Ravindran BMC Public Health 2012, 12(Suppl 1):S4 http://www.biomedcentral.com/1471-2458/12/S1/S4 Page 2 of 7 Figure 1 Three dimensions to consider when moving towards universal coverage Source: World Health Report 2010, p.12 [2] Women and Primary Health Care Renewal” [3]. The search strategy adopted for information used in this paper consisted of searching Google, Medline and WHO websites using the following key words. For financial pro- tection and population coverage, the key words used along side ‘gender’ and ‘women’ were as follows: health financing, health insurance, community-based health insurance, health micro-insurance, out-of-pocket health expenditure, catastrophic health expenditure, and health equity. For health care coverage, the key words used were gender or women and/or essential service-packages, priority-setting and health. In addition, literature pertain- ing to laws and policies on the availability in the public sector in health of contraceptive and abortion services was searched. For information pertaining to barriers to access in organisation and delivery of health services, the key words used included gender/women and/or health- seeking behaviour, service delivery, social exclusion, dis- crimination, provider-client (provider-patient) relation- ship, quality of care. The publications were scanned for information relevant to the analysis of universal coverage from a gender perspective, i.e. examined for their impli- cations for women and men, boys and girls, of different social and economic groups and included publications that contained such information. Findings Gendered impact of Universal Coverage Reforms This section queries universal coverage reforms from a gender lens and presents evidence that suggests that Women, especially those from vulnerable population groups, are more likely to be excluded in terms of popu- lation coverage Essential and routine health needs of women often do not find a place in the package of services covered As a consequence of both the above, women are more at risk of having unmet need for health care and/ or less likely to receive adequate financial protection Coverage of women In order to achieve universal coverage, health financing mechanisms in a country would have to reduce the pro- portion of out-of-pocket payment and increase the share of health expenditure financed by health insurance or other prepayment mechanisms [4]. Health insurance is a mechanism for risk pooling and cross-subsidising across income groups, and eliminating or substantially reducing out-of-pocket payment at the point of service delivery. Insurance and other prepayment schemes are therefore an important mechanism for financial protection. The universal coverage reform package in many countries consists of a combination of large scale compulsory health insurance – called Social Insurance – for those in formal employment; smaller scale voluntary micro- insurance schemes to cover those working in the infor- mal sector and tax-revenue based financing to cover the poor and indigent [5,6]. Social Insurance Schemes are compulsory schemes consisting of payroll deductions of employees in the for- mal economic sector complemented by contributions by