Women will benefit from UHC - and they will deliver it

By Caitlin Pley, Women in Global Health

Imagine investing in universal health coverage (UHC) using only half the available resources, and recruiting leadership from only half the talent pool? If the aim of UHC is to leave no one behind then gender equality is not a nice-to-have, it is an essential ingredient. Gender equality makes for smarter global health, and is everyone’s business. Women in Global Health, a global network dedicated to achieving gender equality in global health, is advocating for gender-transformative approaches to UHC that will enable us to build stronger and smarter health systems that respond to the physical, mental and social health needs of all people.

Gender equality, and its central role in the achievement of UHC, is a major omission in the current discourse. UHC needs to address sex-and gender-based determinants of health; including how sexual and reproductive health and rights (SRHR) and gender-based violence disproportionately affect the health of women, whereas men are more likely to die from tobacco use, suicide, and road injuries. Considering that prevention and health promotion are key components of UHC, upstream gender determinants of health must also be addressed, including access barriers to seeking care, since women and girls are often the hardest to reach with health services, and poverty. 

Globally, women and girls are more likely to live in poverty and less likely to be in employment, and when they are employed, earn on average 24% less than men[1]. Importantly, these sex- and gender-based determinants of health must be addressed as one of the earliest interventions in UHC, and in the first instance, in a primary health care system that is gender-responsive and accessible. Women will not access UHC if it is unaffordable. Iversen and Meyers have echoed this viewpoint, arguing that “girls’ and women’s health and rights are more than a measure for progress on UHC. They are a prerequisite”[2]. Furthermore, data disaggregated by sex and gender is urgently needed not only in the design of UHC interventions, but also in monitoring and evaluation, to ensure that the most marginalised and vulnerable women and girls are not left behind. Gender-responsive UHC will even up life chances between genders, as well as between rich and poor women within and between countries. Addressing gender equality will make or break the achievement of UHC, and generate wider social, economic and political benefits.

A second key interaction between gender and UHC is the female health workforce. Women provide healthcare for more than 5 billion people, amounting to $3 trillion dollars a year, however, nearly half of this work is unpaid[3]. Unpaid health and social care work keeps women in poverty and keeps girls out of school. Currently, health systems are subsidised by the unpaid health and social care work of the poorest women. Since 40 million new health and social care jobs are needed globally by 2030[4], 18 million in low-income countries to reach UHC, it is likely that the majority of these will be filled by women. There is therefore an urgent need to invest in the female health workforce but going beyond business as usual.

Currently, a large percentage of female health workers are in low status, low paid roles working on insecure conditions. Alongside investment, it is also crucial that women are afforded decent working conditions, equal pay, and a working environment free from bias, discrimination and harassment. Occupational segregation by gender, both vertical and horizontal, is also a major driver of other inequalities in the health workforce, particularly the gender pay gap. In most countries the majority of nurses are women and the majority of surgeons are men (horizontal segregation). Despite women representing 70% of the health workforce, they only occupy 25% of leadership roles[4,5] (vertical segregation). Without gender parity in senior and decision-making roles, female talent and perspectives are being lost. It’s time for women to be acknowledged as drivers of change in health, not just beneficiaries.

A gender-transformative UHC agenda requires strong political will from all stakeholders. In particular, gender balance, meaningful participation by all genders, and consideration of intersectional factors must be reflected in all aspects of the UN HLM process. Women in Global Health advocates for gender parity amongst all speakers and panellists at both the HLM and the Multi-stakeholder Meeting, and an intersectional approach to take other factors, including geographical representation, into account. Of 140 global health organisations surveyed this year, 72% of executive heads and 71% of board chairs were male[6]. On the first day of the 144th Executive Board meeting at the WHO in January of this year, of the 34 Member State representatives on the Executive Board, only 8 were women[7]. Life and death decisions about health coverage for all genders are being decided overwhelmingly by men. To ensure that due consideration is given to the importance of gender within UHC, gender equality in UHC should be a stand-alone item on the official agendas of both the HLM and the Multi-stakeholder Meeting. 

Women in Global Health is a non-governmental organisation that started in 2015 as a volunteer driven global movement, uniting individuals of all genders and backgrounds to achieve gender equality in global health, with the belief that everyone, regardless of gender, has an equal right to participate in leadership at all levels of decision-making. Women in Global Health is also a platform for discussion and collaboration, cultivating a network of global health professionals advocating for gender-transformative leadership. Women in Global Health has inspired women in all regions to create national chapters which now ground our global advocacy in the realities of diverse country contexts. As a member of the UHC2030 partnership, Women in Global Health is working with Member States and civil society to mainstream gender equality and women’s rights into the UHC process, understanding that it will bring better health for all. 

Call to Action: UHC to the members of the UN High-level Meeting on UHC

References:

1. UN Women (2017). Progress of the World’s Women 2015- 2016: Transforming Economies, Realizing Rights. Chapter 1. 

2. Iversen, K and Myers, M (2017). Opinion: Want to deliver on the promises of UHC? Invest in girls' and women's health and rights. Devex. 09 October 2017.
    
3. Langer, A et al. (2015). Women and Health: the key for sustainable development. The Lancet September 2015. 
    
4. Keeling, A (2017). All Roads Lead to Universal Health Coverage –and Women Will Deliver It. Women in Global Health.
    
5. ILO (2017). Improving employment and work conditions in health services. April 2017
    
6. Global Health 50/50 (2019). Global Health 50/50 Report: Equality Works.
    
7. Women in Global Health @womeninGH. “Of 34 member state reps at @WHO #EB144, only 8 are women—just 24%! Most (21 of 34) reps are experts nominated by their governments, not ministers. There’s no reason there could not be #genderparity at a meeting of such importance to the future of #globalhealth & #HealthforAll”. 24 Jan 2019, 6:33AM.