Earlier this month I attended the Women Deliver 2019 global conference in Vancouver, Canada. More than 6,000 world leaders, influencers, advocates, academics and activists gathered to discuss and find ways to meet girls’ and women’s right to health and gender equality. It was a great platform for sharing experiences on progress towards a more gender equal world and how this is key to catalysing progress across all the Sustainable Development Goals (SDGs). It was particularly useful and interesting to understand how all those conversations contribute to countries’ progress on universal health coverage (UHC) – given that UHC itself is based on concepts of equity.
Prioritise girls’ issues within UHC
All too often at global health conferences, women’s health and girls’ health are linked together. This has benefits – for example, more financial investment and a life-cycle approach to care. But it also risks overlooking issues that are unique to adolescent girls. For example, global data shows that:
- 13 million adolescent girls give birth every year.
- They face a higher risk of maternal mortality and morbidity than adult women.
- Children of adolescent mothers are at a higher risk of neonatal, infant and child mortality and morbidity.
- 60% of sexually active adolescent girls in developing countries have an unmet need for family planning.
- Early childbearing among adolescent girls perpetuates the intergenerational cycle of malnutrition.
Clearly, there are many good reasons to prioritise girls’ issues as a distinct objective within UHC packages. Doing this presents an opportunity to build on previous investments made in child survival: many girls have benefited from the gains in child health, nutrition and other areas of development that drive the need to meet the SDGs and UHC. Now, in adolescence, these girls and young women have arrived at a critical moment in their lives. The healthcare they receive now can lay stronger foundations for adolescent and adult women post 2030.
What’s the way forward?
While there is no standard approach for reaching UHC, it’s critical that steps towards UHC don’t embed existing inequalities more deeply. National UHC packages must be deliberate, objective and persistent in ensuring that they reach the most vulnerable and marginalised people. For adolescent girls, this means countries’ UHC packages should reflect how they seek, experience and are provided with healthcare. Adolescent girls should be meaningfully engaged in the process.
1 Empower girls to protect their health with comprehensive sexuality education (CSE)
SDG 3.7 calls for “universal access to sexual and reproductive health care services, including for family planning, information and education”. Conversely, in many contexts adolescent girls face multiple challenges to accessing sexuality education. Through providing age-appropriate information and developing skills, CSE empowers adolescent girls to take personal responsibility for their sexual and reproductive health and overall wellbeing. If the UHC movement envisions a world in which no adolescent girl will be left behind, then UHC reforms should include CSE from the onset.
2 Invest in primary health care (PHC)
PHC remains the foundation of any great health system. It can meet the majority of an individual’s health needs and fast-track progress towards the goal of “health for all by 2030”. But first and foremost governments will need to increase domestic public health expenditure towards a target of 5% of gross domestic product at the PHC level. Investing in strengthening PHC and community systems will, according to the World Health Organization, “deliver better health outcomes, efficiency and improved quality of care”. For adolescent girls, this will potentially mean travelling shorter distances to access healthcare and the opportunity to seek healthcare in a secure, familiar and trusted space by people from their communities.
3 Remove out-of-pocket spending
The cost of healthcare is a common barrier that discourages people, even paid workers in many countries, from seeking services and discussing their needs. Paying for healthcare and other reproductive health services places a high financial burden on adolescent girls and their families. A simple way for countries to prioritise adolescent girls within UHC is by removing user fees and prioritising PHC services – including a guaranteed package for sexual and reproductive health services and commodities – reaching those who are most deprived and marginalised first. It will help bridge financial barriers and enable adolescent girls to seek timely healthcare and without worrying about the financial implications.
4 Data – collect, analyse, and use gender- and age-disaggregated data
A lack of sex- and age-disaggregated data analysis of health systems means the specific needs of adolescent girls are not considered and is a persistent obstacle to the realisation of girl’s health and rights. To deliver on UHC promise of reaching the most vulnerable and marginalised groups – and to know whether we’re delivering on it – national health information systems must be revised to include sex- and age-disaggregated date analysis and usage.