Gender equality, disability and social inclusion

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Ensuring that everyone can access vaccines
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About NCIRS Global Health

At NCIRS – and in all work undertaken as part of the Regional Immunisation Strengthening and Engagement 2 (RISE-2) initiative – gender equality, disability and social inclusion (GEDSI) principles have been embedded to underpin effective, resilient and equitable immunisation programs. 

RISE-2 is a partnership between the NCIRS Global Health team, the World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance to support ministries of health and program partners establish safe, effective, equitable and accessible immunisation programs.

The RISE-2 initiative will be implemented from July 2024 to June 2027 as part of the Australian Government’s Partnerships for a Healthy Region initiative.

What is GEDSI?

GEDSI brings together 3 interconnected dimensions of equity. 

Gender equality – understanding and addressing gender roles, responsibilities, decision making power and constraints. 

In many settings:

  • women are responsible for bringing children to clinics but have limited autonomy or mobility
  • men often control household health decisions
  • healthcare workers are predominantly female
  • female health workers may be under represented or unavailable in outreach teams, creating discomfort or safety concerns for women and adolescent girls accessing services.
     
Disability equity and rights – recognising people with disabilities as rights holders and leaders, rather than simply service users. 

Common barriers to disability equity and rights include:

  • inaccessible clinics and outreach sites
  • materials not being available in accessible formats
  • negative attitudes or stigma (for example, assumptions that children with disabilities do not require vaccination).
     
Social inclusion – ensuring systems actively include groups who face marginalisation. 

These groups may include:

  • adolescent mothers
  • people living in remote or rural areas
  • ethnic minorities and those facing language barriers
  • young parents or youth caregivers
  • people experiencing poverty or restrictive social norms.
     

Why GEDSI matters for immunisation

Barriers to immunisation are rarely about vaccines alone. 

Social norms, gender power dynamics, stigma and geography often shape who gets reached and who gets left behind. Programs that do not account for these realities cannot achieve full or equitable vaccination coverage.

Across countries where NCIRS and our partners work, evidence shows immunisation gaps are strongly shaped by overlapping forms of disadvantage. For example:

  • adolescent mothers may avoid clinics due to stigma or fear of judgement
  • women without decision-making autonomy may be unable to attend clinics without permission or financial support from male household members
  • children with disabilities are often excluded due to stigma, inaccessible facilities or myths about vaccine safety
  • remote and rural populations face transport, cost and logistical barriers.

When these factors intersect – for example, for a young woman with a disability living in a remote area – the barriers multiply. 

These inequities undermine vaccination coverage, health system performance and disease control goals.

Embedding GEDSI into planning, delivery and monitoring strengthens immunisation systems for everyone.
 

Policy foundations

The Australian Government Department of Foreign Affairs and Trade (DFAT) has made GEDSI central to its development agenda. Its relevant guiding policies include:

The RISE-2 initiative aligns with these commitments. In the Global Health team’s work, GEDSI is not treated as a separate project – it is a lens applied across all immunisation activities, from training to materials development to data systems.
 

Common GEDSI barriers

Lessons from ARIA-RISE programs highlight recurring GEDSI barriers. These include:

  • gender dynamics: limited autonomy for women, male dominated outreach teams
  • disability stigma: ‘hidden’ children, lack of accessible information
  • geographical barriers: transport costs, long distances, limited infrastructure
  • cultural and linguistic factors: literacy challenges, local beliefs, trusted influencer roles
  • safeguarding risks: lack of privacy for adolescent mothers and other vulnerable groups.

Programs that address these barriers early achieve stronger engagement, trust and uptake.
 

Program design

RISE-2 partners are supported to incorporate GEDSI across all country programs through the following activities.
 

GEDSI analysis and planning

A supportive GEDSI template is provided to help immunisation project teams:

  • review existing data
  • consult diverse groups
  • identify barriers
  • prioritise actions
  • develop context-specific, measurable, achievable, relevant and time-bound (SMART) plans.
     
Stakeholder engagement

Examples include consultations with:

  • women’s religious groups on clinic scheduling
  • organisations of persons with disabilities
  • community and religious leaders
  • health workers with lived experience of disability.
     
Team collaboration

Cross disciplinary teams develop shared understanding, avoid blind spots and ensure consistent approaches.
 

SMART GEDSI actions

RISE-2 partners typically set 2 to 4 practical actions per year, such as:

  • making materials accessible (for example, low literacy, audio or visual formats)
  • adjusting outreach to include female health workers
  • engaging men and young fathers in immunisation messaging
  • improving clinic privacy and safety
  • collecting sex-, age- and disability-disaggregated data.
     

Monitoring and data

It is essential to track who in the community is vaccinated and who is missed. Many RISE-2 partners now collect:

  • sex-disaggregated data
  • age-specific data
  • disability status data
  • information on participation in community sessions
  • feedback from diverse groups.

These insights guide program adjustments and ensure actions remain grounded in lived realities.
 

Support for RISE-2 partners

NCIRS and Learning for Development (L4D) provide ongoing support, including:

  • one-on-one coaching
  • Q&A and troubleshooting
  • review of GEDSI templates
  • practical resources and tools.

RISE-2 partners are supported – rather than assessed – throughout this process.
 

GEDSI partners

  • The Australian Government Department of Foreign Affairs and Trade: Gender equality, disability and social inclusion analyses are used by DFAT to ensure its investments reach socially disadvantaged groups. Analyses prevent unintended harm, exclusion and further marginalisation while promoting these groups’ rights and equitable opportunities and benefits. 
  • Gavi, the Vaccine Alliance: integrates GEDSI into its immunisation programs to ensure equal access to vaccines. 
  • Learning4Developement: L4D advises and directly assists organisations and governments to foster better international development practices, better partnerships and stronger civil society organisations.
  • WHO Disability Health Equity Initiative: aims to close the avoidable health gaps between persons with disabilities and the broader population.
  • UNICEF: embeds GEDSI into its global programs to ensure that children of all backgrounds, genders and abilities can survive, thrive and participate in their communities.
     

Case study: GEDSI in practice – Papua New Guinea

Through its work administering the Australian Regional Immunisation Alliance (ARIA), NCIRS was able to support the Burnet Institute’s Vaccine Champion Plus program embed GEDSI across training for healthcare workers, village health volunteers, community leaders and caregivers.

Key approaches included:

  • the development of a dedicated GEDSI training module co-developed with provincial partners
  • near-equal participation of men and women at the provincial level
  • active focus on engaging single mothers, young fathers and people with disabilities
  • monitoring of gender- and disability-disaggregated participation data.

This model strengthened inclusive communication and built community-led strategies to reach marginalised groups.

Read more: The Burnet Institute’s Vaccine Champion Plus program

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