Journal Article
25 Jul 2017
14 views

Minding the gaps: health financing, universal health coverage and gender

Health Policy and Planning Sophie Witter, Veloshnee Govender, TK Sundar...+2 more
Health Policy and Planning
Sophie Witter, Veloshnee Govender, TK Sundari Ravindran, Robert Yates
South-East Asian Region
10 mins
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What you'll learn
Integrating gender and health financing
  • This paper reviews the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a case-study of India
  • Highlights the gendered impacts of health financing initiatives
  • Outlines opportunities for intersectional gender analysis
Key Takeaways
1
Address the gaps in evidence
Address the gaps in evidence
Insufficient attention has been paid to the interaction of gender and health financing, and better collaboration is needed to fill this gap.
2
Without a gender lens, UHC will fail to be equitable
Without a gender lens, UHC will fail to be equitable
While Universal Health Coverage (UHC) emphasises equity, some groups have higher health needs and lower financing capabilities than others. This implies the need for progressive universalism, which puts the needs of vulnerable groups like women and children first. The underlying political and social determinants that undermine access for vulnerable and marginalised groups must be tackled to achieve the goals of UHC.
3
Invest in recommendations for a more gender-equitable approach to health financing
Invest in recommendations for a more gender-equitable approach to health financing
These recommendations include: public financing of health care services with resources mobilised from progressive taxation; regulation of the private health sector; attention to coverage of different groups of women when it comes to social insurance and micro-insurance; and social protection schemes that go beyond women from households below the poverty line and with packages covering more than maternal health.
4
Consider opportunities for intersectional gender analysis
Consider opportunities for intersectional gender analysis
The India case study highlights the gendered impacts of health financing initiatives and opportunities for intersectional gender analysis. For example, only five members of a household may be enrolled in India’s main social protection scheme, RSBY. Girls and elderly women are more likely to be excluded, and overall enrolment of women is lower than that of men, due to unequal gender power dynamics. Another example is the Conditional Cash Transfer Scheme. While it has increased the proportion of women delivering in institutions, it excludes women who already have two live births. This disproportionately affects poor women and women with lower educational levels who have higher fertility levels.

Unless explicit attention is paid to gender and its intersectionality with other social stratifiers, through explicit protection and careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, female-headed households), movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity.

A woman walks own a street in Chennai, India.

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    Affiliations
    1. Sophie Witter, Institute for Global Health and Development, Queen Margaret University, Edinburgh; Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK.
    2. Veloshnee Govender, Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
    3. TK Sundari Ravindran, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
    4. Robert Yates, Centre on Global Health Security Chatham House, The Royal Institute of International Affairs, 10 St James’s Square, London, SW1Y 4LE UK
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