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

摘要

In a webinar in 2015 on health financing and gender, the question was raised why we need to focusudon gender, given that a well-functioning system moving towards Universal Health Coverage (UHC)udwill automatically be equitable and gender balanced. This article provides a reflection on this questionudfrom a panel of health financing and gender experts.udWe trace the evidence of how health-financing reforms have impacted gender and health access throughuda general literature review and a more detailed case-study of India. We find that unless explicit attentionudis paid to gender and its intersectionality with other social stratifications, through explicit protection andudcareful linking of benefits to needs of target populations (e.g. poor women, unemployed men, femaleheadedudhouseholds), movement towards UHC can fail to achieve gender balance or improve equity, andudmay even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs ofudless powerful groups, which can include women and children, are not necessarily given priority.udWe identify the need for closer collaboration between health economists and gender experts, andudhighlight a number of research gaps in this field which should be addressed. While some aspectsudof cost sharing and some analysis of expenditure on maternal and child health have been analysedudfrom a gender perspective, there is a much richer set of research questions to be explored to guideudpolicy making. Given the political nature of UHC decisions, political economy as well as technicaludresearch should be prioritized.udWe conclude that countries should adopt an equitable approach towards achieving UHC and,udtherefore, prioritize high-need groups and those requiring additional financial protection, in particularudwomen and children. This constitutes the ‘progressive universalism’ advocated for by the 2013udLancet Commission on Investing in Health.