By Katja Iversen, Franciose Gerard, Roopa Dhatt, Kim van Daalen, Ann Keeling, and Caitlin Pley| The Lancet| 21 September 2019
We support Simon Wright and Refiloe Mabjeane, who wrote on behalf of the Civil Society Engagement Mechanism for UHC2030, calling for a “radically different approach” to the UN high-level meeting on universal health coverage (UHC) on Sept 23, 2019. However, a radically different approach means prioritising gender equality and girls and women's health and rights in UHC, and this includes the health workforce.
Firstly, UHC design and delivery should address the needs of girls, women, adolescents, and marginalised groups throughout the life course, and this includes protecting their sexual and reproductive health and rights.
UHC must incorporate comprehensive sexual and reproductive health services into essential benefits packages, and must respond to girls’ and women's diversity and intersecting identities of race, ethnicity, age, ability, migrant status, gender identity or expression, indigeneity, health condition, or socioeconomic status that can impact health.
To protect girls and women from financial risk, they must be able to fully participate in financial protection schemes and coverage must be adequate.
Secondly, UHC should address socially constructed gender roles and gender determinants of health that drive risk and poor health. Greater risk taking, violence, and avoidance of health services affect men's life expectancy, whereas the health of women and transgender people is affected by gender-based discrimination, harmful practices, and poor autonomy over their own bodies. UHC needs a gender lens and gender-disaggregated data to prioritise the most marginalised individuals and tackle inequities.
Thirdly, women comprise 70% of the health workforce and are central to filling 18 million additional health worker jobs for UHC. However, they hold only 25% of global health leadership posts and generally have lower status, lower pay, or even unpaid roles. Women will deliver UHC, but only with investment in decent work protecting their fundamental rights, guaranteeing fair pay and safe workplaces, and integrating unpaid health and social care into the formal sector.
As emphasised by the UN Secretary-General, women and girls should not only be beneficiaries of UHC systems—they should also be involved in their design.UHC discussions risk forgetting that gender equality and women's rights drive health for all. The International Women's Health Coalition, Women Deliver, and Women in Global Health have convened 107 organisations in a global Alliance for Gender Equality and UHC. Building on the six asks set by the UHC2030 movement, the Alliance for Gender Equality and UHC has issued a seventh ask to UN member states and partners to commit to gender equality and women's rights in UHC.
KI is President/CEO of Women Deliver. AK has held a consultancy contract with WHO since March 18, 2019 (extended to Aug 15, 2019). CP was doing an internship in the Antimicrobial Resistance and Healthcare-Associated Infections Department of Public Health England during the preparation of this Correspondence. All other authors declare no competing interests.