Challenging the health system of the autonomous community of Cantabria in Spain: Evaluation of an innovative gender health policy framed in the women's health plan

Background: The autonomous community of Cantabria integrated in its first Women´s Health Plan 2004-2007 a new gender health policy to affect all health interventions. This priority public health policy had an umbrella approach that went beyond the scope of the plan, to challenge the entire health system.

Objectives: To evaluate: 1) the conceptual framework of the policy, its validity, and significance; 2) the process regarding mainstreaming, efficiency, scope, and access; and 3) the results with respect to its effectiveness. Timeframe: October 2007-December 2008. Subjects are the stakeholders involved. Sampling was carried out by theoretical representation with maximum variation. Methods: 1) Methaevaluation of main gender equality plans in Spain; 2) Selection and analysis of secondary information sources and databases available; 3) Questionnaire to health professionals; 4) Stakeholders analysis; 5) In-depth interviews and discussion groups; 6) Consensus workshop with policy makers.

Results: The preliminary results obtained after triangulation of quantitative and qualitative data show that whereas the introduction of the gender health policy in the Women´s Health Plan represented an opportunity for the health system to address gender health inequalities, its expected goals and ambiguity exceeded the scope and potential of the plan.  However, 13 programs and protocols of the Plan integrated a gender perspective, including the gender-based violence and the natural birth programs. Moreover, policy makers, health providers and researchers are beginning to take a gender approach in their work.

Conclusions: Despite its limitations, this initiative represents today one of the few gender health policies in the country to address gender health inequalities. This participatory evaluation is contributing to give visibility and relevance to the policy as well as credibility to the practice of evaluating for equity and accountability.