scholarly journals User fee policies and women’s empowerment: a systematic scoping review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Veronique Plouffe ◽  
Frank Bicaba ◽  
Abel Bicaba ◽  
Thomas Druetz
Keyword(s):  
Decision Making ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Healthcare Decision Making ◽  
User Fee ◽  
Free Healthcare ◽  
Universal Health

Abstract Background Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy’s positive effects impact on health-related indicators, the repercussions on women’s empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women’s empowerment. Methods A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis of the included articles was conducted using a thematic analysis approach. The material was organized based on the Gender at Work analytical framework. Results Out of the 206 initial records, nine articles were included in the review. The study settings include three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Four of them examine a direct association between user fee policies and women’s empowerment, while the others address this issue indirectly —mostly by examining gender equality or women’s decision-making in the context of free healthcare. The evidence suggests that user fee removal contributes to improving women’s capability to make health decisions through different mechanisms, but that the impact is limited. In the context of free healthcare, women’s healthcare decision-making power remains undermined because of social norms that are prevalent in the household, the community and the healthcare centers. In addition, women continue to endure limited access to and control over resources (mainly education, information and economic resources). Conclusion User fee removal policies alone are not enough to improve women’s healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women’s empowerment. A focus on “gender equitable access to healthcare” is needed to reconcile women’s empowerment and the efforts to achieve universal health coverage.

scholarly journals 22A Survey-Based Women's Empowerment Index for Low- and Middle-Income Countries: The SWPER Goes Global

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Fernanda Ewerling ◽  
Anita Raj ◽  
Cesar G Victora ◽  
Franciele Hellwig ◽  
Carolina VN Coll ◽  
...  
Keyword(s):  
Decision Making ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
African Countries ◽  
Middle Income ◽  
Household Decision ◽  
Middle Income Countries ◽  
World Regions ◽  
Country Rankings ◽  
Low And Middle Income

Abstract Background In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. We explored the applicability of the SWPER in national health surveys from countries in other world regions. Methods We used data from the latest Demographic and Health Survey for 62 low- and middle-income countries (LMICs) since 2000, and adapted the indicator so that it could be used for any LMIC. Adaptations included the exclusion of women's working status and recategorization of the household decision-making related items. We compared the loading patterns obtained from principal components analysis for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII). Results Most countries presented similar patterns regarding item loadings for the three SWPER empowerment domains. Correlations between the country-specific and global individual-level scores were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.71 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.82, 0.67, and 0.44, respectively, with GDI. Conclusions The SWPER global is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women's empowerment and allowing wider comparisons across countries and world regions.

scholarly journals SWPER Global: A survey-based women’s empowerment index expanded from Africa to all low- and middle-income countries

2020 ◽  
Author(s):  
Fernanda Ewerling ◽  
Anita Raj ◽  
Cesar G. Victora ◽  
Franciele Hellwig ◽  
Carolina V. N. Coll ◽  
...  
Keyword(s):  
Decision Making ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
List Type ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
World Regions ◽  
Over Time ◽  
Low And Middle Income

