Gender, women and primary health care renewal

The WHO has launched an ambitious course of transforming health systems towards primary health care (PHC), yet integrating a gender perspective within PHC reform is a major challenge. This document aims to outline the basic elements of gender-equitable PHC reforms.

The paper concludes the following:

• women are less likely to be able to participate in voluntary health insurance schemes.
• out-of-pocket payments for health widen gender inequities in ability to access care.
• social protection health schemes and conditional cash transfers are important mechanisms for increasing the utilisation of health services by women.
• civil society organisations (particularly women’s organisations) have a special role to play as leaders in advocacy for gender equity in health.
  

Furthermore, the authors deem that addressing gender issues within universal coverage reforms implies identifying health financing mechanisms that do not exacerbate gender inequality. Accordingly, they suggest these recommendations: 

• health-financing mechanisms should reduce the proportion of out-of-pocket payment in total health expenditure and increase the share of health expenditure financed by insurance or pre-payment mechanisms.
• insurance schemes should not be restricted to those working in the formal sector of the economy and their dependents, and should cover a wide range of sexual and reproductive health needs.
• enrolling households as a unit in insurance schemes is advisable, and the government should subsidise those with limited ability to pay (that is vulnerable groups).
• service delivery settings will have to be redesigned and offer specific timings and settings within which women would feel comfortable when seeking services.
• training health workers in gender competencies is vital in making health services more gender-responsive.
• gender inequalities within the health workforce and women’s disproportionate burden of unpaid health care at home should be addressed within policies.