Gendered health systems: evidence from low- and middle-income countries

Intersectional gender analysis – i.e., analysing how gender intersects with other social stratifiers – enables researchers to go beyond binary categories of male and female, to offer new forms of disaggregation of data, and to emphasise a transformational change in improving women’s access to services. The examples included in the study highlighted the importance of the intersections of gender with age and education in the Indian Sundarbans in relation to eye health and with migration and ethnic identity in Uganda in relation to maternal health.

Examples from Cambodia, Tanzania and Nigeria illustrate the importance of addressing the power relations underlying men’s involvement in health programs directed towards women, including within human resources, access to healthcare, and service delivery. Intersectional gender analysis is needed to explore men’s positions and vulnerabilities, the potential benefits or harms caused by their involvement, and how institutional arrangements reinforce power relations in decision-making.

Studies in Zimbabwe and Uganda demonstrate how the gendered experiences of health workers reflect gender norms and power relations in society with regard to differential access to resources, division of labour, and career development.

Health systems intensely rely upon unpaid care, which is overwhelmingly performed by women. In Uganda, community health workers (CHWs), the majority of whom are women, are a critical force in expanding health service access but are underpaid – or not paid at all – and under-supported. In China, gender analysis reveals gender differences in who provides elder care in rural and urban areas. Additional research is needed to identify weaknesses and gaps in provision and improve social welfare systems.

Health systems policy development lacks adequate attention to gender. Policymakers often have limited knowledge about gender, which limits its recognition and inclusion. A study of Tanzania’s policies for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) services shows the need to go beyond the simple inclusion of gender in policy and promote gender-transformative approaches in order to effectively reduce child and maternal morbidity and mortality.