Building Back Fairer: Supporting Universal Access to Sexual and Reproductive Health

In low-resource settings and during times of crisis, sexual and reproductive health (SRH) services are often overlooked. This has been especially true during COVID-19. A recent report from UNFPA indicates that the pandemic disrupted contraceptive use for approximately 12 million women, resulting in an estimated 1.4 million unintended pregnancies across 115 low- and middle-income countries. Though data on gender-based violence (GBV) is limited, a rapid assessment by UN Women found that calls to GBV helplines have increased in 80% of reporting countries since the start of the pandemic. As we build back better from COVID-19, we have an opportunity to build fairer, more resilient health systems—health systems that prioritize equity, quality, and universal financial protection, and that can continue delivering key SRH services through periods of instability. That’s why for World Health Day this year, as the world convenes around the theme of “Building a Fairer, Healthier World,” we reflect on how EngenderHealth and other sexual and reproductive health and rights (SRHR) organizations can work to strengthen health systems to realize Universal Health Coverage (UHC), including universal access to SRH care.

Three Guiding Principles for Strengthening Health Systems

There are three core principles that guide EngenderHealth’s approach to health systems strengthening. We hope that sharing them may inspire other SRHR organizations to engage and challenge us as we strive to ensure universal access to SRH in the countries where we partner and work.

First, EngenderHealth helps countries achieve long-term impacts by working with and through governments to build resilient and equitable health policies and systems that advance UHC. A key component of this principle is non-substitution, which means that we do not build facilities or deliver services in ways that replace what local systems are doing; instead, we build the capacity of the government and local providers to deliver quality SRH care to promote sustainable change.

Second, we work with and through communities to prioritize people-centered primary healthcare, which is the backbone of health systems strengthening, UHC, and emergency preparedness. EngenderHealth’s work with facilities and communities at the national and sub-national levels focuses on: (1) ensuring availability of high-quality SRH services close to the communities; (2) promoting the role of women in communities as co-developers of health, including recognizing the gender-transformative power of self-care options; (3) strengthening existing community systems; and (4) working across multiple sectors to deliver key SRH services like comprehensive sexuality education and the prevention and mitigation of GBV.

Third, EngenderHealth integrates gender-transformative and inclusive programming throughout our health systems strengthening and UHC work. A gender-transformative approach is important not only because gender equality is a human right, but also because inequality and exclusion lead to poorer social determinants of health. In this domain, EngenderHealth works with communities on gender-transformative programming and partners with national governments to implement policies and guidelines that are inclusive, so that SRH service delivery is non-judgmental and respectful. Through our work, we aim to change harmful gender norms that prevent women, girls, and young people from making decisions that affect their own bodies and lives.

The Role of SRHR Organizations in Achieving Universal Health Coverage

EngenderHealth and other SRHR organizations have a key role – and a key stake – in achieving UHC. Inherently, there cannot be UHC without SRHR. But with COVID-19 shifting human and financial resources to the pandemic response and an economic recession that is diminishing funds, there is a real risk that the full spectrum of SRH services will not be included in national UHC benefit packages. As a few countries have started putting forth national UHC strategies, we are already seeing insufficient allocation of resources for gender-based violence, comprehensive sexuality education, and safe abortion services. Now is the time to prioritize working with governments and communities to help build fairer health systems that provide critical, gender-transformative sexual and reproductive health for all.