PHA-Exchange> What evidence is there about the effects of health care reforms on gender equity

[claudio at hcmc.netnam.vn]

What evidence is there about the effects of health care reforms on gender 
equity, particularly in health?

Piroska Östlin,  Senior Lecturer, Division of International Health (IHCAR), 
Department of Public Health Sciences, Karolinska Institutet
Stockholm, Sweden
Karen Facey, Health Evidence Network.
The peer reviewers of this synthesis are:
Hilary Standing, Institute of Development Studies at the University of Sussex.
Mercedes Juarez, Gender Mainstreaming Programme, WHO Regional Office for Europe
World Health Organization - WHO/Europe -November 2005
Health Evidence Network

Website: http://www.euro.who.int/HEN/Syntheses/genderEquity/20051027_1 
<http://www.euro.who.int/HEN/Syntheses/genderEquity/20051027_1>  

Summary <http://www.euro.who.int/HEN/Syntheses/genderEquity/20051027_2> 

Introduction <http://www.euro.who.int/HEN/Syntheses/genderEquity/20051027_1> 

Findings <http://www.euro.who.int/HEN/Syntheses/genderEquity/20051025_5> 

Discussion <http://www.euro.who.int/HEN/Syntheses/genderEquity/20051025_4> 

Conclusions <http://www.euro.who.int/HEN/Syntheses/genderEquity/20051025_3> 

References <http://www.euro.who.int/HEN/Syntheses/genderEquity/20051025_1> 

.pdf version [pdf, 230KB] 
<http://www.euro.who.int/HEN/Syntheses/genderEquity/20051027_3> 

 

".......In most countries the pressure for health care reform is aimed at 
improving the efficiency, equity and effectiveness of the health sector. 
Emerging evidence shows that health care reforms can affect men and women 
differently, as a consequence of their different positions as users and 
producers of health care. This review assesses the impact of four key health 
care reforms - decentralization, financing, privatization and priority setting -
 on gender equity in health.

Findings

Literature on health sector reform and gender equity is sparse and often 
focused on low-income countries. Moreover, gender-related papers are 
predominantly concerned with women's health issues and focus on adverse health 
effects. These limitations affect the generalizability of the findings.

Rapid decentralization of responsibilities without corresponding devolution of 
authority and requisite human, institutional and financial resources may lead 
to difficulties in providing affordable, accessible and equitable health 
services, as has been the case in many low-income countries. Decentralization 
may also inadvertently support more conservative reproductive health agenda, 
particularly in services for adolescents.

There is substantial evidence from both high-income and low-income countries 
that taxes and social insurance schemes provide the most equitable basis for 
health care financing. Other schemes, such as private insurance or direct out-
of-pocket payment, are likely to increase inequities, particularly in access to 
care and health-seeking behaviour and this may affect women more, as they 
generally have fewer financial resources.

Privatization, accompanied by emphasis on reducing costs and maximizing 
efficiency, may have an important impact on gender equity in health care access 
and financial protection. In some countries patient/staff ratios have been 
raised, personnel have been shifted, duties have been reassigned to less 
skilled workers and the use of casual workers has increased. The negative 
consequences of these policies affect women more than men since women are over-
represented among both patients and health care personnel.

A range of gender biases have been revealed in some priority setting 
methodologies, such as DALYs, which lead to the underestimation of women's 
burden of disease. These systematic gender biases are generated through various 
technical and conceptual limitations.

Policy considerations

Gender equity in health requires that men and women will be treated equally 
where they have common needs, and that their differences will be addressed in 
an equitable manner. This should be a consideration particularly in the 
planning and delivery of services at national, regional and local levels.

Decentralization of responsibilities in health care should be accompanied by a 
corresponding devolution of authority and adequate human, institutional and 
financial resources.

Well functioning and wide-ranging public health services provide equitable and 
affordable services to the less privileged, many of whom are women. Shifting 
from taxes to direct user fees to finance health services may increase the 
burden of payment among economically less privileged groups, reduces access, 
and may generate a serious poverty trap. When health insurance schemes are 
introduced, assurances are needed that vulnerable and marginalized groups, 
including poor men and women, will be adequately covered.

Efficiency and equity need to be assured when privatizing health services. 
Incentives may encourage the commercial health care sector to invest in public 
health and preventive care. If private sector management practices are adopted, 
steps should be taken to ensure that the working conditions of health personnel 
do not deteriorate.

The priority-setting methodologies require good quality evidence and data free 
from systematic gender biases and investments in high quality, gender 
sensitive, medical and social research.

Type of evidence

The report is a synthesis of systematic reviews, narrative reviews and 
individual articles. As it focuses on the impact of health policies, the 
quality of the evidence has not been judged formally, but reference is made to 
the quantity of evidence and its generalizability...."   [au] .

 




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