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

How decentralisation, insurance schemes, privatisation and priority setting in health can affect gender equity

By: Östlin P
Published by: Health Evidence Network, WHO , 2005
Via: Eldis

This review article, published by the World Health Organization, assesses the impact of four key health care reforms – decentralisation, financing, privatisation and priority setting – on gender equity in health. It reports that, in many low income countries, rapid decentralisation has led to difficulties in providing affordable, accessible and equitable health services, and may also inadvertently support a more conservative reproductive health agenda. Other findings include that: taxes and social insurance schemes provide the most equitable basis for health care financing; privatisation may worsen gender equity; and some priority setting methods incorporate gender biases, and so underestimate the burden of disease on women.

The article argues that 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. Decentralisation should be accompanied by a corresponding devolution of authority and adequate human, institutional and financial resources. When health insurance schemes are introduced, they must adequately cover vulnerable and marginalised groups. Other recommendations include protecting the working conditions of health personnel – the majority of whom are female.