Table 3. Illustrative gender analysis HSR questions.

Health system area		Illustrative gender analysis research questions
Service delivery, including access and utilization	Access to resources	To what extent do health facilities provide services with appropriate conditions (with functioning toilets, bathing areas for inpatient facilities, shelter from sun/rain in the waiting area) and with appropriate staff for all populations? Do sexual and reproductive health services provide services to both men and women? Are they available to those who are unmarried or widows/ widowers? To what extent are marginalized populations (transgender people, ethnic minorities, migrants, inhabitants of informal settlements, people employed in illegal occupations, etc.) able to access relevant information and care? What are the barriers that affect their access? How does gender interact with these other forms of marginalisation among these communities to affect access to health care? Do women have to endure waiting periods or have their cases reviewed by multiple providers before accessing safe abortions? Do women dependent on government funding face more restrictions, than women who can afford private abortion services? Are there services for gender-based violence such as domestic violence?
	Division of labour and everyday practices	To what extent are maternal and child health outreach visits or clinics organised considering women’s agricultural, economic, or caretaking activities in their communities? How do women’s social roles, such as childcare and infant feeding, affect their access to and utilization of health facilities?
	Social norms	Do services encourage the participation of men in women’s and children’s health? If yes, how and on what terms? To what extent are certain health conditions normalised (e.g. reproductive tract infections)? Do providers normalise irrational use of certain procedures (e.g. oxytocin to induce labour, caesarean sections that are not medically indicated)? How does stigma inhibit certain male or female populations more than other groups?
	Rules and decision-making	Who decides whether and how much to allocate household resources to pay for health care services? Do women require the permission of a male partner or relative to access a healthcare facility? To what extent are there policies in place guiding health services to be more gender-responsive? Do they have review procedures to ensure follow up? Are maternal death audits mandated? Are they transparent?
Human resources	Access to resources	To what extent do women and men have the same access to educational and training opportunities? To what extent do family support and roles help or limit opportunities for training by gender, marital status or parity? Are there sex differences in relation to remuneration, promotion, job security, working hours and benefits across and within all types of health workers? How does this interact with marital status, parity or sexual orientation? Do performance-based incentives mean the same thing for female and male health workers across and within cadres? To what extent is retention in rural areas more or less of a problem for female or male health workers? Is retention over time more or less of a problem for female or male health workers? Does this differ by marital status, parity, type of partner?
	Division of labour and everyday practices	To what extent are women more or less likely to work in frontline service delivery in poorly compensated (including volunteer) or less supported positions than men? To what extent are women more or less likely to work in management positions than men?
	Social norms	Are female and male health providers recognised differently? To what extent are female providers expected to provide more emotional support than male providers? To what extent are female providers less likely to ask for promotions and less likely to complain about poor working conditions than male providers due to less assertive social norms?
	Rules and decision-making	Are there female members and workers from across the health workforce hierarchy on committees that adjudicate over sexual harassment in the health workforce? Has gender been mainstreamed into human resource policy, and if so how, with what impact? Are there policies in place—and implemented—to effectively address sexual harassment against health workers? To what extent are there adequate maternity, paternity and family leave policies for both female and male health workers at all levels?
Health financing	Access to resources	Are girls, women, boys or men more or less likely to know about user fees exemptions, cash transfer entitlements and health insurance benefits? To what extent are services that are needed by only some populations included in performance-based incentive programs or health insurance plans? Do insurance packages include services exclusively used by women, such as maternal health? Do they include services for men’s sexual and reproductive health? To what extent do user fees or the removal of user fees have more impact on women from marginalised groups, because they have less access to cash? Have sex-disaggregated information on out-of-pocket expenditures on health been obtained? What services incur the greatest out-of-pocket expenditures for men and women? And what is the impact on individuals and households?
	Division of labour and everyday practices	To what extent are services provided by female vs. male health workers more likely to be included in performance-based incentive programs? To what extent are girls, women, boys or men more or less likely to work in jobs that offer health insurance? To what extent is insurance coverage available to people who work in the informal sector, in paid domestic service, in seasonal or part-time work, or unpaid home-based carers? Are women from marginalised groups more likely to be found in these types of work?
