Methods

The focus of the Sex, Gender and COVID-19 Health Policy Portal is national level public health policies published by governments as part of their response to COVID-19. Government policies addressing secondary impacts of the COVID-19 pandemic beyond health, such as domestic violence and food and financial insecurity, are beyond the scope of this portal and the accompanying review.

We performed a standardised review of publicly available policies along six areas of national COVID-19 response:

Area of the health sector response to COVID-19 Description Examples of policies
1. Vaccine uptake Vaccinating the national population against COVID-19. Vaccination strategies; vaccination roll-out information.
2. Public health messaging on risk mitigation behaviours and testing Communicating with the public about how to reduce risk of becoming infected, how to avoid spreading the virus to others, and how to access testing and healthcare. Risk communication and community engagement strategies; public health communication guidelines; public engagement materials.
3. Clinical management of COVID-19 patients  Caring for people with confirmed COVID-19 infection within the health system in order to mitigate adverse outcomes and support recovery. Clinical guidelines for medical professionals; preparedness and response plans.
4. Protection of healthcare workers Mitigating the risk of COVID-19 infection of healthcare professionals in healthcare settings. Healthcare sector guidelines and protocols; infection prevention and control guidelines.
5. COVID-19 surveillance Tracking the progression of the COVID-19 epidemic including among populations at particular risk. Surveillance plans; preparedness and response plans; testing strategies.
6. Continuation of non-COVID-19 essential health services Ensuring that essential health services are maintained alongside COVID-19 care amid reduced health service capacity. Preparedness and response plans; health service-specific guidance; population-specific healthcare guidance.

These policy areas were selected as the focus for our review on the basis that: (i) they are among the components of a national COVID-19 response recommended in the WHO Strategic Preparedness and Response Plan; (ii) they target the health-related impacts of COVID-19; and (iii) there is evidence of gendered health impacts in these areas and gender-responsive policy measures that could be adopted to mitigate them.

WHO-recommended pillars of national pandemic responses
  1. Coordination, planning, financing, and monitoring
  2. Risk communication, community engagement and infodemic management
  3. Surveillance, epidemiological investigation, contact tracing, and adjustment of public health and social measures
  4. Points of entry, international travel and transport, and mass gatherings
  5. Laboratories and diagnostics
  6. Infection prevention and control, and protection of the health workforce
  7. Case management, clinical operations, and therapeutics
  8. Operational support and logistics, and supply chains
  9. Strengthening essential health services and systems
  10. Vaccination

Selection of Countries for inclusion in the Portal

At the start of the review in October 2020, we used the 183 countries in our COVID-19 sex-disaggregated data tracker as the sampling frame. For this review, we selected countries on the basis of maintaining a roughly even distribution across the six WHO Regions and all four World Bank country income groups. Countries were excluded in the initial round of review on the basis of having a low prevalence epidemic in October 2020. This gave us a sample of 137 countries whose websites we reviewed using the inclusion and exclusion criteria listed below:

Inclusion criteria for countries to be included:

  • Policies available on official Government websites or drawn from secondary sites which collate Government policies
  • Policies available in English, Chinese, Farsi, French, Spanish 
  • Policies at various levels of policy stringency/authoritativeness including strategies, plans, guidelines
  • Policies written or updated in 2020 or 2021

Exclusion criteria:

  • Mentions of policy areas only found in press releases and circulars 
  • Policies not available in English, Spanish, French or Chinese 
  • Policies that were not indicated as being used to guide national COVID-19 responses
  • Policies written before 2020 and not updated subsequently

After applying these criteria to the 137 countries in our sampling frame, we had a final list of 76 countries whose policies we have included in the review on the Policy Portal.

Selection of policies

The primary data source used to identify policies were official Government websites including Ministries of Health websites and Government COVID-19 websites. In addition, we used three databases as secondary sources, all of which collate national COVID-19 response policies: COVID Law Lab, ACAPS COVID-19 Government Dashboard and COVID-19 Health Systems Response Monitor (covering Europe only).

Up to three policies per response area were selected for each country on the basis of relevance to the policy area. Only government-published policies were included. Some policies are included under more than one policy response area, with different sections reviewed for each area (in this case, a policy may receive a different score across different policy areas). Where there were multiple iterations of a policy, the most recent version was included.

Assessment

Gender-responsiveness

We applied a standardised evaluation of policies using the WHO Gender Responsiveness Assessment Scale.

