Financing Equality: Lessons from Global Champions of Gender-Responsive Health Systems

As the world moves closer to achieving Universal Health Coverage (UHC), the critical role of addressing gender disparities in health financing has become increasingly evident. Gender, as a social determinant of health, significantly influences access to care and health outcomes. However, addressing gender in health financing is both vital and complex, especially when focusing on the unique needs of women. Women often bear a disproportionate burden in health systems, not only due to biological factors but also because of entrenched social, cultural, and economic inequities. This blog explores how these inequities manifest, considers strategies for addressing them, and highlights global examples of success in fostering gender-responsive health systems.

Why do these inequities exist?

Gender-based inequities in health financing stem from structural, socio-cultural, and economic factors that interact in ways that disproportionately disadvantage women and other marginalised gender groups. Women, for instance, tend to have greater healthcare needs than men due to reproductive functions, higher life expectancy, and an increased prevalence of certain chronic conditions. Economic disparities compound the issue, as women in low- and middle-income countries generally have lower incomes and less control over household finances, limiting their ability to pay for healthcare. Furthermore, social and cultural barriers, including restrictive gender norms and roles, often curtail women’s autonomy in making health decisions or accessing services. Health insurance schemes may also fail to adequately cover services primarily needed by women, such as maternal health care, leaving critical gaps in coverage.

Addressing these inequities requires a gender-responsive approach to all functions of health financing, starting with revenue generation. Women are disproportionately represented among low-income populations, often due to wage gaps and high rates of informal employment. Progressive taxation can ease the financial burden on these groups, while community-based health insurance schemes can provide coverage for women working in informal or part-time roles. Digital financial inclusion, through platforms such as mobile wallets and payment systems, offers another avenue to channel subsidies and enable premium contributions, particularly in underserved and rural areas. These strategies recognise the socio-economic realities faced by women and ensure they are not excluded from health financing systems.

Risk pooling is another critical area where gender considerations are essential. Inclusive risk pooling ensures women’s unique health and financial needs are addressed by encouraging mandatory participation and cross-subsidisation. This approach, endorsed by the World Health Organization, allows lower-income or higher-risk individuals—often women—to receive support from wealthier or lower-risk participants. For such systems to be equitable, they must include targeted subsidies for low-income groups, ensuring no one is left behind.

Purchasing health services also offers an opportunity to advance gender equity. By ensuring that health insurance schemes cover essential services such as reproductive and maternal health care, countries can significantly improve women’s access to care. Reducing or eliminating co-payments for services predominantly used by women and incentivising maternal health services through provider payment methods can further reduce financial barriers. Additionally, monitoring performance indicators for gender-specific services, quality of care, and patient satisfaction ensures that gender equity remains a core focus of purchasing decisions.

Country Experiences 

Some countries provide valuable examples of how gender-responsive health financing can transform health outcomes. Rwanda’s Mutuelles de Santé, a community-based health insurance scheme, has dramatically improved women’s access to healthcare. By 2020, it covered 84% of the population, with a particular emphasis on maternal health services. This focus has contributed to a significant reduction in maternal mortality rates, showcasing the potential of targeted health financing.

Thailand’s Universal Coverage Scheme has also been lauded for its gender-responsive approach. By offering comprehensive reproductive health services, including maternal care, family planning, and cervical cancer screening, the scheme has achieved significant improvements in women’s health outcomes, including a 44% reduction in maternal mortality between 2000 and 2015.

India’s Ayushman Bharat scheme, launched in 2018, aims to provide health insurance to 500 million people, with a specific focus on vulnerable populations. It demonstrates gender sensitivity by ensuring automatic eligibility for households headed by women and providing comprehensive coverage for maternal health services.

Mexico’s Seguro Popular programme, which operated from 2003 to 2019, significantly reduced gender disparities in health financing by offering free insurance to informal sector workers, many of whom were women. By providing comprehensive coverage for women’s health services, the programme helped reduce catastrophic health expenditures for poor households by 30%.

Despite these successes, achieving gender equity in health financing remains a formidable challenge. Persistent gender norms, limited political commitment, and resource constraints continue to hinder progress. To address these barriers, countries must mainstream gender into health policy development and implementation. This includes investing in gender-sensitive health information systems, engaging women in decision-making processes, and promoting intersectoral collaboration to tackle broader inequalities that affect health outcomes.

At Amref Health Africa, we believe that building gender-responsive health financing systems is not just a matter of equity—it is essential to ensuring universal access to quality healthcare without financial hardship. Countries like Rwanda, Thailand, India, and Mexico offer invaluable lessons on how targeted strategies can reduce gender disparities and significantly improve health outcomes. As nations continue reforming their health systems, prioritising gender equity in health financing policies is more critical than ever.

The upcoming Africa Health Agenda International Conference (AHAIC), scheduled from 2nd to 5th March 2025 in Kigali, presents a unique platform to delve into these pressing issues. At AHAIC, stakeholders from across Africa and the globe will come together to share best practices and innovative strategies that have been adopted to tackle gender disparities in health financing, in among other topics. These discussions will provide a crucial opportunity to inspire bold commitments and transformative actions to address the unique health needs and barriers faced by diverse gender groups. Together, by shaping a deeper understanding of gender-responsive health financing, we can catalyse impactful solutions that promote health equity and accelerate progress toward Universal Health Coverage for all.

About the Authors 

Charlotte Muheki, Technical Director, Primary Health Care, Health Systems Strengthening Directorate, Amref Health Africa 

Olatubosun Akinola, Technical Director, Health Financing, Health Systems Strengthening Directorate, Amref Health Africa