Minding the gaps: health financing, universal health coverage and gender
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Date
2017-07-25Author
Witter, Sophie
Govender, Veloshnee
Ravindran, T. K. Sundari
Yates, Robert
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Witter, S., Govender, V., Ravindran, T. & Yates, R. (2017) Minding the gaps: health financing, universal health coverage and gender. Health Policy and Planning, 32(Suppl. 5), pp. v4-v12.
Abstract
In a webinar in 2015 on health financing and gender, the question was raised why we need to focus
on gender, given that a well-functioning system moving towards Universal Health Coverage (UHC)
will automatically be equitable and gender balanced. This article provides a reflection on this question
from a panel of health financing and gender experts.
We trace the evidence of how health-financing reforms have impacted gender and health access through
a general literature review and a more detailed case-study of India. We find that unless explicit attention
is paid to gender and its intersectionality with other social stratifications, through explicit protection and
careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, femaleheaded
households), movement towards UHC can fail to achieve gender balance or improve equity, and
may even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs of
less powerful groups, which can include women and children, are not necessarily given priority.
We identify the need for closer collaboration between health economists and gender experts, and
highlight a number of research gaps in this field which should be addressed. While some aspects
of cost sharing and some analysis of expenditure on maternal and child health have been analysed
from a gender perspective, there is a much richer set of research questions to be explored to guide
policy making. Given the political nature of UHC decisions, political economy as well as technical
research should be prioritized.
We conclude that countries should adopt an equitable approach towards achieving UHC and,
therefore, prioritize high-need groups and those requiring additional financial protection, in particular
women and children. This constitutes the 'progressive universalism' advocated for by the 2013
Lancet Commission on Investing in Health.