Ravindran BMC Public Health 2012, 12(Suppl 1):S4 http://www.biomedcentral.com/1471-2458/12/S1/S4 P R O C E E D I N G S Open Access Universal access: making health systems work for women TK Sundari Ravindran From Universal Coverage: Can We Guarantee Health For All? Bandar Sunway, Malaysia. 3-4 October 2011 Abstract Universal coverage by health services is one of the core obligations that any legitimate government should fulfil vis- à-vis its citizens. However, universal coverage may not in itself ensure universal access to health care. Among the many challenges to ensuring universal coverage as well as access to health care are structural inequalities by caste, race, ethnicity and gender. Based on a review of published literature and applying a gender-analysis framework, this paper highlights ways in which the policies aimed at promoting universal coverage may not benefit women to the same extent as men because of gender-based differentials and inequalities in societies. It also explores how ‘gender- blind’ organisation and delivery of health care services may deny universal access to women even when universal coverage has been nominally achieved. The paper then makes recommendations for addressing these. Background Universal coverage is a term defined and understood differently by different people. In this paper, we use the term ‘universal coverage’ to mean that ‘financing and organisational arrangements are sufficient to cover the entire population, removing ability to pay as a barrier to accessing health services and protecting people from financial risks [1].’ ‘Coverage’ of a population essentially means that when the population seeks health care, they are assured of receiving at least a package of essential services at affordable or no cost at the point of service delivery. Achieving universal coverage calls for progress in three dimensions (fig 1). One is expanding the extent of financial protection available to the population, prin- cipally through reducing out-of-pocket expenditure. The second is putting in place organisational and financial mechanisms so that an increasing proportion of the population gets financial protection. The third is widen- ing the range of services which are available at subsi- dised or no costs, so that services for which one will have to pay out-of-pocket (and hence face financial risks) are gradually minimised [2]. Correspondence: ravindrans@usa.net Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College P.O, Trivandrum- 695 011, Kerala, India Universal access is a concept that includes but goes beyond universal coverage. It implies ‘the absence of geo- graphic, financial, organizational, socio-cultural and gender- based barriers to care [1].’ In other words, universal access calls for making health systems functional and remove sup- ply-side barriers, and for removing demand side barriers such as social exclusion and discrimination, lack of informa- tion and lack of decision-making power to seek health care. Among the many challenges to ensuring universal coverage as well as access to health care are structural inequalities by caste, race, ethnicity and gender. This paper, based on a review of published literature, high- lights ways in which policies aimed at promoting univer- sal coverage may not benefit women to the same extent as men because of health system’s failure to recognise and address gender-based differentials and inequalities in societies. It also illustrates how, while universal cover- age that factors in-gender may be a step in the right direction, universal access may still delude women because of gender-blind organisation and delivery of health care services. The paper then makes recommen- dations for addressing these. Methods This paper draws on a larger publication prepared by this author for the World Health Organization on “Gender, © 2012 Ravindran; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.