Health Policy and Planning, Vol 12, 1-18, Copyright © 1997 by Oxford University Press
H Standing
This paper reviews current literature and debates about Health Sector
Reform (HSR) in developing countries in the context of its possible
implications for women's health and for gender equity. It points out that
gender is a significant marker of social and economic vulnerability which
is manifest in inequalities of access to health care and in women's and
men's different positioning as users and producers of health care. Any
analysis of equity must therefore include a consideration of gender issues.
Two main approaches to thinking about gender issues in health care are
distinguished - a 'women's health' approach, and a 'gender inequality'
approach. The framework developed by Cassels (1995), highlighting six main
components of HSR, is used to try to pinpoint the implications of HSR in
relation to both of these approaches. This review makes no claim to
sociological or geographical comprehensiveness. It attempts instead to
provide an analysis of the gender and women's health issues most likely to
be associated with each of the major elements of HSR and to outline the
actual impact of HSR from a gender point of view and in relation to
substantive forms of vulnerability (e.g. particular categories of women,
specific age groups). The use of generic categories, such as 'the poor' or
'very poor' leads to insufficient disaggregation of the impact of changes
in the terms on which health care is provided. This suggests the need for
more carefully focused data collection and empirical research.
ARTICLES
Gender and equity in health sector reform programmes: a review
Centre for Culture, Development and the Environment, University of Sussex, Brighton, UK; Health Sector Reform Programme, Liverpool School of Tropical Medicine, Liverpool, UK
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