Evidence examined in this paper, while not conclusive, indicates that universal coverage is likely to exclude more women than men, and even when achieved unlikely to translate into universal access to health care for women unless factors contributing to inequalities in affordability, availability and access to health care by women are systematically addressed. Based on the findings about the nature of barriers that women face, the following is a tentative agenda for action to make health systems work for women.
• When implementing insurance reforms, such as introduction of Social Health Insurance /Micro-Insurance, special attention is to be paid to coverage of women. Partially or fully subsidising premium payments for those who cannot afford to pay, and being aware that women, even when they belong to better-off households may fall within this category, would be important. Making households as the unit of enrolment in insurance schemes would help extend insurance coverage to women and other household members with low decision-making making power and financial resources.
• Social Protection Health Schemes and Conditional Cash Transfers should be free of conditionality and administrative procedures which may exclude the most marginalized women. Cash incentives made available as part of CCTs should be adequate to protect women from catastrophic health expenditures.
• For expanding ‘health care’ coverage to adequately cover women’s health needs, the range and content of services provided need to address differences between women and men in terms of conditions that occur exclusively in women or men; that are more common; manifest differently; more severe or with more serious consequences; and with different risk factors, for women or men.
• The range of reproductive health services in the Essential Services Package need to go beyond antenatal care and family planning, to include, at the least, skilled attendance at delivery and essential gynaecological services.
• Expanding health care coverage also calls for insurance schemes that are large enough to ensure effective risk pooling and cross-subsidising. Micro-insurance schemes will have to be subsidised to be able to include sexual and reproductive health services in the benefits package.
• Attention to gender differences in factors affecting health seeking behaviour should inform the location and timing of services. Services available closer to home or workplace and at times suitable to women or men are more likely to be utilised, and could make a big difference to identification of morbidity and effective treatment and cure.
• Changes towards more democratic and gender-sensitive provider-patient interactions are needed in the service -delivery setting. At the minimum, there should be no physical or verbal abuse of any patient by any member of the health team.
All of these are feasible given the political will. For, gender inequality is not a problem without a solution. What is needed is the political will and determination amidst policy makers at the highest level in international agencies and national governments [45