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

Insufficient attention has been paid to the interaction of gender and health financing, and better collaboration is needed to fill this gap.

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.

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.

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.