As we commemorate Universal Health Coverage (UHC) Day on the 12th of December, the Alliance for Gender Equality and UHC calls on governments to act on the UHC promise of health for all and to advance gender equality, women’s rights, and sexual and reproductive health and rights (SRHR). In 2019, governments agreed to the UN Political Declaration on UHC, the most comprehensive global agreement on health ever, but it has not been adequately implemented. And, it did not go far enough to meet the needs of every person and ensure health for all.
We urge governments to:
1. Stand by and deliver on the commitments made in the Political Declaration at the 2019 United Nations High-Level Meeting on UHC, including the strong commitments made to gender equality, the rights of women and girls, and women health workers.
2. Commit to and act on delivering comprehensive sexual and reproductive health (SRH) services as central to the UHC essential package of services.
● The full spectrum of SRH services, including those that can be self-managed/self-administered, must be integrated in primary health care (PHC) and UHC, and must be of high quality, available, acceptable and accessible to all women and girls in all their diversity.
● Prioritize inclusion of comprehensive sexuality education (CSE) as part of the comprehensive SRH services in the UHC essential services package, and ensure that adolescents have access to information and CSE in and outside of school.
3. Address gender inequities in leadership and ensure fair and equal compensation and opportunities in the health workforce, and support health workers in health budgets.
● Women health workers must have safe and decent work and those in the informal sector integrated into formal jobs. Women health workers, as 70% of health workers and 90% nurses and midwives, are delivering UHC. They have made an exceptional contribution during the COVID-19 pandemic, but significant numbers are now burned out and planning to leave the profession. Without women health workers there will be no UHC.
● Ensure access to training and leadership opportunities for women health workers. There is evidence that women, who were already marginalized to 25% of leadership roles, have lost ground in health sector governance during the pandemic.
4. Ensure women’s meaningful participation in UHC design, implementation and monitoring, and ensure their perspectives and voices are fully reflected. Engage with and fund women’s rights organizations, feminist leaders and community groups to understand the priorities of diverse girls and women, especially from marginalized groups.
5. Reinforce and reinvigorate the promotion, protection and fulfillment of women’s and girls’ human rights as crucial to advancing achievement of UHC. Despite significant progress in many countries on women’s rights, there is a backlash against the rights of diverse women and girls and gender equality at the global level and in many countries. No country can prosper or achieve UHC if women and girls lack fundamental rights or bodily autonomy. Lack of political will that hinders women’s and girls’ rights and bodily autonomy, also limits UHC.
6. Approach health financing with a gender equality lens as fundamental for the path toward UHC. Health financing for UHC must ensure adequate funding for SRH services to safeguard against out-of-pocket expenditures for services that largely impact women and girls. Health financing must be gender-responsive and transformative, using gender budgeting at the whole of government and the systems level, leaving no women or girls behind. Financing decisions should be made based upon the needs and realities of girls, women and gender diverse people.
7. Collect and analyze data disaggregated by sex and gender, as well as other intersecting characteristics such as age, race, class, (dis)ability, ethnicity and sexual orientation, in order to effectively identify and break down barriers that prevent girls and women from accessing health promotion, prevention, diagnosis, treatment and care.
This year’s UHC Day theme is “Build the world we want: A healthy future for all.” The world we, the Alliance and our partners, want is a world with the full realization of gender-responsive UHC. This means a world in which health systems are transformed to address determinants of health, build in climate resilience, and work for all people across the life course. On this UHC Day, the Alliance calls on governments, as the primary duty bearers for delivering health and securing human rights, to urgently act on the above priorities.