IWHC's Work on Health Sector Reforms

Since the early 1990s, many developing countries have undertaken health sector reforms: far-reaching, fundamental changes intended to improve the overall efficiency, equity, and effectiveness of their health systems. Also in the early 1990s, 179 governments worldwide signed the Cairo Programme of Action—a landmark agreement that recognized the need to replace top-down population policies and demographic targets with a more rights-based approach to individual health, and a particular emphasis on reproductive health. This approach also identified women’s empowerment as a critical element in achieving healthy, stable populations, and recognized that health systems would have to be strengthened in order to deliver the kind of comprehensive services women need to attain an acceptable standard of sexual and reproductive health. Finally, the idea that gender differences and poverty are important structural determinants of health was also recognized.

Despite these progressive commitments, however, many of the health sector reforms undertaken during the 1990s have done little to improve the quality or the accessibility of reproductive health services for women. The current biomedical approach to health care—reflected in many reform efforts—largely ignores the importance of poverty and gender as determinants of health, and often may reinforce rather than address social and economic inequalities between men and women. A review of existing research on the impact of health sector reform indicates that in most health systems, men and women are not treated equally even when they have common health needs; and when their health needs are different, these differences are not addressed equitably. Women lack equal access to health services and bear a disproportionate burden of providing health care to their families and communities. The hierarchical health workforce is predominantly female, but positions of influence and power remain largely held by men.

Gender often determines who has access to health services; how decisions are made at the family, community, and sector levels; and how resources are allocated, most reforms are prepared using a “gender-blind” approach. This approach has resulted in a disproportionately negative effect on girls’ and women’s ability to benefit from the reform process. Evidence suggests that the best way to address this problem is to ensure that women, women’s organizations, and other civil society actors play a central role in both reform design and implementation. When women themselves participate in these processes, the resulting reforms tend to reflect their needs and realities more effectively.

More research is urgently needed to determine the impact of health sector reforms on women’s health. IWHC is currently supporting efforts in a number of countries and through a number of international agencies to ensure that health sector reforms recognize and address social and economic inequalities. We are also helping to develop a base of resources that analyze these reforms from a gender perspective, accessible in the orange box on the right side of this page.