‘If it is not gender responsive, it is not UHC’: reflections on a gender & health financing webinar

Are health economists from Mars and gender folk from Venus? That was one of the sub-texts of the Gender and Health Financing webinar held on the 1st July, organized through the RinGs network.

As a health financing person, I spend much of my time thinking about equity and power – who sets agendas, who pays for services, who gains, who has access or not to health care, and so on. I rarely think about gender. I am too busy thinking about other forms of disadvantage, such as poverty.

Why are we shy of gender? Does it feel like special pleading? I think there are a number of issues here. First, women are half the population. While in many societies they lack voice and power, they don’t fit into the ‘persecuted minority’ box. Secondly, gender is a more nuanced concept than poverty. Few would argue that being poor is not a disadvantage, relatively and often absolutely. But men and women are not better or worse than one another but different, with different (and also shared) needs. Which makes gender a much more complex lens. Finally, practically speaking, there are only so many lenses you can focus with and through when analyzing a topic.

Which may explain why, when I did a scoping review to inform my presentation for the webinar, I found it a surprisingly unrewarding search. People are working hard in both fields, but beyond some work on user fees and allocations to maternal and child health, it looks like they are not talking much to each other. Hopefully our webinar will kick-start the conversation.

So what are my take-home messages from the webinar?

First, that we can all tackle some aspects of exclusion, whatever our field of work. It is the combination of barriers which is so damaging. They are additive, and sometimes multiplicative.

Gender barriers + poverty + caste/low social status + disability + weak health systems + poorly designed health financing mechanisms + conflict + political disempowerment = failure to meet UHC and indeed SDG goals

Secondly, that identifying specific types of barriers to universal health coverage is not a matter of privileging certain facets of people’s lives but recognizing that they all matter, and are inter-connected. Addressing some can help with others.

Finally, the connecting strand underling prioritization is power (or lack of it). Will we ever get the political will to reach UHC in a country where women are not effectively represented? It seems unlikely. UHC is intensely political, as Rob Yates highlighted on the panel. So is sexuality and reproduction, something that is socially contested in many countries, something which all too easily gets sidelined when planning ‘universal’ health coverage?

So there you have it – a heady mix of sex, politics and money. Sounds like an airport thriller? No, it is what happens when people from Mars and Venus meet!

Thanks to my co-panelists for their stimulating thoughts:

• Rob Yates, Senior Fellow at Chatham House
• Veloshnee Govender, Researcher/Lecturer at the Health Economics Unit at the University of Cape Town.
• TK Sundari Ravindran, Professor at the Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology.
• Sarah Ssali, Senior Lecturer at the School of Women and Gender Studies, Makerere University.

Sophie Witter is a Professor of International Health Financing and Health Systems at the Institute for International Health and Development, Queen Margaret University.