Gender equity in health financing towards achieving universal health coverage: What does it take to successfully address inequities that affect women's access to healthcare?

Background and objectiveHealth financing is recognised as the most critical health system component to achieve UHC. UHC is built on the principle of equity, yet UHC and health financing strategies are still gender-blind and perpetuate pervasive gender inequities. This thesis is a realist review that assesses how to address gender inequities in health financing that affect women’s ability to access and utilise healthcare services according to their needs, compared to men. It aims to define the conditions for the success of policies and programmes in addressing those inequities.MethodsThe thesis is theory-driven and follows the standard realist review approach. Three theories were formulated. An initial search using PubMed was completed to identify policies across geographies and intervention types for which there is evidence of successful impact on gender inequities. Additional literature was identified to test theories across certain geographies and intervention types.Results and conclusionsThe theories were overall confirmed and enriched. Policies and programmes proactively integrating gender perspectives and addressing intersectional factors are more likely to improve women’s ability to utilise a financial protection scheme and to receive quality care. Health financing programmes complemented with investments and interventions to improve the capacity and quality of healthcare delivery are more likely to benefit women. UHC schemes should carefully consider the gender implications of enrolment criteria and methods in the design and execution of their benefit packages. Across diverse contexts, social participation and community engagement are critical success factors to contribute to addressing gendered social and cultural barriers and help sustain political will and government commitment towards gender-equitable health financing programmes and UHC reforms.