Gender and equity in health sector reform programmes: a review

Abstract

This paper reviews current literature and debates about Health Sector Reform (HSR) in developing countries in the context of its possible implications for women's health and for gender equity. It points out that gender is a significant marker of social and economic vulnerability which is manifest in inequalities of access to health care and in women's and men's different positioning as users and producers of health care. Any analysis of equity must therefore include a consideration of gender issues. Two main approaches to thinking about gender issues in health care are distinguished--a 'women's health' approach, and a 'gender inequality' approach. The framework developed by Cassels (1995), highlighting six main components of HSR, is used to try to pinpoint the implications of HSR in relation to both of these approaches. This review makes no claim to sociological or geographical comprehensiveness. It attempts instead to provide an analysis of the gender and women's health issues most likely to be associated with each of the major elements of HSR and to outline an agenda for further research. It points out that there is a severe paucity of information on the actual impact of HSR from a gender point of view and in relation to substantive forms of vulnerability (e.g. particular categories of women, specific age groups). The use of generic categories, such as 'the poor' or 'very poor', leads to insufficient disaggregation of the impact of changes in the terms on which health care is provided. This suggests the need for more carefully focused data collection and empirical research.

PIP: Current literature and debates about health sector reform (HSR) in developing countries are reviewed with consideration of the potential implications for women's health and gender equity. Gender is highly relevant with regard to the inequalities of access to health care and men's and women's use and production of health care. All analyses of equity must therefore consider gender. A women's health approach and a gender inequality approach are discussed as the two main approaches to thinking about gender issues in health care. Cassels' framework highlighting the six main components of HSR is applied upon the implications of HSR in relation to both approaches. There is a major lack of information on the impact of HSR from a gender perspective and in relation to substantive forms of vulnerability. More carefully focused data collection and empirical research are called for.