Gender and UHC: Policy priorities for equitable and resilient health systems

Achieving universal health coverage (UHC) and meeting the commitments from the 2019 Political Declaration in a world changed by COVID-19 is a considerable challenge for health policymakers. One important lesson learned from the pandemic is that to achieve both UHC and health security, countries must invest in resilient and equitable health systems based on primary health care. We were also reminded that women were more impacted by the health, economic, social and political consequences of the crisis than men.

This is why ensuring gender equality in health systems governance, design, financing and delivery is a fundamental part of strengthening health systems and building back stronger from COVID-19. For this to happen, health systems must respond to gender-related health needs, including sexual and reproductive health and rights, throughout the life course. They must also address discriminatory norms and laws, as well as information and finance gaps.

With this in mind, what are the policy priorities for gender-responsive UHC in the context of strengthening health systems, including for health emergencies? And how can we build on lessons learned to make health systems more gender-responsive?

These questions were the focus of a lively dialogue convened on the sidelines of the 75^th World Health Assembly on 26 May by UHC2030 and the Alliance for Gender Equality and UHC (represented by Women in Global Health, Women Deliver and Spectra Rwanda).

If you missed the event, see below for an overview of key takeaway messages and highlights from panelists.

To continue the conversation and transform words into action, UHC2030 and the Alliance for Gender Equality and UHC will develop a tool to guide policy makers in making health systems fully gender responsive. This tool will provide a powerful resource to push governments to take necessary action and hold them accountable for meaningful health reform. Stay tuned for the tool development later this year.

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Key takeaway messages the panel discussion

The panel discussion highlighted the importance of the following aspects to move towards gender responsive health systems and UHC inclusive of women’s needs:

• Legislation to guarantee equality and a right-based approach
• Elevating the voices and participation of women in policy making
• A community focus to better understand and respond to the needs of women and girls
• Affordability and sufficiently resourced maternal and child health services, including for sexual and reproductive health
• Youth perspectives
• Better consideration of unpaid care provided by women
• Recognition of experience based on merit rather than seniority

The key policies and tools to prioritize included:

• Publicly financed primary health care
• Gender budgeting
• Gender impact assessments
• Sex-disaggregated data
• Gender-based violence policy
• Intersectional feminist frameworks
• A one-stop shop for all youth health and social services
• A new social contract for women and girls

 

Key highlights from panelists

Habibou Ouedraogo, senior analyst in health financing and UHC, Clinton Health Access Initiative, Burkina Faso, moderated the event and emphasized the critical role of gender equality in strengthening health systems and ensuring universal health coverage.

Ms Eleanor Blomstrom, Women Deliver, Senior Advisor for Political Advocacy, Women Deliver, highlighted the challenges faced since the 2019 High level meeting, the progress made so far, and the availability of new tools for advocates that focus on sexual and reproductive health and rights as crucial to the fulfilment of rights to health and achieving transformative and gender-responsive UHC.

“We must address the social and gender determinants of health, such as harmful gender norms and gender discrimination.”

Mireille Batamuliza, Permanent Secretary, Minister for Gender and Family Promotion, Rwanda, highlighted the work Rwanda is doing to ensure Gender Equality and UHC, including the policies, strategies and reforms established. She also described the work being done to prevent and respond to Gender Based Violence.

“Rwanda has ensured that laws and policies respond to the needs of women and girls and are gender sensitive, including SRHR, safe abortion and gender-based violence.”

Taru Koivisto, Director, Department for Communities and Functional Capacity, Ministry of Social Affairs and Health, Finland, shared the experience of Finland in mainstreaming gender equality across health sectors and how they overcame the challenges of the pandemic.

“We have impact assessments that take into account different population groups and gender. It’s essential to understand the local context, the local services and trends, and peoples’ actual needs, and to take the perspective of youth into account.”

Deepa Venkatachalam, Sama Resource Group for Women and Health, India, shared SAMA’s experience conducting policy analysis to ensure that disadvantaged and marginalized communities are not left behind and working towards gender-responsive health sectors, including emergency responses.

“The Intersection Feminist Framework is based on the pandemic experiences of marginalized communities and offers a feminist analysis of the government’s response to the health crises, suggesting gender-responsive policies and practices.”

Kughon Reuben Chia, Program Director, Organization for health in sustainable development, Cameroon, emphasized the role of youth in UHC and the main challenges they face. As a leader of a youth-led and focused organization, he also described their experience and how they designed strategies to address the existing challenges and leverage available opportunities.

 “Youth are marginalized in health decision tables. Youth are always denied [the right] to bring new solutions and ideas.”

Veloshnee Govender, Scientist, Department of Sexual and Reproductive Health and Research, WHO, explained WHO’s work in the area and highlighted the critical need of sex-disaggregated data to track progress as well as the barriers to accessing health care services.

“We do not have sufficient sex-disaggregated data. Until we do, we can’t track out-of-pocket payments and unpaid house care."

Gabriela Cueva Baron, UHC2030 co-chair, made closing remarks, emphasizing the need to design a new social contract that addresses the needs of women and girls. She also highlighted the need to include more women in decision-making and policy-making and to redefine UHC that is inclusive.

“Health is a right, not a privilege. Let’s [hold] governments accountable.”