[Gender mainstreaming in health policies and health services. Preconditions, structures and requirements for success: the example North Rhine Westphalia]

By building up an integrated framework of political initiatives, distribution of specific knowledge, consulting, networking and tools for gender mainstreaming, the state of North Rhine Westphalia was successful in integrating a gender perspective into the health system from 2001 to 2006. The process developed in concentric circles--starting with women's rights initiatives, then reaching health politics--and has meanwhile reached health services. Important determinants for success were (1) statewide campaigns and offers of gender-specific consulting that distributed the topic to the city level and health services, (2) the linking of gender mainstreaming and the debate about quality in health services, (3) referring to specific health requirements or health problems of women or men and (4) a precise definition of 'sex' and 'gender'. A difficulty in implementing gender-sensitive approaches in the health system is seen in connecting specific medical or public health knowledge with the more general gender competence. To further promote gender sensibility, gender knowledge and gender-specific approaches to health and illness, an integration of gender mainstreaming tools into strategies and tools of project or quality management is proposed.