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

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Study Justification:
– The study aims to address the question of why gender is important in the context of health financing and universal health coverage (UHC).
– It provides a reflection on the impact of health-financing reforms on gender and health access.
– The study highlights the need for explicit attention to gender and its intersectionality with other social stratifications to achieve gender balance and improve equity in UHC.
– It identifies research gaps in the field and the need for closer collaboration between health economists and gender experts.
Highlights:
– The study finds that without explicit attention to gender, movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity.
– Political trade-offs made on the road to UHC may not prioritize the needs of less powerful groups, including women and children.
– The study emphasizes the importance of adopting an equitable approach towards achieving UHC and prioritizing high-need groups, particularly women and children.
Recommendations:
– Closer collaboration between health economists and gender experts is needed to address the gender implications of health financing and UHC.
– More research is needed to guide policy making, particularly in exploring the gender perspective of cost sharing, expenditure on maternal and child health, and political economy considerations.
– Countries should adopt an equitable approach towards achieving UHC and prioritize high-need groups, including women and children.
Key Role Players:
– Health economists
– Gender experts
– Policy makers
– Researchers
– Health practitioners
Cost Items for Planning Recommendations:
– Research funding for conducting studies on the gender implications of health financing and UHC
– Collaboration and coordination costs for bringing together health economists and gender experts
– Resource allocation for prioritizing high-need groups, including women and children, in UHC policies and programs
– Budget allocation for implementing equitable approaches in achieving UHC

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is based on a general literature review and a case-study of India. It draws on a range of primary documents, reports, and published articles from reputable sources. However, it does not provide specific details on the methodology used for the literature review or the case-study. To improve the strength of the evidence, the authors could provide more information on the search strategy, inclusion criteria, and data analysis methods. Additionally, they could consider including a systematic review or meta-analysis to further strengthen the evidence base.

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

This paper draws on the expertise of the authors and on a rapid review of the health literature (grey and peer-reviewed articles). Although there are bodies of work on related topics in the economics and wider development literature, our interest was to capture the extent to which health practitioners had researched and reflected on this topic, so our focus was on health literature. With respect to universal health coverage, there were several primary documents and reports (i.e. grey literature) that were drawn on. These included WHO reports (i.e. 2010 report on universal coverage, the 2008 report on primary health care) and technical reports (Carrin and James 2004). With respect to gender and women, primary documents included reports by the United Nations (United Nations 2009,2010). In addition, we included reports and publications focusing on the gender implications of health financing (Witter and Ensor 2012), health-financing reforms (WHO 2010 b) and universal coverage (Witter and Ensor 2012; Sen and Govender 2015) that were relevant to this paper. The reference lists of these documents were also reviewed and relevant articles identified for inclusion in this paper. For published articles, both empirical and review, searches were conducted on PubMED and Google Scholar as well as specific journals focusing on gender and sexual and reproductive health (e.g. Reproductive Health Matters) and health policy (e.g. Health Policy and Planning, WHO Bulletin). The following key words were used for searches: ‘universal health coverage’, ‘universal coverage’, ‘health care financing’, ‘health financing reforms’, ‘insurance’, ‘community-based insurance’, ‘demand-side financing’, ‘gender’, ‘women’, ‘maternal health’, ‘sexual and reproductive health’, ‘access’, ‘equity’, ‘equality’ and ‘efficiency’. The search limits included all articles published since 2000 in English. The India case study was based on published articles and reports about health financing in India since 2000 available from the same databases and journals, and key Indian sources publishing policy related articles (e.g. Economic and Political Weekly). The key words for the search included, in addition to those already mentioned, names of specific health financing schemes (e.g. Rashtriya Swasthya Bhima Yojana (RSBY)).

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The publication titled “Minding the gaps: health financing, universal health coverage and gender” provides a reflection on the importance of considering gender in health financing and achieving universal health coverage (UHC). The authors conducted a literature review and a case study on India to explore the impact of health financing reforms on gender and health access.

