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

INTRODUCTION

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. Highlighting the gendered impacts of health financing initiatives, authors outlines opportunities for intersectional gender analysis

KEY TAKEAWAYS

1. 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

   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

   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

   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.

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