Comments on Gender Equity and Universal Health Coverage
9 December 2022
On the occasion of Universal Health Coverage Day, December 12 – Women in Global Health spoke to recent awardees of the 2022 Heroines of Health, Dr Sara Saaed Khurram and Dr Iffat Zafar Aga. As co-founders of Sehat Kahani, a telemedicine start-up in Pakistan, the 2022 Heroines have reached 1.8 million people with remote health consultations and services across their native country. Here they comment on the importance of gender equity towards the achievement of UHC, and their role in addressing a gender-sensitive health response in Pakistan.
How are you currently addressing gender equity toward the achievement of Universal Health Coverage in your work?
It is imperative to highlight women’s role as providers, beneficiaries, leaders, and advocates for access to adequate health care. At Sehat Kahani, not only do we focus on empowering female physicians and other female health care professionals to optimize their medical practice through digital mediums, we also enable more and more female patients to access services through our telemedicine platform.
There is much to be done to ensure adequate support to front-line health workers, to meaningfully engage all stakeholders in decision-making and to ensure gender-equitable responses. A gender-sensitive response to disease outbreaks is crucial, and responses will be more likely to be effective for everyone if there is diversity in leadership panels.
Through Sehat Kahani, a women-owned and led telemedicine initiative with 75% women leadership in place, we have created a network of 7,500 healthcare professionals; 80% of which are females. Similarly, to date Sehat Kahani has successfully catered to 1.8 million consultations out of which around 68% are female patients who were unable to access services otherwise.
What are the biggest barriers for women that you see when we think about making progress on Universal Health Coverage?
Limited geographic access to primary care is one of the most important and hardest challenges for achieving UHC and improving population health in developing countries. Women and girls are still struggling to access health services, and are disproportionately affected by barriers to accessing and using health services. For example, women and girls experience structural barriers, including financial hardship, lack of transport (especially if they live in rural areas) and lack of time because of a care burden or other unpaid labor.
In addition, a significant proportion of women globally do not participate in waged employment and for those who do, they work mostly in the informal sector. Social insurance schemes are therefore likely to exclude a vast majority of women except those who are covered as dependents of formal sector employees, resulting in exclusion from universal health coverage. Most health programs are targeted at maternal and child health services. What this means in practice is that adolescent girls and older women are among subgroups of women often excluded from coverage. This is because of the almost exclusive focus on maternal health needs in services covered by prepayment schemes and essential service packages.
You are working on providing access to a range of services, including sexual and reproductive health and rights services (SRHR) in Pakistan. What are the biggest challenges?
Pakistan struggles with high maternal mortality ratios, adolescent birth rates and unmet need for contraception. The country has the third highest burden of maternal, fetal and child mortality globally. It is considered a great taboo to access SRH services even today whether it is a married or an unmarried female. Then other major gaps remain at both service delivery and policy level, preventing adequate access to basic health facilities. Denying these rights have grave consequences that exacerbate poverty and inequality. It can lead to greater vulnerabilities to gender-related ill health, unintended pregnancies, maternal death, harmful cultural practices and sexual and gender-based violence.
One of the challenges is that millions of girls and women are currently “invisible”, preventing them from fully participating in their communities and restricting their access to rights and opportunities. Their invisibility is exacerbated by incomplete, missing or underutilized data about the barriers that girls and women face, their potential to transform societies, and what works to improve their wellbeing. The challenges are more deeply felt at the bottom of the socioeconomic pyramid. Girls deprived of opportunities at home are vulnerable in their communities and marginalized in society
For the achievement of UHC, gender equality is critically important to redress gender power dynamics and ensure and protect women’s and children’s rights, including: supporting women’s empowerment in the health workforce, advancing sexual and reproductive health, changing harmful gender norms, and eliminating political, economic and social gender barriers that prevent all people from enjoying their right to health
What steps can countries take to advance towards UHC and universal access to quality SRHR services and interventions?
Sehat Kahani has been an advocate for promoting SRHR in marginalized communities through the implementation of SRH services. We are working to realize SRHR needs of marginalized populations in Pakistan that is free from discrimination, coercion, and violence. We have conducted several projects that have focused on gaining insights on common factors for poor SRH practices in low-income communities and have provided SRH education and services to the beneficiaries via our telemedicine platform. Our goal is to strengthen effective community based action and joint advocacy for improved SRHR.
The integration and better coordination of SRHR in health and policy interventions and programs play an important role in improving health and wellbeing for all. Delivering on SRHR ensuring that citizens are free to make their own choices about their bodies without any forms of discrimination, stigma, violence or coercion. Another crucial element is the establishment of resilient health systems, which allow for task shifting to different facilities and community-based cadres to deliver quality health care and services.
