Participatory design partnerships for gender and health in low- and middle-income countries: a scoping review

Gender inequality remains an intersectional determinant of health insufficiently addressed in programmes and policies. Progress requires systematic integration of gender perspectives but is constrained by the embeddedness of gender inequality across sectors, socioecological levels, and stakeholders. Participatory design approaches hold promise, but the role of participatory design partnerships in advancing gender equality remains underexplored. This scoping review explores what can be learned by examining gender and health programming undertaken within participatory partnerships in low- and middle-income countries (LMICs). Four electronic databases were searched for participatory design and implementation projects addressing an aspect of gender to improve health. Systematic screening resulted in 19 articles published between 2013 and 2023 representing N = 17 projects. Data were extracted and synthesised based on intersecting concepts of gender programming, participatory design, and partnership synergy. Across (N = 17) projects, (n = 6) originated in South Africa, (n = 13) focused on sexual and reproductive health or violence prevention, (n = 12) used co-design approaches, and (n = 11) were gender specific. Participatory approaches complemented gender programming by creating spaces for reflection, adaptation and power-shifting, strengthening participant agency and local buy-in. Most initiatives achieved change at individual or community levels, with limited structural or policy impact. Partnership dynamics were infrequently described. Power dynamics were cross-cutting determinants of project functioning across contextual levels. This review highlights the potential for participatory processes to shift gendered power relations if embedded in inclusive, reflective, and equitably resourced collaboration. Better understanding of partnership processes and synergies between gender integration and participatory design could support future projects advancing gender equality for health.