On March 8, 2017, to commemorate the International Women's Day, the Pan American Health Organization (PAHO/WHO) organized a dialogue entitled "Women's Access to Social Protection in Health" highlighting how the realities of women's unequal participation in the labor market can make the difference between their access to universal health on the one hand, and the disproportionate risks of catastrophic health expenditures and inability to access care on the other.

Ernesto Báscolo, Regional Advisor on Governance, Leadership, Policy and Planning, participated in the dialogue, analyzing the main challenges faced by women in terms of access to social protection in health regarding PAHO's Strategy for Universal Access to Health and Universal Health Coverage, from the perspective of health systems in the region. Below are some of the reflections shared by Ernesto Bascolo at the meeting.

In the countries of the Region, which are the main challenges faced by social protection systems to address women's health?

In the Region of the Americas, there isn't a single model of social protection system. Therefore, it is necessary to distinguish between different social protection systems and their relation to women's health.

First, there are countries that choose to strengthen their social protection system through the social security system, so the extension of financing coverage acquires relevance. Within this framework, women's health challenges depend on their type of coverage, which can be either through their participation in the formal labor market, or as a family member on their couple's coverage. In both situations, significant limitations exist. In the first case, the limitations exist because women have a lower participation in the labor market compared to men. In the second case, there are limitations because many social security systems still offer very limited family coverage, in terms of services' coverage and in terms of the inclusion of all family members.

Second, other countries choose to strengthen their social protection system by expanding the supply of public health services to the population, without the need for social security coverage. In this case, the challenge lies in having sufficient public funding to develop a health care model focused on the needs of people and communities. The main challenge for women's health is to achieve sufficient access conditions. Given that women experience more needs for the use of health services, the barriers to access the services are more evident in this case. For this reason, women pay more than men in out-of-pocket expenses.

Third, because most health systems in the Americas are segmented with different coverage systems for different population groups (depending on their contribution capacity or pay capacity), there are inequities in access. Women's health suffers from these same conditions of inequity.

How can the challenges of women's health be addressed through the Strategy for Universal Access to Health and Universal Health Coverage?

To answer this question, we need to analyze the four line of action of the Strategy.

First, the strengthening of health care models that focus on the needs of people and communities requires an adaptation to women's social and cultural characteristics in our region. This adaptation is critical to overcome many kinds of barriers: cultural, organizational, geographical and economic. This last barrier is explicitly related to the third line of action that proposes to move towards the elimination of direct payment, understood as the costs that individuals face for health services fees.

Second, the line of action to strengthen intersectoral coordination to address social determinants of health has included diverse manifestations and programs. Conditional transfer programs have produced good results in terms of income redistribution. In these cases, women assumed a key role as a subject of the law and as a manager of those resources.

Finally, stewardship and governance are part of a strategic line that emphasizes that collective action is necessary for the processes of institutional transformation. It is essential to highlight the political role of women as part collective action. In this way, it is necessary to emphasize the relevance of women not only as a subject of the law, but as a key actor involved in policy making and implementation processes.


International Women's Day 2017

"Women's Access to Social Protection in Health" in a changing world of work

PAHO. Health Systems and Services (HSS)