	Social norms	To what extent are women or other marginalised groups less likely to follow up on financial claims because of less assertive social norms, or a history of government discrimination? Are health workers in public facilities more likely to respond to certain groups of clients based on perceived ability to pay, gender etc.
	Rules and decision-making	Who designs insurance policies? Are women involved or people from marginalised groups? Who designs exemptions or waivers from payment? Is it mostly male managers? To what extent are health budgets publically debated by political parties? Are these political parties skewed by gender or other social determinants? Do insurance policies require levels of paperwork and verification that are not possible for marginalised groups? To what extent is health spending made public at different health system levels and who has the right to access such data?
Leadership/Governance	Access to resources	Who is more likely to have information about health entitlements? Who is more likely to have higher literacy levels and access to social capital enabling them to participate more effectively in health committees and other forms of health planning? Who is more likely to have access to transport to travel to headquarter locations to participate in health planning processes? To what extent have those in leadership positions received training in gender sensitivity or gender mainstreaming?
	Division of labour and everyday practices	What is the representation of women and men in boards, panels, working groups and other decision-making bodies, or in supervisory and management positions? To what extent are there differences by sex and other social markers in participation, decision-making and planning of interventions? Who is more likely to vote and how does this influence political priorities for health? Who engages with policy makers at the local and national level? Does having more female legislators ensure more support for women’s health services, like safe abortion? If yes, how?
	Social norms	To what extent are men or women more or less likely to register complaints or participate in accountability initiatives due to social norms around assertiveness? To what extent are women or other marginalised populations less able to advocate for their health needs?
	Rules and decision-making	To what extent do policies exist to ensure that females are represented on decision-making bodies? To what extent do structures at the community level (including community health workers) have the opportunity to feed into decisions and priority setting in the health sector?
Information and research	Access to resources	Who has access to the skills, devices and technology that transmits and processes health information? How do they use this information? Who gets to do HSR and can access research scholarships?
	Division of labour and everyday practices	Who bears the burden of routine data collection in health systems, and do these frontline workers have the capacity, time and support to do so effectively? To what extent are there gender differences? Who supervises data collection and are they given gender training?
	Social norms	What kind of social norms permeate medical text books and are they discriminatory? To what extent are people from stigmatised groups less likely to respond to data collection efforts? Does conservative gender bias make reporting on rape, violence against women, or maternal deaths less likely? If yes, in what way? To what extent do information systems have mechanisms for detecting and treating domestic violence?
	Rules and decision-making	Who decides what data is collected and how health system performance is measured? Do indicators include issues that may differ by men and women? How accessible is routine health information and are there policy measures that ensure transparency? To what extent are there confidentiality measures in place to protect the rights of marginalised or stigmatised groups?
Medical products/ technologies	Access to resources	To what extent do women have sufficient literacy, autonomy and ICT access to effectively use mHealth interventions or other medical projects? To what extent is protective health equipment and gear made to fit bodies that are not the male standard? How is the financing for commodities required specifically by women different than those needed specifically by men?
	Division of labour and everyday practices	How do men’s and women’s roles and responsibilities affect use of products (e.g. bed nets, vaccinations)? What are the challenges different groups of women and men face in adhering to long term treatment (e.g. for tuberculosis or HIV)? Are they appropriately supported within health systems and community based structures?
	Social norms	How do women and men within households and communities prioritise individuals’ access to medical technologies, e.g. are boys or girls more likely be prioritised for oral rehydration therapy (ORT)? To what extent are female providers less or more likely to be risk averse and therefore more likely to use protective equipment than male providers? Does this differ across and within cadres?
	Rules and decision-making	Which cadres are authorised to prescribe and distribute certain drugs or commodities and is there a gender difference? If yes, in what way? To what extent does regulation stand in the way of making certain commodities more widely accessible for women or marginalised groups, (e.g. medical abortion, blood)? What is the effectiveness of regulatory mechanisms to ensure that medical products for women or other marginalised groups are not misused, (e.g. oxytocin to augment labour)?