| Revenue raising |
Fairness of financial contributions: who is paying for health care? How is that changing over time How far does the burden fall disproportionately on one sex? What is the gender implication of changing revenue sources (e.g. out of pocket likely to fall heavily on women; prepaid mechanisms may be more protective)? How do different payment systems affect men and women’s access to health care? How are they affected by household arrangements (livelihoods, access to cash, decision-making power etc.) and how do they affect these in turn? What is the pattern of private and public funding and what does that mean for meeting the needs of different population groups? |
This has received most attention but focussed on questions 4 and 5, especially in relation to user fees. Other areas need more probing |
| Risk pooling |
Who is protected under different risk pooling systems (tax-based, insurance, prepaid mechanisms etc.)? How effective are the risks pools in protecting men and women against health shocks (ensuring access and also financial protection)? |
This question is usually examined in relation to quintiles, but not gender |
| Resource allocation |
How do patterns of resource allocation at different levels (national, regional, district) and within different systems and schemes affect equity of access and use for both genders, as well as quality of care? (Not just allocation of funding, but also infrastructure, human resources, etc.)
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This is an important but neglected area |
| Purchasing |
Which programmes are being prioritized for funding and how do these reflect different gender needs? Does the public/private mix serve the interests of both men and women effectively? Are gender-sensitive services being purchased (e.g. facilities which provide confidentiality, sensitivity, right staffing mix, at appropriate opening times, etc.)? Are provider payment mechanisms incentivising appropriate and high quality services for both genders? |
Work has been done on resource allocation to mother and child health and sexual and reproductive health programmes but limited wider analysis (including of gender implications of different public private partnerships) |
| Benefits package |
Is there a clear and fair entitlement to services? Are different genders equally aware of them and able to access without stigma? Do utilization patterns suggest that needs are being fairly met across the genders, or are there remaining financial and social barriers? |
Not usually approached from a gender angle, but benefits packages do have gendered implications (e.g. may neglect some common male conditions, or important elements for women, such as family planning, safe abortion, infertility treatment and treatment for victims of sexual violence) |
| Health financing governance |
Is there adequate and fair representation of different genders in health financing governance structures? Who is represented in health facility management committees, for example? Who decides on resource allocations?, etc. Does the regulatory system ensure fairness and quality of care for both genders? |
This is an important but neglected area |
