTD programmes
meet the needs of people of all genders.

3Acknowledgements
This factsheet was authored by Kim Ozano, Laura Dean,
Eleanor MacPherson and Sally Theobald (COUNTDOWN
consortium at the Liverpool School of Tropical Medicine),
Tenu Avafia, Cecilia Oh and Mami Yoshimura (UnitedNations Development Programme) and Christine Halleux,
Mariam Otmani del Barrio and Olumide Ogundahunsi (TDR,
UNICEF/UNDP/World Bank/WHO Special Programme
for Research and Training in Tropical Diseases). We are
grateful for the generous funding from the Governmentof Japan.

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Contact information
Cecilia Oh (cecilia.oh@undp.org) and Mami Yoshimura (mami.yoshimura@undp.org) in the the HIV, Health andDevelopment Group, Bureau for Policy and Programme Support, United Nations Development Programme.

www.adphealth.org@ADP_health

From the People of Japan