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Same difference? Effects of health sector reforms on women’s access to reproductive healthcare

What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result?

A report from the UK Institute of Development Studies argues that the impacts of health reform depend heavily on the local context in different countries. This includes economic, political, demographic and epidemiological factors. Different strategies are therefore needed to ensure further improvements in reproductive healthcare.

Health sector reforms have accelerated globally, driven by pressures such as structural adjustment policies, economic liberalisation, an ageing population and HIV/AIDS. An increasingly unregulated healthcare market has emerged in many countries. Co-existing sources of healthcare include the public and private sectors, NGOs and traditional healers. Decentralisation is another common health sector reform strategy, but national policies often fail to get implemented regionally due to lack of resources or local political will.

An investigation of policy issues in relation to women’s access to reproductive healthcare shows that:

Different national financing strategies can have very important consequences for women's capacity to access reproductive health services.
Insurance schemes alone are unlikely to compensate for the impact of women's and men's different relationships with the labour market. Very few insurance schemes cater to the informal sector, where many women work.
Recent attempts to link micro-credit schemes to health objectives have had positive gender effects, but these tend to be small scale and run by NGOs.
There are some examples of successful multisectoral approaches to reproductive healthcare at the municipal or sub-national level, but it is difficult to achieve this at the national level.
The concept of health as a global public good - a shared resource to be protected - is gaining some credence in international dialogue but reproductive health has not so far been part of that debate.

The report argues that improvements have been limited for several reasons:

While the women's health movement has successfully exploited international advocacy, there has not been enough dialogue with the national and international agencies driving health sector reform.
Reproductive health advocates and programmes have focused on service delivery issues to the neglect of broader systems-level thinking.
Reproductive health remains largely based in vertical programmes with components split between different ministries and sectors. This produces conflicts between stakeholders.
Progress continues to be hampered by a lack of data.

To implement a reproductive health approach at a system level, health planners will need to:

improve skills for advocacy, leadership, planning, management and implementation
develop supportive management systems including planning, information systems, human resources management and logistics
resolve financing and interdepartmental issues
move from good policies into implementation.

Source(s):
'Gender impacts of health reforms - the current state of policy and implementation' by H. Standing, Women's Health Journal 3-4 (2000)

Funded by: UK Department for International Development

id21 Research Highlight: 03 October 2001

Further Information:
Hilary Standing
Health and Social Change Programme
Institute of Development Studies
University of Sussex
Falmer, Brighton
BN1 9RE
UK

Tel: + 44 (0)1273 877147
Fax: + 44 (0)1273 621202
Contact the contributor: h.standing@ids.ac.uk

Institute of Development Studies (IDS), UK

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