By Katja Iversen and Michael Myers | Devex | 9 October 2017
In India, if you are living in poverty, you and up to four family members should be able to access select inpatient health services at little to no cost. The government created this health scheme with the intention of helping more poor families get the health care they need. But the policy has produced an unforeseen side effect. When families exceed the five person limit, they often choose to prioritize health care for the boys and men, and forgo health care for daughters or elderly mothers. For the girls and women left behind, getting sick could mean a choice between spending the family’s savings on treatment or going without treatment at all.
Stories like this are a powerful reminder that without an intentional, relentless commitment to gender equality, even well-meaning plans to advance universal health coverage — the goal of reaching everyone with quality, affordable health services — can leave girls and women behind. They are 51 percent of the population, overrepresented in the world’s poor and marginalized, and powerful agents of change; leaders who have committed to UHC must be held accountable for advancing girls’ and women’s health, rights, and well-being as a priority.
What would it mean to reform health systems with girls and women top of mind? Every step of the way, leaders’ choices should reflect how girls and women seek, experience, and pay for health care.
1. Invest in primary health care
From this vantage point, investing in strong primary health care systems is one important solution for improving the health and well-being of girls and women. When effective, primary health care can manage 90 percent of people’s diverse health needs so that patients only require hospitals or specialists 10 percent of the time. For girls and women, whose needs vary dramatically over the course of their lives, this can be a game-changer. What’s more, they can ideally seek care in a trusted space within their own community.
For example, take Ethiopia, where a vast cadre of health workers — primarily women — were trained to deliver comprehensive, quality, peer-to-peer care in communities across the country. This meant fewer girls and women had to travel long distances or fear violence on the journey. It also meant a serious decrease in stigma around contraceptives and other sexual and reproductive health services. As a result, Ethiopia increased contraceptive use from 8 percent in 2000 to 42 percent in 2014 and reduced maternal mortality by 69 percent in the same period.
“With their health and rights intact, especially from a young age, girls and women will unleash a tidal wave of progress, resulting in healthier families, stronger economies, and nations that lift up all of their citizens.”
2. Cut out-of-pocket health care costs, especially for sexual and reproductive health services
Paying for health care is another concern that girls and women across income levels face in greater measure than their male counterparts. Women have less access to wealth overall, yet are often expected to decide how to split the family’s income between essentials such as health, food, or education.
To correct this imbalance, Thailand’s UHC policy successfully reduced or eliminated out-of-pocket health costs, including for a wide range of sexual and reproductive health services. Five years after the policy was launched in 2001, there were almost no rich-poor gaps in access to maternal health care and contraceptives, and women and men achieved near parity on health and survival — which is still true to this day.
3. Ensure gender parity in political participation
Of course, as we saw in India’s case, continuously factoring gender into decision-making is easier said than done. By creating pathways for more women to hold seats in government and voice their concerns in the civic sphere, countries can ensure that gender equality is ever-present in policy negotiations.
This is exactly the case in Sweden, where women represent 50 percent of ministers and nearly half of parliament. With gender equality as a core value, Sweden’s government has achieved parity in primary education and catalyzed progress on sexual and reproductive health and rights at home and worldwide.
4. Collect, analyze, and use gender and age disaggregated data
Finally, the only way we can know for certain whether we are delivering on our promises of UHC is to collect robust health data disaggregated by gender and age. In particular, we need to see young girls benefiting first from health reforms; the health care they receive as children and adolescents can open doors for the rest of their lives.
There is no time to waste. If countries redouble their focus on girls and women now, the benefits will stretch far beyond the individual. Girls and women represent a majority of health workers, caregivers, and educators worldwide. With their health and rights intact, especially from a young age, girls and women will unleash a tidal wave of progress, resulting in healthier families, stronger economies, and nations that lift up all of their citizens.
As long-time supporters of UHC, the Rockefeller Foundation and Women Deliver are thrilled to see the “health for all” movement gaining momentum, strength, and resolve like never before. We look forward to the day when the movement champions gender equality with equal force, because only then will necessary transformative change follow.
Put simply: girls’ and women’s health and rights are more than a measure for progress on UHC. They are a prerequisite.