Globalization, Health Sector Reform, Gender and ... - Ford Foundation

The “Targeting Women” Approach Failsto Address Society-Wide Gender InequalitiesMost sector programs “target” poor women to strengthen reproductivehealth and gender equity in health. However, the targetingapproach is partial and ineffective as a tool of gender-awarehealth strategy (Elson and Evers, 1998; Gilson, 1998). For instance,gender disaggregated indicators may show that most healthclinics do not have women doctors, so gender-specific policy componentsmay target expenditure for training more women doctors.However, without addressing the special problems womenface in finding the time and/or money to travel to and from aclinic—regardless of the presence of a female doctor—women’sneeds will not be adequately met. In a report for UNICEF,Vandemoortele (2000) concludes that narrow targeting of servicesto the most needy is likely to yield savings that are “penny-wisebut pound-foolish.”The targeting approachshows little appreciationof the ways in whichgender inequalitieshave an impact on thecauses of poor healthamong the populationas a whole.By relying on better targeting, health sector reforms do not considerthe ways in which gendered norms pose particular difficultiesfor women providers and users—such as the problems facedby women doctors in re-locating to rural areas or women’s tendencyto undervalue their own health needs in comparison to thoseof their children and husbands.Broadly speaking, targeting does not take into account the sectorwideand society-wide gender inequalities that influence women’sreproductive health status, women’s access to reproductive healthservices, and gender inequalities and gender bias in human resourcemanagement which have a strong bearing on the quality ofcare in reproductive health service delivery (see Standing, H., 1997,1999, for a gender analysis of the human resource aspects of HSR).The targeting approach shows little appreciation of the ways inwhich gender inequalities among both providers and users of healthservices have an impact on the causes of poor health among thepopulation as whole. Some donors take these points on board.For instance, CIDA policy notes that “women are the main caregiversfor all the family; empowering girls and women throughcommunity development and access to education is the key tosocial and economic development, and the health of children, familiesand communities.” (CIDA, 1996, p.5, cited in Elson and Evers,1998). Yet the design of services and training which reflects thisunderstanding tend to be absent from the implementation stage ofsector programs.26