The findings highlight the need for explicit attention to gender and its intersectionality with other social stratifications in order to achieve gender balance and improve equity in UHC. The authors emphasize the importance of providing explicit protection and linking benefits to the needs of target populations, such as poor women, unemployed men, and female-headed households.

The paper also emphasizes the need for collaboration between health economists and gender experts to address the gender implications of health financing and UHC. The authors identify research gaps in this field and highlight the importance of conducting research that explores the gender perspective of cost sharing, expenditure on maternal and child health, and other related aspects to inform evidence-based decision-making.

In conclusion, the paper recommends adopting an equitable approach towards achieving UHC and prioritizing high-need groups, particularly women and children. This approach, known as “progressive universalism,” aims to provide additional financial protection and address the specific needs of vulnerable populations. The authors stress the importance of collaboration between different disciplines and addressing research gaps to inform policy-making processes. The publication was published in the journal Health Policy and Planning in 2017.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to adopt an equitable approach towards achieving Universal Health Coverage (UHC) and prioritize high-need groups, particularly women and children. This approach, known as “progressive universalism,” emphasizes the need to provide additional financial protection and prioritize the needs of vulnerable populations.

To implement this recommendation, it is crucial to pay explicit attention to gender and its intersectionality with other social stratifications. This can be achieved by ensuring explicit protection and careful linking of benefits to the needs of target populations, such as poor women, unemployed men, and female-headed households. By addressing the specific needs of these groups, movement towards UHC can achieve gender balance, improve equity, and avoid exacerbating gender inequity.

Close collaboration between health economists and gender experts is also essential to effectively address the gender implications of health financing and UHC. This collaboration can help identify and address research gaps in this field, guiding policy-making processes. It is important to conduct research that explores the gender perspective of cost sharing, expenditure on maternal and child health, and other related aspects to inform evidence-based decision-making.

Overall, the recommendation is to prioritize an equitable approach to UHC, focusing on high-need groups, including women and children, to ensure improved access to maternal health services. This approach requires collaboration between different disciplines and addressing research gaps to inform policy-making.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Mobile Health (mHealth) Solutions: Utilize mobile technology to provide information, education, and support to pregnant women and new mothers. This can include text message reminders for prenatal care appointments, access to telemedicine consultations, and educational resources on maternal health.

2. Community Health Workers: Train and deploy community health workers to provide maternal health services in remote or underserved areas. These workers can provide prenatal care, assist with deliveries, and offer postnatal support and education.

3. Telemedicine: Implement telemedicine platforms to connect pregnant women in rural or remote areas with healthcare providers. This can enable remote consultations, monitoring, and guidance throughout pregnancy and postpartum.

4. Maternal Health Vouchers: Introduce voucher programs that provide financial assistance to pregnant women for accessing maternal health services. These vouchers can cover the cost of prenatal care, delivery, and postnatal care, ensuring that financial barriers do not prevent women from seeking necessary care.

5. Transportation Support: Develop transportation initiatives to address the challenge of reaching healthcare facilities. This can include providing subsidized or free transportation for pregnant women to attend prenatal appointments and deliver their babies in healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of prenatal care visits, percentage of deliveries in healthcare facilities, and maternal mortality rates.

2. Collect baseline data: Gather existing data on the selected indicators before implementing the recommendations. This data will serve as a baseline for comparison.

3. Implement the recommendations: Introduce the recommended innovations and interventions to improve access to maternal health. Ensure proper implementation and monitor the process.

4. Collect post-implementation data: After a sufficient period of time, collect data on the selected indicators again. This data will reflect the impact of the implemented recommendations on access to maternal health.

5. Analyze and compare data: Compare the baseline data with the post-implementation data to assess the impact of the recommendations. Analyze the changes in the selected indicators and determine the extent to which access to maternal health has improved.

6. Evaluate and refine: Evaluate the results and identify areas for improvement. Refine the recommendations based on the findings to further enhance access to maternal health.

It is important to note that this methodology may require collaboration with relevant stakeholders, data collection efforts, and ongoing monitoring and evaluation to ensure accurate and reliable results.

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