WHO gender responsiveness assessment scale Examples of COVID-19 health policy measures 
Gender-unequal
Perpetuates gender inequality
A COVID-19 testing strategy that makes diagnostic tests available for children via schools in a region where few girls receive education. Underprivileged children would not be reached by the intervention, perpetuating inequities in access to health services.   
Gender-blind
Ignores gender norms, roles and relations
A plan for PPE distribution that procures single-size PPE designed for a ‘standard male body’, failing to acknowledge the high proportion of healthcare workers that are women who require different sizes of PPE for adequate protection.
Gender-sensitive
Considers gender norms, roles and relations; does not address gender inequality
A vaccine distribution policy that includes an analysis of rates of uptake of similar vaccines in men and women and observes that vaccine hesitancy is more common among women but does not integrate policy measures  to improve women’s vaccine uptake.
Gender-specific 
Considers gender norms, roles and relations; Targets and benefits specific women, men or transgender/nonbinary populations to meet their needs
Evaluation of compliance with risk mitigation behaviours such as mask-wearing found that men are less likely to engage in such behaviours. In response, a public health communication strategy includes activities designed to reach men, such as interventions in male dominated workplaces or social settings or marketing materials that target men.
Gender-transformative
Considers gender norms, roles and relations; Address the causes of gender inequality; Transforms harmful gender norms, roles and relations
A COVID-19 vaccination policy engages local communities to promote equitable decision-making within families around accessing health services including vaccination in order to challenge harmful gender norms that limit women’s agency as well as men’s health seeking behaviour.
Population beneficiaries

In addition to assesing gender-responsiveness, we recorded whether women, men, transgender people, non-binary people, pregnant women or a combindation were explicitly identified as populations specifically targeted in the intentions of the policy.

Some of the policies reviewed target a particular sex but are gender-blind. While sex refers to a person’s biological make-up, gender refers to the roles, behaviours, activities and attributes that any given society considers appropriate for men, women, and people with non-binary identities. For example, a clinical guidance policy may call for different care of male and female COVID-19 patients on the basis of biological differences to COVID-19 (meaning it is sex-specific) without considering the social factors that influence different health needs of men and women based on gender.

Assessing populations targeted for essential health services

For policies relating to essential health services, we assessed whether consideration was given to marginalised, vulnerable or high-risk groups in decisions around which essential health services to maintain. Commitment to maintain services that are in practice predominantly used by a particular population, without reference to a specific vulnerable population targeted, was insufficient for a policy to be considered as targeting vulnerable populations. For example, commitment to maintain sexual and reproductive health services (SRHS) (which are primarily used by women) without reference to the populations targeted by this intervention, or to gender, would score N2. In recognition of the importance of maintaining SRHS and maternal health services during pandemics to mitigate secondary impacts among women, we recorded reference to these.

For surveillance policies, we adopted a different assessment method and reviewed only whether there were commitments to sex-disaggregated data reporting and the population(s) targeted. We included a small number of policies reviewed under other policy areas, that made commitments to reporting sex-disaggregated COVID-19 data, in the surveillance policy area.

Equity

We reviewed policies for reference to health equity or relevant language, for example commitments to equality, universal access to health and health access of vulnerabile or marginalised groups. For policies addressing essential health services, we considered commitments to maintaining specific services to protect vulnerable populations to be sufficient to score positively for the equity variable.

Human rights

We reviewed policies for any mention of commitments to protecting human rights including the right to health. Any mention of human rights in any of the six policy areas was counted as a positive human rights score for the country’s policies overall.

COVID-19 task forces

Data on the gender distribution of national COVID-19 task forces and the gender of task force leads data is drawn primarily from the UNDP COVID-19 Global Gender Response Tracker and the article "Symptoms of a broken system: the gender gaps in COVID-19 decision-making".1van Daalen KR, Bajnoczki C, Chowdhury M, et al (2020) Symptoms of a broken system: the gender gaps in COVID-19 decision-making BMJ Global Health https://gh.bmj.com/content/bmjgh/5/10/e003549.full.pdf Different task forces than those reported on in the UNDP tracker (in order to report on public health task forces rather than economic task forces) are presented for Australia and for Luxembourg. Data for England, Ethiopia, Eswatini and New Zealand reports the combined gender distribution of two or more task forces.

Limitations

The focus of this review is commitments made by governments in national level health policies. We recognise that commiting to policy measures does not guarantee implementation of these measures and therefore the findings of the review do not speak to the strength or effectiveness of governments’ health programmes in response to COVID-19.

Policies for five of the six policy areas were collected between October 2020 and January 2021, while vaccination policies were collected in March 2021. The Policy Portal does not include policies published more recently. It is possible that reviewers were unable to locate relevant country policies using the data-collection methods outlined above. The sample of countries and policies included in the review was limited by the language abilities of the reviewers.

If you think a policy that is relevant for this review has been excluded, please get in touch via the ‘Share data’ button on the homepage.