Core sets of intervention
Of the 51 interventions reviewed, 13 interventions were identified as having significant
stand-alone transformative potential in terms of the transformative criteria (see
Table 5) and more so when implemented in combination, that is, in “core sets.†The reviewers
formulated these core sets to include those interventions that were necessary (though
not sufficient) to counter a particular form of discrimination in HPE settings. The
core sets of priority interventions to counter sexual harassment and caregiver discrimination
were those that met the critical criteria such that an intervention that met, for
example, the top two critical criteria was ranked higher than an intervention that
met only the top critical criterion. The panel also identified implementation challenges
for each set where such information was available and formulated recommendations for
addressing those challenges.
Core set to counter sexual harassment
The expert reviewers identified a core set of three gender-transformative interventions
with the potential to counter sexual harassment in HPE, shown in Table 6. Establishing a sexual harassment policy and a grievance procedure appears to be
feasible across high- and low-resource settings, as evidenced by implementation of
the two practices in a number of African and North American universities 22].
Table 6. Interventions included in the core set to counter sexual harassment in health professional
education
Key implementation challenges for interventions to counter sexual harassment
Although many HPE and other higher-education institutions included in the review had
implemented one or more of the interventions in the core set to counter sexual harassment,
the review identified a number of challenges:
Sexual harassment policies may outline strong principles and institutional responsibilities,
but the practical implementation of such policies can differ widely from their intentions.
For example, the University of Stellenbosch’s (South Africa) policy mandates a sexual
harassment advisory and disciplinary committee, yet an assessment found that not only
were many managers unaware of the policy but committee members’ workloads made trainings
on the policy difficult to schedule and implement 25].
The lack of awareness of grievance procedures (and of sexual harassment policies),
along with inadequate individual and institutional training, can contribute to anemic
use of grievance procedures in settings where sexual harassment is normative.
Most policies explicitly prohibit retaliation against victims who report sexual harassment,
but flawed grievance procedures and prevailing environments of intimidation or impunity
can render anti-retaliation policies ineffective.
Fear of retribution and lack of accountability discourage many victims of sexual
harassment from using grievance procedures 25]–28]. Assessments of Chancellor College in Malawi 26] and the University of Botswana 27] noted that when cases were reported, significant errors occurred in handling investigations,
maintaining confidentiality, assuring that alleged harassers showed up, coordinating
with responsible agencies, and even following the prescribed procedures, which caused
students to lose confidence in the process.
Given the possibility of culturally normative and unregulated sexual harassment in
HPE settings, grievance procedures are an important intervention. To address the identified
challenges, grievance procedures should pay special attention to confidentiality,
guidance for documenting and reporting, clearly outline consequences for the perpetration
of sexual harassment and retaliation, avoid an inadvertent chilling effect on reporting
that may result from an overemphasis on false reporting, and take concrete action
to both decrease and eliminate fear of retribution. Equally important, strategies
must be implemented and enforced through strong institutional leadership, vigilant
oversight, and timely follow-up and resolution.
Core set to counter discrimination based on caregiver responsibilities
The reviewers also identified two core sets of interventions for students and faculty
to counter caregiver discrimination (Table 7). Practices included in these core sets have been shown to be feasible in some settings,
with institutions in South Africa, Tanzania, and other countries offering child care
29], 30]. However, of the institutions reviewed, only the University of California and the
University of Michigan, both in North America, offered the full set of interventions
comprising the core set for faculty, and no institutions were identified that offered
the full core set for students 22].
Table 7. Interventions included in the core sets for HPE students and faculty to counter caregiver
discrimination
Key implementation challenges for interventions to counter caregiver discrimination
Interventions to counter discrimination based on caregiver responsibilities also face
implementation challenges, although these, too, can be met by strong HPE leadership
commitment:
Adverse consequences—or fear thereof—are a significant barrier associated with some
interventions. For example, faculty who opt for reduced duty leave or flexible training
programs may experience resentment from colleagues. Moreover, HPE faculty may not
always take advantage of interventions for fear that others will perceive them as
uncommitted or that their careers will be negatively affected.
Work-life integration is a key concern for many current and prospective HPE faculty
(both women and men) 31]. Institutions with family-friendly policies may, therefore, have a competitive edge
in recruitment. Indeed, outside of the HPE sector, the University of Washington law
school has used its family-friendly environment as a student- and faculty-recruiting
tool 32], and the University of California and University of Michigan both highlight their
family-friendly initiatives to faculty candidates.
Families and communities may resist some of the changes required to address discrimination
based on caregiver responsibilities, because the interventions challenge longstanding
gender norms, expectations, and divisions of labor. Girls and women who go to school
likely need a reduced workload at home, potentially adding to their families’ workload.
Communication of policy and education of faculty and students, as well as ongoing
public support of faculty who use such flexible policies, is key to preventing adverse
consequences. A complementary strategy is to proactively plan for pregnancy coverage
and flexible scheduling.
HPE planners must also anticipate the different levels of resistance that may arise
in recruitment and retention efforts and deliberately mobilize communities around
reducing women’s and girls’ housework, preventing early marriage and pregnancy and
sharing responsibility for caregiving. This implies a long-term, multidimensional,
and multisectoral strategy to keep girls in school from the primary through tertiary
levels. This might include provision of reproductive health services (including family
planning) through HPE institutions.
Interventions that address multiple forms of gender discrimination and inequality
In addition to selecting the core sets of interventions targeting sexual harassment
and caregiver discrimination, the reviewers identified gender centers and equal employment
opportunity units as having significant gender-transformative potential. These are
institutional structures that advocate for, coordinate, oversee, implement, and evaluate
multilevel strategies. These entities generally work to:
Develop gender equality, equal opportunity, or affirmative action policies
Engage in awareness raising and information sharing
Serve advocacy and accountability functions
Conduct gender sensitization workshops or sexual harassment training for women and
men
Conduct research and university assessments
Provide financial assistance to female students
Offer mentoring and faculty career and leadership programs to women
The last two objectives are examples of special measures to counter systemic structural
discrimination and promote substantive equality (see Table 2). These special measures counter the discrimination that may occur when poor families
allocate scarce financial resources to fund boys’ education and to compensate for
the career barriers faced by women in HPE institutions characterized by high concentrations
of men in top faculty and administrative positions.
Whereas equal employment opportunity units which aim to counter discrimination in
employment and occupation 33] are often backed by national equal opportunity laws, gender centers face the challenge
of not necessarily being backed by law. In addition, implementation challenges may
arise from funding or staffing constraints. Leaders in HPE reform should educate stakeholders
and advocate for the need for resource allocations to fund special measures to counter
systemic structural discrimination to achieve substantive equality.
Research limitations
The relative lack of descriptive contextual and evaluation data for the 51 interventions
limited the expert reviewers’ ability to determine the exact nature, feasibility,
sustainability, or effectiveness of the various interventions and, therefore, constrained
their capacity to make recommendations for specific contexts such as low-resource
settings. Overall, more information was available for institutions in high-resource
than low-resource settings.
The research team invited a variety of published experts representing different sectors
and countries to participate as reviewers, but most experts were unavailable. A larger
expert review group (including stakeholders such as students and faculty), or one
with a more diverse range of expertise, would likely strengthen future reviews.