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. 2017 Dec 1;32(suppl_5):v4-v12.
doi: 10.1093/heapol/czx063.

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

Sophie Witter  1 , Veloshnee Govender  2 , T K Sundari Ravindran  3 , Robert Yates  4
Affiliations

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

Sophie Witter et al. Health Policy Plan. .

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, female-headed 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.

Keywords: India; gender; health financing; universal health coverage.

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References

    1. Ahmed S, Khan MM.. 2011. A maternal health voucher scheme: what have we learned from the demand-side financing scheme in Bangladesh? Health Policy and Planning 26: 25–32. - PubMed
    1. De Allegri M, Ridde V, Louis VR. et al. 2011. Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy 99: 210–8. - PubMed
    1. Balagopal G. 2009. Access to health care among poor elderly women in India: how far do policies respond to women’s realities? Gender & Development 17: 481–91.
    1. Balasubramanian P. 2011. Utilisation of health services for reproductive health care: a case study from rural Tamil Nadu, India. In: Asia-Pacific Resource & Research Centre for Women (ARROW) (ed). Maternal mortality and morbidity in Asia Kuala Lumpur, 67–94.
    1. Balasubramanian P, Ravindran TKS. 2012. Pro-poor maternity benefit schemes and rural women: findings from Tamil Nadu. Economic & Politcal Weekly 25: 19–22.