AbstractIntroductionIn 2017, a survey-based women’s empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. External validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception. To determine its value for global monitoring, we explored the applicability of the SWPER in national health surveys from low- and middle-income countries (LMICs) in other world regions.MethodsWe used data from the latest Demographic and Health Survey for 62 LMICs since 2000. 14 pre-selected questions (items) were considered during the validation process. Content adaptations included the exclusion of women’s working status and recategorization of the decision-making related items. We compared the loading patterns obtained from principal components analysis performed for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII) for external validation.ResultsConsistency regarding item loadings for the three SWPER empowerment domains was observed for most countries. Correlations between the scores generated for each country and global score obtained from the combined data were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.72 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.81, 0.67, and 0.44, respectively, with GII.ConclusionThe indicator we propose, named SWPER Global, is a suitable common measure of women’s empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women’s empowerment that allows for tracking of progress over time and across countries at the individual and country levels.SummaryWhat is already known?Although survey-based women’s empowerment indicators have been used in the literature, until 2017 there was no indicator proposed for use in a large set of countries that would be comparable between and within countries.In 2017, we proposed the Survey-based Women’s emPowERment indicator (SWPER, pronounced as “super”), to be used in African countries, that encompasses three wellrecognized domains of women’s empowerment (attitude to violence, social independenceand decision making).The external validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception.Validation of the index was restricted to African countries, and a common measure to allow comparisons across low and middle-income countries (LMICs) from all world regions was still lacking.What are the new findings?We show that the SWPER Global may serve as a valid common measure of women’s empowerment among LMICs, as consistent patterns were obtained for most countries and world regions.The SWPER Global index addresses the need for a single cross-cultural standardized survey-based indicator of women’s empowerment in the context of LMICs that enables comparability between countries and over time and subgroup analyses, extending previously proposed indicators such as the Gender Development Index which is limited to the country-levelWhat do the new findings imply?The SWPER Global index enables the study of how women’s empowerment is linked to developmental and health outcomes, allowing for broad comparisons across countries and world regions.As a comprehensive cross-cultural standard tool, it also contributes to the monitoring and accountability of country progress over time in advancing gender equality and women’s empowerment.The new tool may help target and prioritize policy and advocacy efforts toward SDG 5 (achieve gender equality and empower all women and girls) at the regional and country levels.

Universal healthcare in our lifetime? All teach, all learn

2019 ◽  
pp. 144-152
Author(s):  
Mark Britnell
Keyword(s):  
Health Coverage ◽  
National Elections ◽  
Middle Income ◽  
Universal Healthcare ◽  
Middle Income Countries ◽  
The World ◽  
Global Movement ◽  
Development Goals ◽  
The Caribbean ◽  
Universal Health

The United Nation’s Sustainable Development Goals of achieving universal health coverage (UHC) by 2030 have energized many governments to devise bold strategies and make big investments in their health systems. The global movement around UHC has gathered momentum at blistering speed. Within a few years it has transformed the focus of healthcare in low- and middle-income countries from a few diseases to a comprehensive vision of affordable, accessible, and acceptable care for all. In this chapter, Mark Britnell looks at how Philippines, Vietnam, Kenya, India, Indonesia, Columbia, Costa Rica, Panama, Nigeria, South Africa, Cyprus, islands across the Caribbean, and many others have announced significant UHC reforms since the development goals were passed in 2014, and UHC has been a headline issue in a number of national elections. He analyses UHC across the world, and looks to at the future of healthcare globally.

scholarly journals Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries

2020 ◽  
Vol 5 (8) ◽  
pp. e002205
Author(s):  
Sanam Roder-DeWan ◽  
Anna Gage ◽  
Lisa R Hirschhorn ◽  
Nana A Y Twum-Danso ◽  
Jerker Liljestrand ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Internet Survey ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Internet Users ◽  
Effective Care ◽  
Universal Health

IntroductionPeople’s confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.MethodsWe conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare.ResultsOf 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to ‘become very sick tomorrow’; 30% endorsed the health system, that is, agreed that it ‘works pretty well and only needs minor changes’. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76).ConclusionConfidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system.

scholarly journals Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA) - the cost evaluation of life-style related NCD interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Koot
Keyword(s):  
Scaling Up ◽  
Decision Makers ◽  
Cost Evaluation ◽  
Health Coverage ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Gains ◽  
The Cost ◽  
Universal Health

Abstract Vietnam, Myanmar, and Indonesia are trying to create innovative synergies within and between sectors to prevent and treat NCDs. Universal Health Coverage (UHC) is the objective of these countries. The challenge for decision makers in healthcare is to implement programmes and interventions that effectively contain NCDs at the lowest possible cost both in community-based and primary care facilities. The value of implementation and upscaling is assessed by estimating costs, savings and health gains. The presentation focuses on cost-effectiveness evaluation of the entire scaling-up, allowing for comparison within and among countries and generate recommendations for achieving UHC in low- and middle-income countries.

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