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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 23, 2015 - Issue 45: Knowledge, evidence, practice and power
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Sexual and reproductive health and rights in changing health systems

This paper explores what introduction of concepts of universal health coverage and care mean for sexual and reproductive health and rights, and for gender equity in health. Health system reform that does not address the core elements of the sexual and reproductive health and rights agenda will fail to meet important criteria of equality of access and affordability and will fail to meet the need for acceptability and quality in health services. Such reform could also remain weak on accountability. Although many elements in the concept of universal health coverage (such as its core principle of universality and its recognition of critical systemic factors) have value for sexual and reproductive health, there are missing or weak aspects, especially the assumption that universality will automatically result in equity. To achieve equity and equality and therefore to be consistent in achieving girls’ and women’s sexual and reproductive health, it is necessary that girls’ and women’s needs and concerns are centrally included in the systemic changes that universal health care promotes. These include: ensuring that financing and other mechanisms incentivise health providers to focus on persons rather than particular diseases or health conditions; regulating mixed public-private systems that use criteria of equality, quality, scientific rigour and human rights compliance; providing a comprehensive and integrated set of sexual and reproductive health services over the life course of all girls and women that reaches those who cannot easily access health services; and ensuring that institutions that monitor, evaluate and set benchmarks toward universal health care coverage include benchmarking, standard-setting and monitoring and evaluation of sexual and reproductive health services. There must be both vertical and horizontal accountability through effective voice and participation by women's and young people's organisations in planning, monitoring and reviewing all health services.1

1. Sen G, Govender V. Sexual and reproductive health and rights in changing health systems. Global Public Health 2015;10(2):228-242. http://dx.doi.org/10.1080/17441692.2014.986161.

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