Event Summary: The missing link in UHC is women's and girls' health needs
An UNGA side event highlighted progress made by Georgia and Rwanda and shared tools for accelerating equitable health care coverage
One of the greatest challenges to achieving universal health coverage (UHC) is the delivery of sexual and reproductive health and rights (SRHR). Comprehensive SRHR services are often not included in national strategies or government- sponsored health benefits packages. Notably, women are often not consulted in the design of the national health policies and programs that affect them the most.
A few data points illustrate this challenge: more than 200 million girls and women in low- and middle-income countries have an unmet need for modern contraception; 48 million women worldwide give birth without a skilled birth attendant each year; and 300,000 women die in childbirth annually.
Global women’s rights and health care activists met on September 15 at an Alliance for Gender Equality and Universal Health Coverage side event at the United Nations General Assembly in New York to highlight how some countries are showing a path forward. They also committed to accelerating progress and shared a new advocacy guide to help bring about change.
“UHC has the potential to transform the lives and life chances of all women and girls. But millions face social and financial barriers to accessing the quality health services they need throughout their life cycles," said Ann Keeling, a Senior Fellow at Women in Global Health, which convened the event with Women Deliver and SPECTRA Rwanda in advance of the second U.N. High Level Meeting on Universal Health Coverage scheduled for 2023.
The solution, added Keeling, is recognizing women’s needs as users of health systems and including women at the table as leaders within those systems. “We want to see processes led by women and that listen to women,” she said.
Participants in the event highlighted two countries that have recently made progress toward this goal: Georgia and Rwanda.
Tamila Barkalaia, Georgia's deputy minister of labor, health and social affairs, shared policy reforms introduced as part of her country's Universal Health Care Program in 2013, which extended access to publicly financed health services to most of the population. The reforms also included specific measures aimed at making health services more responsive to women’s needs.
To identify, understand, and address the challenges faced by women, the Georgian government, in partnership with funders, conducted national surveys that found that a lack of awareness, social stigma, and a lack of clinical competencies undermined women’s health outcomes. The government responded to these challenges with a strategy and action plan that focused on maternal and neonatal health, and the availability and quality of family planning and sexual and reproductive health services. The plan included expanded trainings for service providers.
The country also launched routine clinical audits of maternal and neonatal mortality cases in 2017. These comprehensive audits identified causes, gaps, and deficiencies in existing practices, protocols, and skills in the health system to improve health outcomes. More recently, the country passed legal reforms to support gender equality and developed the first free, online training module for health care practitioners to improve the quality of care provided to women.
“These are solid steps towards achieving universal access to high-quality sexual and reproductive health care for women,” said Barkalaia.
Chantal Muhoza, executive director of SPECTRA, outlined the drivers of Rwanda’s progress: a robust community health worker (CHW) program that extends services to the village level; a national health insurance program that is both affordable and community-based; one-stop centers that provide comprehensive services for gender-based violence; and massive investments in health infrastructure.
Rwanda now has 45,000 CHWs working across its 15,000 villages. Typically, each village has both a male and female CHW and one female Agent de Santé Maternelle, who provides maternal and newborn health care through home visits – reducing barriers to care for women who may not be able to leave their homesteads or may not be comfortable seeking care from a male provider.
The work continues, said Muhoza: “We are analyzing remaining gaps and pushing for a more human rights approach to reach vulnerable groups.”
To help other countries attain similar progress, Women Deliver launched a new advocacy guide called Advancing Sexual and Reproductive Health and Rights in Universal Health Care. The new guide builds on the WHO’s handbook on SRHR and UHC. The new guide is meant to strengthen advocacy to governments and other stakeholders to establish gender responsive UHC, which should include comprehensive sexual and reproductive health services.
The guide also provides tips for women's health advocates based on interviews with leaders around the world. It includes examples of advocacy successes, such as Zambia's decision that contraceptives, including oral contraception, implants, injectables, intrauterine devices, and emergency contraception, would be included in national health insurance as of January 2020.
Gender responsive health services are a smart investment and cost effective, added María Fernanda Espinosa Garcés, president of the 73rd session of UNGA and a former Ecuadorian cabinet minister. “We can’t have a fair or healthy world if we leave half of the population behind,” she said.
To view the full event, click here.
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