Health systems and gender in post-conflict contexts: building back better?

INTRODUCTION

A Gender Equitable System

Overall, a gender equitable health system can be defined as one that provides access to services that address the most urgent needs of men and women across the life span and is unimpeded by social, geographic, and financial barriers; produces sex-disaggregated health information that informs policy; ensures equitable health outcomes; and provides equal opportunities for male and female health professionals

Without a definition of a gender equitable health system, those planning and funding the reconstruction and rebuilding of health systems in post-conflict context have no guidance or incentives to implement gender sensitive reforms.

KEY TAKEAWAYS

1. Planning processes must be nuanced and multi-level

   Little research has been published on the gendered effects of health service delivery reforms. Planning processes in post conflict contexts need to consider the needs of all groups within a given context and across their life spans to ensure that reforms improve, rather than undermine, gender equity.

2. Strategies must address gender disparities

   Women are overrepresented in lower paid and informal care-giving roles and have been disproportionately affected by gender-blind human resource policies. Human resource strategies must address gender disparities across all areas of the health workforce. This is critical in post-conflict contexts, where opportunities exist to break down gender barriers and stereotypes.

3. Health information systems must be tailored to post-conflict settings

   In post-conflict settings, health information systems are weak and do not routinely collect data that would monitor and measure the impact of health reforms on gender equity. They should be tailored to facilitate the rapid collection and use of accessible information to support the evaluation and adaption of services to meet the needs of different groups.

4. More gender analysis required

   Health system financing mechanisms tend to disproportionately negatively affect women, as few are eligible for employment-based health insurance, and their lower status in society means they have less access to financial resources. More gender analysis, including gender budgeting, is needed to inform equitable financing mechanisms as part of post-conflict reconstruction.

5. Understanding financial and socio-cultural contexts is key

   There is a need to understand financial and socio-cultural contexts, and the roles of the informal sector and multilateral actors, in order to support access and adherence to medical products and technologies for different groups of women and girls, men and boys.

6. Promote women to leadership positions

   The post-conflict context presents an opportunity to promote the advancement of women to health leadership positions. The authors caution against health reforms that decentralise governance of health services to the local level, which can result in neglect of women’s health needs and reinforce patriarchal policies in communities by reinforcing men’s decision-making power.

There are two key reasons to build gender equitable health systems in post-conflict contexts. First, ensuring that health system reform builds gender equitable systems will improve the operation and responsiveness of health systems with the goal of improving health outcomes. And second, emerging research suggests that gender equality facilitates broader social and economic wellbeing, as well as stability. Ensuring that the reconstruction and reform of health systems creates gender equitable systems can facilitate gender equality.

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