This document discusses universal health care (UHC) and the importance of considering gender as a social determinant of health. It notes that UHC is a key topic in global health discussions and aims to achieve equity, but gender has received uneven attention. It presents a framework that shows how gendered social and structural determinants can lead to differential exposures, vulnerabilities, and health outcomes. For UHC to be equitable, pathways to achieving it must address whose health problems are prioritized and how they are addressed in a gender-sensitive way. Location and timing of services, access, accountability, and non-discrimination are important to engender the healthcare system. Engagement in post-2015 discussions is important to link sexual and reproductive health activists

1. Engendering Universal Health Care –
Experiences and Challenges
Gita Sen
Professor, Centre for Public Policy, IIM Bangalore
7th Australian Women’s Health Conference (Gender Matters:
Determining Women’s Health), Sydney, 7-10 May 2013

2. Why is this important now?
• UHC is at the centre of global debates on
‘Health in the post 2015 Development
Agenda’ – Botswana meeting, March 2013
• Multiple health goals of MDGs may well be
rolled into a single overarching goal, albeit
with multiple targets
• Attention to UHC (by WHO, World Bank,
UNICEF, others) much greater than ever
before

3. Why is this important now? Contd.
• In these discussions, UHC is assumed by many
to lead automatically to equity
• Or rather, equity is considered along the single
dimension of income / wealth
• Uneven attention to gender in prior UHC
discussion although some traditional aspects
of women’s health are not ignored, esp
maternal health

4. Framework for the role of gender as a social determinant of health
(Ref: Report of the Women and Gender Equity Knowledge
Network of WHO Commission on Social Determinants of Health)
Gendered Structural Determinants
Structural Processes ↔ Social/Gender
Stratification
Discriminatory
values, norms,
practices and
behaviours (A)
Differential exp &
vulnerabilities to
diseases, disabilities
and injuries (B)
Biases in health
systems (C)
Biases in health
research (D)
Health
Outcomes
Social &
Economic
Consequences
Structural causes
Intermediary factors
Consequences
Note: The dashed lines represent feedback effects

5. What’s the issue?
• 7 broad priorities of Knowledge Network on
Women and Gender Equity (WGEKN) of WHO
Commission on Social Determinants of Health:
– Addressing key structural issues
– Challenge gender norms and stereotypes
– Tackle gendered exposures and vulnerabilities
– Women as producers and consumer of health care
– Engendering the evidence base
– Mainstreaming requires supportive structures,
incentives and accountability mechanisms
– Support women’s orgns as catalysts of change

6. From the UHC perspective
• How does focusing on gender help?
• What can we say about equity – Davidson
Gwatkin’s ongoing work (ref: recent
presentation at Harvard conference on the
ethics of UHC) – ambiguous effects
• Pathway to UHC matters – whose problems
are addressed? How they are addressed?

8. Engendering the ‘cube’
• Example of services: importance of
– Location, timing
– Ensuring acknowledgement – the demand side
– Ensuring accountability – the supply side
– Addressing issues of abuse, genuine consent
– Access – privacy, confidentiality, permission
requirements, conditionalities, non-discrimination,
sensitivity of providers to signs of
violence

9. Final word…
• Pathways matter…
• Politics matters also – imp of engagement in
the post 2015 process; linking SRHR activists
(energy of the movement) to the mainstream
health discussions.